Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Cooperative Agreement for Ecstasy and Other Club Drugs Prevention
Services**

**(Short Title: Ecstasy and Other Club Drugs Cooperative Agreements)**

**SP 04-004**

**(Initial Announcement)**

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications must be submitted by June 18,  |
| Deadline**           | 2004**                                        |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Letters from State Single Point of Contact  |
| Review**             | (SPOC) are due no later than 60 days after    |
|                      | application deadline.**                       |
| **(E.O. 12372)**     |                                               |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by application deadline. Comments from Single |
| (PHSIS)/Single State | State Agency are due no later than 60 days    |
| Agency               | after application deadline.**                 |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

Number range CHAPTER

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

Beverly Watts Davis Charles G. Curie, M.A., A.C.S.W.

Director, Center for Substance Abuse Prevention Administrator

Substance Abuse and Mental Health Substance Abuse and Mental Health

Services Administration Services Administration

Date of Issuance: April 2004

**Table of Contents**

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

[1. INTRODUCTION AND BACKGROUND 4](#introduction-and-background)

[2. EXPECTATIONS 4](#expectations)

[II. AWARD INFORMATION 10](#ii.-award-information)

[1. AWARD AMOUNT 10](#award-amount)

[2. FUNDING MECHANISM 11](#funding-mechanism)

[III. ELIGIBILITY INFORMATION 11](#iii.-eligibility-information)

[1. ELIGIBLE APPLICANTS 11](#eligible-applicants)

[2. COST SHARING 12](#cost-sharing)

[3. OTHER 12](#other)

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

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

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

[3. SUBMISSION DATES AND TIMES 21](#submission-dates-and-times)

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

[5. FUNDING LIMITATIONS/RESTRICTIONS
22](#funding-limitationsrestrictions)

[6. OTHER SUBMISSION REQUIREMENTS 24](#other-submission-requirements)

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

[1. EVALUATION CRITERIA 24](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 29](#review-and-selection-process)

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

[1. AWARD NOTICES 30](#award-notices)

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

[3. REPORTING REQUIREMENTS 31](#reporting-requirements)

[VII. AGENCY CONTACTS 32](#vii.-agency-contacts)

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

[Appendix B - Glossary 35](#appendix-b---glossary)

[Appendix C - National Registry of Effective Programs
37](#appendix-c---national-registry-of-effective-programs)

[Appendix F - Statement Of Assurance
38](#appendix-f---statement-of-assurance)

[Appendix G -- Logic Model Resources
39](#appendix-g-logic-model-resources)

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

## 1. INTRODUCTION AND BACKGROUND {#introduction-and-background .unnumbered}

As authorized by Section 506B of the Public Health Service Act, the
Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Prevention (CSAP) announces the availability
of funds for Cooperative Agreements for Ecstasy and Other Club Drugs
Prevention Services. These grants will expand and strengthen effective,
culturally appropriate ecstasy and other club drugs prevention services
at the State and local levels. The services implemented through these
grants must incorporate the best objective information available
regarding effectiveness and acceptability. SAMHSA/CSAP expects that the
services funded through these grants will be sustained by the grantee
beyond the term of the grant.

Ecstasy and Other Club Drugs are substances whose use can lead to
serious health and behavioral problems, including memory loss,
aggression, violence, psychotic behavior, and potential heart and/or
neurological damage. Their use also contributes to increased
transmission of infectious diseases, especially hepatitis and HIV/AIDS.
Use is increasing among the general adolescent population as well as the
following populations: men who have sex with men and use other drugs;
young adults who attend "raves" or private clubs; homeless and runaway
youth; and male and female commercial sex workers.

## 2. EXPECTATIONS {#expectations .unnumbered}

The Ecstasy and Other Club Drugs Cooperative Agreements program are one
of SAMHSA/CSAP=s Services Grants programs. Grantees must use the funds
to expand and strengthen effective, culturally appropriate Ecstasy and
Other Club Drugs prevention services at the State and local levels, and
SAMHSA/CSAP expects that the services will be sustained beyond the term
of the grant.

SAMHSA/CSAP intends that its Services Grants, including the Ecstasy and
Other Club Drugs Cooperative Agreements, will result in the delivery of
services as soon as possible and encourages grantees to begin service
delivery within 4 months of receiving the grant award. However,
SAMHSA/CSAP recognizes that grantees may need to enhance their
prevention system infrastructure in order to enhance/expand Ecstasy and
Other Club Drugs prevention services. Therefore, **grantees may propose
an infrastructure development phase in [year one]{.underline} of their
grant projects. If a community is ready to provide services at the time
of the award, service delivery may [be implemented without]{.underline}
this planning phase.**

These Ecstasy and Other Drugs Cooperative Agreements will be implemented
over a project period of up to five years. During this same time period,
SAMHSA/CSAP will be working with the States to conduct comprehensive
needs assessments in order to develop strategic plans to prevent/reduce
the use of alcohol, tobacco and other drugs through a new SAMHSA/CSAP
initiative called the Strategic Prevention Framework (SPF). SAMHSA/CSAP
recognizes that Ecstasy and Other Drugs Cooperative Agreements grantees
may need to adjust their plans as their SPF plans unfold. Therefore,
amendments to the Ecstasy and Other Drugs Cooperative Agreements may be
made in Years 3, 4 or 5 in order to bring the Ecstasy and Other Drugs
Cooperative Agreements project into alignment with the SPF plans.

######## **2.1 Documenting the Evidence-Base for Services to be Implemented** {#documenting-the-evidence-base-for-services-to-be-implemented .unnumbered}

The services implemented through the Ecstasy and Other Club Drugs
Cooperative Agreements must incorporate the best objective information
available regarding the effectiveness and acceptability of the services
to be implemented. In general, the services implemented through the
Ecstasy and Other Club Drugs Cooperative Agreements must have strong
evidence of effectiveness. However, because the evidence base for
Ecstasy and Other Club Drugs prevention is limited, SAMHSA/CSAP may fund
services for which the evidence of effectiveness is based on formal
consensus among recognized experts in the field and/or evaluation
studies that have not been published in the peer reviewed literature.

Applicants must document in their applications that the
services/practices they propose to implement are evidence-based
services/practices. In addition, applicants must justify use of the
proposed services/practices for the target population along with any
adaptations or modifications necessary to meet the unique needs of the
target population or otherwise increase the likelihood of achieving
positive outcomes. Further guidance on each of these requirements is
provided below.

*Documenting the Evidence-Based Practice/Service*

SAMHSA/CSAP has already determined that certain services/practices are
solidly evidence-based services/practices. These include practices in
SAMHSA/CSAP's National Registry of Effective Programs (NREP), and
SAMHSA/CSAP encourages applicants to select services/practices from
NREP.

None of the models listed in NREP specifically addresses prevention of
Ecstasy and Other Club Drug use. However, many of the NREP models do
address similar risk and protective factors associated with the
prevention of Ecstasy and Other Club Drug use. SAMHSA/CSAP encourages
applicants to adapt/replicate a NREP model that is culturally and
developmentally appropriate for the target population to be served. To
review the NREP models, go to
[www.modelprograms.samhsa.gov/template.cfm](http://www.modelprograms.samhsa.gov/template.cfm).

Applicants may propose other services/practices not listed in NREP, but
the applicant must demonstrate evidence of effectiveness in order to
receive funding. Such applicants must provide a narrative justification
that summarizes the evidence for effectiveness and acceptability of the
proposed service/practice. The preferred evidence of effectiveness and
acceptability will include the findings from clinical trials, efficacy
and/or effectiveness studies published in the peer-reviewed literature.

If little or no research specific to the proposed target population or
service delivery setting has been published in the peer-reviewed
scientific literature, applicants may present evidence involving studies
that have not been published in the peer-reviewed research literature
and/or documents describing formal consensus among recognized experts.
If consensus documents are presented, they must describe consensus among
multiple experts whose work is recognized and respected by others in the
field. Local recognition of an individual as a respected or influential
person at the community level is not considered a "recognized expert"
for this purpose.

In presenting evidence in support of the proposed service/practice,
applicants must show that the evidence presented is the best objective
information available.

*Justifying Selection of the Service/Practice for the Target Population*

Regardless of the strength of the evidence-base for the
service/practice, all applicants must show that the proposed
service/practice is appropriate for the proposed target population.
Ideally, this evidence will include research findings on effectiveness
and acceptability specific to the proposed target population. However,
if such evidence is not available, the applicant should provide a
justification for using the proposed service/practice with the target
population. This justification might involve, for example, a description
of adaptations to the proposed service/practice based on other research
involving the target population.

*Justifying Adaptations/Modifications of the Proposed Service/Practice*

SAMHSA/CSAP has found that a high degree of faithfulness or "fidelity"
(see Glossary) to the original model for an evidence-based
service/practice increases the likelihood that positive outcomes will be
achieved when the model is used by others. Therefore, SAMHSA/CSAP
encourages fidelity to the original evidence-based service/practice to
be implemented. However, SAMHSA/CSAP recognizes that adaptations or
modifications to the original model may be necessary for a variety of
reasons:

-   To allow implementers to use resources efficiently

-   To adjust for specific needs of the client population

-   To address unique characteristics of the local community where the
    service/practice will be implemented

All applicants must describe and justify any adaptations or
modifications to the proposed service/practice that will be made.

2.2 Services Delivery

SAMHSA/CSAP's Ecstasy and Other Club Drug Cooperative Agreement funds
must be used primarily to support direct services, including the
following types of activities:

-   Conducting outreach [and]{.underline} pre-service strategies to
    expand access to prevention services to underserved populations. If
    you propose to provide [only]{.underline} outreach and pre-service
    strategies, you must show that your organization is an effective and
    integral part of a network of service providers.

-   Purchasing or providing prevention services for populations at risk.

-   Purchasing or providing "wrap-around" services (see Glossary) (e.g.,
    child care, transportation services) designed to improve access and
    retention.

-   Collecting data using specified tools to measure program
    effectiveness and standards to measure and monitor prevention
    services and costs. (No more than 20% of the total grant award may
    be used for data collection and evaluation.)

######## **2.3 Infrastructure Development**  {#infrastructure-development .unnumbered}

########  {#section .unnumbered}

######## Although SAMHSA/CSAP expects that its Ecstasy and Other Club Drug Cooperative Agreement funds will be used primarily for direct services, SAMHSA/CSAP recognizes that applicants may need to enhance their prevention system infrastructure in order to enhance/expand Ecstasy and Other Club Drug prevention services. Therefore, applicants [may]{.underline} (but are not required to) propose an infrastructure development phase in year one of their projects. Infrastructure development activities may include: {#although-samhsacsap-expects-that-its-ecstasy-and-other-club-drug-cooperative-agreement-funds-will-be-used-primarily-for-direct-services-samhsacsap-recognizes-that-applicants-may-need-to-enhance-their-prevention-system-infrastructure-in-order-to-enhanceexpand-ecstasy-and-other-club-drug-prevention-services.-therefore-applicants-may-but-are-not-required-to-propose-an-infrastructure-development-phase-in-year-one-of-their-projects.-infrastructure-development-activities-may-include .unnumbered}

-   Planning

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-   Building partnerships to ensure the success of the project and
    entering into service delivery and other agreements.

-   Developing or changing the infrastructure to expand prevention
    services.

-   Training of State and local law enforcement officials, prevention
    and education officials, members of anti-drug coalitions, and
    parents.

Regardless of the infrastructure development activities proposed by the
applicant, the infrastructure development phase must result in the
development of a service implementation plan by the end of the first
year of the project. This plan must be approved by CSAP before services
may be implemented.

After the infrastructure development phase is complete, infrastructure
development activities necessary to support service expansion will be
limited to 15% of the total grant award.

**2.4 Data and Performance Measurement**

The Government Performance and Results Act of 1993 (P.L.103-62, or
"GPRA") requires all Federal agencies to set program performance targets
and report annually on the degree to which the previous year's targets
were met. Agencies are expected to evaluate their programs regularly and
to use results of these evaluations to explain their successes and
failures and justify requests for funding.

To meet the GPRA requirements, SAMHSA/CSAP must collect performance data
(i.e., "GPRA data") from grantees. Grantees are required to report these
GPRA data to SAMHSA/CSAP on a timely basis. In your application, you
must demonstrate your ability to collect and report on these measures,
and you may be required to provide some baseline data. The terms and
conditions of the grant award also will specify the data to be submitted
and the schedule for submission. Grantees will be required to adhere to
these terms and conditions of award.

########  {#section-1 .unnumbered}

######## GPRA Requirements for the Infrastructure Development Phase {#gpra-requirements-for-the-infrastructure-development-phase .unnumbered}

Grantees with an infrastructure development phase will be required to
report on the following systems outcome indicators as appropriate:

-   needs assessment

-   community awareness

-   relationship building, and

-   capacity building.

CSAP is currently developing these systems outcome indicators and will
seek the Office of Management and Budget approval for use of these
indicators by the grantees. CSAP will then work with each grantee to
determine appropriate indicators based on the activities being
implemented.

*GPRA Requirements for Service Delivery*

For all grantees, once service delivery begins, data must be collected
for those ages 12 and older using CSAP's GPRA data tool. The CSAP GPRA
data tool is posted with this Request for Applications (RFA) on
SAMHSA/CSAP's website at
[www.samhsa.gov/grants](http://www.samhsa.gov/grants). A hard copy of
the CSAP GPRA data tool will be included in application kits distributed
by the National Clearinghouse for Alcohol and Drug Information (NCADI).

If services are being provided for individuals age 9-11, applicants must
propose an approach and instrument for collecting data from these
participants that is comparable to CSAP's GPRA data tool.

In addition, if grantees are targeting any of the five domains of
prevention-related human behaviors and attitudes \[Alcohol, Tobacco, and
Other Drug Use (ATOD); Individual/Peer; Family; School; or Community\],
they must use additional performance measures selected from CSAP's Core
Measures. All applicants must: 1) identify which core measures the
applicant proposes to collect for their program, and 2) describe their
ability to collect and report data on these measures. The grantee and
the CSAP project officer will jointly finalize the selection of core
measures based on the nature of the program model selected and the
domain within which the program will be implemented. This will be
accomplished following the notice of award.

CSAP's Core Measures will be posted with this RFA on SAMHSA's web site,
[www.SAMHSA.gov/grants](http://www.SAMHSA.gov/grants). Applicants unable
to access the document on-line should contact Beverlie Fallik at (301)
443-5827 or <bfallik@samhsa.gov>; or Sue Fialkoff at (301)443-1248 or
<sfialkof@samhsa.gov>.

The following documents should be consulted when planning for data
collection and reporting:

  -------------------------------------------------------------------------------------------------------
  **Document**           **Purpose**              **Where it can be found**
  ---------------------- ------------------------ -------------------------------------------------------
  CSAP GPRA Data         Required data for        Posted with this RFA on SAMHSA=s website at
  Collection Tool        programs providing       [www.SAMHSA.gov/grants](http://www.SAMHSA.gov/grants)
                         direct services to       and included in the application kit distributed by
                         individuals age 12 and   SAMHSA/CSAP=s clearinghouse.
                         over. Youth and adult    
                         versions in English and  
                         Spanish available        

  Core Measures Guidance Describes how to use     Posted with this RFA on SAMHSA=s website at
                         CSAP Core Measures       [www.samhsa.gov/grants](http://www.samhsa.gov/grants)
                                                  and included in the application kit distributed by
                                                  SAMHSA=s clearinghouse.

  CSAP Core Measures     Full description of CSAP Posted with this RFA on SAMHSA=s website at
  Notebook               Core Measures (200+      [www.samhsa.gov/grants](http://www.samhsa.gov/grants)
                         pages)                   If you are unable to access this document, contact
                                                  Beverlie Fallik at (301) 443-5827 or
                                                  <bfallik@samhsa.gov>; or Sue Fialkoff at (301) 443-1248
                                                  or <sfialkof@samhsa.gov>.
  -------------------------------------------------------------------------------------------------------

Applicants should be aware that SAMHSA/CSAP is working to develop a set
of required core performance measures for four types of grants (i.e.,
Services Grants, Infrastructure Grants, Best Practices Planning and
Implementation Grants, and Service-to-Science Grants). As this effort
proceeds, some of the data collection and reporting requirements for
this program may change. All grantees will be expected to comply with
any changes in data collection requirements that occur during the
grantee's project period.

######## **2.5 Grantee Meetings** {#grantee-meetings .unnumbered}

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

######## **2.6 Evaluation** {#evaluation .unnumbered}

Grantees must evaluate their projects, and you are required to describe
your evaluation plans in your application. The evaluation should be
designed to provide regular feedback to the project to improve services.
The evaluation must include both process and outcome components. Process
and outcome evaluations must measure change relating to project goals
and objectives over time compared to baseline information. Control or
comparison groups are not required. You must consider your evaluation
plan when preparing the project budget.

An ongoing goal for SAMHSA/CSAP is to assure that effective program
models are developed and added to CSAP's National Registry of Effective
Programs (NREP). Therefore, grantees will be strongly encouraged to
adapt/replicate and evaluate their program models and submit them to
NREP for review as the programs generate statistically significant
findings in Years 3, 4, and 5.

**Process components** should address issues such as:

-   How closely did implementation match the plan?

-   What types of deviation from the plan occurred?

-   What led to the deviations?

-   What effect did the deviations have on the planned intervention and
    evaluation?

-   Who provided (program, staff) what services (modality, type,
    intensity, duration), to whom (individual characteristics), in what
    context (system, community), and at what cost (facilities,
    personnel, dollars)?

#######  {#section-2 .unnumbered}

**Outcome components** should address issues such as:

-   What was the effect of intervention on participants?

-   What program/contextual factors were associated with outcomes?

-   What individual factors were associated with outcomes?

-   How durable were the effects?

No more than 20% of the total grant award may be used for evaluation and
data collection, including GPRA.

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

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

It is expected that \$4.5 million will be available to fund up to 15
Ecstasy and Other Club Drug Prevention Services awards in FY 2004. The
awards will be up to \$300,000 in total costs (direct and indirect) per
year. The actual amount available for the awards may vary, depending on
unanticipated program requirements and the number and quality of the
applications received.

Awards will be made for project periods of up to five years**. Proposed
budgets cannot exceed \$300,000 in any year of the proposed project.**
Annual continuations will depend on the availability of funds, grantee
progress in meeting program goals and objectives, and timely submission
of required data and reports. Applicants proposing an infrastructure
development phase in year one must have their service implementation
plan approved before service delivery may begin.

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

The Ecstasy and Other Club Drug Prevention Services awards will be made
as cooperative agreements.

[Role of Federal Agency]{.underline}:

The CSAP project officer will actively participate in the program
planning and program decision-making processes throughout the length of
the Cooperative Agreement. In addition to the provision of program
monitoring and technical assistance to the awardee, the CSAP project
officer, in cooperation with the awardee, will: 1) approve the
development and selection of the service model and the services
implementation plan; 2) assist with development/refinement of
infrastructure development activities, if appropriate; 3) select system
outcome and core measure outcomes based on the services model selected
and; 4) approve the program services sustainability plan.

[Role of the Awardee**:**]{.underline}

Awardees will: 1) collaborate with CSAP staff in the implementation,
monitoring of all aspects of the cooperative agreement and; 2) provide
CSAP (and its Program Coordinating Center) with required reporting data.

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

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

Eligible applicants are States, Territories, the District of Columbia,
and Native American Tribal Governments. Eligibility is limited to these
entities for two reasons: 1) to facilitate State and community planning
and coordination, and assure that program infrastructure development and
selection of ecstasy and other club drug service models are consistent
with the State/Territory Strategic Prevention Framework for substance
abuse prevention, and 2) to enhance program sustainability.

Eligible applicants are States, Territories, the District of Columbia,
and Native American Tribal Governments. Eligibility is limited to these
entities for two reasons: 1) it will facilitate State and community
planning and coordination, and assure that program infrastructure
development and selection of ecstasy service models are consistent with
State/Territory strategic plans for substance abuse prevention and; 2)
program sustainability will be enhanced should these
services/infrastructure devel«Å!Although eligibility is limited to
these governmental entities, these governmental entities must partner
with local community organizations (public or private) in developing and
implementing the grant project. Eligible applicants may submit more than
one application, but only one community may be targeted in each
application. States, tribes, and territories may retain up to 10% per
year of the total grant award for costs associated with the
administration and management of each grant submitted. At least 90% of
the total grant award each year must be allocated to the community
partner for implementation of services/infrastructure development at the
community level.

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

Cost sharing (see Glossary) is not required in this program, and
applications will not be screened out on the basis of cost sharing.
However, you may include cash or in-kind contributions (see Glossary) in
your proposal as evidence of commitment to the proposed project.

## 3. OTHER {#other .unnumbered}

**3.1 Additional Eligibility Requirements**

**Applications must comply with the following requirements, or they will
be screened out and will not be reviewed:** use of the PHS 5161-1
application; application submission requirements in Section IV-3 of this
document; and formatting requirements provided in Section IV-2.3 of this
document.

**3.2 Evidence of Experience and Credentials**

> SAMHSA/CSAP believes that only existing, experienced, and
> appropriately credentialed organizations with demonstrated
> infrastructure and expertise will be able to provide required services
> quickly and effectively. Therefore, in addition to the basic
> eligibility requirements specified in this announcement, applicants
> must meet three additional requirements related to the provision of
> prevention services.
>
> The three requirements are:

-   A provider organization for direct client services (e.g., substance
    abuse prevention services) appropriate to the grant must be involved
    in each application. More than one provider organization may be
    involved;

-   Each direct service provider organization must have at least 2 years
    experience providing services in the geographic area(s) covered by
    the application, as of the due date of the application; and

-   Each direct service provider organization must comply with all
    [applicable]{.underline} local (city, county) and State/tribal
    licensing, accreditation, and certification requirements, as of the
    due date of the application.

\[Note: The above requirements apply to all service provider
organizations. A license from an individual clinician will not be
accepted in lieu of a provider organization's license.\]

In **Appendix 1** of the application, you must: (1) identify at least
one experienced, licensed service provider organization; (2) include a
list of all direct service provider organizations that have agreed to
participate in the proposed project, including the applicant agency if
the applicant is a treatment or prevention service provider
organization; and (3) include the Statement of Assurance (provided in
Appendix F of this announcement), signed by the authorized
representative of the applicant organization identified on the face-page
of the application, that all participating service provider
organizations:

-   meet the 2-year experience requirement

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-   meet applicable licensing, accreditation, and certification
    requirements, and,

-   if the application is within the funding range, will provide the
    Government Project Officer (GPO) with the required documentation
    within the time specified.

> **If Appendix 1 of the application does not contain items (1)-(3), the
> application will be considered ineligible and will not be reviewed.**

In addition, if, following application review, an application's score is
within the fundable range for a grant award, the GPO will call the
applicant and request that the following documentation be sent by
overnight mail:

-   a letter of commitment that specifies the nature of the
    participation and what service(s) will be provided from every
    service provider organization that has agreed to participate in the
    project;

-   official documentation that all participating organizations have
    been providing relevant services for a minimum of 2 years before the
    date of the application in the area(s) in which the services are to
    be provided; and

-   official documentation that all participating service provider
    organizations comply with all applicable local (city, county) and
    State/tribal requirements for licensing, accreditation, and
    certification or official documentation from the appropriate agency
    of the applicable State/tribal, county, or other governmental unit
    that licensing, accreditation, and certification requirements do not
    exist.

If the GPO does not receive this documentation within the time
specified, the application will be removed from consideration for an
award and the funds will be provided to another applicant meeting these
requirements.

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

**To ensure that you have met all submission requirements, a checklist
is provided for your use in Appendix A of this document.**

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

You may request a complete application kit by calling the National
Clearinghouse for Alcohol and Drug Information (NCADI) at
1-800-729-6686.

You also may download the required documents from the SAMHSA/CSAP Web
site at [www.samhsa.gov](http://www.samhsa.gov/). Click on "grant
opportunities."

Additional materials available on this web site include:

-   a technical assistance manual for potential applicants;

-   standard terms and conditions for SAMHSA grants;

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

-   enhanced instructions for completing the PHS 5161-1 application.

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

**2.1 Required Documents**

SAMHSA application kits include the following documents:

-   PHS 5161-1 (revised July 2000) -- Includes the face page, budget
    forms, assurances, certification, and checklist. **Applications that
    are not submitted on the 5161-1 application form will be screened
    out and will not be reviewed.**

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

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

**2.2 Required Application Components**

To ensure equitable treatment of all applications, applications must be
complete. In order for your application to be complete, it must include
the required ten application components (Face Page, Abstract, Table of
Contents, Budget Form, Project Narrative and Supporting Documentation,
Appendices, Assurances, Certifications, Disclosure of Lobbying
Activities, and Checklist).

-   **Face Page --** Use Standard Form (SF) 424, which is part of the
    PHS 5161-1. \[Note: Beginning October 1, 2003, applicants will need
    to provide a Dun and Bradstreet (DUNS) number to apply for a grant
    or cooperative agreement from the Federal Government. SAMHSA
    applicants will be required to provide their DUNS number on the face
    page of the application. Obtaining a DUNS number is easy and there
    is no charge. To obtain a DUNS number, access the Dun and Bradstreet
    web site at
    [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
    1-866-705-5711. To expedite the process, let Dun and Bradstreet know
    that you are a public/private nonprofit organization getting ready
    to submit a Federal grant application.\]

-   **Abstract** -- Your total abstract should not be longer than 35
    lines. In the first five lines or less of your abstract, write a
    summary of your project that can be used, if your project is funded,
    in publications, reporting to Congress, or press releases.

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

-   **Budget Form** -- Use SF 424A, which is part of the PHS 5161-1.
    Fill out Sections B, C, and E of the SF 424A.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A
    through E. Sections A-E together may not be longer than 30 pages.
    More detailed instructions for completing each section of the
    Project Narrative are provided in "Section V -- Application Review
    Information" of this document.

> The Supporting Documentation provides additional information necessary
> for the review of your application. This supporting documentation
> should be provided immediately following your Project Narrative in
> Sections F through I. There are no page limits for these sections,
> except for Section H, the Biographical Sketches/Job Descriptions.

-   *Section F* -- Literature Citations. This section must contain
    complete citations, including titles and all authors, for any
    literature you cite in your application.

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-   *Section G* **-** Budget Justification, Existing Resources, Other
    Support. You must provide a narrative justification of the items
    included in your proposed budget, as well as a description of
    existing resources and other support you expect to receive for the
    proposed project. Be sure to show that:

    -   no more than 10% of the total award is retained by the applicant
        to cover costs of administering the grant;

    -   at least 90% of the total grant award is allocated to the
        community partner to implement the project;

    -   no more than 15% of the total grant award will be used for
        infrastructure development, except during the allowable
        infrastructure development phase in the first year of the
        project; and

    -   no more than 20% of the total grant award will be used for data
        collection and evaluation (including GPRA).

The infrastructure development, data collection and evaluation costs may
be shared by the State and the community partner.

####### *Section H* - Biographical Sketches and Job Descriptions. 

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

####### Include job descriptions for key personnel. Job descriptions should be no longer than 1 page each.

####### Sample sketches and job descriptions are listed on page 22, Item 6 in the Program Narrative section of the PHS 5161-1.

####### *Section I* - Confidentiality and SAMHSA Participant Protection/Human Subjects. Section IV-2.4 of this document describes requirements for the protection of the confidentiality, rights and safety of participants in SAMHSA/CSAP-funded activities. This section also includes guidelines for completing this part of your application. 

#######  {#section-3 .unnumbered}

####### Appendices 1 through 3-- Use only the appendices listed below. Do not use more than 30 pages for Appendices 1 and 3. There is no page limit for Appendix 2. Do not use appendices to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do.

-   *Appendix 1*: Letters of commitment/support. Identification of at
    least one experienced, licensed service provider organization. A
    list of all direct service provider organizations that have agreed
    to participate in the proposed project, including the applicant
    agency, if it is a treatment or prevention service provider
    organization. The Statement of Assurance (provided in Appendix F of
    this announcement) signed by the authorized representative of the
    applicant organization identified on the face page of the
    application, that assures SAMHSA that all listed providers meet the
    2-year experience requirement, are appropriately licensed,
    accredited, and certified, and that if the application is within the
    funding range for an award, the applicant will send the GPO the
    required documentation within the specified time.

####### *Appendix 2*: Data Collection Instruments/Interview Protocols

####### *Appendix 3*: Sample Consent Forms

-   **Assurances** -- Non-Construction Programs. Use Standard Form 424B
    found in PHS 5161-1. Applicants are required to complete the
    Assurance of Compliance with SAMHSA Charitable Choice Statutes and
    Regulations, Form SMA 170. This form will be posted on SAMHSA's web
    site with the RFA and provided in the application kits available at
    NCADI.

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-   **Certifications** -- Use the "Certifications" forms found in PHS
    5161-1.

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

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

2.3 Application Formatting Requirements

**Applicants also must comply with the following basic application
requirements. Applications that do not comply with these requirements
will be screened out and will not be reviewed.**

-   Information provided must be sufficient for review.

-   Text must be legible.

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

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

footnotes will not be considered in determining compliance.)

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

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

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded.

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

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by 30. This number represents the full page less margins,
multiplied by the total number of allowed pages.

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

-   The 30-page limit for Appendices 1 and 3.

To facilitate review of your application, follow these additional
guidelines. Failure to adhere to the following guidelines will not, in
itself, result in your application being screened out and returned
without review. However, following these guidelines will help reviewers
to consider your application.

-   Pages should be typed single-spaced with one column per page.

-   Pages should not have printing on both sides.

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

-   Send the original application and two copies to the mailing address
    in Section IV-6.1 of this document. Please do not use staples, paper
    clips, and fasteners. Nothing should be attached, stapled, folded,
    or pasted. Do not use heavy or lightweight paper or any material
    that cannot be copied using automatic copying machines. Odd-sized
    and oversized attachments such as posters will not be copied or sent
    to reviewers. Do not include videotapes, audiotapes, or CD-ROMs.

**2.4 SAMHSA Confidentiality and Participant Protection Requirements
and**

**Protection of Human Subjects Regulations**

Applicants must describe procedures relating to Confidentiality,
Participant Protection and the Protection of Human Subjects Regulations
in Section I of the application, using the guidelines provided below.
Number range CHAPTERProblems with confidentiality, participant
protection, and protection of human subjects identified during peer
review of the application may result in the delay of funding.

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

All applicants [must]{.underline} describe how they will address
requirements for each of the following elements relating to
confidentiality and participant protection.

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

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

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

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

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

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

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

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

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

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

3.  [Absence of Coercion]{.underline}

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

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

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

4.  [Data Collection]{.underline}

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

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

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-   Provide in **Appendix 2, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

5.  [Privacy and Confidentiality:]{.underline}

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

-   Describe:

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-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

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

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

6.  [Adequate Consent Procedures:]{.underline}

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

-   State:

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-   Whether or not their participation is voluntary.

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

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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

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

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

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

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

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

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

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

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

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

Depending on the evaluation design you propose in your application, you
may have to comply with the Protection of Human Subjects Regulations (45
CFR 46).

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

Additional information about Protection of Human Subjects Regulations
can be obtained on the web at
[http://ohrp.osophs.dhhs.gov](http://ohrp.osophs.dhhs.gov/). You may
also contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline} or by
phone (301/496-7005).

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

Applications are due by June 18, 2004.

Your application must be received by the application deadline.
Applications received after this date must have a proof-of-mailing date
from the carrier dated at least 1 week prior to the due date. Private
metered postmarks are not acceptable as proof of timely mailing.

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

Applications not received by the application deadline or not postmarked
by a week prior to the application deadline will be screened out and
will not be reviewed.

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

Executive Order 12372, as implemented through Department of Health and
Human Services (DHHS) regulation at 45 CFR Part 100, sets up a system
for State and local review of applications for Federal financial
assistance. A current listing of State Single Points of Contact (SPOCs)
is included in the application kit and can be downloaded from the Office
of Management and Budget (OMB) web site at
[www.whitehouse.gov/omb/grants/spoc.html](http://www.whitehouse.gov/omb/grants/spoc.html).

-   Check the list to determine whether your State participates in this
    program. You **do not** need to do this if you are a federally
    recognized Indian tribal government.

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

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

    -   The SPOC should send any State review process recommendations to
        the following address within 60 days of the application
        deadline:

Substance Abuse and Mental Health Services Administration

Office of Program Services, Review Branch

5600 Fishers Lane, Room 17-89

Rockville, Maryland, 20857

ATTN: SPOC -- Funding Announcement No. SP-04-004

## 5. FUNDING LIMITATIONS/RESTRICTIONS {#funding-limitationsrestrictions .unnumbered}

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

-   Institutions of Higher Education: OMB Circular A-21

-   State and Local Governments: OMB Circular A-87

-   Nonprofit Organizations: OMB Circular A-122

-   Appendix E Hospitals: 45 CFR Part 74

In addition, SAMHSA Services Grant recipients must comply with the
following funding restrictions:

-   

-   No more than 15% of the total grant award may be used for developing
    the infrastructure necessary for expansion of services, except
    during the allowable infrastructure development phase in year one of
    the project. (There is no limit on expenditure for infrastructure
    development during this phase of the project.)

-   No more than 20% of the total grant award may be used for evaluation
    and data collection (including GPRA). These costs may be shared by
    the applicant and the community partner.

-   No more than 10% of the total grant award may be retained by the
    applicant for costs associated with the administration and
    management of the grant.

-   At least 90% of the total grant award must be allocated to the
    community partner for implementation of services/infrastructure
    development at the community level.

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

-   Pay for any lease beyond the project period.

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

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

-   Pay for incentives to induce individuals to enter services. However,
    a grantee or service provider may provide up to \$20 or equivalent
    (coupons, bus tokens, gifts, child care, and vouchers) to
    individuals as incentives to participate in required data collection
    follow-up. This amount may be paid for participation in each
    required interview.

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

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

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

**6.1 Where to Send Applications**

Send applications to the following address:

Substance Abuse and Mental Health Services Administration

Office of Program Services, Review Branch

5600 Fishers Lane, Room 17-89

Rockville, Maryland, 20857

Be sure to include the funding announcement number (SP 04-004) in item
number 10 on the face page of the application. If you require a phone
number for delivery, you may use (301) 443-4266.

**6.2 How to Send Applications**

Mail an original application and 2 copies (including appendices) to the
mailing address provided above. The original and copies must not be
bound. Do not use staples, paper clips, or fasteners. Nothing should be
attached, stapled, folded, or pasted.

You must use a recognized commercial or governmental carrier. **Hand
carried applications will not be accepted. Faxed or e-mailed
applications will not be accepted.**

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

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

Your application will be reviewed and scored according to the quality of
your response to the requirements listed below for developing the
Project Narrative (Sections A-E). These sections describe what you
intend to do with your project.

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

-   The Project Narrative (Sections A-E) together may be no longer than
    30 pages.

-   You must use the five sections/headings listed below in developing
    your Project Narrative. Be sure to place the required information in
    the correct section, **or it will not be considered**. Your
    application will be scored according to how well you address the
    requirements for each section of the Project Narrative.

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-   Reviewers will be looking for evidence of cultural competence in
    each section of the Project Narrative. Points will be assigned based
    on how well you address the cultural competence aspects of the
    evaluation criteria. SAMHSA guidelines for cultural competence can
    be found on the SAMHSA web site at
    [www.samhsa.gov/grants](http://www.samhsa.gov/grants).

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-   The Supporting Documentation you provide in Sections F-I and
    Appendices 1-5 will be considered by reviewers in assessing your
    response, along with the material in the Project Narrative.

-   The number of points after each heading is the maximum number of
    points a review committee may assign to that section of your Project
    Narrative. Bullet statements in each section do not have points
    assigned to them. They are provided to invite the attention of
    applicants and reviewers to important areas within the criterion.

**Section A: Statement of Need (10 points)**

-   Describe the target population (see Glossary) as well as the
    geographic area to be served, and justify the selection of both.
    Include the numbers to be served and demographic information.
    Clearly identify the target community that is partnering with the
    applicant organization in developing and implement the proposed
    project. Discuss the target population's language, beliefs, norms
    and values, as well as socioeconomic factors that must be considered
    in delivering programs to this population.

-   Describe the nature of the problem and extent of the need for the
    target population based on data. The statement of need should
    include a clearly established baseline for the project.
    Documentation of need may come from a variety of qualitative and
    quantitative sources. The quantitative data could come from local
    data or trend analyses, State data (e.g., from State Needs
    Assessments), and/or national data (e.g., from SAMHSA's National
    Household Survey on Drug Abuse and Health or from National Center
    for Health Statistics/Centers for Disease Control reports). For data
    sources that are not well known, provide sufficient information on
    how the data were collected so reviewers can assess the reliability
    and validity of the data.

-   Describe how the proposed project is guided by the Drug Enforcement
    Agency's (DEA) assessment of the incidence, disposition, and
    prevalence of ecstasy and other club drug use within the State,
    Tribal area, or Territory. (Information in the DEA assessments is
    available on the DEA website at
    [www.dea.gov/pubs/state_factsheets.html](http://www.dea.gov/pubs/state_factsheets.html).)

-   Applicants proposing an infrastructure development phase must
    document the need for infrastructure development to improve
    effective Ecstasy and Other Club Drug Use prevention services
    implementation in the target community. This documentation should
    include a description of the service gaps, barriers and other
    problems related to need for infrastructure development and how they
    will be overcome.

    **Section B: Proposed Evidence-Based Service/Practice (30 points)**

-   Clearly state the purpose, goals and objectives of your proposed
    project. Describe how achievement of goals will produce meaningful
    and relevant results (e.g., increase access, availability,
    prevention, outreach, pre-services, and/or intervention).

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-   Identify the evidenced based service/practice that you propose to
    implement. Describe the evidence-base for the proposed
    service/practice and show that it incorporates the best objective
    information available regarding effectiveness and acceptability.
    Follow the instructions provided in #1, #2 or #3 below, as
    appropriate:

1.  [If you are proposing to implement a service/practice included in
    NREP (see Appendix C)]{.underline}, simply identify the practice and
    state the source from which it was selected. You do not need to
    provide further evidence of effectiveness.

2.  [If you are providing evidence that includes scientific studies
    published in the peer-reviewed literature or other studies that have
    not been published, describe the extent to which]{.underline}:

    -   the service/practice has been evaluated and the quality of the
        evaluation studies (e.g., whether they are descriptive,
        quasi-experimental studies, or experimental studies)

    -   the services/practice has demonstrated positive outcomes and for
        what populations the positive outcomes have been demonstrated

    -   the service/practice has been documented (e.g., through
        development of guidelines, tool kits, treatment protocols,
        and/or manuals) and replicated

    -   fidelity measures have been developed (e.g., no measures
        developed, key components identified, or fidelity measures
        developed)

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3.  [If you are providing evidence based on a formal consensus process
    involving recognized experts in the field, describe]{.underline}:

    -   the experts involved in developing consensus on the proposed
        service/practice (e.g., members of an expert panel formally
        convened by SAMHSA, NIH, the Institute of Medicine or other
        nationally recognized organization). The consensus must have
        been developed by a group of experts whose work is recognized
        and respected by others in the field. Local recognition of an
        individual as a respected or influential person at the community
        level is not considered a "recognized expert" for this purpose.

    -   the nature of the consensus that has been reached and the
        process used to reach consensus

    -   the extent to which the consensus has been documented (e.g., in
        a consensus panel report, meeting minutes, or an accepted
        standard practice in the field)

    -   any empirical evidence (whether formally published or not)
        supporting the effectiveness of the proposed service/practice

    -   the rationale for concluding that further empirical evidence
        does not exist to support the effectiveness of the proposed
        service/practice

-   Justify the use of the proposed service/practice for the target
    population. Describe and justify any adaptations necessary to meet
    the needs of the target population as well as evidence that such
    adaptations will be effective for the target population.

-   Identify and justify any additional adaptations or modifications to
    the proposed service/practice.

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-   Describe how the proposed project will address issues of age, race,
    ethnicity, culture, language, sexual orientation, disability,
    literacy, and gender in the target population, while retaining
    fidelity to the chosen practice.

-   Demonstrate how the proposed service/practice will meet your goals
    and objectives. Provide a logic model (see Glossary) that links
    need, the services or practice to be implemented, and outcomes.

    **Section C: Proposed Implementation Approach (25 points)**

-   Describe how the proposed service or practice will be implemented.
    Provide a realistic time line for the project (chart or graph)
    showing key activities, milestones, and responsible staff. \[Note:
    The time line should be part of the Project Narrative. It should not
    be placed in an appendix.\]

-   If applicable, describe the infrastructure development phase and how
    it will be implemented. Discuss how the infrastructure development
    phase will lay the groundwork for implementation of the proposed
    service or practice. Show that the infrastructure development phase
    will be completed by the end of the first year of the project.

    -   Describe how the community partner has been involved in
        developing the grant project and how it will be involved in
        implementing the evidence-based practice and infrastructure
        development activity(ies), if appropriate.

-   Clearly state the unduplicated number of individuals you propose to
    serve (annually and over the entire project period) with grant
    funds, including the types and numbers of services to be provided
    and anticipated outcomes. Describe how the target population will be
    identified, recruited, and retained.

-   Describe how members of the target population helped prepare the
    application, and how they will help plan, implement, and evaluate
    the project.

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-   Describe how the project components will be embedded within the
    existing service delivery system, including other SAMHSA-funded
    projects, if applicable. Identify any other organizations that will
    participate in the proposed project. Describe their roles and
    responsibilities and demonstrate their commitment to the project.
    Include letters of commitment from community organizations
    supporting the project in **Appendix 1**. Identify any cash or
    in-kind contributions that will be made to the project by the
    applicant or other partnering organizations.

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-   For applicants that are [not]{.underline} proposing an
    infrastructure development phase, show that the necessary groundwork
    (e.g., planning, consensus development, development of memoranda of
    agreement, identification of potential facilities) has been
    completed or is near completion so that the project can be
    implemented and service delivery can begin as soon as possible and
    no later than 4 months after grant award.

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-   Describe the potential barriers to successful conduct of the
    proposed project and how you will overcome them.

-   Provide a plan to secure resources to sustain the proposed project
    when Federal funding ends.

    **Section D: Staff and Organizational Experience (20 points)**

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-   Discuss the capability and experience of the applicant organization
    and other participating organizations with similar projects and
    populations, including experience in providing culturally
    appropriate/competent services and implementing effective prevention
    interventions.

-   Provide a list of staff who will participate in the project, showing
    the role of each and their level of effort and qualifications.
    Include the Project Director and other key personnel, such as the
    evaluator and treatment/prevention personnel.

-   Describe the racial/ethnic characteristics of key staff and indicate
    if any are members of the target population/community. If the target
    population is multi-linguistic, indicate if the staffing pattern
    includes bilingual and bicultural individuals.

-   Describe the resources available for the proposed project (e.g.,
    facilities, equipment), and provide evidence that services will be
    provided in a location that is adequate, accessible, compliant with
    the Americans with Disabilities Act (ADA), and amenable to the
    target population.

-   Describe how the applicant has worked with local communities to
    plan, coordinate and implement effective prevention activities.

-   Describe the applicant's ability to utilize data to monitor services
    and costs.

    **Section E: Evaluation and Data (15 points)**

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-   Document your ability to collect and report on the required
    performance measures.

-   Identify and justify the Core Measures appropriate to your project
    and document your ability to collect and report those measures.

    -   Describe plans for data collection, management, analysis,
        interpretation and reporting. Describe the existing approach to
        the collection of data, along with any necessary modifications.
        Be sure to include data collection instruments/interview
        protocols in **Appendix 2**.

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-   Discuss the reliability and validity of evaluation methods and
    instrument(s) in terms of the gender/age/culture of the target
    population.

-   Describe the process and outcome evaluation, including assessments
    of implementation and individual outcomes. Show how the evaluation
    will be integrated with requirements for collection and reporting of
    performance data, including data required by SAMHSA to meet GPRA
    requirements.

-   Describe how the evaluation will be used to ensure the fidelity to
    the practice.

-   Provide a per-person or unit cost of the project to be implemented,
    based on the applicant's actual costs and projected costs over the
    life of the project.

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

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

SAMHSA applications are peer-reviewed according to the review criteria
listed above. For those programs where the individual award is over
\$100,000, applications must also be reviewed by the appropriate
National Advisory Council.

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by
    peer reviewers and, when applicable, approved by the appropriate
    National Advisory Council;

-   availability of funds;

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-   equitable distribution of awards in terms of geography (including
    urban, rural and remote settings) and balance among target
    populations and program size; and

-   after applying the aforementioned criteria, the following method for
    breaking ties: When funds are not available to fund all applications
    with identical scores, SAMHSA will make award decisions based on the
    application(s) that received the greatest number of points by peer
    reviewers on the evaluation criterion in Section V-1 with the
    highest number of possible points (Proposed Evidence-Based
    Service/Practice -- 30 points). Should a tie still exist, the
    evaluation criterion with the next highest possible point value will
    be used, continuing sequentially to the evaluation criterion with
    the lowest possible point value, should that be necessary to break
    all ties. If an evaluation criterion to be used for this purpose has
    the same number of possible points as another evaluation criterion,
    the criterion listed first in Section V-1 will be used first.

#######  {#section-4 .unnumbered}

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

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

#######  {#section-5 .unnumbered}

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

If you are approved for funding, you will receive an **additional**
notice, the Notice of Grant Award, signed by SAMHSA's Grants Management
Officer. The Notice of Grant Award is the sole obligating document that
allows the grantee to receive Federal funding for work on the grant
project. It is sent by postal mail and is addressed to the contact
person listed on the face page of the application.

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

#######  {#section-6 .unnumbered}

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

[]{.mark}

-   You must comply with all terms and conditions of the grant award.
    SAMHSA's standard terms and conditions are available on the SAMHSA
    web site at
    [www.samhsa.gov/grants/2004/useful_info.asp](http://www.samhsa.gov/grants/2004/useful_info.asp).

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

    -   actions required to be in compliance with human subjects
        requirements;

    -   requirements relating to additional data collection and
        reporting;

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

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

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

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

#######  {#section-7 .unnumbered}

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

**3.1 Progress and Financial Reports**

-   Grantees must provide annual and final progress reports. The final
    report must summarize information from the annual reports, describe
    the accomplishments of the project, and describe next steps for
    implementing plans developed during the grant period.

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-   Grantees must provide annual and final financial status reports.
    These reports may be included as separate sections of annual and
    final progress reports or can be separate documents. Because SAMHSA
    is extremely interested in ensuring that treatment or prevention
    services can be sustained, your financial reports should explain
    plans to ensure the sustainability (see Glossary) of efforts
    initiated under this grant. Initial plans for sustainability should
    be described in year 01. In each subsequent year, you should
    describe the status of your project, as well as the successes
    achieved and obstacles encountered in that year.

-   SAMHSA will provide guidelines and requirements for these reports to
    grantees at the time of award and at the initial grantee orientation
    meeting after award. SAMHSA staff will use the information contained
    in the reports to determine the grantee's progress toward meeting
    its goals.

3.2 Government Performance and Results Act (GPRA)

The Government Performance and Results Act (GPRA) mandates
accountability and performance-based management by Federal agencies. To
meet the GPRA requirements, SAMHSA must collect performance data (i.e.,
"GPRA data") from grantees. These requirements are specified in Section
I-2.4 (Data and Performance Measurement) of this document.

**3.3 Publications**

If you are funded under this grant program, you are required to notify
the Government Project Officer (GPO) and SAMHSA's Publications Clearance
Officer (301-443-8596) of any materials based on the SAMHSA-funded grant
project that are accepted for publication.

In addition, SAMHSA requests that grantees:

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

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

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

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

### 

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

For questions about program issues, contact:

Tom DeLoe, Ph.D.

SAMHSA/CSAP

5600 Fishers Lane

Rockwall II, Suite 1075

Rockville, MD 20857

301-443-9110

E-mail: <tdeloe@samhsa.gov>

For questions on grants management issues, contact:

> Edna Frazier

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

5600 Fishers Lane

Rockwall II, Suite 630

Rockville, MD 20857

\(301\) 443-6816

<efrazier@samhsa.gov>

### Appendix A -- Checklist for Formatting Requirements and Screenout Criteria for SAMHSA Grant Applications

*SAMHSA's goal is to review all applications submitted for grant
funding. However, this goal must be balanced against SAMHSA's obligation
to ensure equitable treatment of applications. For this reason, SAMHSA
has established certain formatting requirements for its applications.
**If you do not adhere to these requirements, your application will be
screened out and returned to you without review.** In addition to these
formatting requirements, programmatic requirements (e.g., relating to
eligibility) may be stated in the specific funding announcement. Please
check the entire funding announcement before preparing your
application.*

-   Use the PHS 5161-1 application.

-   Applications must be received by the application deadline.
    Applications received after this date must have a proof of mailing
    date from the carrier dated at least 1 week prior to the due date.
    Private metered postmarks are not acceptable as proof of timely
    mailing. Applications not received by the application deadline or
    not postmarked at least 1 week prior to the application deadline
    will not be reviewed.

-   Information provided must be sufficient for review.

-   Text must be legible.

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

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

footnotes will not be considered in determining compliance.)

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

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

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded.

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

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

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

-   The page limit for Appendices stated in the specific funding
    announcement cannot be exceeded.

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

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

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

-   Abstract

-   Table of Contents

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

-   Project Narrative and Supporting Documentation

-   Appendices

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

-   Certifications (a form within PHS 5161-1)

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

-   Checklist (a form in PHS 5161-1)

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-   Applications should comply with the following requirements:

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-   Provisions relating to confidentiality, participant protection and
    the protection of human subjects specified in Section IV-2.4 of the
    FY 2004 standard funding announcements.

-   Budgetary limitations as specified in Section I, II, and IV-5 of the
    FY 2004 standard funding announcements.

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

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-   Pages should be typed single-spaced with one column per page.

-   Pages should not have printing on both sides.

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

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

### Appendix B - Glossary

**[Best Practice:]{.underline}** Best practices are practices that
incorporate the best objective information currently available regarding
effectiveness and acceptability.

**[Catchment Area:]{.underline}** A catchment area is the geographic
area from which the target population to be served by a program will be
drawn.

**[Cooperative Agreement:]{.underline}** A cooperative agreement is a
form of Federal grant. Cooperative agreements are distinguished from
other grants in that, under a cooperative agreement, substantial
involvement is anticipated between the awarding office and the recipient
during performance of the funded activity. This involvement may include
collaboration, participation, or intervention in the activity. HHS
awarding offices use grants or cooperative agreements (rather than
contracts) when the principal purpose of the transaction is the transfer
of money, property, services, or anything of value to accomplish a
public purpose of support or stimulation authorized by Federal statute.
The primary beneficiary under a grant or cooperative agreement is the
public, as opposed to the Federal Government.

**[Cost Sharing or Matching:]{.underline}** Cost sharing refers to the
value of allowable non-Federal contributions toward the allowable costs
of a Federal grant project or program. Such contributions may be cash or
in-kind contributions. For SAMHSA grants, cost sharing or matching is
not required, and applications will not be screened out on the basis of
cost sharing.  However, applicants often include cash or in-kind
contributions in their proposals as evidence of commitment to the
proposed project. This is allowed, and this information may be
considered by reviewers in evaluating the quality of the application.

**[Fidelity:]{.underline}** Fidelity is the degree to which a specific
implementation of a program or practice resembles, adheres to, or is
faithful to the evidence-based model on which it is based. Fidelity is
formally assessed using rating scales of the major elements of the
evidence-based model. A toolkit on how to develop and use fidelity
instruments is available from the SAMHSA-funded Evaluation Technical
Assistance Center at [http://tecathsri.org](http://tecathsri.org/) or by
calling (617) 876-0426.

**[Grant:]{.underline}** A grant is the funding mechanism used by the
Federal Government when the principal purpose of the transaction is the
transfer of money, property, services, or anything of value to
accomplish a public purpose of support or stimulation authorized by
Federal statute. The primary beneficiary under a grant or cooperative
agreement is the public, as opposed to the Federal Government.

**[In-Kind Contribution]{.underline}**: In-kind contributions toward a
grant project are non-cash contributions (e.g., facilities, space,
services) that are derived from non-Federal sources, such as State or
sub-State non-Federal revenues, foundation grants, or contributions from
other non-Federal public or private entities.

**[Logic Model:]{.underline}** A logic model is a diagrammatic
representation of a theoretical framework. A logic model describes the
logical linkages among program resources, conditions, strategies,
short-term outcomes, and long-term impact. More information on how to
develop logics models and examples can be found through the resources
listed in Appendix G.

**[Practice]{.underline}:** A practice is any activity, or collective
set of activities, intended to improve outcomes for people with or at
risk for substance abuse and/or mental illness. Such activities may
include direct service provision, or they may be supportive activities,
such as efforts to improve access to and retention in services,
organizational efficiency or effectiveness, community readiness,
collaboration among stakeholder groups, education, awareness, training,
or any other activity that is designed to improve outcomes for people
with or at risk for substance abuse or mental illness.

**[Practice Support System]{.underline}:** This term refers to
contextual factors that affect practice delivery and effectiveness in
the pre-adoption phase, delivery phase, and post-delivery phase, such as
a) community collaboration and consensus building, b) training and
overall readiness of those implementing the practice, and c) sufficient
ongoing supervision for those implementing the practice.

#### [Stakeholder:]{.underline} A stakeholder is an individual, organization, constituent group, or other entity that has an interest in and will be affected by a proposed grant project. {#stakeholder-a-stakeholder-is-an-individual-organization-constituent-group-or-other-entity-that-has-an-interest-in-and-will-be-affected-by-a-proposed-grant-project. .unnumbered}

#### [Strategic Prevention Framework]{.underline}: This term refers to a SAMHSA/CSAP initiative to encourage States to develop strategic plans to prevent/reduce the use of alcohol, tobacco and other drugs. This process will include needs assessment, capacity building, planning, implementation, and evaluation.  {#strategic-prevention-framework-this-term-refers-to-a-samhsacsap-initiative-to-encourage-states-to-develop-strategic-plans-to-preventreduce-the-use-of-alcohol-tobacco-and-other-drugs.-this-process-will-include-needs-assessment-capacity-building-planning-implementation-and-evaluation. .unnumbered}

**[Sustainability:]{.underline}** Sustainability is the ability to
continue a program or practice after SAMHSA grant funding has ended.

**[Target Population]{.underline}:** The target population is the
specific population of people whom a particular program or practice is
designed to serve or reach.

**[Wraparound Service:]{.underline}** Wraparound services are
non-clinical supportive services---such as child care, vocational,
educational, and transportation services---that are designed to improve
the individual's access to and retention in the proposed project.

### Appendix C - National Registry of Effective Programs

To help SAMHSA's constituents learn more about science-based programs,
SAMHSA's Center for Substance Abuse Prevention (CSAP) created a National
Registry of Effective Programs (NREP) to review and identify effective
programs. NREP seeks candidates from the practice community and the
scientific literature. While the initial focus of NREP was substance
abuse prevention programming, NREP has expanded its scope and now
includes prevention and treatment of substance abuse and of co-occurring
substance abuse and mental disorders, and psychopharmacological programs
and workplace programs.

NREP includes three categories of programs: Effective Programs,
Promising Programs, and Model Programs. Programs defined as Effective
have the option of becoming Model Programs if their developers choose to
take part in SAMHSA dissemination efforts. The conditions for making
that choice, together with definitions of the three major criteria, are
as follows.

[**Promising
Programs**](http://modelprograms.samhsa.gov/template_cf.cfm?page=promising_list)
have been implemented and evaluated sufficiently and are scientifically
defensible. They have positive outcomes in preventing substance abuse
and related behaviors. However, they have not yet been shown to have
sufficient rigor and/or consistently positive outcomes required for
Effective Program status. Nonetheless, Promising Programs are eligible
to be elevated to Effective/Model status after review of additional
documentation regarding program effectiveness. Originated from a range
of settings and spanning target populations, Promising Programs can
guide prevention, treatment, and rehabilitation.

[**Effective
Programs**](http://modelprograms.samhsa.gov/template_cf.cfm?page=effective_list)
are well-implemented, well-evaluated programs that produce consistently
positive pattern of results (across domains and/or replications).
Developers of Effective Programs have yet to help SAMHSA/CSAP
disseminate their programs, but may do so themselves.

[**Model
Programs**](http://modelprograms.samhsa.gov/template_cf.cfm?page=model_list)
are also well-implemented, well-evaluated programs, meaning they have
been reviewed by NREP according to rigorous standards of research. Their
developers have agreed with SAMHSA/CSAP to provide materials, training,
and technical assistance for nationwide implementation. That helps
ensure the program is carefully implemented and likely to succeed.

Programs that have met the NREP standards for each category can be
identified by accessing the NREP Model Programs Web site at
[www.modelprograms.samhsa.gov](http://www.modelprograms.samhsa.gov/).

### Appendix F - Statement Of Assurance

As the authorized representative of the applicant organization, I assure
SAMHSA that if *{insert name of organization}* application is within the
funding range for a grant award, the organization will provide the
SAMHSA Government Project Officer (GPO) with the following documents. I
understand that if this documentation is not received by the GPO within
the specified timeframe, the application will be removed from
consideration for an award and the funds will be provided to another
applicant meeting these requirements.

-   a letter of commitment that specifies the nature of the
    participation and what service(s) will be provided from every
    service provider organization, listed in Appendix 1 of the
    application, that has agreed to participate in the project;

-   official documentation that all service provider organizations
    participating in the project have been providing relevant services
    for a minimum of 2 years prior to the date of the application in the
    area(s) in which services are to be provided. Official documents
    must definitively establish that the organization has provided
    relevant services for the last 2 years; and

-   official documentation that all participating service provider
    organizations are in compliance with all local (city, county) and
    State/tribal requirements for licensing, accreditation, and
    certification or official documentation from the appropriate agency
    of the applicable State/tribal, county, or other governmental unit
    that licensing, accreditation, and certification requirements do not
    exist. (Official documentation is a copy of each service provider
    organization's license, accreditation, and certification.
    Documentation of accreditation will not be accepted in lieu of an
    organization's license. A statement by, or letter from, the
    applicant organization or from a provider organization attesting to
    compliance with licensing, accreditation and certification or that
    no licensing, accreditation, certification requirements exist [does
    not]{.underline} constitute adequate documentation.)

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

Signature of Authorized Representative Date

### Appendix G -- Logic Model Resources

Chen, W.W., Cato, B.M., & Rainford, N. (1998-9). Using a logic model to

plan and evaluate a community intervention program: A case study.
*International Quarterly of Community Health Education*, *18*(4),
449-458.

Edwards, E.D., Seaman, J.R., Drews, J., & Edwards, M.E. (1995). A
community approach for Native American drug and alcohol prevention
programs: A logic model framework. *Alcoholism Treatment Quarterly*,
*13*(2), 43-62.

Hernandez, M. & Hodges, S. (2003). *Crafting Logic Models for Systems of
Care: Ideas into Action*. \[Making children's mental health services
successful series, volume 1\]. Tampa, FL: University of South Florida,
The Louis de la Parte Florida Mental Health Institute, Department of
Child & Family Studies.
[http://cfs.fmhi.usf.edu](http://cfs.fmhi.usf.edu/) or phone (813)
974-4651

Hernandez, M. & Hodges, S. (2001). Theory-based accountability. In M.
Hernandez & S. Hodges (Eds.), *Developing Outcome Strategies in
Children\'s Mental Health*, pp. 21-40. Baltimore: Brookes.

Julian, D.A. (l997). Utilization of the logic model as a system level
planning and evaluation device. *Evaluation and Planning,* *20*(3),
251-257.

Julian, D.A., Jones, A., & Deyo, D. (1995). Open systems evaluation and
the

logic model: Program planning and evaluation tools. *Evaluation and
Program*

*Planning,* *18*(4), 333-341.

Patton, M.Q. (1997). *Utilization-Focused Evaluation* (3^rd^ Ed.), pp.
19, 22,

241\. Thousand Oaks, CA: Sage.

Wholey, J.S., Hatry, H.P., Newcome, K.E. (Eds.) (1994). *Handbook of
Practical Program Evaluation.* San Francisco, CA: Jossey-Bass Inc.