**U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES**

**Health Resources and Services Administration**

*Bureau of Primary Health Care*

**PROGRAM GUIDANCE**

Fiscal Year 2006

**Application Due Date: March 31, 2006**

**Date of Issuance: *February 8, 2006***

*Guidance contact:*

Kirsten Argueta

Public Health Analyst

Division of Policy and Development

Bureau of Primary Health Care

Telephone: (301) 594-4300

Fax: (301) 594-4997

Authority: Public Health Service Act, Section 330, 42 U.S.C. 254b. (as
amended)

**Executive Summary**

This application guidance details the expectations, eligibility
requirements, review criteria, and awarding factors for existing section
330 supported health centers seeking supplemental grant support to
expand medical capacity to serve migrant and seasonal farmworkers
(MSFWs) and their families (section 330(g)) and/or homeless people
(section(h)) **only,** through Expanded Medical Capacity (EMC)
applications in fiscal year (FY) 2006. The goal of this funding
opportunity is to expand access to primary health care services by
increasing penetration into a health center's current service area to
improve the health status of people in those areas (i.e., significantly
increasing the number of medical users served by existing health center
grantees).

This funding opportunity is separate and distinct from the previous EMC
funding opportunity announced this fiscal year as HRSA 06-054.

Final determinations are underway regarding the availability of new
competitive funding for the Consolidated Health Center Program in FY
2006, authorized by section 330 of the Public Health Service Act, as
amended. The Bureau of Primary Health Care (BPHC) anticipates that funds
will be available to accept applications for this funding cycle from
existing health center grantee organizations seeking funds to expand
medical capacity to serve additional MSFWs and/or homeless persons under
the Migrant Health Center (MHC) and/or Health Care for the Homeless
(HCH) programs *only*, at service delivery sites within the
organization's most current approved scope of project.

Applications must be submitted electronically through Grants.gov; paper
submissions will not be accepted for this EMC application cycle. The
application submission deadline is 5:00 P.M. ET on March 31, 2006.
Applications submitted electronically by the published due date/time
will be reviewed, with an anticipated award date of September 1, 2006.
Applications submitted after the due date/time will not be accepted for
processing and will be returned.

**All applicants requesting EMC funds must use this guidance.** The
guidance should be reviewed thoroughly prior to making a decision to
apply.

Questions regarding the application and review process described in this
guidance may be directed to Kirsten Argueta in the Division of Policy
and Development at <kargueta@hrsa.gov> or 301-594-4300.

# Guidance Table of Contents

[Guidance Table of Contents 3](#guidance-table-of-contents)

[I. Funding Opportunity Description
5](#i.-funding-opportunity-description)

[Purpose 5](#__RefHeading___Toc124826023)

[Definition of Significant Increase in New Users
6](#definition-of-significant-increase-in-new-users)

[Time-Limited State Funded Programs
6](#time-limited-state-funded-programs)

[Background 7](#background)

[Other Program Requirements and Expectations
7](#other-program-requirements-and-expectations)

[Consolidated Health Center Program
8](#consolidated-health-center-program)

[Replacement Sites 9](#replacement-sites)

[Mobile Vans 10](#mobile-vans)

[Technical Assistance 10](#technical-assistance)

[II. Award Information 11](#ii.-award-information)

[1. Type of Award 11](#type-of-award)

[2. Summary of Funding 11](#summary-of-funding)

[Maximum Grant Support 11](#maximum-grant-support)

[III. Eligibility Information 12](#iii.-eligibility-information)

[1. Eligible Applicants 12](#eligible-applicants)

[2. Cost Sharing/Matching 14](#cost-sharingmatching)

[3. Other 14](#other)

[IV. Application and Submission Information
14](#iv.-application-and-submission-information)

[1. Address to Request an Application Package
14](#address-to-request-an-application-package)

[Application Materials 14](#application-materials)

[2. Content and Form of Application Submission
15](#content-and-form-of-application-submission)

[Application Format Requirements 15](#application-format-requirements)

[3. Submission Dates and Times 25](#submission-dates-and-times)

[4. Intergovernmental Review 26](#intergovernmental-review)

[5. Funding Restrictions 26](#funding-restrictions)

[6. Other Submission Requirements 26](#other-submission-requirements)

[V. Application Review Information
28](#v.-application-review-information)

[1. Review Criteria 28](#review-criteria)

[2. Review and Selection Process 32](#review-and-selection-process)

[Funding Preferences 33](#funding-preferences)

[Other Awarding Factors 33](#other-awarding-factors)

[3. Anticipated Announcement and Award Date
34](#anticipated-announcement-and-award-date)

[VI. Award Administration Information
34](#vi.-award-administration-information)

[1. Award Notices 34](#award-notices)

[2. Administrative and National Policy Requirements
34](#administrative-and-national-policy-requirements)

[3. Reporting 35](#reporting)

[4. Performance Review 35](#performance-review)

[VII. Agency Contacts 36](#vii.-agency-contacts)

[VIII. Other Information 36](#viii.-other-information)

[Contact Information for Application Development Assistance
36](#contact-information-for-application-development-assistance)

[IX. Tips for Writing a Strong Application
37](#ix.-tips-for-writing-a-strong-application)

appendix a - electronic submission guide

**appendix b - registering and applying through grants.gov**

[[Attachment 1: Program Specific Forms]{.smallcaps}
63](#attachment-1-program-specific-forms)

[FORM 1 - PART A:](#form-1-part-a) [GENERAL INFORMATION WORKSHEET - FY
2006 EMC 64](#general-information-worksheet---fy-2006-emc)

[FORM 1 - PART B: BPHC FUNDING REQUEST SUMMARY -- FY 2006 EMC
65](#form-1---part-b-bphc-funding-request-summary-fy-2006-emc)

[FORM 2 - INCOME ANALYSIS FORMAT -- FY 2006 EMC
66](#form-2---income-analysis-format-fy-2006-emc-page-1-of-2)

[Instructions for Completing Form 2: Income Analysis
68](#__RefHeading___Toc124826070)

[[Attachment 2: Format for the Line Item Budget
Justification]{.smallcaps}
71](#attachment-2-format-for-the-line-item-budget-justification)

[Line-Item Budget Justification \[Required Format\]
72](#line-item-budget-justification-required-format)

[[Attachment 3: Service Delivery Plan and Business Plan]{.smallcaps}
74](#attachment-3-service-delivery-plan-and-business-plan)

[Guidelines For Developing the](#guidelines-for-developing-the) [Service
Delivery Plan and the Business Plan
75](#service-delivery-plan-and-the-business-plan)

[Format for the Service Delivery Plan & Business Plan Presentations
76](#format-for-the-service-delivery-plan-business-plan-presentations)

**PUBLIC BURDEN STATEMENT:** An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless
it displays a currently valid OMB control number. The OMB control number
for this project is 0915‑0285. Public reporting burden for the applicant
for this collection of information is estimated to average 100 hours,
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 this
burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to HRSA Reports
Clearance Officer, 5600 Fishers Lane, Room 14-45, Rockville, Maryland,
20857.

# I. Funding Opportunity Description

## Purpose

Funding for the Consolidated Health Center Program is authorized under
section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b), as
amended. The appropriation increase represents the fifth installment in
the President's Health Centers Initiative to serve millions of
additional people in the Nation's neediest communities. The Consolidated
Health Center Program promotes the development and operation of
community-based primary health care service systems in medically
underserved areas and improves the health status of medically
underserved populations.

The goal of President Bush's Health Centers Initiative, which began in
FY 2002, is to increase health care access to 1,200 of the Nation's
neediest communities through new and/or significantly expanded health
center sites over five years. This Expanded Medical Capacity (EMC) grant
opportunity assists in achieving this goal, by supporting the expansion
of sites that significantly increase the provision of comprehensive
primary and preventive health care services for MSFWs and homeless
persons in areas of high need. The increased access to primary health
care services will also improve the health status and decrease health
disparities of the medically underserved populations to be served.

In FY 2006, the Bureau of Primary Health Care (BPHC) will accept EMC
applications from the following types of existing health centers
currently receiving support under the Consolidated Health Center
Program:

> \- Community Health Centers (CHC)[^1] - section 330(e)

\- Migrant Health Centers (MHC) - section 330(g)

> \- Health Care for the Homeless (HCH) - section 330(h)
>
> \- Public Housing Primary Care (PHPC) - section 330(i)

For the purpose of this guidance, the term "health center" refers to the
diverse types of health centers (i.e., CHC, MHC, HCH, and PHPC) that are
authorized under section 330 of the PHS Act. This document provides
detailed information on the expectations, eligibility requirements,
review criteria and awarding factors for these supplemental awards. The
goal of the EMC program is to increase and expand access to primary
health care services by increasing penetration into a health center's
current service area, to improve the health status of people in those
areas and to decrease health disparities within the service area.

**Please note that only those applications that request funding to serve
migrant and seasonal farmworkers (MSFWs) and their families and/or
homeless persons under section 330(g) MHC and/or section (h) HCH *only*
will be considered under this funding opportunity. Proposals that
include a request, in whole or in part, for section 330(e) CHC and/or
section 330(i) PHPC funding will not be considered.**

For the purpose of this application guidance, EMC sites are defined as
service delivery sites **within a health center's current approved scope
of project** (i.e., listed on a grantee's most recently approved Form
5-Part B/Exhibit B from a service area competition, approved change in
scope, or a non-competing continuation application), which are being
expanded to significantly increase access to primary health care
services to MSFWs and/or homeless persons in communities where the
health center's ability to provide care falls short of meeting the need
for services. **EMC funds may not be used to expand capacity at sites
operated outside of a grantee's current approved scope of project.** EMC
funds may not be used to establish new sites, nor to expand non-medical
services except as noted under *Other Program Requirements and
Expectations* on page [7](#other-program-requirements-and-expectations).

Strategies for expanded medical capacity may include but are not limited
to expanding existing primary care medical services, adding new medical
providers where excess facility capacity exists, expanding hours of
operations, or providing additional medical services through contractual
relationships (e.g., obstetrics and gynecology services) at an existing
health center site.

EMC applications should demonstrate 1) that the EMC proposal will
increase access to comprehensive primary and preventive health care and
improve the health status of MSFWs and/or homeless persons, and 2) that
the EMC proposal will address the major health care needs of the target
population and will assure the availability and accessibility of
essential primary and preventive health services to the target
population in the service area.

### Definition of Significant Increase in New Users

All EMC applicants must ensure that proposed strategies will result in a
significant increase in the number of health center users served by
existing delivery sites. For the purpose of this announcement, a
significant increase is defined as follows:

> Applicants must demonstrate growth in the form of **a minimum increase
> in MSFW and/or homeless users equal to 10 percent of the total number
> of users** for the organization reported in the calendar year (CY)
> 2004 Uniform Data System (UDS), **or 1000 new MSFW and/or homeless
> users** -- whichever is less.

Health centers must propose to expand medical capacity to serve MSFWs
and/or homeless persons by **initiating or expanding *only* a section
330(g) MHC and/or section 330(h) HCH program; they may NOT also include
a request for new or additional section 330(e) CHC and/or section 330(i)
PHPC funding.** Note: Applicants must indicate the type of health center
funding requested on Form 1-A and Form 1-B (provided in Attachment 1:
Program Specific Forms of this guidance).

### 

### Time-Limited State Funded Programs

The BPHC recognizes that a few States have implemented time-limited
programs to support the development and initial operations of health
centers that propose to increase access to primary care services (i.e.,
incubator programs, State-funded start up funds). Through the EMC
program, the BPHC will allow for the coordination of these State
programs and the President's Initiative, and will enable the
continuation of these expansion efforts. As a result, a significant user
increase for centers that can document successful participation in such
time-limited State programs will be defined as 50 percent of the
applicable eligibility requirement set forth above (e.g., health centers
expanding/initiating a section 330(g) MHC and/or section 330(h) HCH in
such State-funded programs will be deemed eligible by meeting the lesser
of 5 percent or 500 new MSFW and/or homeless users). The applicant must
also demonstrate that the expansion efforts supported by the State
program prior to an EMC award, in addition to expansion efforts
subsequent to an EMC award, will result in combined outcomes that are
equal to or greater than 100 percent of the applicable eligibility
requirement. **Information regarding the successful participation in
such State funded programs must be included on the Form 1-A, General
Information Worksheet (see page [64](#form-1-part-a)), and in the
Evaluative Measures section of the program narrative (see page
[30](#ref84836880)).** Applicants should document the center's progress
toward meeting the initial goals and objectives under the State funded
program, and the additional goals resulting from the receipt of EMC
grant funding.

## Background

The mission of the BPHC is "to increase access to comprehensive primary
and preventive health care and to improve the health status of
underserved and vulnerable populations." All of the programs
administered by the BPHC are focused toward ensuring the availability
and accessibility of essential primary and preventive health services to
the people who have the most limited access to services and face the
greatest barriers to care. The BPHC is committed to the goal of
improving and expanding access to health care for all Americans
nationwide, and most importantly for the estimated 45 million uninsured
people in the United States who do not have adequate access to
affordable, appropriate primary and preventive health care. More than 50
million people live in federally designated medically underserved areas
and lack access to a private primary care provider.

Individually, each health center plays an important role in this plan
and combined they have had a critical impact on the health care status
of underserved and vulnerable populations throughout the United States
(U.S.). Currently there are 955 federally funded health centers with
more than 3,700 primary care service sites located in urban and rural
underserved areas throughout the U.S. and its territories. Approximately
13.2 million medically underserved and uninsured patients receive high
quality, cost-effective, culturally appropriate, accessible and
affordable preventive and primary health care services through the
federally funded health centers**.**

## Other Program Requirements and Expectations

**EMC applicants must propose to expand medical capacity to serve MSFWs
and/or homeless persons at sites within the health center's current
approved scope of project** in communities where the health center's
ability to provide care falls short of meeting the need for services. In
other words, at the time of application submission, the sites proposed
for a medical expansion must be listed on the applicant's most recently
approved Form 5-Part B/Exhibit B from a service area competition, change
in scope, or non-competing continuation application. Applicants are
expected to present a sound and complete plan for the successful
expansion of their medical capacity to serve MSFWs and/or homeless
persons that demonstrates responsiveness to the identified needs of the
target population within the existing service area. EMC applications
must demonstrate a significant increase in penetration into underserved
communities or populations.

EMC applicants must also demonstrate **readiness** to initiate the
proposed project, i.e., proposed staff recruited and services provided
to the community within 120 days of receiving the grant award. However,
BPHC will consider on a case-by-case basis a future request to extend
the expected operational date for good cause.

Applicants are also expected to present a reasonable and appropriate
budget(s) based on the activities proposed in the project plan and
business plan. It is understood that the operating budgets of health
centers are comprised of many revenue streams, some of which can be time
limited. The proposed budget should be based on an appropriate increase
in medical users, at least the required minimum number of new users to
be served (refer to guidelines in the Definition of Significant Increase
in New Users section on page
[6](#definition-of-significant-increase-in-new-users)) and the expanded
medical services to be provided at the EMC site(s).

EMC applicants are expected to demonstrate the extent to which the EMC
award will increase the number of MSFWs and/or homeless persons served,
the number of primary medical care providers made available to the
population, and penetration into the existing service area. As a point
of reference, it is anticipated that, on average, applicants may propose
to hire one additional full time equivalent (FTE) medical providers to
address the significant growth in medical capacity. For the purposes of
this guidance, primary care medical providers include primary care
physicians, nurse practitioners, physician assistants, and certified
nurse midwives. It is important to note that this definition of primary
care medical providers **does not** include oral health (OH), or mental
health and substance abuse (MH/SA) service providers. Mental health and
substance abuse services providers can be included in the EMC scope only
where necessary to support medical providers when mental health and
substance abuse problems are prevalent in the new populations being
served.

Applicants should describe their systems that ensure participation of
the diverse cultures in their communities, including participation of
persons with limited English-speaking ability, in programs offered by
the health center. Applicants must demonstrate that the proposed
clinical staffing pattern (e.g., number and mix of primary care
physicians and other providers and clinical support staff, linguistic
and cultural competency, etc.) is appropriate for the level and mix of
services to be provided.

### Consolidated Health Center Program

All applicants are expected to demonstrate compliance with the
applicable requirements of either section 330(g) and/or section 330(h)
of the PHS Act and BPHC guidelines, including the Health Center Program
Expectations (Program Information Notice 98-23). Community Health
Centers and/or Migrant Health Centers are also expected to demonstrate
compliance with the implementing regulations (42 CFR 51c and 42 CFR 56,
respectively). In addition to these general requirements, there are
specific requirements and expectations for applicants requesting funding
under section 330(g) and/or section 330(h). Applicants requesting
funding under this funding announcement are expected to demonstrate
compliance in the application with the specific guidelines, expectations
and requirements, as applicable. Failure to document and demonstrate
compliance in the application will significantly reduce the likelihood
of approval and funding.

For applicants seeking funding to expand to serve populations for which
they do not currently receive Federal support, it is important that the
proposal adequately exhibit the awareness of the appropriate
organizational changes (i.e., statutory or other) that may be necessary
to assure compliance and the ability of the organization to implement
these changes. Areas of consideration should include representation in
governance, modifications to clinical and business systems, additional
enabling services and overall cultural competency. In the
Resources/Capabilities section of the narrative, these applicants are
required to identify the changes necessary to comply with all relevant
program requirements to receive grant funds for services targeted to the
proposed populations. The application must also certify that the
organization will be brought into compliance upon receipt of grant
funding, and include information exhibiting the applicant's ability to
do so.

All applicants must include information about how the health center
governance requirements are being addressed and how the governance may
be impacted by the proposed expansion (i.e., adding additional
representation from the area/population to be served). Organizations
that currently receive funding under *only section 330(g), section
330(h) and/or section 330(i)* and propose to expand services only to
MSFWs and/or homeless populations, as applicable, may continue to
receive a waiver for all or some of the governance requirements, as
appropriate. If the application proposes to expand capacity to serve a
new population and, if a waiver has been granted for all or some of the
governance requirements, the waiver request must be amended to reflect
the new population served and a description of the reasons for the
amended waiver and the alternative mechanism being proposed to ensure
consumer input is in compliance with guidelines as described in PIN
98-12. The amended waiver request should be submitted as a letter with
the application.

MIGRANT HEALTH CENTER (MHC) APPLICANTS (section 330(g)):

MHC applicants must 1) address how the special needs of MSFWs and their
families are being or will be met, 2) describe how the EMC proposal will
ensure that farmworkers will have access to comprehensive and preventive
health care services through mechanisms such as: outreach that is
integrated into the primary health care delivery system; use of existing
mobile vans or health teams that travel to migrant camps;
transportation; extended clinic hours; etc, 3) demonstrate how the
special environmental health concerns that are associated with MSFWs,
will be addressed and 4) demonstrate compliance with sections 330(e) and
330(g), and all applicable BPHC regulations and guidelines.

[]{.mark}

In addition, migrant voucher programs applying for EMC funds must
propose to increase new users by the minimum threshold for MHCs as
described in the Definition of Significant Increase in New Users
section. Proposals to expand medical capacity within a migrant voucher
program may only be one of the following: 1) expansion of medical
services provided at fixed delivery sites within the current approved
scope of project; and/or 2) expansion of the number of vouchers offered
to community-based providers. The applicant must assure that the target
population has access to the full range of required services. Voucher
programs must also describe how adjustments will be made for service
delivery during peak and off-season cycles.

HEALTH CARE FOR THE HOMELESS (HCH) APPLICANTS (section 330(h)):

HCH applicants must also 1) indicate the mechanism for delivering
substance abuse services to homeless patients, 2) describe the manner in
which comprehensive outreach is to be conducted, and how transportation
and other enabling services will be provided, 3) describe the manner in
which case management, eligibility assistance, and access to housing
services will be made available to homeless patients, and 4) demonstrate
compliance with sections 330(e) and 330(h), and all applicable BPHC
regulations and guidelines.

### Replacement Sites

Applicants proposing to expand medical capacity to serve MSFWs and/or
homeless persons by completely replacing a current site(s) by moving all
clinical operations to a larger facility should do so only if the
proposed location for the replacement site(s) allows the organization to
continue to provide access to the same community/target population
within the applicant organization's currently approved scope of project.
**Organizations proposing to replace a current site(s) must move ALL
clinical services from the site(s) being replaced to the new site and**
**must ensure that the new site(s) will result in a significant increase
in new users.** If the proposed replacement site(s) will not yield a
significant increase in medical users, the proposal will not be eligible
under this announcement. The proposal to replace a site(s) must also
address proximity of the relocated site to other health center delivery
sites in the service area and should assure that providers (including
other section 330 grantees, Federally Qualified Health Center (FQHC)
Look-Alikes, and other primary care providers) serving the same target
population in the same service area have been consulted regarding the
proposed relocation of the site(s). Applicants should include letters or
some other indication of support for the proposed expansion from the
other area providers. Additionally, organizations must indicate the
proposed timeline under which the new facility will be available and
operational. **All replacement sites MUST be operational within 120 days
of receiving an EMC award. (NOTE: On a case by case basis, the BPHC will
consider post-award requests to extend this time limit for good cause.
However, the application should demonstrate assurance that the
replacement site will be operational within 120 days of the award
date.)** EMC funds may not be used to pay for construction costs for a
replacement site.

### Mobile Vans

EMC proposals may include an expansion of the medical capacity of an
**existing** mobile van within the organization's currently approved
scope of project for the delivery of primary care services in any of the
following ways:

-   Renovation or replacement of an existing mobile van currently used
    by the health center (see the following page for restrictions on the
    amount of the EMC award that may be used for one-time minor capital
    costs);

-   Increase in medical provider FTEs dedicated to the mobile van;

-   Increase in the mobile van's hours of operation; and/or

-   Addition of primary care medical services provided through the
    mobile van.

The existing van must serve one or more locations, operate on a regular,
fixed schedule, and provide primary care services through the use of
clinicians who exercise independent judgment and generate clinical
encounters. **Proposals to add a new** **mobile van would be considered
new access points and would not be eligible for consideration under EMC
funding.**

### Technical Assistance

Applicants are strongly encouraged to work with their respective Primary
Care Association and/or National Associations during the planning and
development of the EMC application. A listing of all Primary Care
Associations can be found on the HRSA website at the following location:
http://bphc.hrsa.gov/OSNP/PCADirectory.htm. See section VIII. Other
Information of this guidance for a list of National Organization
Contacts.

# II. Award Information

## 1. Type of Award

Funding will be provided in the form of a grant.

## 2. Summary of Funding

Based on the final Congressional appropriation for FY 2006 activities,
approximately \$13 million is expected to be available to support an
estimated 33 total awards for EMC in FY 2006.

This announcement is inviting applications for project periods up to two
(2) years. Awards, on a competitive basis, will be for a one year budget
period, although project periods may be for two (2) years. Awards will
be aligned with the applicant's current approved project period.
Applications for continuation grants funded under these awards beyond
the initial one-year budget period but within the approved project
period will be entertained in subsequent years on a noncompetitive
basis, subject to availability of funds, satisfactory progress of the
grantee and a determination that continued funding would be in the best
interest of the Government.

## 

## Maximum Grant Support

The BPHC has established an **annual cap of \$600,000 for section 330
support** of EMC grants. However, the average award amount for EMC is
anticipated to be approximately \$400,000.

The cap is the **maximum amount of section 330 funding** that can be
requested annually in an EMC grant application in FY 2006, regardless of
the number and/or type of EMC sites to be supported and/or populations
to be served through the application. Not all applicants approved and
funded will receive this maximum amount. **The total request for section
330 support MUST NOT exceed the established annual cap of \$600,000 in
Year 1 or Year 2. Applications that present a request for support in
excess of the established annual cap in either Year 1 or Year 2 are
considered ineligible for review and will be returned without further
consideration.**

**Applicants may request support up to \$150,000 in Year 1 only for
one-time minor capital costs for equipment and/or
alteration/renovation.** **Total Federal funds requested for the initial
budget period (including the request for one-time funds in Year 1 only)
must be at or below the established EMC cap of \$600,000.** Minor
alteration and renovation is defined as work required to change the
interior arrangements or other physical characteristics of an existing
facility or installed equipment so that it may be more effectively
utilized for its currently designated purpose or adapted to an
alternative use to meet a programmatic requirement. No one-time capital
costs should be included in the request for support in the Year 2
operational budget. Any additional minor capital cost necessary to
achieve the goals of the proposal must be covered by other sources.
**Federal funds may not be used to support new construction costs for
activities proposed under this announcement.**

It is expected that the request for Federal support and the budgets
presented in the application will be reasonable and appropriate based on
the scope of the services to be provided and the number and type (i.e.,
homeless, MSFWs) of individuals to be served. **Requests for Federal
funding and the proposed budgets must be aligned with the required
minimum increase in the number of new users.** The budget should also be
consistent with the service delivery plan and business plan presented in
the application. A guideline in developing the Federal budget request is
as follows: \$200 Federal grant dollars per migrant/seasonal farmworker
user and/or homeless user.

Funds can be used to either hire directly or contract with medical
providers. A portion of the funds may be used to: (1) hire outreach
workers and other enabling services staff to increase penetration in
support of the capacity expansion; (2) hire administrative, nursing, and
other support staff (e.g., translators, data analysts, etc.) necessary
to support services provided through this expansion and achieve the
goals and objectives of the proposal; and (3) support one-time minor
capital costs in Year 1 only (up to \$150,000) for renovating and
expanding existing sites or replacing and expanding existing sites to a
location proximate to the current health center(s).

Federal funding levels will be reviewed prior to a final funding
decision and may be adjusted based on the organization's past
performance and an analysis of experience related to operating costs,
utilization, provider staffing, revenue generation, and budget/cost
factors. Funding beyond first year is dependent on the availability of
funds, satisfactory performance, and a determination that continuation
of this project is in the best interest of the Federal government.

# III. Eligibility Information

## 

## 1. Eligible Applicants

Organizations eligible to compete include public or nonprofit private
entities, including tribal, faith-based and community-based
organizations who meet the eligibility criteria delineated below.

An application will be considered eligible if it meets all of the
specific eligibility requirements. **Applications that do not meet all
of the following eligibility requirements will not be accepted and will
be returned without further consideration.** Those eligibility
requirements are:

1.  Applicant must be an existing health center grantee. Health center
    grantees are those organizations which currently receive funding
    under the Consolidated Health Center Program authorized under
    section 330 of the Public Health Service (PHS) Act, specifically:

-   Community Health Centers (CHC)[^2] -- section 330(e)

-   Migrant Health Centers (MHC) -- section 330(g)

-   Health Care for the Homeless (HCH) -- section 330(h)

-   Public Housing Primary Care (PHPC) -- section 330(i)

> Note: For the purposes of this guidance, the term "health center"
> refers to CHCs (including previously identified SBHCs), MHCs, HCHs,
> and PHPCs;

2.  Applicant must request funding under only section 330(g) MHC and/or
    section 330(h) HCH to expand the health center's medical capacity to
    serve migrant and seasonal farmworkers and their families, and/or
    homeless persons.

3.  Application must propose a significant increase in new users, per
    the Definition of Significant Increase in New Users section on page
    6 of this guidance;

4.  Applicant must submit a request for annual Federal section 330
    funding in Year 1 and Year 2, as presented in Budget Form SF 424A
    and Form 1-B (with accompanying Budget Justification), that **DOES
    NOT exceed the established cap of \$600,000 per year** (including
    one-time capital improvement requests in the Year 1 budget);

5.  Application must adhere to the **80-page limit** on the length of
    the total application when printed by HRSA (including the narrative
    proposal, budget presentation, all other forms, documents,
    appendices, and attachments), whether submitting electronically or
    on paper;

6.  Application must not propose to expand the medical capacity at a
    site that received New Access Point funding in FY 2005 or FY 2006,
    or a site that received EMC funding in FY 2005;

7.  Applicant must not propose to expand capacity to serve a new
    community through the establishment of one or more **NEW** primary
    health care service delivery sites. All sites proposed as EMC sites
    **MUST** be within the applicant's current approved scope of project
    at the time of application or a replacement site of an existing
    site. **Form 3 of the application must reflect the organization's
    most recently approved Form 5-Part B/Exhibit B from a service area
    competition, change in scope, or non-competing continuation
    application as evidence;**

8\. Applicant must not propose to expand capacity for oral health,
mental health, and/or substance abuse services ***only***; and

9\. Applicant organization must not have experienced an overall decline
in either their user **OR** encounter base, as reported in the UDS from
CY 2002 to CY 2004, unless a reasonable justification is provided that
includes a strong, persuasive explanation as to why previous downward
trends occurred and have since been corrected. Otherwise, these levels
must be at least at the same level as the average of UDS CY 2002 and CY
2003 figures for users and encounters. Total organization user and
encounter data **as reported in the UDS reports for 2002, 2003 and 2004,
and any other relevant justification** will be used to determine
eligibility.

> The table format below is included in the Form 1-A, General
> Information Worksheet (see page [64](#form-1-part-a)). Total
> organization user and encounter totals **as reported in the UDS
> reports for 2002, 2003 and 2004** must be used to calculate the change
> over this period. The average of UDS 2002 and 2003 should be
> subtracted from UDS 2004 figures. *Applicants that have experienced a
> decrease in users and/or encounters as reported must attach to the
> FORM 1-PART A: General Information Worksheet a strong justification
> for the decrease.* This information will be taken into consideration
> in determining eligibility to participate in the EMC program.

+-------------+---------+----------+---------+----------+-----------+
|             | UDS     | UDS 2003 | UDS     | Average  | Change    |
|             | 2004    |          | 2002    | 02-03    |           |
|             |         | \(b\)    |         |          | (a)-(d)   |
|             | \(a\)   |          | \(c\)   | (        |           |
|             |         |          |         | b)+(c)/2 |           |
|             |         |          |         |          |           |
|             |         |          |         | \(d\)    |           |
+-------------+---------+----------+---------+----------+-----------+
| Total Users |         |          |         |          |           |
+-------------+---------+----------+---------+----------+-----------+
| Total       |         |          |         |          |           |
| Encounters  |         |          |         |          |           |
+-------------+---------+----------+---------+----------+-----------+

## 2. Cost Sharing/Matching

Cost sharing or matching is not a requirement for this funding
opportunity. As required by 42 CFR 51c.305, BPHC will take into
consideration whether and to what extent an applicant plans to maximize
all sources of revenue through an appropriate and reasonable budget
which includes non-grant resources to support the proposed project.
Please see the budget and budget justification section of this document
for clarification and guidelines pertaining to the presentation of the
budget.

## 3. Other 

Applications that exceed the funding cap amount will be considered
non-responsive and will not be considered for funding under this
announcement.

Any application that fails to satisfy the deadline requirements
referenced in *Section IV.3* will be considered non-responsive and will
not be considered for funding under this announcement

Multiple Funded Section 330 Applicant Organizations

Organizations that currently receive support for more than one type of
health center under section 330 may submit only one EMC application.
These organizations may apply for funding to support the expansion of
medical capacity to serve a single population or multiple populations
(for example, homeless individuals only (HCH), or homeless individuals
and migrant and seasonal farmworkers and their families (HCH/MHC)).
Organizations that receive grants under multiple section 330 programs
are expected to:

-   **Submit only ONE application for the overall organization** (e.g.,
    an organization that receives funding for both MHC and HCH programs
    may **NOT** submit separate MHC and HCH proposals).

-   **Request no more than \$600,000 in annualized grant support for
    proposed EMC activities for the organization.**

-   If applying for funding to increase capacity to serve a recognized
    special population, discuss how expanded medical capacity will
    increase access for that targeted population served (i.e., MSFWs,
    homeless persons). Multiple funded organizations do not have to
    expand medical capacity for the entire service area, or for all
    special populations served, but may choose to target expansion to a
    particular special population group.

# IV. Application and Submission Information

## 1. Address to Request an Application Package

### Application Materials

The application and submission process has changed significantly. HRSA
is ***requiring*** applicants for this funding opportunity to apply
electronically through Grants.gov. All applicants ***must*** submit in
this manner unless the applicant is granted a written exemption from
this requirement in advance by the Director of HRSA's Division of Grants
Policy. Grantees must request an exemption in writing from
<DGPClearances@hrsa.gov>, and provide details as to why they are
technologically unable to submit electronically though the Grants.gov
portal. Make sure you specify the announcement number you are seeking
relief for. As indicated in this guidance, HRSA and its Grants
Application Center (GAC) will only accept paper applications from
applicants that received prior written approval.

Refer to Appendix A for detailed application and submission
instructions. Pay particular attention to Section 3, which provides
detailed information on the competitive application and submission
process.

The entire application guidance should be reviewed thoroughly prior to
making a decision to apply. **Applicants must submit applications
according to the instructions in Appendix A, using this guidance in
conjunction with Public Health Service (PHS) Application Form 5161-1.**
The PHS 5161-1 forms contain additional general information and
instructions for grant applications, proposal narratives, and budgets;
therefore, that information is not repeated in this document. These
forms may be obtained from the following sites by:

> []{.mark}

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

> Or

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

> The Legin Group, Inc.
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> <HRSAGAC@hrsa.gov>
>
> []{.mark}
>
> Instructions for preparing portions of the application that must
> accompany Application Form 5161-1 appear in the "Application Format"
> section below.

## 2. Content and Form of Application Submission

**See Appendix A, Section 4, for detailed application submission
instructions. These instructions must be followed.**

### Application Format Requirements

Applications for funding must consist of the following documents in the
following order:

# SF 424 Non Construction -- Table of Contents

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

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

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

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

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

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

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

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

  Project             Attachment   Can be uploaded on page  Required attachment.
  Summary/Abstract                 2 of SF-424 - Box 15.    Counted in the page
                                                            limit. Refer to
                                                            guidance for
                                                            detailed
                                                            instructions.
                                                            Provide a table of
                                                            contents specific to
                                                            this document only
                                                            as the first page.
                                                            This table of
                                                            contents page will
                                                            not be counted in
                                                            the page limit.

  Additional          Attachment   Can be uploaded on page  Applicable; Not
  Congressional                    2 of SF 424 - Box 16.    counted in the page
  District                                                  limit.

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

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

  Project Narrative   Attachment   Can be uploaded in       Required attachment.
                                   Project Narrative        Counted in the page
                                   Attachment form.         limit. Refer to
                                                            guidance for
                                                            detailed
                                                            instructions. Merge
                                                            program narrative
                                                            documents (including
                                                            the Service Delivery
                                                            Plan and the
                                                            Business Plan) into
                                                            one attachment.
                                                            Provide table of
                                                            contents specific to
                                                            this document only
                                                            as the first page
                                                            This table of
                                                            contents page will
                                                            not be counted in
                                                            the page limit.

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

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

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

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

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

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

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

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

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Form 1--A: General Information Worksheet. Merge
                      similar documents into one attachment.

  Attachment 2        Form 1-B: BPHC Funding Request Summary.

  Attachment 3        Form 2: Income Analysis Sheet. Merge similar
                      documents into one attachment.

  Attachment 4        Form 3: EMC Site Table. Merge similar documents
                      into one attachment.

  Attachment 5        Budget Justification (line item budget plus
                      additional budget narrative). Merge similar
                      documents into one attachment.

  Attachment 6        Staffing Plan and Personnel Requirements.

  Attachment 7        Appendix A: Job Descriptions for Key
                      Personnel/Positions. Merge similar documents into
                      one attachment. Where several pages are expected in
                      the attachment, ensure that you place a table of
                      contents cover page specific to the attachment. The
                      table of contents page will not be counted in the
                      page limit.

  Attachment 8        Appendix B: Biographical Sketches of Key Personnel.

  Attachment 9        Appendix C: Organizational Chart

  Attachment 10       Appendix D: Letters of Agreement and/or Contracts.
                      Merge into one attachment.

  Attachment 11       Appendix E: Other Relevant Documents. Merge into
                      one attachment.

  Attachment 12       

  Attachment 13       

  Attachment 14       

  Attachment 15       
  -----------------------------------------------------------------------

Information and data should be accurate and consistent, and written
instructions should be followed carefully and completely. Applications
not meeting application requirements may be returned without processing
or may result in a low rating by the Objective Review Committee (ORC).

Only those materials/documents included with the application submitted
by the announced deadline will be considered. Supplemental
materials/documents submitted after the application deadline will not be
included for consideration. Documents such as letters of support should
be submitted as part of the application. Letters of support sent
directly to DHHS, HRSA, or BPHC administrators or sent after the
application deadline will not be added to an application.

**i. *Application Face Page ***

> Use Public Health Service (PHS) Application Form 5161-1 provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. Please include the title "Expanded
> Medical Capacity for MSFWs/Homeless, HRSA-06-116." **The Catalog of
> Federal Domestic Assistance Number is 93.224.**
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> <http://www.hrsa.gov/grants/preview/dunsccr.htm> or call
> 1-866-705-5711. Please include DUNS number next to OMB Approval Number
> on the application face page. Applications ***will not*** be reviewed
> without a DUNS number.
>
> Additionally, the applicant organization will be required to register
> with the Federal Government's Central Contractor Registry (CCR) in
> order to do electronic business with the Federal Government.
> Information about registering with the CCR can be found at
> <http://www.hrsa.gov/grants/preview/dunsccr.htm>.

ii\. *Table of Contents*

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

iii\. *Application Checklist*

> Use Application Form 5161-1 provided with the application package.

iv\. *Budget*

> This announcement is inviting applications for supplemental funding.
> Applicants must submit two 12-month budgets for the proposed project.
> Awards will be aligned with the applicant's current project period.
> Subsequent funding will be based on Congressional appropriations,
> satisfactory progress of the grantee and a determination that
> continued funding would be in the best interest of the Government. The
> Budget section includes the following:
>
> 1\. SF-424A
>
> Use Application Form 5161-1 provided with the application package.
> *Please complete Sections A, B, E, and F.*
>
> 2\. BPHC Funding Request Summary -- FORM 1-B
>
> To facilitate identification of the amount of Federal funding being
> requested, each applicant must complete the Form 1-B, BPHC Funding
> Request Summary (see page
> [65](#form-1---part-b-bphc-funding-request-summary-fy-2006-emc)).
> Note: **Only funding requests for section 330(g) MHC and/or section
> 330(h) HCH programs will be considered eligible.**

v\. *Budget Justification*

> The required format for the line-item budget is provided in Attachment
> 2 on page [72](#line-item-budget-justification-required-format) of
> this document.
>
> Provide a line-item budget plus attached narrative that details and
> explains the amounts requested for each line in the PHS Form 5161-1:
> Form SF 424A. Applicants must submit two detailed, 12-month line-item
> budgets that reflect the total revenues and necessary costs for the
> proposed project. (NOTE: Two proposed 12-month operating budgets are
> required regardless of the number of months remaining in the project
> period of the parent grant. If funded, the project period requested
> under this supplemental application will be aligned with the parent
> grant's approved project period). Applicants should also include the
> total organizational budget in the line-item budget.
>
> Each EMC application must include appropriate revenue and expense
> budget justifications for two 12-month operating periods that
> realistically represent resources needed to carry out the goals and
> objectives of the expansion and is reasonable in terms of dollars per
> medical user and the scope of services proposed. (A guideline in
> developing your Federal budget is as follows: approximately \$200 per
> medical user for MHC programs and/or HCH programs. Applications that
> propose a higher Federal grant cost per user must provide an adequate
> justification). In all cases, the proposal must address how the
> revenue projections were made. The projected patient income for each
> 12-month period should be reasonable and based on the patient mix and
> number of projected new users (at least the minimum number of new
> users required). It is understood that the operating budgets of health
> centers are comprised of many revenue streams, some of which can be
> time-limited. The requested level of grant funds (including the
> request for one-time funds) must not exceed the cap of \$600,000
> established for this opportunity. No one-time capital costs should be
> requested in the proposed second or subsequent 12-month operating
> budget(s). The budget requests must reflect the EMC proposal at full
> capacity.
>
> The detailed line-item budget must reflect and expand on the costs
> entered in the PHS Form 5161-1: Form SF 424A. **The additional
> attached budget narrative must clearly describe each cost element and
> explain how each cost contributes to meeting the project's
> objectives/goals.** The budget narrative must clearly describe each
> cost element and explain any changes from year to year. Be very
> careful about showing how each item in the "other" category is
> justified. The budget narrative MUST be concise. Do NOT use the budget
> narrative to expand the project narrative.
>
> This announcement is inviting applications for project periods up to
> two (2) years. Awards, on a competitive basis, will be for a one year
> budget period, although project periods may be for two (2) years.
> Awards will be aligned with the applicant's current approved project
> period. Applications for continuation grants funded under these awards
> beyond the initial one-year budget period but within the approved
> project period will be entertained in subsequent years on a
> noncompetitive basis, subject to availability of funds, satisfactory
> progress of the grantee and a determination that continued funding
> would be in the best interest of the Government.
>
> Include the following in the Budget Justification line item and/or
> narrative. **The required format for the line item budget
> justification is included in the *Program Specific Forms* section,
> page [72](#line-item-budget-justification-required-format) of this
> guidance.**
>
> *Personnel Costs:* Personnel costs should be explained by listing each
> staff member who will be supported from funds, name (if possible),
> position title, percent full time equivalency, annual salary, and the
> exact amount requested for each project year.
>
> *Fringe Benefits:* List the components that comprise the fringe
> benefit rate, for example health insurance, taxes, unemployment
> insurance, life insurance, retirement plan, tuition reimbursement. The
> fringe benefits should be directly proportional to that portion of
> personnel costs that are allocated for the project.
>
> *Travel:* List travel costs according to local and long distance
> travel. For local travel, the mileage rate, number of miles, reason
> for travel and staff member/consumers completing the travel should be
> outlined. The budget should also reflect the travel expenses
> associated with participating in meetings and other proposed trainings
> or workshops.
>
> *Equipment:* List equipment costs and provide justification for the
> need of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items. *Applicants for EMC funding are limited to using no
> more than \$150,000 of the total Federal funds requested (not to
> exceed \$600,000 in any year) to support equipment and minor facility
> alteration/renovation in the first year only.*
>
> *Supplies:* List the items that the project will use. In this
> category, separate office supplies from medical and educational
> purchases. Office supplies could include paper, pencils, and the like;
> medical supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately.
>
> *Subcontracts:* To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> *Alteration and Renovation:* In general, Alteration and Renovation
> (A&R) is work required to change the interior arrangements or other
> physical characteristics of an existing facility or installed
> equipment so that it may be more effectively utilized for its
> currently designated purpose or adapted to an alternative use to meet
> a programmatic requirement. A&R costs that do not constitute
> construction are allowable charges to PHS supported projects and
> activities. Section 330 grant funds may not be used to support
> construction of facilities.
>
> *Other:* Put all costs that do not fit into any other category into
> this category and provide and explanation of each cost in this
> category. In some cases, grantee rent, utilities and insurance fall
> under this category if they are not included in an approved indirect
> cost rate.
>
> *Indirect Costs:* Indirect costs are those costs incurred for common
> or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. For institutions subject to OMB Circular A-21, the term
> "facilities and administration" is used to denote indirect costs. If
> an organization applying for an assistance award does not have an
> indirect cost rate, the applicant may wish to obtain one through HHS's
> Division of Cost Allocation (DCA). Visit DCA's website at:
> http://rates.psc.gov/ to learn more about rate agreements, the process
> for applying for them, and the regional offices which negotiate them.

vi\. *Staffing Plan and Personnel Requirements*

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

vii\. *Assurances*

> Use Application Form 5161-1 provided with the application package.

viii\. *Certifications*

> Use Application Form 5161-1 provided with the application package.

ix\. *Project Abstract*

> The project abstract should be single-spaced, limited to one page in
> length, and provide a brief summary of the application. Because the
> abstract may be distributed to the Department of Health and Human
> Services (HHS) and Congress or used in press releases, it must include
> a brief description of the proposed grant project including the needs
> to be addressed, the proposed services, the population group(s) to be
> served, and a summary of the applicant organization. Please prepare
> the abstract so that it is clear, accurate, concise, and *without
> reference to other parts of the application*.
>
> Please place the following at the top of the abstract:

-   Project title (include "Expanded Medical Capacity for
    MSFWs/Homeless, HRSA-06-116" in title)

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

-   Type(s) of section 330 funding requested (i.e., MHC and/or HCH)

-   Current Federal funding received (including type of section 330
    funds)

x\. *Program Narrative*

> The Program Narrative should provide a comprehensive framework and
> description of all aspects of the proposed EMC project. It should be
> succinct, self-explanatory and well organized so that reviewers can
> understand your proposed project.
>
> **The Program Narrative is expected to describe the EMC site(s) at
> full operational capacity and demonstrate how this will be achieved
> over the first two years of the project.**
>
> All applicants should ensure that each category is completely
> addressed based on the specific elements in the respective Review
> Criterion. Use the following section headers for the Program
> Narrative:

-   **INTRODUCTION (0 points)**

> The introduction is intended to be a brief synopsis of the
> community/target population(s), the applicant organization, and the
> scope of the proposed EMC project.

-   **NEED (20 points maximum)**

> See Criterion 1: NEED in the Review Criteria section (page
> [28](#_Ref84836858)) for the specific elements that should be
> addressed.

-   **RESPONSE (35 points maximum)**

> See Criterion 2: RESPONSE in the Review Criteria section (page
> [29](#_Ref84836847)) for the specific elements that should be
> addressed.
>
> Present a detailed description of the proposed EMC project, including
> the number and location of sites targeted, the types of services
> targeted, and the extent to which the primary health care services
> will be increased at each site. Describe how the proposed project is
> responsive to the access barriers identified in the previous NEED
> Section.
>
> Include a **Service Delivery Plan** that outlines specific
> goals/objectives, action items, and desired outcomes for the EMC
> project. Address how the proposed EMC service delivery plan relates to
> the Health Care Plan for the entire organization. Also address
> proposed changes or increases in levels of effort that are necessary
> to support the EMC project.
>
> Include a **Business Plan** that outlines specific goals/objectives,
> action items, and desired outcomes for the EMC project. The plan
> should address the systems of the health center (e.g., Administrative,
> Fiscal, Clinical, MIS, Governance, etc.), and the proposed changes or
> increases in levels of effort that are necessary to support the
> proposed EMC project. (See page
> [74](#attachment-3-service-delivery-plan-and-business-plan) for
> required format for Service Delivery and Business Plans.)

-   **EVALUATIVE MEASURES (10 points maximum)**

> See Criterion 3: EVALUATIVE MEASURES in the Review Criteria section
> (page [30](#ref84836880)) for the specific elements that should be
> addressed.

-   **IMPACT (5 points maximum)**

> See Criterion 4: IMPACT in the Review Criteria section (page
> [30](#_Ref84836892)) for the specific elements that should be
> addressed.

-   **RESOURCES/CAPABILITIES (20 points maximum)**

> See Criterion 5: RESOURCES/CAPABILITIES in the Review Criteria section
> (page [31](#_Ref84836902)) for the specific elements that should be
> addressed.

-   **SUPPORT REQUESTED (10 points maximum)**

> See Criterion 6: SUPPORT REQUESTED in the Review Criteria section
> (page [32](#_Ref84836916)) for the specific elements that should be
> addressed.

xi\. *Program-Specific Forms*

> Please refer to Attachment 1 for copies of all program specific forms.
> This section provides Forms to present other required program-specific
> information. Please complete and place as noted in the Table of
> Contents above.
>
> All applicants must complete the following:

-   **FORM 1--A: General Information Worksheet:** see page
    [64](#form-1-part-a). This form should present summary information
    that is consistent with the budget, user and encounter projections
    presented in the project description, Service Delivery and Business
    Plans and any other forms.

-   **FORM 2: Income Analysis Format:** see page [66](#_Ref84847978).
    Complete an Income Analysis (2 pages) for Year 1 and Year 2.
    Indicate projections for patient service revenue for each year by
    breaking out revenue by payment source.

-   **FORM 3: EMC Site Table:** see page
    [70](#form-3-fy-2006-emc-service-site-table). Applicants should
    include addresses **for only those sites to be expanded** as part of
    the EMC application, including any proposed replacement sites.

xii\. *Appendices*

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative. Be
> sure each appendix is clearly labeled and placed in the appropriate
> section of the application, as noted in the Table of Contents above.
>
> **Appendix A: Job Descriptions for Key Personnel/Positions**
>
> Keep each to one page in length as much as possible. Item 6 in the
> Program Narrative section of the PHS 5161-1 Form provides some
> guidance on items to include in a job description.
>
> **Appendix B: Biographical Sketches of Key Personnel**
>
> Include biographical sketches for persons occupying the key positions
> described in the narrative, not to exceed one page in length. In the
> event that a biographical sketch is included for an identified
> individual who is not yet hired, please include a letter of commitment
> from that person with the biographical sketch.
>
> **Appendix C: Organizational Chart**
>
> Provide a one-page figure that depicts the project within the
> organizational structure, including any subcontractors and other
> significant collaborators.
>
> **Appendix D: Letters of Agreement and/or Description(s) of
> Proposed/Existing Contracts**
>
> Provide any project specific documents that describe working
> relationships between the applicant agency and other agencies and
> programs cited in the proposal. Documents that confirm actual or
> pending contractual agreements should clearly describe the roles of
> the subcontractors and any deliverables. Letters of agreements must be
> dated.
>
> **Appendix E: Other Relevant Documents**
>
> Include here any other documents that are relevant to the application,
> including tables, charts, map of the service area, and letters of
> support. Letters of support must be dated. Include only letters of
> support which specifically indicate a commitment to the
> project/program (in-kind services, dollars, staff, space, equipment,
> etc.) List all other support letters on one page.

## 3. Submission Dates and Times

Application Due Date

The due date for applications under this grant announcement is March 31,
2006 at 8:00 P.M. ET.

Applications will be considered as meeting the deadline if they are E
marked on or before the due date. Please consult Appendix A, Section 3
for detailed instructions on submission requirements.

The Chief Grants Management Officer (CGMO) or a higher level designee
may authorize an extension of published deadlines when justified by
circumstances such as acts of God (e.g. floods or hurricanes),
widespread disruptions of mail service, or other disruptions of
services, such as a prolonged blackout. The authorizing official will
determine the affected geographical area(s).

Applications must be submitted by 8:00 P.M. ET. **To ensure that you
have adequate time to follow procedures and successfully submit the
application, we recommend you register immediately in Grants.gov (See
Appendix B) and complete the forms as soon as possible, as this is a new
process and may take some time.**

**Please refer to the Appendix B for important specific information on
registering, and Appendix A, Section 3 for important information on
applying through Grants.gov.**

[]{.mark}

Late Applications:

Applications that do not meet the criteria delineated in Appendix A are
considered late applications. Health Resources and Services
Administration (HRSA) shall notify each late applicant that its
application will not be considered in the current competition.

## 4. Intergovernmental Review

This funding opportunity is subject to the provisions of Executive Order
12372, as implemented by 45 CFR 100. Executive Order 12372 allows States
the option of setting up a system for reviewing applications from within
their States for assistance under certain Federal programs. Application
packages made available under this guidance will contain a listing of
States that have chosen to set up such a review system, and will provide
a State Single Point of Contact (SPOC) for the review. Information on
states affected by this program and State Points of Contact may also be
obtained from the Grants Management Officer listed in the Agency
Contacts section, as well as from the following Web site:
<http://www.whitehouse.gov/omb/grants/spoc.html>.

All applicants other than federally recognized Native American Tribal
Groups should contact their SPOC as early as possible to alert them to
the prospective applications and receive any necessary instructions on
the State process used under this Executive Order.

Letters from the SPOC in response to Executive Order 12372 are due sixty
days after the application due date.

State Coordination

It is suggested that all applicants should contact their State Primary
Care Associations (PCAs), State Primary Care Offices (PCOs) to alert
them to the prospective applications and if applicable, coordinate
application with State primary care activities. Listings of PCAs and
PCOs can be found at the following websites:

> PCAs: <http://bphc.hrsa.gov/OSNP/PCADirectory.htm>

PCOs: <http://bphc.hrsa.gov/OSNP/PCODirectory.htm>

## 5. Funding Restrictions 

Awards to support projects beyond the first budget year will be
contingent upon Congressional appropriation, satisfactory progress in
meeting the project's objectives, and a determination that continued
funding would be in the best interest of the government.

Applicants responding to this announcement may not request funding
greater than the allowable cap of \$600,000 per year in Federal funds
for EMC applications.

Consistent with the statutory restrictions, section 330 funds may not be
used for construction of facilities. Funds may, however, be used for
minor capital cost including equipment and minor alteration and
renovation. Applicants may request to use up to \$150,000 of Federal
funds in the first year of the EMC project for such minor capital costs;
however, the total Federal section 330 funds requested may not exceed
the established cap of \$600,000 in any year.

## 6. Other Submission Requirements

As stated in Section IV.1, except in rare cases HRSA will no longer
accept applications for grant opportunities in paper form. Applicants
submitting for this funding opportunity are ***required*** to submit
***electronically*** through Grants.gov. To submit an application
electronically, please use the
[http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
Grants.gov you will be able to download a copy of the application
package, complete it off-line, and then upload and submit the
application via the Grants.gov site.

As soon as you read this, whether you plan on applying for a HRSA grant
later this month or later this year, it is incumbent that your
organization ***immediately register*** in Grants.gov and become
familiar with the Grants.gov site application process. If you do not
complete the registration process you will be unable to submit an
application. The registration process can take up to one month, so you
need to begin immediately.

To be able to successfully register in Grants.gov, it is necessary that
you complete all of the following required actions:

> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider

Instructions on how to register, tutorials and FAQs are available on the
Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
Assistance is also available from the Grants.gov help desk at
<support@grants.gov> or by phone at 1-800-518-4726.

More specific information, including step-by-step instructions on
registering and applying, can be found in Appendix B of this guidance.

**Formal submission of the electronic application:** Applications
completed online are considered formally submitted when the Authorizing
Official electronically submits the application to HRSA. However, to
complete the submission requirements, a hard-copy of the SF-424/5161
Face Sheet must be printed, signed, and submitted to the HRSA Grants
Application Center. The SF-424/5161 must be printed from the online
application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the following address and received by
HRSA by no later than five days after the date of submission in
Grants.gov:

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: Expanded Medical Capacity for MSFWs/Homeless
>
> Program Announcement No. HRSA-06-116
>
> CFDA No. 93.224
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the date of submission in
Grants.gov

# V. Application Review Information

## 

## 1. Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation.

All EMC applicants should ensure the following six (6) Review Criteria
are fully addressed within the Program Narrative and supported by other
supplementary information in the other sections of the application, as
appropriate. The following Review Criteria will be used by the Objective
Review Committee (ORC) to evaluate the merits of the proposed plan
presented in each EMC application.

Reviewers will assign points based on how well the application has
addressed each of the Review Criteria. The six (6) Review Criteria for
the EMC funding opportunity and maximum points awarded are as follows:

[]{#_Ref84836858 .anchor}**CRITERION 1: NEED (20 points maximum)**

1.  Applicant clearly describes the service area(s)/community(ies) to be
    impacted by the EMC project, including:

    a.  The service area population and the area to be served (i.e.,
        urban, rural).

    b.  If the applicant is requesting a funding preference as a
        sparsely populated rural frontier area (i.e., the *entire
        proposed service area* has 7 or fewer people per square mile).
        *Note: The request must also be specified by checking the
        appropriate box on FORM 1-PART A: General Information Worksheet,
        and provide documentation (i.e., current census data) to support
        the request.*

    c.  The counties, census tracts, minor civil divisions,
        schools/school districts, etc., (as appropriate) in the service
        area.

    d.  Any Medically Underserved Areas (MUAs), Medically Underserved
        Populations (MUPs), High Impact Areas, and Health Professional
        Shortage Areas (HPSAs), as applicable.

```{=html}
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```
1.  Applicant clearly describes the target population(s) for the EMC
    project including:

> \(a\) The unserved and underserved MSFWs and/or homeless persons in
> the community.
>
> \(b\) The unique demographic characteristics of the target population
> (e.g., age, gender, insurance status, unemployment, poverty level,
> ethnicity/culture, education, etc.).
>
> \(c\) The relevant access to care and health status indicators of the
> target population/community including the most common causes of
> mortality and the incidence and prevalence of chronic and infectious
> diseases.

2.  Applicant clearly identifies and describes the most significant
    barriers to care, gaps in services, significant health disparities
    and the major health care problems of the target population that
    will be addressed by the EMC project. This should include a
    description of:

> \(a\) Any culturally specific characteristics that impact access to
> and the delivery of health care services.
>
> \(b\) Any relevant geographic barriers to care and other factors
> impacting access to care.
>
> \(c\) Any major and/or unique health care needs of the target
> population(s).

3.  For those organizations proposing to serve a new population (i.e.,
    MSFWs, homeless persons) for which they do not currently receive
    Federal support, the applicant clearly identifies the specific
    health care needs and barriers to care for this population to be
    addressed by the EMC project and justifies the need to expand its
    focus to new populations.

4.  Applicant clearly describes any significant changes over the past
    year in the health care environment, service area or population
    being served (e.g., influx of refugee population, closing of local
    factory) impacting on the need for services. This should include a
    description of any significant changes for each target population
    type served (i.e., MSFWs, homeless persons).

5.  Applicant clearly identifies any health care providers (including
    all other FQHC Look Alikes and section 330 grantees), resources
    and/or services of other public and private organizations within the
    proposed service area that are providing care to the target
    population(s). Appropriate justification is provided as to why
    existing health center resources and other local resources (e.g.,
    other HRSA supported programs, rural health clinics, etc.) are
    unable to meet the need for increased access to primary care.

[]{#_Ref84836847 .anchor}**CRITERION 2: RESPONSE (35 points maximum)**

1.  Applicant provides a detailed description of the proposed project
    that is appropriate and responsive to the identified health care
    needs of the target population. Included should be the number and
    location of targeted EMC sites, the number of new MSFWs and/or
    homeless persons to be served, the number of new encounters
    projected, the types of services impacted, the increase in providers
    and support staff, and any increase or modification to hours of
    operation.

2.  Applicant describes reasonable and appropriate strategies/methods
    that will attract new MSFWs and/or homeless users, expand access to
    primary care services for the target population and increase primary
    care medical capacity. Strategies may include but are not limited to
    providing additional services, additional providers where excess
    facility capacity exists, expanded hours of operation, or providing
    additional services through contractual relationships (e.g., OB/GYN)
    at existing sites. If the proposal includes completely relocating an
    existing site(s) to a more appropriate facility, the applicant
    clearly demonstrates how the project will continue to maximize
    access to health care for the community currently being served by
    the existing site.

3.  Applicant provides a Service Delivery Plan that is appropriate and
    realistic for the proposed EMC project, and responsive to the
    identified needs of the target population, including any targeted
    health disparities. The plan includes adequate medical and other
    providers (e.g., outreach workers, case managers) and support staff
    associated with the expansion. The Service Delivery Plan addresses
    its impact on the current Heath Care Plan for the organization, and
    any significant changes (e.g., serving a new population or age
    group, or expanding into new services) are noted in an addendum to
    the existing Health Care Plan. (See page
    [74](#attachment-3-service-delivery-plan-and-business-plan) for
    required format for Service Delivery Plan.)

4.  Applicant provides a Business Plan that is appropriate and realistic
    for the proposed EMC project. Each relevant component of the Heath
    Center (e.g., Administration, Fiscal, Clinical, MIS, Governance,
    etc.) is sufficiently addressed, and the goals and activities are
    appropriate for the proposed project. (See page
    [74](#attachment-3-service-delivery-plan-and-business-plan) for
    required format for Business Plan.)

5.  Applicant proposes appropriate plans for incorporating or improving
    the use of outreach and other enabling services to bring new users
    in to the health centers and/or medical services for special
    populations (i.e., MSFWs and their families, homeless persons).

6.  Applicant demonstrates that the new or expanded services being
    proposed are culturally and linguistically appropriate for the
    populations to be served.

7.  For organizations proposing an expansion to serve a population for
    which they do not currently receive Federal support, the applicant:

> \(a\) Demonstrates awareness of the appropriate organizational changes
> to be made (per statutory and other requirements and expectations of
> health centers). Areas of consideration include representation in
> governance, and modifications to clinical and business systems,
> enabling services and overall cultural competency.
>
> \(b\) Presents a sound plan to assure compliance upon receipt of
> funding.
>
> \(c\) Assures the organization's ability to implement the necessary
> changes.

8.  Applicant provides a feasible and credible timeline for
    implementation of the project. The applicant demonstrates
    operational readiness within 120 days of award (i.e., proposed staff
    recruited and services provided), including those applicants
    proposing to open a replacement site.

[]{#ref84836880 .anchor}**CRITERION 3: EVALUATIVE MEASURES (10 points
maximum)**

1.  Applicant demonstrates the ability to evaluate the effectiveness of
    the EMC project, including the quality and outcomes of the services
    provided (e.g., adequate management information systems, patient
    satisfaction). Applicant provides an evaluation plan that is
    appropriate for the EMC project goals and projected outcomes.

2.  If applicable, the applicant describes the health center's
    successful progress in meeting the initial goals and objectives
    under a time-limited State funded program (i.e., incubator program),
    and how these goals/objectives will align with the proposed EMC
    project.

3.  Applicant demonstrates an appropriate quality improvement program
    that includes eliminating disparities in health outcomes, reducing
    patient risk, credentialing and privileging, incident reporting,
    etc.

4.  Applicant describes the mechanism(s) by which the organization
    identifies and responds to the community and its needs (e.g.,
    patient surveys, needs assessments, statewide data, census data).

[]{#_Ref84836892 .anchor}

**CRITERION 4: IMPACT (5 points maximum)**

1.  Applicant demonstrates the extent to which the proposed EMC project
    will increase access to care and eliminate major barriers to care
    for target population to be served.

2.  Applicant demonstrates the extent to which the proposed EMC project
    will address the major health care needs and reduce health
    disparities for the medically target population to be served.

[]{#_Ref84836902 .anchor}

**CRITERION 5: RESOURCES/CAPABILITIES (20 points maximum)**

1\. Applicant clearly describes its mission and structure, scope of
current activities (including participation in a state-funded incubator
program if applicable) and systems, and includes an organizational chart
depicting the EMC project within the organizational structure in
Appendix C. The applicant also demonstrates the organization's ability
to successfully implement the proposed medical expansion project and
meet program expectations.

2.  Applicant demonstrates experience with similar projects and
    sufficient knowledge, skills and abilities within the organization
    to successfully implement the EMC project. (e.g., previous
    successful expansion projects, etc.)

3.  Applicant demonstrates and documents that it is operating at full
    capacity for the providers currently in place and the resources
    currently available.

4.  Applicant discusses the ability and experience of the proposed
    management team in leading and managing internal administrative,
    human resources, financial systems, information systems, and
    clinical disciplines.

5.  Applicant demonstrates that the facilities proposed for the EMC
    project are adequate and appropriate for the projected increase in
    the provision of services. The applicant also provides an
    appropriate plan for any necessary facility
    modifications/renovations.

> 6\. Applicant demonstrates appropriate collaboration with other area
> providers (including other section 330 funded programs), to minimize
> duplication of services and assure an effective continuum of care.
> MOAs, MOUs, and/or a list of additional letters of commitment, on file
> at the health center, should be included as appropriate in Appendix D.
>
> 7\. Applicant demonstrates and provides evidence of the community's
> support for the proposed EMC project. Letters of support should be
> included as appropriate in Appendix E.
>
> 8\. For applicants proposing to expand into new target populations
> (i.e., MSFWs, homeless persons), the applicant demonstrates an
> awareness of all appropriate organizational changes necessary for a
> successful project, a plan for compliance and the ability to implement
> the necessary organizational changes for serving new populations. The
> applicant must discuss the changes necessary to comply with all
> relevant program requirements to receive grant funds for services
> targeted to the proposed populations. The application certifies that
> the organization will be brought into compliance upon receipt of grant
> funding, and include information exhibiting the applicants ability to
> do so.

9.  Applicant demonstrates that the organization's existing operations
    will not be jeopardized if the expansion budget projections are not
    realized, and that the addition of new providers and staff will not
    adversely affect the efficiency of current providers.

[]{#_Ref84836916 .anchor}**CRITERION 6: SUPPORT REQUESTED (10 points
maximum)**

1.  Applicant demonstrates in the budget presentation, two 12-month
    annualized budgets which are appropriate and reasonable in terms of:

> \(a\) The level of requested Federal grant funds versus total budget
> for each year;
>
> \(b\) The total resources required to achieve the goals and objectives
> of the proposed EMC project (i.e., total project budget) and Business
> Plan provided as part of the RESPONSE section of the Program
> Narrative;
>
> \(c\) The maximization of non-grant revenue relative to the proposed
> plan and other Federal/State/local/in-kind resources applied to the
> project;
>
> \(d\) The projected patient income for each year is reasonable based
> on the patient mix and number of projected users and encounters;
>
> \(e\) The number of proposed users and encounters, after the first
> year of finding, and at full capacity after two years of funding;
>
> \(f\) The total cost per user and encounter;
>
> \(g\) The total Federal section 330 grant dollars per user; and
>
> \(h\) The one-time minor capital costs.

2.  Applicant demonstrates how all sources of revenue, including
    non-Federal, will be maximized.

3.  Applicant presents a budget narrative that is complete,
    comprehensive and provides an explanation for each budget line item.

4.  Applicant describes how the proposed expansion project is a
    cost-effective approach to meeting the primary care needs of the
    target population given the health care needs of the target
    population and the level of health care resources currently
    available in the community.

## 2. Review and Selection Process

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

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

**Those applications that are determined to be ineligible, incomplete or
non-responsive to the grant application guidance and/or section 330
program requirements will be returned to the applicant without further
consideration.**

### Funding Preferences 

The authorizing legislation provides a funding preference for some
applicants. Applicants requesting and receiving the preference may be
placed in a more competitive position among applications considered for
funding. Applications that do not receive a funding preference will be
given full and equitable consideration during the review process. It
should be noted that other factors including those listed below in Other
Awarding Factors, will be considered as part of the selection of
applications for funding.

The funding preference will be determined based on supporting
documentation contained in the application. The law provides that a
funding preference be granted to any qualified applicant that
specifically requests the preference and meets the criteria for the
preference as follows:

> *Sparsely Populated Rural Frontier Areas*: In order to be considered
> for a funding preference, an applicant must demonstrate that the
> **entire** proposed service area for the EMC project has seven or
> fewer people per square mile (i.e., all census tracts within the
> defined service area meet the definition). Applicants requesting
> consideration of a funding preference must indicate the request on
> Form 1-A: General Information Worksheet, and attach to it
> documentation indicating that the entire area served has seven or
> fewer people per square mile (e.g., most recent Census Bureau data).

### Other Awarding Factors

HRSA will consider all of the following factors, in addition to the
preference indicated above, in making EMC awards in FY 2006. As well as
those listed below, the need for primary health care services within a
Federally defined county along the United States/Mexico Border has been
identified as an area of high need. Therefore, we strongly encourage all
eligible applicants in these areas to submit an application under this
announcement.

*RURAL/URBAN DISTRIBUTION OF AWARDS*

Aggregate awards in FY 2006 to serve rural and urban areas will be made
to ensure that no more than 60 percent and no fewer than 40 percent of
the people served come from either rural or urban areas.

*PROPORTIONATE DISTRIBUTION*

Aggregate awards in FY 2006 to support the various types of health
centers will be made to ensure continued proportionate distribution of
funds across the Consolidated Health Center Program.

*GEOGRAPHIC CONSIDERATION*

The goal of the HRSA in making this funding announcement is to expand
the current safety net on a national basis. Therefore, the HRSA will
consider geographic distribution when deciding which applications to
fund.

*PERFORMANCE UNDER SECTION 330 PROGRAM EXPECTATIONS*

Current grantees found to be out of compliance with section 330 program
expectations may not be considered for funding.

### 

## 3. Anticipated Announcement and Award Date

The anticipated date of award for EMC is **September 1, 2006.**

# VI. Award Administration Information

## 1. Award Notices

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the objective review
committee's assessment of the application's merits and weaknesses, and
whether the application was selected for funding. Organizations whose
applications are selected for funding may be required to respond in a
satisfactory manner to Conditions placed on their application before
funds can be awarded. Letters of notification of funding do not provide
authorization to begin performance.

Successful applicants will receive a Notice of Grant Award following the
announcement of the funding decisions. The Notice of Grant Award sets
forth the amount of funds granted, the terms and conditions of the
grant, the effective date of the grant, the budget period for which
initial support will be given, the non-Federal share to be provided (if
applicable), and the total project period for which support is
contemplated. Signed by the Grants Management Officer, it is sent to the
applicant agency's Authorized Representative, and reflects the only the
authorizing document. It will be sent prior to the start date of
September 1, 2006.

## 2. Administrative and National Policy Requirements

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92
(governmental), as appropriate.

Public Policy Issuance

**Healthy People 2010** is a national initiative led by HHS that sets
priorities for all HRSA programs. The initiative has two major goals:
(1) To increase the quality and years of a healthy life; and (2)
Eliminate our country's health disparities. The program consists of 28
focus areas and 467 objectives. HRSA has actively participated in the
work groups of all the focus areas, and is committed to the achievement
of the Healthy People 2010 goals.

As part of the Service Delivery Plan, applicants must summarize those
programs objectives and/or sub-objectives that relate to the goals of
the Healthy People 2010 initiative.

Copies of the Healthy People 2010 may be obtained from the
Superintendent of Documents or downloaded at the Healthy People 2010
website: <http://www.health.gov/healthypeople/document/>.

The Public Health Service strongly encourages all award recipients to
provide a smoke-free workplace and to promote the non-use of all tobacco
products. Further, Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities (or in some cases, any portion
of a facility) in which regular or routine education, library, day care,
health care or early childhood development services are provided to
children.

### 

## 3. Reporting

Instructions for post-award reporting (e.g., frequency, paper or
electronic submission) will be provided in the Notice of Grant Award.
Successful applicants under this guidance must:

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

(b) Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Reports are to be submitted to:

Division of Payment Management

DPM/FMS/PSC/ASAM/HHS

PO Box 6021

Rockville, MD 20852

Telephone: (301) 443-1660

(c) Submit a Financial Status Report. A financial status report is
    required within 90 days of the end of each grant year. The report is
    an accounting of expenditures under the project that year;

(d) Submit a Progress Report(s).

# 

## 4. Performance Review

HRSA's Office of Performance Review (OPR) serves as the agency's focal
point for reviewing and enhancing the performance of HRSA funded
programs within communities and States. On a regularly scheduled basis,
HRSA grantees are required to participate in a performance review of
their HRSA funded program(s) by a review team from one of the ten OPR
regional divisions. Grantees should expect to participate in a
performance review at some point during their project period. When a
grantee receives more than one HRSA grant, each of the grantee's HRSA
funded programs will be reviewed during the same performance review.

The purpose of performance review is to improve the performance of HRSA
funded programs. Through systematic pre-site and on-site analysis, OPR
works collaboratively with grantees and HRSA Bureaus/Offices to measure
program performance, analyze the factors impacting performance, and
identify effective strategies and partnerships to improve program
performance, with a particular focus on outcomes. Upon completion of the
performance review, grantees are expected to prepare an Action Plan that
identifies key actions to improve program performance as well as
addresses any identified program requirement issues. Performance reviews
also provide direct feedback to the agency about the impact of HRSA
policies on program implementation and performance within communities
and States.

For additional information on performance reviews, please visit:
<http://www.hrsa.gov/performancereview>.

# VII. Agency Contacts

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

> Mike Rowland
>
> HRSA/Division of Grants Management Operations, OFAM
>
> 5600 Fishers Lane, 11A-16
>
> Rockville, MD 20857
>
> Phone: 301-594-4243
>
> Fax: 301-594-4073
>
> Email: <mike.rowland@hrsa.hhs.gov>

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

> Kirsten Argueta
>
> HRSA/Bureau of Primary Health Care
>
> Division of Policy and Development
>
> 5600 Fishers Lane, 17-61
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4300
>
> Fax: (301) 594-4997
>
> Email: [kargueta@hrsa.gov](mailto:kirsten.argueta@hrsa.hhs.gov)

# VIII. Other Information

# 

### Contact Information for Application Development Assistance

Contact information for Primary Care Associations and Primary Care
Offices can be found at the following website:
<http://bphc.hrsa.gov/osnp/pcapco.htm>

In addition, the following National Organizations may be contacted for
additional assistance in preparing an EMC application:

Karen Mountain

Migrant Clinicians Network, Inc.

P.O. Box 16485

Austin, TX 78716

Tel: 512-327-2017

Email: kmountain@migrantclinician.org

www.migrantclinician.org

Laura Brey

National Assembly on School-Based HealthCare

Center for Technical Assistance and Training

666 11^th^ Street, NW

Washington, DC 20001

Tel: 202-638-5872 ext. 202

Email: lbrey@nasbhc.org

www.nasbhc.org

Pamela J. Byrnes, Ph.D.

National Association of Community Health Centers

Managed Growth Assistance Program

50 South Washington Avenue

Niantic, CT 06357

Tel: 860-739-9224

Fax: 860-691-1388

Email: pbyrnes@nachc.com

www.nachc.com

Alicia Gonzales

National Center on Farmworker Health

1770 FM 967

Buda, TX 78610

Tel: 512-312-5469

Email: Gonzales@ncfh.org

www.ncfh.org

Karen Rotondo

National Health Care for the Homeless Council

13 Railway Bluffs

Hyannis Park, MA 02601

Tel: 508-775-4374

Email: kerotondo@aol.com

www.nhchc.org

# IX. Tips for Writing a Strong Application

**Include DUNS Number.** You must include a DUNS Number to have your
application reviewed. Applications *will not* be reviewed without a DUNS
number. To obtain a DUNS number, access
[www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
1-866-705-5711. Please include the DUNS number next to the OMB Approval
Number on the application face page.

**Keep your audience in mind.** Reviewers will use only the information
contained in the application to assess the application. Therefore, the
applicant should be sure the application and responses to the program
requirements and expectations are complete and clearly written. Do not
assume that reviewers are familiar with the applicant organization. Keep
the review criteria in mind when writing the application.

**Start preparing the application early.** Allow plenty of time to
gather required information from various sources.

**Follow the instructions in this guidance carefully.** Place all
information in the order requested in the guidance. If information is
not placed in the requested order, you may receive a lower score.

**Be brief, concise, and clear.** Make your points understandable.
Provide accurate and honest information, including candid accounts of
problems and realistic plans to address them. If any required
information or data is omitted, explain why. Make sure the information
provided in each table, chart, attachment, etc., is consistent with the
proposal narrative and information in other tables.

**Be organized and logical.** Many applications fail to receive a high
score because the reviewers cannot follow the thought process of the
applicant or because parts of the application do not fit together.

**Be careful in the use of appendices.** Do not use the appendices for
information that is required in the body of the application. Be sure to
cross-reference all tables and attachments located in the appendices to
the appropriate text in the application.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages are numbered (including appendices) and that page limits are
followed. Limit the use of abbreviations and acronyms, and define each
one at its first use and periodically throughout the application. Make
sure you submit your application in final form, without markups.

**Print out and carefully review an electronic application.** If
submitting electronically, print out the application before submitting
it to ensure appropriate formatting and adherence to page limit
requirements. Ensure that all information is submitted at the same time.
We will not consider additional information and/or materials submitted
after your initial submission, nor will we accept e-mailed applications
or supplemental materials once your application has been accepted.

![](media/image1.jpeg){width="1.34375in" height="0.375in"}**APPENDIX A**

**HRSA's Electronic Submission User Guide**

Version 1.0 January 2006

Table of Contents

[***[1.]{.underline}** **[Introduction]{.underline}
2***](#__RefHeading___Toc126565107)

> [[1.1.Document Purpose and Scope]{.underline}
> 2](#__RefHeading___Toc126565108)
>
> [[1.2.Document Organization and Version Control]{.underline}
> 2](#__RefHeading___Toc126565109)

[***[2.]{.underline}** **[Noncompeting Continuation
Application]{.underline} 2***](#__RefHeading___Toc126565110)

> [[2.1.Process Overview]{.underline} 2](#__RefHeading___Toc126565111)
>
> [[2.2.Grantee Organization Needs to Register With Grants.gov (if not
> already registered)]{.underline} 3](#__RefHeading___Toc126565112)
>
> [[2.3.]{.underline} [Project Director and Authorizing Official Need to
> Register with HRSA EHBs (if not already
> registered)]{.underline}4](#__RefHeading___Toc126565113)
>
> [[2.4.Apply through Grants.gov]{.underline}
> 4](#__RefHeading___Toc126565114)
>
> [*[2.4.1]{.underline}* *[Find Funding Opportunity]{.underline}
> 4*](#__RefHeading___Toc126565115)
>
> [*[2.4.2]{.underline}* *[Download Application Package]{.underline}
> 5*](#__RefHeading___Toc126565116)
>
> [*[2.4.3]{.underline}* *[Complete Application]{.underline}
> 5*](#__RefHeading___Toc126565117)
>
> [*[2.4.4]{.underline}* *[Submit Application]{.underline}
> 5*](#__RefHeading___Toc126565118)
>
> [*[2.4.5]{.underline}* *[Verify Status of Application]{.underline}
> 5*](#__RefHeading___Toc126565119)
>
> [[2.5.Verify in HRSA Electronic Handbooks]{.underline}
> 6](#__RefHeading___Toc126565120)
>
> [*[2.5.1]{.underline}* *[Verify Status of Application]{.underline}
> 6*](#__RefHeading___Toc126565121)
>
> [*[2.5.2]{.underline}* *[Manage Access to Your
> Application]{.underline} 6*](#__RefHeading___Toc126565122)
>
> [*[2.5.3]{.underline}* *[Check Validation Errors]{.underline}
> 7*](#__RefHeading___Toc126565123)
>
> [*[2.5.4]{.underline}* *[Fix Errors and Complete
> Application]{.underline} 7*](#__RefHeading___Toc126565124)
>
> [*[2.5.5]{.underline}* *[Submit Application]{.underline}
> 7*](#__RefHeading___Toc126565125)
>
> [[2.6.Submit Signed Face Page]{.underline}
> 7](#__RefHeading___Toc126565126)

[***[3.]{.underline}** **[Competing Application]{.underline}
7***](#__RefHeading___Toc126565127)

> [[3.1.Process Overview]{.underline} 7](#__RefHeading___Toc126565128)
>
> [[3.2.Grantee Organization Needs to Register With Grants.gov (if not
> already registered)]{.underline} 8](#__RefHeading___Toc126565129)
>
> [[3.3.Apply through Grants.gov]{.underline}
> 9](#__RefHeading___Toc126565130)
>
> [*[3.3.1]{.underline}* *[Find Funding Opportunity]{.underline}
> 9*](#__RefHeading___Toc126565131)
>
> [*[3.3.2]{.underline}* *[Download Application Package]{.underline}
> 9*](#__RefHeading___Toc126565132)
>
> [*[3.3.3]{.underline}* *[Complete Application]{.underline}
> 9*](#__RefHeading___Toc126565133)
>
> [*[3.3.4]{.underline}* *[Submit Application]{.underline}
> 9*](#__RefHeading___Toc126565134)
>
> [*[3.3.5]{.underline}* *[Verify Status of Application]{.underline}
> 10*](#__RefHeading___Toc126565135)
>
> [[3.4.Submit Signed Face Page]{.underline}
> 10](#__RefHeading___Toc126565136)

[***[4.]{.underline}** **[General Instructions for Application
Submission]{.underline} 10***](#__RefHeading___Toc126565137)

> [[4.1.Narrative Attachment Guidelines]{.underline}
> 11](#__RefHeading___Toc126565138)
>
> [*[4.1.1]{.underline}* *[Font]{.underline}
> 11*](#__RefHeading___Toc126565139)
>
> [*[4.1.2]{.underline}* *[Paper Size and Margins]{.underline}
> 11*](#__RefHeading___Toc126565140)
>
> [*[4.1.3]{.underline}* *[Names]{.underline}
> 11*](#__RefHeading___Toc126565141)
>
> [*[4.1.4]{.underline}* *[Section Headings]{.underline}
> 11*](#__RefHeading___Toc126565142)
>
> [*[4.1.5]{.underline}* *[Page Numbering]{.underline}
> 11*](#__RefHeading___Toc126565143)
>
> [*[4.1.6]{.underline}* *[Allowable Attachment or Document
> Types]{.underline} 12*](#__RefHeading___Toc126565144)
>
> [[4.2.Application Content Order (Table of Contents)]{.underline}
> 12](#__RefHeading___Toc126565145)
>
> [[4.3.Page Limit]{.underline} 12](#__RefHeading___Toc126565146)

[![](media/image1.jpeg){width="1.34375in"
height="0.375in"}***[5.]{.underline}** **[Customer Support
Information]{.underline} 13***](#__RefHeading___Toc126565147)

> [*[5.1.1]{.underline}* *[Grants.gov Customer Support]{.underline}
> 13*](#__RefHeading___Toc126565148)
>
> [*[5.1.2]{.underline}* *[HRSA Call Center]{.underline}
> 13*](#__RefHeading___Toc126565149)
>
> [*[5.1.3]{.underline}* *[HRSA Program Support]{.underline}
> 13*](#__RefHeading___Toc126565150)

[***[6.]{.underline}** **[FAQs]{.underline}
13***](#__RefHeading___Toc126565151)

> [[6.1.Software]{.underline} 13](#__RefHeading___Toc126565152)
>
> [*[6.1.1]{.underline}* *[What are the software requirements for using
> Grants.gov?]{.underline} 13*](#__RefHeading___Toc126565153)
>
> [*[6.1.2]{.underline}* *[Why can't I download PureEdge Viewer onto my
> machine?]{.underline} 14*](#__RefHeading___Toc126565154)
>
> [*[6.1.3]{.underline}* *[I have heard that Grants.gov is not Macintosh
> compatible. What do I do if I use only a Macintosh?]{.underline}
> 14*](#__RefHeading___Toc126565155)
>
> [*[6.1.4]{.underline}* *[What are the software requirements for HRSA
> EHBs?]{.underline} 14*](#__RefHeading___Toc126565156)
>
> [*[6.1.5]{.underline}* *[What are the system requirements for using
> HRSA EHBs on a Macintosh computer?]{.underline}
> 14*](#__RefHeading___Toc126565157)
>
> [[6.2.Application Receipt]{.underline}
> 15](#__RefHeading___Toc126565158)
>
> [*[6.2.1]{.underline}* *[What will be the receipt date\--the date the
> application is stamped as received by Grants.gov or the date the data
> is received by HRSA?]{.underline} 15*](#__RefHeading___Toc126565159)
>
> [*[6.2.2]{.underline}* *[When do I need to submit my
> application?]{.underline} 15*](#__RefHeading___Toc126565160)
>
> [*[6.2.3]{.underline}* *[What emails can I expect once I submit my
> application? Is email reliable?]{.underline}
> 15*](#__RefHeading___Toc126565161)
>
> [*[6.2.4]{.underline}* *[If a resubmission is required because of
> Grants.gov system problems, will these be considered
> \"late\"?]{.underline} 16*](#__RefHeading___Toc126565162)
>
> [[6.3.Application Submission]{.underline}
> 16](#__RefHeading___Toc126565163)
>
> [*[6.3.1]{.underline}* *[How can I make sure that my electronic
> application is presented in the right order for objective
> review?]{.underline} 16*](#__RefHeading___Toc126565164)
>
> [[6.4.Grants.gov]{.underline} 16](#__RefHeading___Toc126565165)

[]{#__RefHeading___Toc126565107
.anchor}![](media/image1.jpeg){width="1.34375in"
height="0.375in"}**Introduction**

1.  []{#__RefHeading___Toc126565108 .anchor} **Document Purpose and
    Scope**

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

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

2.  []{#__RefHeading___Toc126565109 .anchor}**Document Organization and
    Version Control**

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

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

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

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

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

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

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

This document is under version control. Please visit
[[http://www.hrsa.gov/grants]{.underline}](http://www.hrsa.gov/grants)
to retrieve the latest published version.

[]{#__RefHeading___Toc126565110 .anchor}**Noncompeting Continuation
Application**

1.  []{#__RefHeading___Toc126565111 .anchor} **Process Overview**

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

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

2\. Search for the announcement in Grants.gov Apply
([[http://www.grants.gov/Apply]{.underline}](http://www.grants.gov/Apply)).

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}5. Submit the
application package through Grants.gov. (Requires registration)

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

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

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

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

10\. AO prints the application face page from HRSA EHBs (not
Grants.gov), signs it and mails it to HRSA's Grant Application Center
(GAC).

11\. HRSA receives the signed face page and scans it into the system
saving it with the electronic application.

2.  []{#__RefHeading___Toc126565112 .anchor}**Grantee Organization Needs
    to Register With Grants.gov (if not already registered) - See
    Appendix B**

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

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

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

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

• Register the organization with Central Contractor Registry (CCR)

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

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

• Register an Authorized Organization Representative (AOR)

> o Obtain a username and password from the Grants.gov Credential
> Provider
>
> o Register the username and password with Grants.gov
>
> o Get authorized as an AOR by your organization

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

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

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

3.  []{#__RefHeading___Toc126565113
    .anchor}![](media/image1.jpeg){width="1.34375in"
    height="0.375in"}**Project Director and Authorizing Official Need to
    Register with HRSA EHBs (if not already registered)**

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

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

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

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

> • Authorizing Official (AO),
>
> • Business Official (BO), and
>
> • Other Employee (for project directors, assistant staff, AO designees
> and others).

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

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

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

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

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

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

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

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

1.  []{#__RefHeading___Toc126565114 .anchor}**Apply through Grants.gov**

    1.  []{#__RefHeading___Toc126565115 .anchor}**Find Funding
        Opportunity**

Search for the announcement in Grants.gov **Apply**
([[http://www.grants.gov/Apply]{.underline}](http://www.grants.gov/Apply)).

![](media/image1.jpeg){width="1.34375in" height="0.375in"}Enter the
announcement number communicated to you in the field *Funding
Opportunity Number*. (Example announcement number: 5-S45-06-001)

> **Noncompeting announcements are not available in Grants.gov FIND!**

2.  []{#__RefHeading___Toc126565116 .anchor}**Download Application
    Package**

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

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

3.  []{#__RefHeading___Toc126565117 .anchor}**Complete Application**

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

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

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

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

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

4.  []{#__RefHeading___Toc126565118 .anchor}**Submit Application**

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

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

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

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

5.  []{#__RefHeading___Toc126565119 .anchor}**Verify Status of
    Application**

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

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

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

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

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

2.  []{#__RefHeading___Toc126565120 .anchor}**Verify in HRSA Electronic
    Handbooks**

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

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

1.  []{#__RefHeading___Toc126565121 .anchor}**Verify Status of
    Application**

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

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

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

2.  []{#__RefHeading___Toc126565122 .anchor}**Manage Access to Your
    Application**

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}Once you have
access to your grant handbook, use the "Noncompeting Continuations" link
under the deliverables section to access your noncompeting application.

3.  []{#__RefHeading___Toc126565123 .anchor}**Check Validation Errors**

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

4.  []{#__RefHeading___Toc126565124 .anchor}**Fix Errors and Complete
    Application**

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

5.  []{#__RefHeading___Toc126565125 .anchor}**Submit Application**

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

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

3.  []{#__RefHeading___Toc126565126 .anchor}**Submit Signed Face Page**

After successful submission, the AO must print the face page of the
application from the HRSA EHBs, sign it and mail it to HRSA at the
address listed below:

HRSA Grants Application Center

Reference: Announcement Number: *\<Provide HRSA Announcement Number\>*

Reference: Grants.gov Tracking Number: *\<Provide Your Grants.gov
Tracking Number\>*

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

The face page must be received by HRSA within **5** business days from
the date of submission in HRSA EHBs.

Once your signed face page is received by HRSA and saved with the
application, you will receive an email receipt of application from HRSA.

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

2.  []{#__RefHeading___Toc126565127 .anchor}**Competing Application**

    1.  []{#__RefHeading___Toc126565128 .anchor}**Process Overview**

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

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

2\. When program guidance is available, search for the announcement in
Grants.gov Apply
([[http://www.grants.gov/Apply]{.underline}](http://www.grants.gov/Apply)).

![](media/image1.jpeg){width="1.34375in" height="0.375in"}3. Download
the application package and instructions from Grants.gov. The program
guidance is also part of the instructions that must be downloaded.

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

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

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

7\. AO prints the application face page from the local copy, signs it
and mails it to HRSA's Grant Application Center (GAC).

8\. HRSA receives the signed face page and scans it into the system
saving it with the electronic application.

1.  []{#__RefHeading___Toc126565129 .anchor}**Grantee Organization Needs
    to Register With Grants.gov (if not already registered -- See
    Appendix B)**

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

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

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

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

• Register the organization with Central Contractor Registry (CCR)

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

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

• Register an Authorized Organization Representative (AOR)

> o Obtain a username and password from the Grants.gov Credential
> Provider
>
> o Register the username and password with Grants.gov
>
> o Get authorized as an AOR by your organization

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

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

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

2.  []{#__RefHeading___Toc126565130
    .anchor}![](media/image1.jpeg){width="1.34375in"
    height="0.375in"}**Apply through Grants.gov**

    1.  []{#__RefHeading___Toc126565131 .anchor}**Find Funding
        Opportunity**

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

Please visit
[[http://www.hrsa.gov/grants]{.underline}](http://www.hrsa.gov/grants)
to read annual HRSA Preview.

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

2.  []{#__RefHeading___Toc126565132 .anchor}**Download Application
    Package**

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

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

3.  []{#__RefHeading___Toc126565133 .anchor}**Complete Application**

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

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

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

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

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

4.  []{#__RefHeading___Toc126565134 .anchor}**Submit Application**

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

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

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

> ![](media/image1.jpeg){width="1.34375in" height="0.375in"} **You must
> be connected to the Internet and must have a Grants.gov username and
> password to submit the application package.**

5.  []{#__RefHeading___Toc126565135 .anchor}**Verify Status of
    Application**

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

In case of any errors, you must correct the application and resubmit it
to Grants.gov. If you are unable to resubmit because the opportunity has
since closed, **contact the Director of the Division of Grants Policy**
via email at
[[DGPClearances@hrsa.gov]{.underline}](mailto:DGPClearances@hrsa.gov)
and thoroughly explain the situation; include a copy of the "Rejected
with Errors" notification.

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

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

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

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

3.  []{#__RefHeading___Toc126565136 .anchor}**Submit Signed Face Page**

After successful submission in Grants.gov, the AO must print the face
page of the application from Grants.gov, write the Grants.gov Tracking
Number in Federal Award Identifier field (box 5b in SF424 or box 4 in
SF424 R&R), sign it and mail it to HRSA at the address listed below:

HRSA Grants Application Center

Reference: Announcement Number: *\<Provide HRSA Announcement Number\>*

Reference: Grants.gov Tracking Number: *\<Provide Your Grants.gov
Tracking Number\>*

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

The face page must be received by HRSA within **5** business days from
the date of submission in Grants.gov.

Once your signed face page is received by HRSA and saved with the
application, you will receive an email receipt of application from HRSA.

3.  []{#__RefHeading___Toc126565137 .anchor}**General Instructions for
    Application Submission**

> **It is mandatory to follow the instructions provided in this section
> to ensure that your application can be printed efficiently and
> consistently for review.**
>
> ![](media/image1.jpeg){width="1.34375in" height="0.375in"} **Failure
> to follow the instructions may make your application non-compliant.
> Non-compliant applications will not be given any consideration and the
> particular applicants will be notified.**

1.  []{#__RefHeading___Toc126565138 .anchor}**Narrative Attachment
    Guidelines**

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

1.  []{#__RefHeading___Toc126565139 .anchor}**Font**

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

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

2.  []{#__RefHeading___Toc126565140 .anchor}**Paper Size and Margins**

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

3.  []{#__RefHeading___Toc126565141 .anchor}**Names**

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

4.  []{#__RefHeading___Toc126565142 .anchor}**Section Headings**

Please put all section headings flush left in bold type.

5.  []{#__RefHeading___Toc126565143 .anchor}**Page Numbering**

**Electronic Submissions**

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

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

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

6.  []{#__RefHeading___Toc126565144
    .anchor}![](media/image1.jpeg){width="1.34375in"
    height="0.375in"}**Allowable Attachment or Document Types**

**Electronic Submissions**

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

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

.XFD -- PureEdge Form

2.  []{#__RefHeading___Toc126565145 .anchor}**Application Content Order
    (Table of Contents)**

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

HRSA uses two standard packages from Grants.gov.

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

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

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

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

3.  []{#__RefHeading___Toc126565146 .anchor}**Page Limit**

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

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

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

> ![](media/image1.jpeg){width="1.34375in" height="0.375in"}
> **Applications, whether submitted electronically or on paper, that
> exceed the specified limits will be deemed non-compliant.
> Non-compliant competing applications will not be given any
> consideration and the particular applicants will be notified.
> Non-compliant noncompeting applications will have to be resubmitted to
> comply with the page limits.**

4.  []{#__RefHeading___Toc126565147 .anchor}**Customer Support
    Information**

    1.  []{#__RefHeading___Toc126565148 .anchor}**Grants.gov Customer
        Support**

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

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

[[http://www.grants.gov/CustomerSupport]{.underline}](http://www.grants.gov/CustomerSupport)

2.  []{#__RefHeading___Toc126565149 .anchor}**HRSA Call Center**

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

Please visit HRSA EHBs for online help. Go to:

[[https://grants.hrsa.gov/webexternal/home.asp]{.underline}](https://grants.hrsa.gov/webexternal/home.asp)
and click on 'Help'

3.  []{#__RefHeading___Toc126565150 .anchor}**HRSA Program Support**

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

5.  []{#__RefHeading___Toc126565151 .anchor}**FAQs**

    1.  []{#__RefHeading___Toc126565152 .anchor}**Software**

        1.  []{#__RefHeading___Toc126565153 .anchor}**What are the
            software requirements for using Grants.gov?**

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

**System Requirements:**

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

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

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

Please visit
[[http://www.grants.gov/DownloadViewer]{.underline}](http://www.grants.gov/DownloadViewer)
for all details and any updates.

2.  []{#__RefHeading___Toc126565154
    .anchor}![](media/image1.jpeg){width="1.34375in"
    height="0.375in"}**Why can't I download PureEdge Viewer onto my
    machine?**

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

3.  []{#__RefHeading___Toc126565155 .anchor}**I have heard that
    Grants.gov is not Macintosh compatible. What do I do if I use only a
    Macintosh?**

Grants.gov is aware of the issues facing Macintosh users who apply for
Federal grants electronically. Grants.gov has provided the following
response regarding this issue on its website at
[[http://www.grants.gov/MacSupport]{.underline}](http://www.grants.gov/MacSupport)

*Grants.gov recognizes that support to users of Non-Windows operating
systems and the PureEdge Viewer is often required across a distinct
segment of the grant applicant community. Although at this time, the
PureEdge Viewer is only available for Windows based installs, Grants.gov
offers support for Non-Windows platforms.*

*Grants.gov is working with PureEdge in the development of a Non-Windows
compatible viewer. PureEdge has committed to providing a platform
independent viewer by November 2006. Information related to the
Non-Windows compatible viewer will be posted to this webpage
(http://www.grants.gov/MacSupport). Please bookmark this page and return
at your convenience for more details.*

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

Grants.gov website states:

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

For details, please visit
[[http://www.grants.gov/MacSupport]{.underline}](http://www.grants.gov/MacSupport)

4.  []{#__RefHeading___Toc126565156 .anchor}**What are the software
    requirements for HRSA EHBs?**

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

IE 6.0 and above is the recommended browser.

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

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

5.  []{#__RefHeading___Toc126565157 .anchor}**What are the system
    requirements for using HRSA EHBs on a Macintosh computer?**

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}In addition,
to view attachments such as Word and PDF, you will need appropriate
viewers.

2.  []{#__RefHeading___Toc126565158 .anchor}**Application Receipt**

    1.  []{#__RefHeading___Toc126565159 .anchor}**What will be the
        receipt date\--the date the application is stamped as received
        by Grants.gov or the date the data is received by HRSA?**

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

2.  []{#__RefHeading___Toc126565160 .anchor}**When do I need to submit
    my application?**

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

3.  []{#__RefHeading___Toc126565161 .anchor}**What emails can I expect
    once I submit my application? Is email reliable?**

**Competing Submissions:**

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

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

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

You will receive an additional email from HRSA once your signed face
page is received and processed. This email serves as the official
receipt for your application.

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

**Noncompeting Submissions:**

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}Subsequently,
the application will be downloaded by HRSA. This happens within minutes
of when your application is successfully validated by Grants.gov and
made available for HRSA to download. On successful download at HRSA, the
status of the application will change to "Received by Agency" and you
will receive another email from Grants.gov.

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

You will receive an additional email from HRSA once your signed face
page is received and processed. This email serves as the official
receipt for your application.

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

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

4.  []{#__RefHeading___Toc126565162 .anchor}**If a resubmission is
    required because of Grants.gov system problems, will these be
    considered \"late\"?**

**Competing Submissions:**

No. But you must **contact the Director of the Division of Grants
Policy** via email at
[[DGPClearances@hrsa.gov]{.underline}](mailto:DGPClearances@hrsa.gov)
and thoroughly explain the situation. Include a copy of the "Rejected
with Errors" notification you received from Grants.gov.

**Noncompeting Submissions:**

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

3.  []{#__RefHeading___Toc126565163 .anchor}**Application Submission**

    1.  []{#__RefHeading___Toc126565164 .anchor}**How can I make sure
        that my electronic application is presented in the right order
        for objective review?**

Follow the instructions provided in section 4 to ensure that your
application is presented in the right order and is compliant with all
the requirements.

4.  []{#__RefHeading___Toc126565165 .anchor}**Grants.gov**

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

[[http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/GrantsGov_UST_Grantee.htm#index.html]{.underline}](http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/GrantsGov_UST_Grantee.htm#index.html)

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

***Appendix B --* Registering and [Applying Through Grants.gov
]{.underline}**

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

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [no]{.underline}t
e-mail an electronic copy of a grant application to us.

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

**Note: Except in rare cases, paper applications will NOT be accepted
for this grant opportunity. If you believe you are technologically
unable to submit an on-line application you MUST contact the Director of
the Division of Grants Policy, at
[[DGPClearances@hrsa.gov]{.underline}](mailto:DGPClearances@hrsa.gov)
and explain why you are technologically unable to submit on-line. Make
sure you specify the announcement number you are seeking relief for.**
**HRSA and its Grants Application Center (GAC) will only accept paper
applications from applicants that received prior written approval.**

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

**REGISTRATION:**

**Get started now and complete the one-time registration process to
begin submitting grant applications as soon as you read this.**

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

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

**Step 1:** Register your organization

**Step 2:** Register yourself as an Authorized Organization
Representative

![](media/image1.jpeg){width="1.34375in" height="0.375in"}**Step 3:**
Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[[www.grants.gov]{.underline}](http://www.grants.gov/). Individual
assistance is available at

[[http://www.grants.gov/Support]{.underline}](http://www.grants.gov/Support)
or 1-800-447-8477. Grants.gov also provides a variety of support options
through online Help including Context-Sensitive Help, Online Tutorials,
FAQs, Training Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

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

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

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

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

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

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

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

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

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

**REGISTER YOUR ORGANIZATION**

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

**Obtain your organization's DUNS number**

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

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

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

**Register your organization with CCR**

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

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

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

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

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

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

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

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

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

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

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

**1. Obtain your username and password**

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

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

2\. **Register with Grants.gov**

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

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

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

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

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

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

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

a\. Electronic [Submission.]{.underline} All applications must be
received by
[[www.grants.gov/Apply]{.underline}](http://www.grants.gov/Apply) **by
8:00 P.M. Eastern Time** on the due date established for each program.

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

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

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

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

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

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

![](media/image1.jpeg){width="1.34375in" height="0.375in"}

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. This face
page should be sent to HRSA's Grants Application Center at:

The HRSA Grants Application Center

The Legin Group, Inc.

Attn: Expanded Medical Capacity for MSFWs/Homeless

> Program Announcement No. HRSA-06-116
>
> CFDA No. 93.224

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov. However, to

complete the submission requirements, a hard-copy of the SF-424/5161
Face Sheet must be printed, signed, and submitted to the HRSA Grants
Application Center. The SF-424/5161 must be printed from the online
application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the above address and received by HRSA
by no later than five days after the date of submission in Grants.gov.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the date of submission in
Grants.gov.

**Performance Measures for Competitive Applications**

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

# [Attachment 1:]{.smallcaps} [Program Specific Forms]{.smallcaps}

####### 

## FORM 1-PART A:![](media/image2.wmf){width="1.7479166666666666in" height="0.3326388888888889in"}![](media/image2.wmf){width="1.4604166666666667in" height="0.2902777777777778in"}

## GENERAL INFORMATION WORKSHEET - FY 2006 EMC

Applicant Name: UDS #:

Name of Contact Person: Title:

Mailing/Street Address: City, State, Zip:

Phone: Fax: Email:

**Please Check:** ‪ URBAN RURAL SPARSELY POPULATED/FRONTIER (persons per
square mile:\_\_\_\_\_\_\_)

**[GENERAL INFORMATION]{.underline}:** Total Health Center Service Area
Population:

+---------+------------------+--------------------+-------------------+
|         | **TOTAL Federal  | **TOTAL ONE-TIME** | **TOTAL PROJECT   |
|         | Funding          |                    | BUDGET**          |
|         | Requested**      | **(included in     |                   |
|         |                  | Year 1 Federal     |                   |
|         |                  | Funds Requested)** |                   |
+---------+------------------+--------------------+-------------------+
| **Year  |                  |                    |                   |
| 1**     |                  |                    |                   |
+---------+------------------+--------------------+-------------------+
| **Year  |                  | []{.mark}          | []{.mark}         |
| 2**     |                  |                    |                   |
+---------+------------------+--------------------+-------------------+

+-------------+---------+----------+---------+----------+-----------+
|             | UDS     | UDS 2003 | UDS     | Average  | Chang     |
|             | 2004    |          | 2002    |          | e**\*\*** |
|             |         | \(b\)    |         | '02-'03  |           |
|             | \(a\)   |          | \(c\)   |          | (a)-(d)   |
|             |         |          |         | (        |           |
|             |         |          |         | b)+(c)/2 |           |
|             |         |          |         |          |           |
|             |         |          |         | \(d\)    |           |
+-------------+---------+----------+---------+----------+-----------+
| Total Users |         |          |         |          |           |
+-------------+---------+----------+---------+----------+-----------+
| Total       |         |          |         |          |           |
| Encounters  |         |          |         |          |           |
+-------------+---------+----------+---------+----------+-----------+

+--------------------------------------------------------+------+------+
| FUNDING PREFERENCE                                     | R    |      |
|                                                        | eque |      |
|                                                        | sted |      |
|                                                        |      |      |
|                                                        | Yes  |      |
|                                                        | No   |      |
+--------------------------------------------------------+------+------+
| Sparsely Populated Rural Frontier Areas                |      |      |
|                                                        |      |      |
| **(persons/mile^2^: [)\*]{.underline}**                |      |      |
+--------------------------------------------------------+------+------+

*\*Applicants requesting a funding preference must attach evidence
(i.e., Census data) to this form that the entire proposed service area
meets the definition of sparsely populated (7 or fewer persons/sq.
mi.).*

> *\*\*Any decline in total users OR encounters (i.e., negative change)
> must be explained/justified in an attachment to this form. This
> information will be considered when determining eligibility to compete
> for EMC funding.*

+-----------------------+----------+----------+-----------+-----------+
| TARGET                | \(b\)    | \(c\)    | \(d\)     | \(e\)     |
|                       |          |          |           |           |
| POPULATION            | CURRENT  | NUMBER   | CHANGE IN | PERCENT   |
|                       | NUMBER   | OF USERS | NEW USERS | CHANGE IN |
| (Total Organizational | OF USERS |          | AFTER 2   | NEW USERS |
| Users)                |          | P        | YEARS     | AFTER 2   |
|                       | *(2004   | ROJECTED |           | YEARS     |
|                       | UDS      | AFTER 2  | (c-b)     |           |
|                       | F        |          |           | (         |
|                       | IGURES)* | YEARS    |           | d/b)\*100 |
+-----------------------+----------+----------+-----------+-----------+
| Migrants/Seasonal     |          |          |           |           |
| Farmworkers           |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Homeless Individuals  |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Residents of Public   |          |          |           |           |
| Housing               |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| All Other CHC Users   |          |          | []{.mark} | []{.mark} |
+-----------------------+----------+----------+-----------+-----------+
| Grand Total Users     |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Total Users at        |          |          |           |           |
| 100-199% FPL          |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Total Users below     |          |          |           |           |
| 100% FPL              |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Total Uninsured Users |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+
| Total FTE Providers   |          |          |           |           |
+-----------------------+----------+----------+-----------+-----------+

## FORM 1 - PART B: BPHC FUNDING REQUEST SUMMARY -- FY 2006 EMC

> *Instructions: EMC applicants may request funding under section 330(g)
> MHC and/or section 330(h) HCH. Applicants should indicate what portion
> of the total Federal funding requested in each of the two years, is
> being requested under either or both of the program types below. The
> funding requested should correspond to what is indicated on FORM
> 1-Part A. The specified types of health centers on this form will
> constitute a request for funding under that section 330 program. NOTE:
> The Federal support requested in Year 1 or Year 2 MAY NOT exceed the
> published cap of \$600,000 established for EMC applications.*

+-------------+---+---------+----+---+--------+--------+----------------+
| FEDERAL     |   |         |    |   |        |        |                |
| FUNDS       |   |         |    |   |        |        |                |
| REQUESTED   |   |         |    |   |        |        |                |
| BASED ON A  |   |         |    |   |        |        |                |
| 12-MONTH    |   |         |    |   |        |        |                |
| BUDGET FOR  |   |         |    |   |        |        |                |
| YEAR 1 and  |   |         |    |   |        |        |                |
| YEAR 2      |   |         |    |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **REQUESTED |   | **PR    | ** |   | **Year |        | **Year 2**     |
| BPHC        |   | OGRAM** | CF |   | 1**    |        |                |
| PROGRAM:    |   |         | DA |   |        |        |                |
| (May        |   |         | ** |   |        |        |                |
| request     |   |         |    |   |        |        |                |
| funding     |   |         |    |   |        |        |                |
| under more  |   |         |    |   |        |        |                |
| than one    |   |         |    |   |        |        |                |
| section 330 |   |         |    |   |        |        |                |
| program)**  |   |         |    |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
|             |   |         |    |   | **[Ope | **[    |                |
|             |   |         |    |   | ration | One-ti |                |
|             |   |         |    |   | al]{.m | me]{.m |                |
|             |   |         |    |   | ark}** | ark}** |                |
|             |   |         |    |   |        |        |                |
|             |   |         |    |   |        | **[(up |                |
|             |   |         |    |   |        | to     |                |
|             |   |         |    |   |        | \$     |                |
|             |   |         |    |   |        | 150,00 |                |
|             |   |         |    |   |        | 0)]{.m |                |
|             |   |         |    |   |        | ark}** |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **Migrant   |   | *       | ** |   |        |        |                |
| Health      |   | *330(g) | 93 |   |        |        |                |
| Center**    |   | (MHC)** | .2 |   |        |        |                |
|             |   |         | 24 |   |        |        |                |
|             |   |         | ** |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **Health    |   | *       | ** |   |        |        |                |
| Care for    |   | *330(h) | 93 |   |        |        |                |
| the         |   | (HCH)** | .2 |   |        |        |                |
| Homeless**  |   |         | 24 |   |        |        |                |
|             |   |         | ** |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **TOTAL     |   |         |    |   |        |        |                |
| FEDERAL     |   |         |    |   |        |        |                |
| FUNDING     |   |         |    |   |        |        |                |
| REQUEST**   |   |         |    |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **ESTIMATED |   |         |    |   |        |        |                |
| TOTAL EMC   |   |         |    |   |        |        |                |
| PROJECT     |   |         |    |   |        |        |                |
| BUDGET:**   |   |         |    |   |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
|             | Y |         |    | Y |        |        |                |
|             | E |         |    | E |        |        |                |
|             | A |         |    | A |        |        |                |
|             | R |         |    | R |        |        |                |
|             | 1 |         |    | 2 |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
|             |   |         |    |   |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
|             | T |         |    | T |        |        |                |
|             | O |         |    | O |        |        |                |
|             | T |         |    | T |        |        |                |
|             | A |         |    | A |        |        |                |
|             | L |         |    | L |        |        |                |
|             | B |         |    | B |        |        |                |
|             | U |         |    | U |        |        |                |
|             | D |         |    | D |        |        |                |
|             | G |         |    | G |        |        |                |
|             | E |         |    | E |        |        |                |
|             | T |         |    | T |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **A.        | * |         |    | * |        |        |                |
| Federal**   | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **B.        | * |         |    | * |        |        |                |
| Applicant** | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **C.        | * |         |    | * |        |        |                |
| State**     | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **D.        | * |         |    | * |        |        |                |
| Local**     | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **E.        | * |         |    | * |        |        |                |
| Other**     | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **F.        | * |         |    | * |        |        |                |
| Program     | * |         |    | * |        |        |                |
| Income**    | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+
| **G.        | * |         |    | * |        |        |                |
| Total**     | * |         |    | * |        |        |                |
|             | \ |         |    | \ |        |        |                |
|             | $ |         |    | $ |        |        |                |
|             | * |         |    | * |        |        |                |
|             | * |         |    | * |        |        |                |
+-------------+---+---------+----+---+--------+--------+----------------+

![](media/image2.wmf){width="1.4604166666666667in"
height="0.2902777777777778in"}![](media/image2.wmf){width="1.4604166666666667in"
height="0.2902777777777778in"}

######## OMB No. 0915-0285, Expiration Date: 6/3/2007

## FORM 2 - INCOME ANALYSIS FORMAT -- FY 2006 EMC (Page 1 of 2)

YEAR 1 \_\_\_\_ YEAR 2 \_\_\_\_

<table>
<colgroup>
<col style="width: 24%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 7%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 2%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 14%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"><strong>Payor Category</strong></td>
<td><p><strong>NUMBER</strong></p>
<p><strong>OF VISITS</strong></p></td>
<td colspan="2"><strong>Average Charge Per Visit</strong></td>
<td colspan="2"><p><strong>TOTAL CHARGES</strong></p>
<p><strong>(a * b)=(c)</strong></p></td>
<td colspan="2"><strong>Average Adjustment Per Visit</strong></td>
<td><p><strong>Amount Billed</strong></p>
<p><strong>[c-(a*d)]</strong></p></td>
<td colspan="2"><p><strong>Collection Rate</strong></p>
<p><strong>(%)</strong></p></td>
<td><p><strong>Projected Income</strong></p>
<p><strong>(e * f)</strong></p></td>
<td colspan="2"><strong>Actual Accrued Income Past 12
Months</strong></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td><strong>(a)</strong></td>
<td colspan="2"><strong>(b)</strong></td>
<td colspan="2"><strong>(c)</strong></td>
<td colspan="2"><strong>(d)</strong></td>
<td><strong>(e)</strong></td>
<td colspan="2"><strong>(f)</strong></td>
<td><strong>(g)</strong></td>
<td colspan="2"><strong>(h)</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>FEE For SERVICE</strong></td>
</tr>
<tr class="even">
<td colspan="2">Medicaid: Medical</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Medicaid: EPSDT (if different from medical rate)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Medicaid: Dental</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Medicaid: Behavioral</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Medicaid: other fee for Service</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Medicaid</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"><strong>Subtotal: Medicaid</strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Medicare: all inclusive FQHC rate</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Medicare: other Fee for Service</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>Subtotal: Medicare</strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Private Insurance (Medical)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Private Insurance (Dental)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Private Insurance (Behavioral)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Self-Pay: 100% charge, no discount (Medical)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Self-Pay: Sliding Fee Scale discounts (Medical)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Self-Pay: 0% of chare, full discount (Medical)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Self-Pay: 100% charge, no discount (Dental)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Self-Pay: Sliding Fee Scale discounts (Dental)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Self-Pay: 0% of chare, full discount (Dental)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Self-Pay: 100% charge, no discount ( Behavioral)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">Self-Pay: Sliding Fee Scale discounts (Behavioral)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">Self-Pay: 0% of chare, full discount (Behavioral)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"><strong>Subtotal: Private Pay</strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>Total Fee For Service</strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="15"><strong>MANAGED CARE - CAPITATED RATE
INCOME</strong></td>
</tr>
<tr class="odd">
<td><strong>CONTRACT NAME</strong></td>
<td colspan="3">Average Members Per Month</td>
<td colspan="2">Number of Months</td>
<td colspan="2">Rate Per Member Per Month</td>
<td colspan="3">Risk Pool Adj. &amp; Other Allowances</td>
<td colspan="3">Projected Gross Income</td>
<td>Collection Rate</td>
</tr>
<tr class="even">
<td>Medicaid:</td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td>Medicare</td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td>Commercial</td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Total Managed Care/Capitated</strong></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="6">Encounters</td>
<td colspan="5">Avg Charge Per Encounter</td>
<td colspan="3">Total Charges</td>
</tr>
<tr class="odd">
<td><strong>Managed Care Charges</strong></td>
<td colspan="6"></td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
</tbody>
</table>

*OMB No. 0915-0285, Expiration Date: 6/3/2007*

**FORM 2 - INCOME ANALYSIS FORMAT** (Page 2 of 2)

YEAR 1 \_\_\_\_ YEAR 2 \_\_\_\_

  ------------------ --------- -- --------- -- --------- ---------------- ---------- --- -- ---- ---------- --------------
  **Total Program                                                                                           
  Income \-- Summary                                                                                        
  Tables**                                                                                                  

  **Worksheet                                            **Estimated                                        
  Summary**                                              Program Income                                     
                                                         Allocation\***                                     

  Encounters                                             CHC                                                

  Average Charge Per                                     MHC                                                \*Estimated
  Encounter                                                                                                 Program Income
                                                                                                            should be
                                                                                                            distributed to
                                                                                                            the Programs
                                                                                                            within your
                                                                                                            scope of
                                                                                                            project.

  Total Gross                                            HCH                                                
  Charges                                                                                                   

  Adjustments to                                         PHPC                                               
  Charges                                                                                                   

  Amount Billed                                          **TOTAL**                                          

  Adjustment for                                                                                            
  Uncollectables                                                                                            

  **Budget Expected                                                                                         
  Program Income**                                                                                          

  Actual Program                                                                                            
  Income Previous 12                                                                                        
  Months                                                                                                    

  **OTHER INCOME**                                                                                          

                     **CHC**      **MHC**      **HCH**                    **PHPC**               **Total    
                                                                                                 Other      
                                                                                                 Income**   

  Applicant Income                                                                                          

  State Funds                                                                                               

  Local Funds                                                                                               

  Other Support                                                                                             

  Other Federal                                                                                             
  Grants                                                                                                    

  Contributions                                                                                             

  Fund Raising                                                                                              

  Foundation Grants                                                                                         

                                                                                                            

  Subtotal Other                                                                                            
  Support                                                                                                   

  **Total Other                                                                                             
  Income**                                                                                                  

  **TOTAL                                                                                                   
  NON-FEDERAL                                                                                               
  SHARE**                                                                                                   
  ------------------ --------- -- --------- -- --------- ---------------- ---------- --- -- ---- ---------- --------------

[]{#_Ref84847978 .anchor}

### Instructions for Completing Form 2: Income Analysis

The Income Analysis Worksheet provides a format for presenting the
estimated non-federal revenues for the budget in the application. The
narrative should be used to fully describe the information presented on
this worksheet. The information presented in the worksheet should be
developed based upon the currently approved scope of project. It should
not include revenues expected from any requested supplemental
improvements or other unapproved increases in capacity.

There are two major classifications of revenues, Program Income and
Other Income:

> **Program Income** includes fees, premiums and third party
> reimbursements received for the provision of health care services.
> Program income is divided into two parts, Fee for Service revenues and
> Managed Care or Capitated Rate Income.
>
> **Other Income** is revenue from State or Local grants and other local
> or private support received to support the applicant's programs.
> Generally, this revenue provides support for the provision of medical
> or support services, but is not considered or based upon revenue
> generated from charges for providing the health service to a patient.

The categories presented in the worksheet may not describe all of the
categories of Fee for Service revenue, Contractor or Other Income
categories used by the applicant organization. Two additional lines are
provided in each revenue source for applicant-defined categories. The
categories presented may also be redefined in the narrative to the
worksheet as necessary to clearly identify revenue sources.

**Use the following steps for projecting revenue and present Years 1 and
2 of the project separately using the attached FORM 2: Income Analysis
Format.**

[SPECIAL INSTRUCTIONS FOR FEE FOR SERVICE:]{.underline}

1.  Enter in column (a) the number of encounters that will be covered by
    each type of payment source: Medicaid, Medicare, other third-party
    payors and patient self-pay (categorized by 100 percent pay, sliding
    fee pay and 0 percent self pay).

2.  Enter in column (b) the average charge per encounter by payor
    category.

3.  Column (c), Total Charges (columns (a)\*(b)), needs to be calculated
    for each payment source.

4.  Enter in column (d) the average adjustment of the average charge per
    encounter. A negative number will reduce and a positive number will
    increase the Billed Amount calculated in column (e). Adjustments in
    this column would relate to:

```{=html}
<!-- -->
```
a)  Projected disallowance or discounts to the average charge per visit.

b)  Adjustments to the FQHC or Prospective Payment System established
    reimbursement rate or the cost based reimbursement expected as a
    result of completion of a cost reimbursement report.

c)  Other adjustments which the applicant defines in the narrative to
    this worksheet.

```{=html}
<!-- -->
```
5.  Column (e) the total Amount Billed by payment source needs to be
    calculated by utilizing the formula \[c-(a\*d)\].

6.  Enter in column (f) the estimated collection rate (%) by payor
    category.

7.  Projected income (columns (e)\*(f)) needs to be calculated in
    column (g) for each payor category.

8.  Column (h) represents the actual accrued income by payor category
    for the most recent 12- month period for which data are available. A
    significant increase or decrease in income should be explained in
    the narrative to this worksheet.

[SPECIAL INSTRUCTIONS FOR MANAGED CARE OR CAPITATED
ARRANGEMENTS:]{.underline}

1.  The Projected Gross Income needs to be calculated using the
    information inputted into the third, fourth and fifth columns in
    this section. The calculation is **((average members per month X
    number of months X rate per member month) + risk pool adj. & other
    allowances = projected gross income).**

2.  RISK POOL ADJ. & OTHER ALLOWANCES, which could include a cost based
    wrap around, should be explained in the narrative to the worksheet.

3.  The applicant must describe in the narrative to the worksheet each
    managed care or capitated rate program included in the budget. For
    each program or contract, please identify the contractor's name and
    the services for which the applicant is at risk. Provide the current
    number of enrollees and the amount of support for the projected
    number of enrollees included in the current budget.

-   Examples of Fee for Service Income are revenues from filing private
    insurance claims, minimum fees charged after a sliding fee scale
    adjustment is applied, payments received from charges to patients on
    a fee for service basis and co-pays for managed care participants.

-   Non-Fee for Service Income would include interest income and
    contracts to serve as Medical Director of a nursing home.

-   Examples of Other Grant Income and State and Local support would be
    grants for construction, equipment or other activities that support
    the project, but for which the revenue is not based upon services
    provided, encounters or charges for encounters

[TOTAL PROGRAM INCOME -- SUMMARY TABLES]{.underline}

1.  The WORKSHEET SUMMARY table is a summary of the program income
    budget information presented in the previous sections. It is
    generated from information input into the previous program income
    sections of the worksheet.

2.  The Estimated Program Income Allocation table will be used by the
    OGM to determine the Estimated Program Income used on the NGA. The
    applicant should distribute in the amount of the BUDGET EXPECTED
    PROGRAM INCOME from the WORKSHEET SUMMARY table to the Health Center
    funding source for which Federal funding is requested in this
    application.

[SPECIAL INSTRUCTIONS FOR STATE, LOCAL & OTHER OPERATIONAL
FUNDING]{.underline}

1.  List by amount, source, and purpose.

2.  Include the source and value of in-kind donations in this
    description, including donated pharmaceuticals, such as samples.

3.  Distribute the funding by program in which the funds will be used.

4.  Provide additional information in the narrative to this worksheet.

    ![](media/image2.wmf){width="1.4604166666666667in"
    height="0.2902777777777778in"}![](media/image2.wmf){width="1.4604166666666667in"
    height="0.2902777777777778in"}

##### FORM 3 -- FY 2006 EMC SERVICE SITE TABLE

*Instructions: Identify **only those sites proposed for an EMC
expansion** from your current Form 5-Part B/Exhibit B (from the most
recently approved service area competition, change in scope, or
non-competing continuation application). Also note any site(s) to be
relocated and the site(s) that will replace them.*

+---------------------------------+------------------------------------+
| SITE #1                         | SITE #2                            |
+---------------------------------+------------------------------------+
| EMC SITE RELOCATION? *(if yes,  | EMC SITE RELOCATION? *(if yes,     |
| check one of the following):*   | check one of the following):*      |
|                                 |                                    |
| Site to be closed or New        | Site to be closed or New           |
| replacement site                | replacement site                   |
|                                 |                                    |
| Year-Round Seasonal Full-Time   | Year-Round Seasonal Full-Time      |
| Part-Time                       | Part-Time                          |
|                                 |                                    |
| \# of hours per week services   | \# of hours per week services are  |
| are available at the site:      | available at the site:             |
|                                 |                                    |
| Date site was/will be opened:   | Date site was/will be opened:      |
|                                 |                                    |
| Name of service site:           | Name of service site:              |
|                                 |                                    |
| Physical Address:               | Physical Address:                  |
|                                 |                                    |
| City State Zip (9 digit         | City State Zip (9 digit required)  |
| required)                       |                                    |
|                                 | Phone No. Fax No.                  |
| Phone No. Fax No.               |                                    |
|                                 | Congressional District:            |
| Congressional District:         |                                    |
|                                 | County Name:                       |
| County Name:                    |                                    |
|                                 | Service Area:                      |
| Service Area:                   |                                    |
|                                 | Census tracts:                     |
| Census tracts:                  |                                    |
|                                 | Urban/Rural/Sparsely Populated:    |
| Urban/Rural/Sparsely Populated: |                                    |
|                                 | Other HRSA Funding Sources:        |
| Other HRSA Funding Sources:     |                                    |
+---------------------------------+------------------------------------+
| SITE #3                         | SITE #4                            |
+---------------------------------+------------------------------------+
| EMC SITE RELOCATION? *(if yes,  | EMC SITE RELOCATION? *(if yes,     |
| check one of the following):*   | check one of the following):*      |
|                                 |                                    |
| Site to be closed or New        | Site to be closed or New           |
| replacement site                | replacement site                   |
|                                 |                                    |
| Year-Round Seasonal Full-Time   | Year-Round Seasonal Full-Time      |
| Part-Time                       | Part-Time                          |
|                                 |                                    |
| \# of hours per week services   | \# of hours per week services are  |
| are available at the site:      | available at the site:             |
|                                 |                                    |
| Date site was/will be opened:   | Date site was/will be opened:      |
|                                 |                                    |
| Name of service site:           | Name of service site:              |
|                                 |                                    |
| Physical Address:               | Physical Address:                  |
|                                 |                                    |
| City State Zip (9 digit         | City State Zip (9 digit required)  |
| required)                       |                                    |
|                                 | Phone No. Fax No.                  |
| Phone No. Fax No.               |                                    |
|                                 | Congressional District:            |
| Congressional District:         |                                    |
|                                 | County Name:                       |
| County Name:                    |                                    |
|                                 | Service Area:                      |
| Service Area:                   |                                    |
|                                 | Census tracts:                     |
| Census tracts:                  |                                    |
|                                 | Urban/Rural/Sparsely Populated:    |
| Urban/Rural/Sparsely Populated: |                                    |
|                                 | Other HRSA Funding Sources:        |
| Other HRSA Funding Sources:     |                                    |
+---------------------------------+------------------------------------+

NOTE: Add additional pages as necessary.

![](media/image2.wmf){width="1.4604166666666667in"
height="0.2902777777777778in"}![](media/image2.wmf){width="1.4604166666666667in"
height="0.2902777777777778in"}

# [Attachment 2: Format for the Line Item Budget Justification]{.smallcaps}

## Line-Item Budget Justification \[Required Format\]

The following required format is provided to assist you in developing
your line-item budget justification. Additional budget narrative should
be attached to fully describe your proposal (see instructions in
*section v. Budget Justification*). This format is provided as a broad
outline. It should reflect the total necessary costs for the proposed
EMC project. **Any significant changes in the costs of each object class
from Year 1 to Year 2 should be fully described and justified in the
budget narrative, as well as the impact on the Federal request.**

**REVENUE:** [Total Org.]{.underline} [Year 1]{.underline} [Year
2]{.underline}

**PATIENT SERVICE INCOME** \$ \$ \$

(including Pharmacy)

**LOCAL & STATE GRANTS** \$ \$ \$

(Break out by fund source)

**LOCAL FUNDING** \$ \$ \$

**FEDERAL BPHC 330 GRANT** \$ \$ \$

**OTHER FEDERAL FUNDING** \$ \$ \$

(Break out by fund source)

**TOTAL: REVENUE \$ \$ \$**

**EXPENSES:** [Total Org.]{.underline} [Year 1]{.underline} [Year
2]{.underline}

**PERSONNEL**: \$ \$ \$

**FRINGE BENEFITS**: Break out each

portion of Fringe Benefits: \$ \$ \$

> FICA
>
> Retirement, etc.

**TOTAL: PERSONNEL & FRINGE \$ \$ \$**

**TRAVEL:**

Providers CME (\$ per full-time equivalent (FTE)) \$ \$ \$

Nursing CME (\$ per FTE) \$ \$ \$

Other Professional CME (\$ per FTE) \$ \$ \$

Travel to meetings (\$ per attendees x \# of trips) \$ \$ \$

Executive Director (2 meetings)

Board Chair (2 meetings)

Management & Board \$ \$ \$

State and National Meetings \$ \$ \$

Other Board/Management Travel \$ \$ \$

Local Travel (# of trips @ organization's mileage rate) \$ \$ \$

> **TOTAL: TRAVEL \$ \$ \$**

**EQUIPMENT:**

List project equipment items

**TOTAL: EQUIPMENT \$ \$ \$**

**SUPPLIES:**

Office & Printing Supplies \$X.XX per encounter \$ \$ \$

Medical & Dental Records \$X.XX per encounter \$ \$ \$

Medical Supplies \$X.XX per encounter \$ \$ \$

Pharmacy Supplies including Drugs

Average per \# of Prescriptions \$ \$ \$

X-ray supplies Average per \# of X-rays \$ \$ \$

Laboratory supplies per average \# of procedures \$ \$ \$

Building and Maintenance Supplies per \# of sites \$ \$ \$

**TOTAL: SUPPLIES \$ \$ \$**

**Expenses Continued:** [Total Org.]{.underline} [Year 1]{.underline}
[Year 2]{.underline}

**CONTRACTUAL** (Please describe with enough detail to justify the
costs)

"Patient Care Contracts"

Outside Reference Lab \$ \$ \$

XYZ Company for any tests that cannot be

Performed in house (Avg \# of procedures

X Avg Cost) \$ \$ \$

Outside Contract Pharmacies (describe)

(Avg \# of prescriptions X Avg Cost) \$ \$ \$

GYN/OB Contract with ABC Company

> (Avg \# of Patients served X Avg Cost) \$ \$ \$

Ophthalmologist with RST Company

(Avg \# of patients @ Avg Cost) \$ \$ \$

Temporary Nursing Coverage

(Avg \# of days @ Avg Costs) \$ \$ \$

**Subtotal: Patient Care Contracts \$ \$ \$**

"Non-Patient Contracts"

Housekeeping Services with LMN Company

for \# of sites \$ \$ \$

Security Services with DEF Company for

\# of hours per site \$ \$ \$

Computer Maintenance Contract \$ \$ \$

**Subtotal: Non-Patient Contracts \$ \$ \$**

**TOTAL: CONTRACTUAL \$ \$ \$**

**ALTERATION & RENOVATIONS**: (describe if applicable)

**TOTAL: A&R** \$ **\$ \$**

**OTHER**: [Total Org.]{.underline} [Year 1]{.underline} [Year
2]{.underline}

Payroll Processing Services \$ \$ \$

Audit Services with JKL Company \$ \$ \$

Legal Fees with WXY Company fee per hour \$ \$ \$

Association Dues \$ \$ \$

Building Contents Insurance \$ \$ \$

Telephone Service \$ \$ \$

Answering Services \$ \$ \$

Postage \$ \$ \$

Utilities \$ \$ \$

Rent (describe per site) \$ \$ \$

Marketing/Outreach \$ \$ \$

Any special taxes (describe) \$ \$ \$

Technical Assistance \$ \$ \$

**TOTAL: OTHER \$ \$ \$**

**TOTAL: ALL BUDGET \$ \$ \$**

####### 

####### 

####### 

####### 

####### 

# [Attachment 3:]{.smallcaps} [Service Delivery Plan and Business Plan]{.smallcaps}

## Guidelines For Developing the

## Service Delivery Plan and the Business Plan

The following components are intended for use in both the service
delivery and business plans. Presenting the plans in \"landscape\" print
format may facilitate easier reading and usage. Please refer to *section
IV. Application and Submission Information* for more information about
completing these plans.

**Problem/Need Statements** are clearly and specifically defined
descriptions of major needs or problems, quantified where possible. The
problem/need statements should tie into and flow from the overall
Program Narrative.

**Column 1: Goals and Objectives.** Goals are relatively broad and
express a sense of a desired future state or direction. Goals should
address identified needs or problems and are usually long-term.
Objectives are descriptions of desired, measurable, time‑limited results
or outcomes. These objectives (intended results or outcomes) are
measures of progress towards a goal. They can be used to identify an
acceptable level of performance or establish criteria for evaluation.
Objectives can be either short‑term (less than 1 year) or long‑term (1
year or longer). Use an upper case letter (A\...) for each goal and list
corresponding objectives by number (1\...).

**Column 2: Key Action Steps** - the major activities that must occur to
accomplish an objective - critical actions that must be taken to attain
the measurable outcome or end result. Reference each action step by
corresponding upper case letter for goal, number for objective, and
lower case letter for action step (i.e., A.1.a.).

**Column 3: Expected Outcome** - action steps to be taken towards an
objective; quantifiable documented outcomes to be achieved. This column
must be completed for each objective. Reference each action step in the
same manner as above for Key Action Steps.

**Column 4: Data, Evaluation, & Measurement** - the source of data,
evaluation method and measurement used to evaluate progress towards an
objective or to identify the actual outcome distinguished in the
objective. Reference each action step in the same manner as above for
Key Action Steps.

**Column 5: Person/Area Responsible** -- indicate the person or area of
the operation responsible for the tracking, evaluation and completion of
the objectives and key action steps.

**Column 6: Comments** - supplementary information for related entries
in the plan. Reference each action step in the same manner as above for
Key Action Steps.

## Format for the Service Delivery Plan & Business Plan Presentations

This format is provided for the Service Delivery and Business Plan
presentations. Additional information may be provided to fully describe
your proposal:

+----------+-------------+--------------+---------+---------+-------+
| Prob     |             |              |         |         |       |
| lem/Need |             |              |         |         |       |
| St       |             |              |         |         |       |
| atement: |             |              |         |         |       |
| Diabetes |             |              |         |         |       |
| is a     |             |              |         |         |       |
| common   |             |              |         |         |       |
| d        |             |              |         |         |       |
| iagnosis |             |              |         |         |       |
| among    |             |              |         |         |       |
| patients |             |              |         |         |       |
| of CHC,  |             |              |         |         |       |
| Inc.     |             |              |         |         |       |
| CHC,     |             |              |         |         |       |
| Inc.     |             |              |         |         |       |
| aims to  |             |              |         |         |       |
| improve  |             |              |         |         |       |
| care and |             |              |         |         |       |
| quality  |             |              |         |         |       |
| of life  |             |              |         |         |       |
| for its  |             |              |         |         |       |
| clients  |             |              |         |         |       |
| with     |             |              |         |         |       |
| diabetes |             |              |         |         |       |
| by       |             |              |         |         |       |
| red      |             |              |         |         |       |
| esigning |             |              |         |         |       |
| the      |             |              |         |         |       |
| delivery |             |              |         |         |       |
| of       |             |              |         |         |       |
| health   |             |              |         |         |       |
| care     |             |              |         |         |       |
| s        |             |              |         |         |       |
| ervices. |             |              |         |         |       |
+----------+-------------+--------------+---------+---------+-------+
| Goals/Ob | Key Action  | Expected     | Data,   | Pers    | Com   |
| jectives | Steps       | Outcome      | Eva     | on/Area | ments |
|          |             |              | luation | Resp    |       |
|          |             |              | &       | onsible |       |
|          |             |              | Meas    |         |       |
|          |             |              | urement |         |       |
+----------+-------------+--------------+---------+---------+-------+
| A. To    | A.1.(a)     | A.1.(a) By   | A.1(a)  | A.1.(a) | A.    |
| improve  | Track       | 5/06, 90% of | Medical | Nursing | 1.(a) |
| the      | patients to | patients     | Records | Staff   | He    |
| health   | insure they | have had a   |         |         | althy |
| status   | have annual | retinal eye  | A.1(b)  | A.1.(b) | P     |
| of       | retinal eye | exam in the  | Data,   | Pers    | eople |
| patients | exams and   | last 12 mts  | Eval &  | on/Area | 2010  |
| with     | foot exams. |              | Meas    |         | Goals |
| diabetes | Refer as    | A.1.(b)      |         | A.1.(c) | and   |
|          | needed      | Expected     | A.1.(c) | Pers    | Obj   |
| A.1. At  |             | Outcome      | Data,   | on/Area | (5-1  |
| least    | A.1 (b)     |              | Eval &  |         | th    |
| 90% of   | Action step | A.1.(c)      | Meas    | A.2.(a) | rough |
| patients | 2 for       | Expected     |         | Pers    | 5     |
| will     | Objective 1 | Outcome      | A.2.(a) | on/Area | -17). |
| have had |             |              | Data,   |         |       |
| a        | A.1.(c)     | A.2.(a)      | Eval &  | A.2.(b) | A.    |
| retinal  | Action step | Expected     | Meas    | Pers    | 1.(b) |
| eye exam | 3 for       | Outcome      |         | on/Area | Com   |
| in the   | Objective 1 |              | A.2.(b) |         | ments |
| last 12  |             | A.2.(b)      | Data,   |         |       |
| months   | A.2.(a)     | Expected     | Eval    |         | A.    |
| by 5/06  | Action step | Outcome      | &Meas   |         | 1.(c) |
|          | 1 for       |              |         |         | Com   |
| A.2.     | Objective 2 |              |         |         | ments |
| O        |             |              |         |         |       |
| bjective | A.2 (b)     |              |         |         | A.    |
| (2)      | Action step |              |         |         | 2.(a) |
|          | 2 for       |              |         |         | Com   |
|          | Objective 2 |              |         |         | ments |
|          |             |              |         |         |       |
|          |             |              |         |         | A.    |
|          |             |              |         |         | 2.(b) |
|          |             |              |         |         | Com   |
|          |             |              |         |         | ments |
+----------+-------------+--------------+---------+---------+-------+
| Prob     |             |              |         |         |       |
| lem/Need |             |              |         |         |       |
| St       |             |              |         |         |       |
| atement: |             |              |         |         |       |
| Well     |             |              |         |         |       |
| -managed |             |              |         |         |       |
| human    |             |              |         |         |       |
| r        |             |              |         |         |       |
| esources |             |              |         |         |       |
| are      |             |              |         |         |       |
| critical |             |              |         |         |       |
| to the   |             |              |         |         |       |
| success  |             |              |         |         |       |
| of any   |             |              |         |         |       |
| organ    |             |              |         |         |       |
| ization. |             |              |         |         |       |
+----------+-------------+--------------+---------+---------+-------+
| B.       | B.1.(a)     | B.1.(a) Exam | B.1.(a) | B.1.(a) | B.    |
| Maintain | Each exam   | rooms        | List of | CQI     | 1.(a) |
| well-q   | room will   | properly     | exam    | Team    | Com   |
| ualified | be fully    | equipped     | room    | and     | ments |
| staff    | equipped    |              | equ     | staff   |       |
| for      | for all     | B.1.(b)      | ipment. |         | B.    |
| health   | aspects of  | Expected     |         | B.1.(b) | 1.(b) |
| center.  | patient     | Outcome      | B.1.(b) | Pers    | Com   |
|          | care.       |              | Data,   | on/Area | ments |
| B.1.     |             | B.2.(a)      | Eva     |         |       |
| I        | B.1 (b)     | Expected     | luation | B.2.(a) | B.    |
| mplement | Action step | Outcome      | &       | Pers    | 2.(a) |
| an       | 2 for       |              | Meas    | on/Area | Com   |
| annual   | Objective 1 | B.2.(b)      | urement |         | ments |
| per      |             | Expected     |         | B.2.(b) |       |
| formance | B.2.(a)     | Outcome      | B.2.(a) | Pers    | B.    |
| ev       | Action step |              | Data,   | on/Area | 2.(b) |
| aluation | 1 for       |              | Eva     |         | Com   |
| and      | Objective 2 |              | luation |         | ments |
| employee |             |              | &       |         |       |
| sati     | B.2 (b)     |              | Meas    |         |       |
| sfaction | Action step |              | urement |         |       |
| program. | 2 for       |              |         |         |       |
|          | Objective 2 |              | B.2.(b) |         |       |
| B.2.     |             |              | Data,   |         |       |
| O        |             |              | Eva     |         |       |
| bjective |             |              | luation |         |       |
| (2)      |             |              | &       |         |       |
|          |             |              | Meas    |         |       |
| B.3.     |             |              | urement |         |       |
| O        |             |              |         |         |       |
| bjective |             |              |         |         |       |
| (3)      |             |              |         |         |       |
+----------+-------------+--------------+---------+---------+-------+
| C. Goal  | C.1.(a)     | C.1.(a)      | C.1.(a) | C.1.(a) | C.    |
|          | Action step | Expected     | Data,   | Pers    | 1.(a) |
| C.1.     | 1 for       | Outcome      | Eva     | on/Area | Com   |
| O        | Objective 2 |              | luation |         | ments |
| bjective |             | C.1.(b)      | &       | C.1.(b) |       |
| (1)      | C.1 (b)     | Expected     | Meas    | Pers    | C.    |
|          | Action step | Outcome      | urement | on/Area | 1.(b) |
|          | 2 for       |              |         |         | Com   |
|          | Objective 2 |              | C.1.(b) |         | ments |
|          |             |              | Data,   |         |       |
|          |             |              | Eva     |         |       |
|          |             |              | luation |         |       |
|          |             |              | &       |         |       |
|          |             |              | Meas    |         |       |
|          |             |              | urement |         |       |
+----------+-------------+--------------+---------+---------+-------+

# 

[^1]: In previous documents, application guidances and other materials,
    HRSA has made reference to the School-Based Health Center (SBHC)
    Program. Section 330 of the PHS Act does not include authorization
    for a SBHC Program. Therefore, HRSA will no longer identify SBHCs as
    a separate Health Center Program or category/type of health center;
    however, there will continue to be recognition of school-aged
    children as an underserved population served by health centers. All
    organizations receiving section 330 funding specifically to support
    a SBHC must comply with the requirements of section 330(e),
    Community Health Center Program.

[^2]: See previous footnote on p. 5 of this guidance.