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

**Health Resources and Services Administration (HRSA)**

Office of Rural Health Policy (ORHP)

Small Health Care Provider Quality Improvement (Rural Quality) Grant
Program

> **Rural Quality Grant Program**
>
> New Competition
>
> Announcement Number: HRSA-08-058
>
> **Catalog of Federal Domestic Assistance (CFDA) No. 93.912**

**PROGRAM GUIDANCE**

Fiscal Year 2008

Letter of Intent Due Date: February 8, 2008

**Application Due Date: March 20, 2008**

**Release Date:** **January 18, 2008**

**Date of Issuance: January 18, 2008**

> Contact Name:

Elizabeth Rezai-zadeh

Rural Quality Grant Program Coordinator

HRSA, ORHP

Telephone: 301/443-4107

Fax: 301/443-2803

Authority: Public Health Service Act Title III, Public Law 330A(g), (42
U.S.C. 254c)

**Guidance Table of Contents**

[I. Funding Opportunity Description 2](#__RefHeading___Toc173896715)

[Purpose 2](#Funding_purpose)

[Background 2](#__RefHeading___Toc173896717)

[II. Award Information 2](#__RefHeading___Toc173896718)

[1. Type of Award 2](#__RefHeading___Toc173896719)

[2. Summary of Funding 2](#__RefHeading___Toc173896720)

[III. Eligibility Information 2](#__RefHeading___Toc173896721)

[1. Eligible Applicants 2](#Eligibility_who)

[2. Cost Sharing/Matching 2](#__RefHeading___Toc173896723)

[IV. Application and Submission Information
2](#__RefHeading___Toc173896724)

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

[Application Materials 2](#__RefHeading___Toc173896726)

[2. Content and Form of Application Submission
2](#__RefHeading___Toc173896727)

[Application Format Requirements 2](#Application_formatrequirements)

[SF 424 Non Construction -- Table of Contents
2](#sf-424-non-construction-table-of-contents)

[Application Format 2](#__RefHeading___Toc173896730)

[i. Application Face Page 2](#__RefHeading___Toc173896731)

[DUNS Number 2](#__RefHeading___Toc173896732)

[ii. Table of Contents 2](#__RefHeading___Toc173896733)

[iii. Application Checklist 2](#__RefHeading___Toc173896734)

[iv. Budget 2](#__RefHeading___Toc173896735)

[v. Budget Justification 2](#__RefHeading___Toc173896736)

[vi. Staffing Plan and Personnel Requirements
2](#__RefHeading___Toc173896737)

[vii. Assurances 2](#__RefHeading___Toc173896738)

[viii. Certifications 2](#__RefHeading___Toc173896739)

[ix. Project Abstract 2](#__RefHeading___Toc173896740)

[x. Program Narrative 2](#__RefHeading___Toc173896741)

[xi. Attachments 2](#__RefHeading___Toc173896742)

[3. Submission Dates and Times 2](#__RefHeading___Toc173896743)

[i. Notification of Intent to Apply 2](#Application_intent)

[ii. Application Due Date 2](#__RefHeading___Toc173896745)

[iii. Late applications: 2](#__RefHeading___Toc173896746)

[4. Intergovernmental Review 2](#Application_materials)

[5. Funding Restrictions 2](#Application_fundingrestrictions)

[6. Other Submission Requirements 2](#__RefHeading___Toc173896749)

[V. Application Review Information 2](#__RefHeading___Toc173896750)

[1. Review Criteria 2](#Review_ReviewCriteria)

[2. Review and Selection Process 2](#__RefHeading___Toc173896752)

[3. Anticipated Announcement and Award Dates
2](#__RefHeading___Toc173896753)

[VI. Award Administration Information 2](#__RefHeading___Toc173896754)

[1. Award Notices 2](#Award_PostAwardNotice)

[2. Administrative and National Policy Requirements
2](#__RefHeading___Toc173896756)

[HEALTHY PEOPLE 2010 2](#__RefHeading___Toc173896757)

[3. Reporting 2](#Award_OtherReportingRequirements)

[VII. Agency Contacts 2](#__RefHeading___Toc173896759)

[VIII. Other Information 2](#__RefHeading___Toc173896760)

[Helpful Web Sites: 2](#__RefHeading___Toc173896761)

[ix. Tips for Writing a Strong Application
2](#__RefHeading___Toc173896762)

[APPENDIX A: HRSA's Electronic Submission User Guide
2](#__RefHeading___Toc173896763)

[1. Introduction 2](#introduction)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[4.1.1 Font 2](#font)

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

[4.1.3 Names 2](#names)

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

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

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

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

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

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

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

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

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

[6. FAQs 2](#faqs)

[6.1 Software 2](#software)

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

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

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

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

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

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

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

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

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

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

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

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

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

[Appendix B -- Registering and Applying Through Grants.gov
2](#__RefHeading___Toc173896823)

[]{#__RefHeading___Toc173896715 .anchor}**I. Funding Opportunity
Description**

[]{#Funding_purpose .anchor}

**[Purpose]{.smallcaps}**

The Small Health Care Provider Quality Improvement (Rural Quality) Grant
Program is authorized by Section 330A(g), Title III of the Public Health
Service Act, as amended. This program is available to support rural
public, rural non-profit, or other providers of healthcare services,
such as a critical access hospital or rural health clinic. The catalog
of Federal Domestic Assistance Number for this grant program is 93.912.

The purpose of the Rural Quality Grant Program is to improve patient
care and chronic disease outcomes by assisting rural primary care
providers with the implementation of quality improvement strategies.
Improving the quality of chronic disease management in primary care
settings can improve health indicators and decrease emergency room
visits or admissions to hospitals. The Rural Quality Grant Program will
focus on quality improvement for two chronic diseases, i.e., diabetes
and cardiovascular disease (CVD).

The goal of Rural Quality is to improve health outcomes through enhanced
chronic disease management in rural primary care settings by:

1.  Implementing and using an electronic patient registry system;

2.  Tracking and reporting specific health indicators by using
    nationally-accepted performance measures;

3.  Assessing the need for and implementing additional quality
    improvement activities; and

4.  Participating in technical assistance through monthly conference
    calls and peer-learning workshops with fellow Rural Quality
    grantees, facilitated by a quality improvement specialist.

    []{#__RefHeading___Toc173896717 .anchor}**[Background]{.smallcaps}**

The Health Resources and Services Administration's Office of Rural
Health Policy is the focal point for rural health activities within the
U.S. Department of Health and Human Services. The Office is statutorily
required in Title VII (Section 711) of the Social Security Act to advise
the Secretary on the effects of current policies and regulatory changes
in the programs established under titles XVIII (Medicare) and XIX
(Medicaid) on the financial viability of small rural hospitals, the
ability of rural areas to attract and retain physicians and other health
professionals and access to (and the quality of) health care in rural
areas. The Social Security Act also requires ORHP to coordinate
activities within HHS that relate to rural health care and provide
relevant information to the Secretary and others in the Department.

ORHP accomplishes this mission through two broad strategies that focus
on policy and programs. The Office addresses the specific difficulties
of providing health care in rural communities through its grant
programs. The CFDA number for this grant program is 93.912. The Rural
Quality Grant Program is authorized by the Public Health Service Act
Title II, Public Law 330A(g), (42 U.S.C. 254c).

The Rural Quality Grant Program was sponsored by ORHP for the first time
in Federal fiscal year (FY) 2006 as a two-year grant program. ORHP plans
to support another two-year grant cycle for Rural Quality starting in FY
2008. As stated in the law, the purpose of the Rural Quality Grant
Program is to provide for the planning and implementation of small
health care provider quality improvement activities.

After the release of the Institute of Medicine's (IOM) reports, "To Err
is Human" and "Crossing the Quality Chasm", improving the quality of
health care is an urgent concern in the United States. As identified by
the IOM reports, patient care should be safe, timely, effective,
efficient, patient-centered, and equitable (STEEPE). The IOM report,
"Quality Through Collaboration: The Future of Rural Health", released in
November 2004, identified that rural health care organizations can be
leaders in quality improvement.

The focus on quality improvement is not only for in-patient hospital
care, but also for primary care settings to decrease morbidity and
mortality. Improving the quality of chronic disease management in
primary care settings can improve health indicators and decrease
emergency room visits or admissions to hospitals. The Rural Quality
Grant Program focuses on improving patients' health outcomes through
enhanced chronic disease management in primary care settings.

[]{#__RefHeading___Toc173896718 .anchor}**II. Award Information**

[]{#__RefHeading___Toc173896719 .anchor}**[1. Type of
Award]{.smallcaps}**

Funding will be provided in the form of a grant.

[]{.mark}

[]{#__RefHeading___Toc173896720 .anchor}**[2. Summary of
Funding]{.smallcaps}**

[]{.mark}

> This program will provide funding for FYs 2008 and 2009. Approximately
> \$4,500,000 is expected to be available annually to fund 60 grantees.
> Therefore, Rural Quality applicants may request up to \$75,000 per
> Federal fiscal year. Funding beyond the first year is dependent on the
> availability of appropriated funds for Rural Quality in subsequent
> fiscal years, grantee satisfactory performance, and a decision that
> funding is in the best interest of the Federal government.

[]{#__RefHeading___Toc173896721 .anchor}**III. Eligibility Information**

[]{#Eligibility_who .anchor}

**[1. Eligible Applicants]{.smallcaps}**

> To be eligible for the Rural Quality Grant Program, the applicant
> organization must meet the following geographic and organization
> requirements:

a.  **Geographic Requirements:**

> Applicants for Rural Quality must meet at least one of the three
> requirements stated below. Failure to meet one of these geographic
> requirements will result in the application being considered
> ineligible and returned without review.

1.  The applicant must be located in a rural area, as determined by
    eligible rural county or census tracts, and all services must be
    provided in a rural county or census tract. To ascertain rural
    eligibility, please refer to
    <http://ruralhealth.hrsa.gov/funding/eligibilitytestv2.asp>. This
    website lists eligibility by county and census tract and includes a
    hyperlink to the Federal Financial Institutions Examining Council's
    (FFIEC) Geocoding System to determine your census tract number and
    eligibility. Failure to meet this criterion will result in the
    application being returned without review.

2.  The applicant exists exclusively to provide services to migrant and
    seasonal farmworkers in rural areas and is supported under Section
    330(g) of the Public Health Service Act, as amended.

3.  The applicant is a Tribal government whose grant-funded activities
    will be conducted within their Federally-recognized Tribal area
    (documentation of status as a Federally-recognized Native American
    Tribe must be included).

```{=html}
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```
b.  **Organization Requirements:**

```{=html}
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```
1.  The applicant must be a rural public, rural non-profit private
    health care provider or provider of healthcare services, such as a
    critical access hospital or rural health clinic or shall be another
    rural provider or network of small rural providers identified by the
    Secretary as a key source of local care and shall not previously
    have received a grant under this subsection for the same or a
    similar project.

2.  Faith-based and community-based organizations, including small
    grassroots organizations, are eligible to apply for these grants.

    []{#__RefHeading___Toc173896723 .anchor}**[2. Cost
    Sharing/Matching]{.smallcaps}**

> This program does not require cost sharing. However, applicants may
> pledge support, either cash or in-kind, to demonstrate commitment to
> the project.

**[3. Other]{.smallcaps}**

a.  **Exceeding the Ceiling Amount:**

> Applications that exceed the ceiling amount will be considered
> non-responsive and will not be considered for funding under this
> announcement. Therefore, applications which request greater than
> \$75,000 per year will not be considered.

b.  **Application Deadline:**

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

[]{#__RefHeading___Toc173896724 .anchor}**IV. Application and Submission
Information**

[]{#Application_materials .anchor}

1.  **[Address to Request Application Package]{.smallcaps}**

    []{#__RefHeading___Toc173896726 .anchor}***Application Materials***

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

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

> Or

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

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

[]{#__RefHeading___Toc173896727 .anchor}**[2. Content and Form of
Application Submission]{.smallcaps}**

[]{#Application_formatrequirements .anchor}***Application Format
Requirements***

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

# SF 424 Non Construction -- Table of Contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Position Descriptions for Key Personnel. Keep each
                      to one page in length as much as is possible.

  Attachment 2        Biographical Sketches of Key Personnel. In the
                      event that a biographical sketch is included for an
                      identified individual who is not yet hired, please
                      include a letter of commitment from that person
                      with the biographical sketch.

  Attachment 3        Organizational Chart. Provide a one-page figure
                      that depicts the organizational structure of the
                      primary care facility.

  Attachment 4        Rural Health Clinic verification letter from a
                      fiscal intermediary, if applicable.

  Attachment 5        Critical Access Hospital verification letter from a
                      fiscal intermediary, if applicable.

  Attachment 6        Any other documents relevant to the application,
                      including letters of support. Letters of support
                      must be dated.

  Attachment 7        Tables, Charts, etc. To give further details about
                      the proposal, and not requested elsewhere in this
                      Table of Contents.
  -----------------------------------------------------------------------

> Note the following specific information related to your submission.

[]{#__RefHeading___Toc173896730 .anchor}**[Application
Format]{.smallcaps}**

i.  []{#__RefHeading___Toc173896731 .anchor}***Application Face Page***

> Public Health Service (PHS) Application Form 5161-1 is provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance, the Catalog of Federal Domestic
> Assistance Number is 93.912.

[]{#__RefHeading___Toc173896732 .anchor}**DUNS [Number]{.smallcaps}**

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

ii. []{#__RefHeading___Toc173896733 .anchor}***Table of Contents***

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

iii. []{#__RefHeading___Toc173896734 .anchor}***Application Checklist***

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

iv. []{#__RefHeading___Toc173896735 .anchor}***Budget***

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

v.  []{#__RefHeading___Toc173896736 .anchor}***Budget Justification***

> Provide a narrative that explains the amounts requested for each line
> in the budget. The budget justification should specifically describe
> how each item will support the achievement of proposed objectives. The
> budget period is for ONE year. However, the applicant must submit
> one-year budgets for each of the subsequent project period years
> (usually one to three years or more) at the time of application. Line
> item information must be provided to explain the costs entered in
> Application Form 5161-1. **The budget justification must clearly
> describe each cost element and explain how each cost contributes to
> meeting the project's objectives/goals.** Be very careful about
> showing how each item in the "other" category is justified. The budget
> justification MUST be concise. Do NOT use the justification to expand
> the project narrative.
>
> **Budget for Multi-Year Grant Award**
>
> This announcement is inviting applications for project periods up to
> two years. Awards, on a competitive basis, will be for a one‑year
> budget period, although project periods may be for two years.
> Applications for continuation grants funded under these awards beyond
> the one-year budget period but within the two-year project period will
> be entertained in subsequent years on a noncompetitive basis, subject
> to availability of funds, satisfactory progress of the grantee and a
> determination that continued funding would be in the best interest of
> the Government.
>
> []{.mark}
>
> Include the following in the Budget Justification narrative:
>
> **Personnel Costs**: Personnel costs should be explained by listing
> each staff member who will be supported from funds, name (if
> possible), position title, percent full time equivalency and annual
> salary.
>
> **Indirect Costs**: Indirect costs are those costs incurred for common
> or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. For institutions subject to OMB Circular A-21, the term
> "facilities and administration" is used to denote indirect costs. If
> an organization applying for an assistance award does not have an
> indirect cost rate, the applicant may wish to obtain one through HHS's
> Division of Cost Allocation (DCA).  Visit DCA's website at:
> <http://rates.psc.gov/> to learn more about rate agreements, the
> process for applying for them, and the regional offices which
> negotiate them.
>
> **Fringe Benefits**: List the components that comprise the fringe
> benefit rate, for example health insurance, taxes, unemployment
> insurance, life insurance, retirement plan, tuition reimbursement. The
> fringe benefits should be directly proportional to that portion of
> personnel costs that are allocated for the project.
>
> **Travel**: List travel costs according to local and long distance
> travel. For local travel, the mileage rate, number of miles, reason
> for travel and staff member/consumers completing the travel should be
> outlined. The budget should also reflect the travel expenses
> associated with sending up to three key staff members to participate
> in two, peer-learning workshops each fiscal year as a condition of the
> award. These semi-annual peer-learning workshops will be approximately
> two days, occurring in the winter and summer, either in the Washington
> D.C metropolitan area or a central location in the U.S.
>
> **Equipment**: List equipment costs and provide justification for the
> need of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items that meet the definition of equipment (a unit cost of
> \$5000 and a useful life of one or more years). No more than 40
> percent of the Federal share for each budget period may be spent on
> equipment.
>
> **Supplies:** List the items that the project will use. In this
> category, separate office supplies from medical and educational
> purchases. Office supplies could include paper, pencils, and the like;
> medical supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately. The justification to
> purchase a computer and/or electronic patient registry system should
> be provided in this section.
>
> **Subcontracts**: To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> **Other**: Put all costs that do not fit into any other category into
> this category and provide and explanation of each cost in this
> category. In some cases, grantee rent, utilities and insurance fall
> under this category if they are not included in an approved indirect
> cost rate.)

vi. []{#__RefHeading___Toc173896737 .anchor}***Staffing Plan and
    Personnel Requirements***

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Position descriptions that include the roles,
> responsibilities, and qualifications of proposed project staff must be
> included in Attachment 1. Copies of biographical sketches for any key
> employed personnel that will be assigned to work on the proposed
> project must be included in Attachment 2.

vii. []{#__RefHeading___Toc173896738 .anchor}***Assurances***

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

viii. []{#__RefHeading___Toc173896739 .anchor}***Certifications***

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

ix. []{#__RefHeading___Toc173896740 .anchor}***Project Abstract***

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

-   Project Title

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

> The project abstract must be single-spaced and limited to one page in
> length. The project abstract should be attached in Box 15, Descriptive
> Title of Applicants Project on the SF 424 face page. From Box 15,
> click "add attachments" and follow the instructions. When finished,
> click "attach" and "done."

i.  []{#__RefHeading___Toc173896741 .anchor}***Program Narrative***

> This section provides a comprehensive framework and description for
> all aspects of the proposed program. It should be succinct,
> self-explanatory and well organized so that reviewers can understand
> the proposed project.
>
> HRSA is committed to ensuring access to quality health care for all.
> Quality care means access to services, information, materials
> delivered by competent providers in a manner that factor in the
> language needs, cultural richness, and diversity of populations
> served.
>
> Quality also means that, where appropriate, data collection
> instruments used should adhere to culturally competent and
> linguistically appropriate norms. For additional information and
> guidance, refer to the National Standards for Culturally and
> Linguistically Appropriate Services in Health Care published by the
> U.S. Department of Health and Human Services. This document is
> available online at http://www.omhrc.gov/CLAS.
>
> Wherever appropriate, present a summary of specific training, and /or
> learning experiences to develop knowledge and appreciation of how
> culture and language influences health literacy improvement and the
> delivery of high quality, effective and predictably safe healthcare
> services.
>
> Please use the following section headers for the Narrative:
>
> **NEED:**
>
> This section should briefly describe the purpose of the proposed
> project. It should outline the needs of your community and/or primary
> care facility, as they relate to chronic disease management of
> diabetes and CVD. The target population and its unmet health needs
> must be described and documented in this section. Demographic data
> should be used and cited whenever possible to support the information
> provided. Also, provide an explanation why Federal assistance is
> required to carry out the project.
>
> **RESPONSE:**
>
> In a workplan, describe the quality improvement activities that will
> be used to improve chronic disease outcomes. In addition, provide a
> timeline that includes each activity and identifies responsible staff.
> The workplan should describe how the applicant will:

-   Acquire and implement an electronic patient registry system, such as
    DocSite or the Patient Electronic Care System (PECS). Having an
    electronic patient registry system will enable Rural Quality
    grantees to track individual patient or a population based on
    chronic disease and demographics. Grantees will be encouraged to use
    the quality improvement specialist through the Rural Quality Grant
    Program to guide them regarding which system to purchase. Therefore,
    it is acceptable for a grantee to purchase an electronic patient
    registry system after the project start date. (In the Budget
    Justification section, applicants should include details about plans
    to purchase the system.)

-   Track and report specific health indicators by using
    nationally-accepted performance measures. Applicants are expected
    explain how they will track and report the data collected for the
    performance measures listed in the Evaluation section below.

-   Implement quality improvement activities for diabetes during the
    first year and add quality improvement activities for CVD during the
    second year. Applicants are expected to have a quality improvement
    team that uses the Chronic Care Model and the Plan, Do, Study, Act
    (PDSA) Model to implement quality improvement activities. Given that
    Rural Quality grantees will have access to a quality improvement
    specialist, including information technology support, applicants
    should discuss how this technical assistance will be utilized.

-   Participate in technical assistance through monthly conference calls
    and peer-learning workshops provided by the quality improvement
    specialist through the Rural Quality Grant Program. Applicants
    should also discuss how they will use a list serve and a virtual
    office, which will be provided through the Rural Quality Grant
    Program, to participate in peer-learning and receive technical
    assistance.

-   Resolve challenges that might be encountered when implementing the
    quality improvement activities.

-   Sustain the quality improvement activities after completion of the
    Rural Quality Grant Program.

> **EVALUATIVE MEASURES:**
>
> Provide a description of how the project will be evaluated. Program
> evaluation should include the use of the Plan, Do, Study, Act (PDSA)
> Model for internal, on-going evaluation. Applicants may also obtain an
> external evaluator.
>
> In addition, this section should identify and cite six
> nationally-accepted performance measures: three for diabetes and three
> for CVD. The measures will be used to track the health outcomes for
> the quality improvement activities implemented. Rural Quality grantees
> will report monthly on these six, nationally-accepted performance
> measures. This will occur during monthly conference calls with the
> quality improvement specialist and fellow grantees to facilitate
> peer-learning and to provide technical assistance.
>
> Six examples of a nationally-accepted, quality improvement performance
> measures for diabetes and CVD are provided below. These measures are
> all used by HRSA's Bureau of Primary Health Care for chronic disease
> management of diabetes and CVD. Applicants are encouraged to use these
> measures in their application. If alternate measures are chosen,
> applicants should cite each measure to document that it is a
> nationally-accepted measure.
>
> Diabetes:

-   Average HbA1c

> Goal: Average HbA1c of \<7% for patients with a diagnosis of diabetes

-   Patients with blood pressure \<130/80 mm/Hg

> Goal: Greater than 40% of patients with a diagnosis of diabetes have a
> blood pressure \<130/80 mm/Hg

-   Patients with LDL \<100 mg/dL

> Goal: Greater than 70% of patients with a diagnosis of diabetes have
> LDL \<100mm/dL
>
> CVD:

-   Patients with blood pressure \<140/90 mm/Hg

> Goal: Greater than 40% of patients with a diagnosis of CVD have blood
> pressure of \<140/90 mm/Hg

-   Patients with LDL \<130 mg/dL

> Goal: Greater than 70% of patients with a diagnosis of CVD have a LDL
> \<130mm/dL.

-   Patients who are current smokers

> Goal: \<12% of patients with a diagnosis of CVD are current smokers.
>
> **IMPACT**
>
> Describe the impact that your diabetes and CVD quality improvement
> activities will have on the target population and community. Identify
> ways to disseminate the information regionally or nationally,
> including efforts by grassroots, faith-based or community-based
> organizations.
>
> Applicants are expected to identify ways to spread their quality
> improvement activities after the Rural Quality Grant Program is
> complete. Two examples include: spreading to incorporate another
> chronic disease (e.g. asthma, obesity, cancer, etc.) within the same
> primary care facility or spreading the current activities to a
> neighboring primary care facility.
>
> **RESOURCES AND CAPABILITIES**
>
> Describe current experience, skills, and knowledge of staff at the
> primary care facility, which will enable the applicant to fulfill the
> Rural Quality Grant Program requirements and meet expectations.
> Applicants should include information about the staff members serving
> on the quality improvement team, previous quality improvement
> initiatives or activities, and an organizational chart for the primary
> care facility.
>
> Identify a permanent director to manage the quality improvement
> activities, the budget, and attend workshops for the Rural Quality
> Grant Program. Applicants must have a financial management system in
> place and have the capability to manage the grant. Applicants should
> document how they plan to:

-   Exercise administrative and programmatic direction over grant-funded
    activities;

-   Be responsible for hiring and managing the grant-funded staff;

-   Demonstrate the administrative and accounting capabilities to manage
    the grant funds;

-   Have at least one permanent staff at the time a grant award is made;
    and

-   Have an Employer Identification Number (EIN) from the Internal
    Revenue Service.

> A private, non-profit applicant must include evidence of its
> non-profit status with the application. Acceptable documents that
> provide proof of an applicant's non-profit status can be found in form
> PHS 5161-1 at the top of page 26.
>
> A for-profit Rural Health Clinic or a for-profit Critical Access
> Hospital must include, in Attachment 4 or 5 (respectively), a recent
> verification letter from their fiscal intermediary. The verification
> letter must provide documentation of their Rural Health Clinic status
> or Critical Access Hospital.
>
> Applicants receiving Federal and/or State funds aimed to improve
> chronic disease management for diabetes and/or CVD during FY 2008-2010
> are not eligible for the Rural Quality Grant Program. This is to limit
> duplication of Federal and/or State funds for the same quality
> improvement activities.
>
> **Support requested**
>
> The budget section should be sufficient to allow reviewers to
> determine the reasonableness of the support requested. This section
> should also include a request for funding preference, if applicable.
> Please refer to the Funding Preference section (pages 25-26) to
> determine if your organization qualifies. Qualified applicants that
> would like to request a funding preference must request it explicitly
> in this Support Requested section. The request must state that a
> funding preference is requested and which specific funding preference
> is being requested (i.e. HPSA, MUC and/or MUP).

[]{.mark}

i.  []{#__RefHeading___Toc173896742 .anchor}**Attachments**

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative. Be
> sure each attachment is clearly labeled.
>
> **Attachment 1:** Position Descriptions for Key Personnel. Keep each
> to one page in length as much as is possible.
>
> []{.mark}
>
> **Attachment 2**: Biographical Sketches of Key Personnel. In the event
> that a biographical sketch is included for an identified individual
> who is not yet hired, please include a letter of commitment from that
> person with the biographical sketch.
>
> **Attachment 3:** Organizational Chart. Provide a one-page figure that
> depicts the organizational structure of the primary care facility.
>
> **Attachment 4**: Rural Health Clinic verification letter from a
> fiscal intermediary, if applicable.
>
> **Attachment 5:** Critical Access Hospital verification letter from a
> fiscal intermediary, if applicable.
>
> **Attachment 6:** Any other documents relevant to the application,
> including letters of support. Letters of support must be dated.
>
> **Attachment 7**: Tables, Charts, etc. To give further details about
> the proposal, and not requested elsewhere in this Table of Contents.
>
> **Include only letters of support which specifically indicate a
> commitment to the project/program (in-kind services, dollars, staff,
> space, equipment, etc.) Letters of agreements and support must be
> dated. List all other support letters on one page.**

[]{.mark}

[]{#__RefHeading___Toc173896743 .anchor}**[3. Submission Dates and
Times]{.smallcaps}**

[]{#Application_intent .anchor}

i.  **Notification of Intent to Apply**

> An applicant is eligible to apply even if no letter of intent is
> submitted.
>
> The letter should identify the applicant organization and its intent
> to apply, and briefly describe the proposal to be submitted. Receipt
> of Letters of Intent will *not* be acknowledged.
>
> This letter should be sent by **February 8, 2008** by mail or fax to:
>
> Director, Division of Independent Review
>
> HRSA Grants Application Center (GAC)
>
> HRSA-08-058
>
> The Legin Group, Inc.
>
> 910 Clopper Road, Suite 155 South
>
> Gaithersburg, MD 20878
>
> *Fax: 877/477-2345*

ii. []{#__RefHeading___Toc173896745 .anchor}***Application Due Date***

> The due date for applications under this grant announcement is March
> 20, 2008 at 8:00 P.M. ET. Applications will be considered as meeting
> the deadline if they are E marked on or before the due date. Please
> consult Appendix A, Section 3 for detailed instructions on submission
> requirements.
>
> The Chief Grants Management Officer (CGMO) or a higher level designee
> may authorize an extension of published deadlines when justified by
> circumstances such as acts of God (e.g. floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> Applications must be submitted by 8:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you register immediately in Grants.gov (see
> Appendix B) and complete the forms as soon as possible, as this is a
> new process and may take some time.**
>
> **Please refer to Appendix B for important specific information on
> registering, and Appendix A, Section 3 for important information on
> applying through Grants.gov.**

iii. []{#__RefHeading___Toc173896746 .anchor}***Late applications:***

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

**[4. Intergovernmental Review]{.smallcaps}**

> The Rural Quality Grant Program is subject to the provisions of
> Executive Order 12372, as implemented by 45 CFR 100. Executive Order
> 12372 allows States the option of setting up a system for reviewing
> applications from within their States for assistance under certain
> Federal programs. Application packages made available under this
> guidance will contain a listing of States which have chosen to set up
> such a review system, and will provide a State Single Point of Contact
> (SPOC) for the review. Information on states affected by this program
> and State Points of Contact may also be obtained from the Grants
> Management Officer listed in the AGENCY Contact(s) section, as well as
> from the following Web site:
> <http://www.whitehouse.gov/omb/grants/spoc.html>.
>
> All applicants other than federally recognized Native American Tribal
> Groups should contact their SPOC as early as possible to alert them to
> the prospective applications and receive any necessary instructions on
> the State process used under this Executive Order.
>
> Letters from the State Single Point of Contact (SPOC) in response to
> Executive Order 12372 are due sixty days after the application due
> date.

[]{#Application_fundingrestrictions .anchor}

**[5. Funding Restrictions]{.smallcaps}**

> Applicants responding to this announcement may request funding for a
> project period of up to two (2) years, at no more than \$75, 000 per
> year. Awards to support projects beyond the first budget year will be
> contingent upon Congressional appropriation, satisfactory progress in
> meeting the project's objectives, and a determination that continued
> funding would be in the best interest of the government.
>
> []{.mark}
>
> Funds under this announcement may not be used, either directly or
> through contract, to pay for the purchase, construction, renovation or
> improvement of facilities or real property.
>
> No more than 40 percent of the Federal share for each budget period
> may be spent on equipment.
>
> Applicants receiving Federal and/or State funds aimed to improve
> chronic disease management for diabetes and/or CVD during FY 2008-2010
> are not eligible for the Rural Quality Grant Program. This is to limit
> duplication of Federal and/or State funds for the same quality
> improvement activities.

[]{#__RefHeading___Toc173896749 .anchor}**[6. Other Submission
Requirements]{.smallcaps}**

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

[]{#__RefHeading___Toc173896750 .anchor}**V. Application Review
Information**

[]{#Review_ReviewCriteria .anchor}

**[1. Review Criteria]{.smallcaps}**

> Procedures for assessing the technical merit of grant applications
> have been instituted to provide for an objective review of
> applications and to assist the applicant in understanding the
> standards against which each application will be judged. Critical
> indicators have been developed for each review criterion to assist the
> applicant in presenting pertinent information related to that
> criterion and to provide the reviewer with a standard for evaluation.
> Review criteria are outlined below with specific detail and scoring
> points.
>
> Review Criteria are used to review and rank applications. The Rural
> Quality Grant Program has six review criteria:

**Criterion 1**: NEED (10 points)

> This includes the purpose of the proposed project. It should outline
> the needs of your community and/or primary care facility, as they
> relate to chronic disease management of diabetes and CVD. The target
> population and its unmet health needs must be described and documented
> in this section. Demographic data should be used and cited whenever
> possible to support the information provided. Also, an explanation
> should be provided about why Federal assistance is required to carry
> out the project.

**Criterion 2**: RESPONSE (25 points)

> This includes a workplan, describing the quality improvement
> activities that will be used to improve chronic disease outcomes. In
> addition, a timeline should be provided that includes each activity
> and identifies responsible staff. The workplan should describe how the
> applicant will:

-   Acquire and implement an electronic patient registry system, such as
    DocSite or the Patient Electronic Care System (PECS). Having an
    electronic patient registry system will enable Rural Quality
    grantees to track individual patient or a population based on
    chronic disease and demographics. Grantees will be encouraged to use
    the quality improvement specialist through the Rural Quality Grant
    Program to guide them regarding which system to purchase. Therefore,
    it is acceptable for a grantee to purchase an electronic patient
    registry system after the project start date. (In the Budget
    Justification section, applicants should include details about plans
    to purchase the system.)

-   Track and report specific health indicators by using
    nationally-accepted performance measures. Applicants are expected
    explain how they will track and report the data collected for the
    performance measures listed in the Evaluation section below.

-   Implement quality improvement activities for diabetes during the
    first year and add quality improvement activities for CVD during the
    second year. Applicants are expected to have a quality improvement
    team that uses the Chronic Care Model and the Plan, Do, Study, Act
    (PDSA) Model to implement quality improvement activities. Given that
    Rural Quality grantees will have access to a quality improvement
    specialist, including information technology support, applicants
    should discuss how this technical assistance will be utilized.

-   Participate in technical assistance through monthly conference calls
    and peer-learning workshops provided by the quality improvement
    specialist through the Rural Quality Grant Program. Applicants
    should also discuss how they will use a list serve and a virtual
    office, which will be provided through the Rural Quality Grant
    Program, to participate in peer-learning and receive technical
    assistance.

-   Resolve challenges that might be encountered when implementing the
    quality improvement activities.

-   Sustain the quality improvement activities after completion of the
    Rural Quality Grant Program.

**Criterion 3**: EVALUATIVE MEASURES (15 points)

> This includes a description of how the project will be evaluated.
> Program evaluation should include the use of the Plan, Do, Study, Act
> (PDSA) Model for internal, on-going evaluation. Applicants may also
> obtain an external evaluator.
>
> In addition, this section should identify and cite six
> nationally-accepted performance measures: three for diabetes and three
> for CVD. The measures will be used to track the health outcomes for
> the quality improvement activities implemented. Rural Quality grantees
> will report monthly on these six, nationally-accepted performance
> measures. This will occur during monthly conference calls with the
> quality improvement specialist and fellow grantees to facilitate
> peer-learning and to provide technical assistance.
>
> Six examples of a nationally-accepted, quality improvement performance
> measures for diabetes and CVD are provided below. These measures are
> all used by HRSA's Bureau of Primary Health Care for chronic disease
> management of diabetes and CVD. Applicants are encouraged to use these
> measures in their application. If alternate measures are chosen,
> applicants should cite each measure to document that it is a
> nationally-accepted measure.
>
> Diabetes:

-   Average HbA1c

-   Goal: Average HbA1c of \<7% for patients with a diagnosis of
    diabetes

-   Patients with blood pressure \<130/80 mm/Hg

-   Goal: Greater than 40% of patients with a diagnosis of diabetes have
    a blood pressure \<130/80 mm/Hg

-   Patients with LDL \<100 mg/dL

-   Goal: Greater than 70% of patients with a diagnosis of diabetes have
    LDL \<100mm/dL

> CVD:

-   Patients with blood pressure \<140/90 mm/Hg

-   Goal: Greater than 40% of patients with a diagnosis of CVD have
    blood pressure of \<140/90 mm/Hg

-   Patients with LDL \<130 mg/dL

-   Goal: Greater than 70% of patients with a diagnosis of CVD have a
    LDL \<130mm/dL.

-   Patients who are current smokers

-   Goal: \<12% of patients with a diagnosis of CVD are current smokers.

**Criterion 4**: IMPACT (15 points)

> This includes a description of the impact that the diabetes and CVD
> quality improvement activities will have on the applicant's target
> population and community. Applicants should identify ways to
> disseminate the information regionally or nationally, including
> efforts by grassroots, faith-based or community-based organizations.
>
> Applicants are expected to identify ways to spread their quality
> improvement activities after the Rural Quality Grant Program is
> complete. Two examples include: spreading to incorporate another
> chronic disease (e.g. asthma, obesity, cancer, etc.) within the same
> primary care facility or spreading the current activities to a
> neighboring primary care facility.
>
> **Criterion 5**: RESOURCES AND CAPABILITIES (20 points)
>
> Describe current experience, skills, and knowledge of staff at the
> primary care facility, which will enable the applicant to fulfill the
> Rural Quality Grant Program requirements and meet expectations.
> Applicants should include information about the staff members serving
> on the quality improvement team, previous quality improvement
> initiatives or activities, and an organizational chart for the primary
> care facility.
>
> Identify a permanent director to manage the quality improvement
> activities, the budget, and attend workshops for the Rural Quality
> Grant Program. Applicants must have a financial management system in
> place and have the capability to manage the grant. Applicants should
> document how they plan to:

-   Exercise administrative and programmatic direction over grant-funded
    activities;

-   Be responsible for hiring and managing the grant-funded staff;

-   Demonstrate the administrative and accounting capabilities to manage
    the grant funds;

-   Have at least one permanent staff at the time a grant award is made;
    and

-   Have an Employer Identification Number (EIN) from the Internal
    Revenue Service.

> A private, non-profit applicant must include evidence of its
> non-profit status with the application. Acceptable documents that
> provide proof of an applicant's non-profit status can be found in form
> PHS 5161-1 at the top of page 26.
>
> A for-profit Rural Health Clinic or a for-profit Critical Access
> Hospital must include, in Attachment 4 or 5 (respectively), a recent
> verification letter from their fiscal intermediary. The verification
> letter must provide documentation of their Rural Health Clinic status
> or Critical Access Hospital.
>
> Applicants receiving Federal and/or State funds aimed to improve
> chronic disease management for diabetes and/or CVD during FY 2008-2010
> are not eligible for the Rural Quality Grant Program. This is to limit
> duplication of Federal and/or State funds for the same quality
> improvement activities.
>
> **Criterion 6:** SUPPORT REQUESTED (15 points)
>
> This includes sufficient information in the budget section to allow
> reviewers to determine the reasonableness of the support requested.
> This section may also include a request for funding preference, if
> applicable. Funding preference definitions are provided in the Funding
> Preference section (pages 25-26) to determine if an applicant
> qualifies. Qualified applicants that request a funding preference must
> request it explicitly in this Support Requested section. The request
> must state that a funding preference is requested and which specific
> funding preference is being requested (i.e. HPSA, MUC and/or MUP).

[]{#__RefHeading___Toc173896752 .anchor}**[2. Review and Selection
Process]{.smallcaps}**

> The Division of Independent Review is responsible for managing
> objective reviews within HRSA. Applications competing for federal
> funds receive an objective and independent review performed by a
> committee of experts qualified by training and experience in
> particular fields or disciplines related to the program being
> reviewed. In selecting review committee members, other factors in
> addition to training and experience may be considered to improve the
> balance of the committee, e.g., geographic distribution. Each reviewer
> is screened to avoid conflicts of interest and is responsible for
> providing an objective, unbiased evaluation based on the review
> criteria noted above. The committee provides expert advice on the
> merits of each application to program officials responsible for final
> selections for award.
>
> Applications that pass the initial HRSA eligibility screening will be
> reviewed and rated by a panel based on the program elements and review
> criteria presented in relevant sections of this program announcement.
> The review criteria are designed to enable the review panel to assess
> the quality of a proposed project and determine the likelihood of its
> success.  The criteria are closely related to each other and are
> considered as a whole in judging the overall quality of an
> application.

[]{.mark}

**[Funding Preferences]{.smallcaps}**

> The authorizing legislation provides a funding preference for some
> applicants. Applicants receiving the funding preference will be placed
> in a more competitive position among applications that can be funded.
> Applications that do not receive a funding preference will be given
> full and equitable consideration during the review process. The law
> provides that a funding preference be granted to any qualified
> applicant that specifically requests the preference and meets the
> criteria for the preference as follows:

1.  Those applicants where the service area is located in an officially
    designated health professional shortage areas (HPSA);

2.  Is a medically underserved community (MUC);

3.  Serves medically underserved populations (MUPs); or

4.  Entities that propose to develop projects with a focus on primary
    care, and wellness and prevention strategies.

> To ascertain HPSA and MUP designation status, please refer to the
> following website: <http://bhpr.hrsa.gov/shortage/index.htm>.
>
> To qualify as a Medically Underserved Community (MUC), the project
> must include facilities that are federally designated as one of the
> following:

-   Rural Health Clinics

-   Community Health Centers

-   Migrant Health Centers

-   Health Care for the Homeless Grantees

-   Public Housing Primary Care Grantees

-   National Health Service Corps sties

-   Indian Health Service Sites

-   Federally Qualified Health Centers

-   Primary Medical Care Health Professional Shortage Areas

-   Dental Health Professional Shortage Areas

-   Nurse Shortage Areas

-   State or Local Health Departments

-   Ambulatory practice sites designated by State Governors as serving
    medically underserved communities; or

-   Applicants whose projects focus on primary care, and wellness and
    prevention strategies.

> To receive a funding preference, applicants must request and clearly
> identify which preference they are requesting the Support Requested
> section of the Program Narrative as instructed in the program guidance
> and application instructions.

**[Funding Special Considerations]{.smallcaps}**

> Special considerations are factors considered in making funding
> decisions that are neither review criteria nor preference, e.g.,
> ensuring that there is an equitable geographic distribution of grant
> recipients. ORHP seeks to distribute the Rural Quality Grant Program
> into a variety of geographic locations and provider types.
> Consequently, ORHP will consider geographic location and provider type
> when deciding which approved applications to fund.

[]{#__RefHeading___Toc173896753 .anchor}**[3. Anticipated Announcement
and Award Dates]{.smallcaps}**

> The FY08 Rural Quality Grant Program applications are scheduled to be
> reviewed early in June 2008. Applicants will be mailed a summary
> assessment of their proposal, with the application score, in early
> August. It is expected that the Notice of Grant Award (NGA) will be
> sent electronically to successful applicants, from Grants Management,
> in August 2008. Applicants, whether successful or not, should receive
> written notification of the funding decision from the Office of Rural
> Health Policy, by August 18, 2008.

[]{#__RefHeading___Toc173896754 .anchor}**VI. Award Administration
Information**

[]{#Award_PostAwardNotice .anchor}

**[1. Award Notices]{.smallcaps}**

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

[]{#__RefHeading___Toc173896756 .anchor}**[2. Administrative and
National Policy Requirements]{.smallcaps}**

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

**PUBLIC POLICY ISSUANCE**

[]{.mark}

[]{#__RefHeading___Toc173896757 .anchor}**HEALTHY PEOPLE 2010**

> **Healthy People 2010** is a national initiative led by HHS that sets
> priorities for all HRSA programs. The initiative has two major goals:
> (1) To increase the quality and years of a healthy life; and (2)
> Eliminate our country's health disparities. The program consists of 28
> focus areas and 467 objectives. HRSA has actively participated in the
> work groups of all the focus areas, and is committed to the
> achievement of the Healthy People 2010 goals.
>
> Applicants must summarize the relationship of their projects and
> identify which of their programs objectives and/or sub-objectives
> relate to the goals of the Healthy People 2010 initiative.
>
> Copies of the Healthy People 2010 may be obtained from the
> Superintendent of Documents or downloaded at the Healthy People 2010
> website: [http://www.health.gov/healthypeople/document]{.underline}/.

[]{.mark}

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

[]{#Award_OtherReportingRequirements .anchor}

**[3. Reporting]{.smallcaps}**

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

a.  **Audit Requirements**

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

b.  **Payment Management Requirements**

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

c.  **Status Reports**

> Submit a **Financial Status Report (SF-269)**. A financial status
> report is required within 90 days of the end of each budget period.
> The report is an accounting of expenditures under the project that
> year. More specific information will be included in the award notice
> and can be found on <http://www.psc.gov/forms/sf/>.
>
> Submit a **Progress Report**(s). Further information will be provided
> in the award notice.
>
> Submit other reports as noted on your Notice of Grant Award
>
> d\. **Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. As part of this agency-wide
> effort, HRSA grantees will be required to participate, where
> appropriate, in an on-site performance review of their HRSA funded
> program(s) by a review team from one of the ten OPR regional
> divisions. Grantees should expect to participate in a performance
> review at some point during their project period. When a grantee
> receives more than one HRSA grant, each of the grantee's HRSA funded
> programs will be reviewed during the same performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees will
> be required to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. In addition, performance reviews also
> provide an opportunity for grantees to offer direct feedback to the
> agency about the impact of HRSA policies on program implementation and
> performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

e\. **ORHP Draft Performance Measures**

> []{.mark}
>
> The Office of Rural Health Policy (ORHP) is in the process of
> identifying specific performance measures that grantees will be
> required to utilize in future non-competing continuation applications.
> Performance measures can be process or outcome measures that allow
> grantees to track their progress toward meeting stated objectives. We
> expect that there will be approximately two or three cross-cutting
> performance measures that will be relevant for all applicants. Once
> these measures are finalized by ORHP, all ORHP grantees will be
> required to use them, and to provide data on these measures annually
> in their non-competing continuation applications for continued
> funding. The measures for the Rural Quality Grant Program are:
>
> Access to Care

-   Total number of people (unduplicated encounters) served.

-   Total number of encounters.

-   Number of people in the target population.

-   Number of people in the target population with access to
    new/expanded programs/services.

-   Number of new and/or expanded services provided.

-   Type(s) of new and/or expanded services provided.

[]{.mark}

> Population Demographics

-   Number of people served by race and ethnicity.

-   Number of people served by age group that received services.

> []{.mark}
>
> Under- and Uninsured

-   Number of total people enrolled for public assistance.

-   Number of total people enrolled for Medicare.

-   Number of total people enrolled for Medicaid.

-   Number of total people enrolled for SCHIP.

-   Number of people who pay out-of-pocket for all or part of the
    services received.

-   Number of people who use third-party payments to pay for all or part
    of the services received.

-   Number of people who receive charity care.

> Sustainability

-   Annual project revenue made through the new or expanded services
    offered through the project.

> In addition to the cross-cutting measures, ORHP will be requiring one
> or two issue-area-specific measures. It has become clear that the
> majority of Rural Quality grantees consistently address a handful of
> topics, such as chronic disease management, health information
> technology, health care workforce issues, etc. We are finalizing a
> list of several performance measures for each major issue area, and
> will ask grantees to select one or two measures from the issue area(s)
> being addressed by their grant. Once a relevant measure is selected,
> it should be used consistently throughout the remainder of the grant.
> Below are several categories of measures based on common focus areas
> of Rural Quality Grant Program projects. In the future, grantees will
> be asked to select one or two from the category best fits your
> project's focus.
>
> Health Promotion/ Disease Prevention

-   Number of health promotion/disease management activities offered to
    the public through this project.

-   Does the project have intentions to spread chronic disease
    management to other diseases? If yes, which diseases?

-   Average HbA1c (Goal: Average HbA1c of \<7% for patients with a
    diagnosis of diabetes)

-   Patients with blood pressure \<130/80 mm/Hg (Goal: Greater than 40%
    of patients with a diagnosis of diabetes have a blood pressure
    \<130/80 mm/Hg)

-   Patients with LDL \<100 mg/dL (Goal: Greater than 70% of patients
    with a diagnosis of diabetes have LDL \<100mm/dL)

-   Patients with blood pressure \<140/90 mm/Hg (Goal: Greater than 40%
    of patients with a diagnosis of CVD have blood pressure of \<140/90
    mm/Hg)

-   Patients with LDL \<130 mg/dL (Goal: Greater than 70% of patients
    with a diagnosis of CVD have a LDL \<130mm/dL)

-   Patients who are current smokers (Goal: \<12% of patients with a
    diagnosis of CVD are current smokers)

> Clinical

-   Number of clinical guidelines / benchmarks adopted.

> Health Information Technology

-   Type(s) of technology implemented, expanded or strengthened through
    this project.

> Workforce

-   Number of new staff recruited to work on the project.

-   Type(s) of new Clinical staff recruited to work on the project.

-   Type(s) of new Non-Clinical staff recruited to work on the project.

-   Number of people trained.

    []{#__RefHeading___Toc173896759 .anchor}**VII. Agency Contacts**

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

Inge Cooper, Grants Management Specialist

HRSA/OFAM/Division of Grants Management Operations

Parklawn Building, Room 11A-02

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-594-4236

Fax: 301-594-6096

Email: icooper@hrsa.gov

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

Elizabeth Rezai-zadeh

Rural Quality Grant Program Coordinator

HRSA, ORHP

HRSA/Office of Rural Health Policy

Parklawn Building, Room 9A-55

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301/443-4107

Fax: 301/443-2803

Email: ERezai@hrsa.gov

Technical assistance regarding this funding announcement may be obtained
by contacting:

Elizabeth Rezai-zadeh

Rural Quality Grant Program Coordinator

HRSA, ORHP

HRSA/Office of Rural Health Policy

Parklawn Building, Room 9A-55

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301/443-4107

Fax: 301/443-2803

Email: ERezai@hrsa.gov

[]{#__RefHeading___Toc173896760 .anchor}**VIII. Other Information**

[]{#__RefHeading___Toc173896761 .anchor}**[Helpful Web
Sites:]{.smallcaps}**

> HRSA's Office of Rural Health Policy web site:
> [www.ruralhealth.hrsa.gov](http://www.ruralhealth.hrsa.gov/).

[]{#__RefHeading___Toc173896762 .anchor}**ix. Tips for Writing a Strong
Application**

[]{.mark}

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

[]{#__RefHeading___Toc173896763 .anchor}APPENDIX A: HRSA's Electronic
Submission User Guide

# 1. Introduction

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

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

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

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

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

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

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

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

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

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

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

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

# 2. Noncompeting Continuation Application

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

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

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

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

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

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

-   Authorizing Official (AO),

-   Business Official (BO), and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# 3. Competing Application

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

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

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

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

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

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

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

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

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

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

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

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

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

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# 4. General Instructions for Application Submission

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

-   

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

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

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

### 4.1.1 Font  {#font .unnumbered}

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

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

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

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

### 4.1.3 Names {#names .unnumbered}

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

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

Please put all section headings flush left in bold type.

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

**Electronic Submissions**

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

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

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

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

**Electronic Submissions**

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

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

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

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

HRSA uses two standard packages from Grants.gov.

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

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

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

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

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

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

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

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

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

# 5. Customer Support Information

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

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

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

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

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

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

Please visit HRSA EHBs for online help. Go to:

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

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

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

# 6. FAQs

## 6.1 Software {#software .unnumbered}

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

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

**System Requirements:**

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

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

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

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

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

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

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

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

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

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

Grants.gov website states:

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

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

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

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

IE 6.0 and above is the recommended browser.

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

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

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

###  {#section .unnumbered}

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

**Competing Submissions:**

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

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

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

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

**Noncompeting Submissions:**

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

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

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

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

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

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

[]{#__RefHeading___Toc173896823 .anchor}**Appendix B -- Registering and
Applying Through Grants.gov**

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

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

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

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

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

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

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

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

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

Step 1: Register your organization

Step 2: Register yourself as an Authorized Organization Representative

Step 3: Get authorized by your organization to submit grants

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

Follow this checklist to complete your registration---

1\. Register Your Organization

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

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

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

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

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

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

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

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

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

**REGISTER YOUR ORGANIZATION**

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

**Obtain your organization's DUNS number**

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

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

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

**Register your organization with CCR**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**2. Register with Grants.gov**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**Formal Submission of the Electronic Application**

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

Competitive applications will be considered as having met the deadline
if the application has been successfully transmitted electronically by
your organization's Authorizing Official through Grants.gov on or before
the deadline date and time.

**Performance Measures for Competitive Applications**

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

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

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