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

**Health Resources and Services Administration**

*Maternal and Child Health Bureau*

*Division of Healthy Start and Perinatal Services*

> ***Fetal Alcohol Spectrum Disorders***
>
> ***New Competition***
>
> *(Cooperative Agreement)*
>
> *Announcement No. HRSA-07-144*
>
> **Catalog of Federal Domestic Assistance (CFDA) No. 93.110**

**PROGRAM GUIDANCE**

Fiscal Year *2007*

**Application Due Date in Grants.gov: July 20, 2007**

**Release Date: *June 20, 2007***

**Date of Issuance*: June 20, 2007***

> *Contact Name: John H. McGovern*
>
> *Title, Office: Division of Healthy Start and Perinatal Services*
>
> *Telephone: 301-443-0543*

*Fax: 301-594-0186*

Authority: *Social Security Act, Title V, section 501 (a) (2)*

**\[This page intentionally left blank\]**

**Table of Content**

[I. Funding Opportunity Description 3](#__RefHeading___Toc128466305)[A.
Purpose 3](#Funding_purpose)

[B. Background 3](#__RefHeading___Toc128466307)

[II. Award Information 3](#__RefHeading___Toc128466308)

[A. Type of Award 3](#__RefHeading___Toc128466309)

[B. Summary of Funding 3](#__RefHeading___Toc128466310)

[III. Eligibility Information 3](#__RefHeading___Toc128466311)

[A. Eligible Applicants ............10](#__RefHeading___Toc128466312)

[B. Cost Sharing/Matching 3](#__RefHeading___Toc128466313)

[C. Other 3](#__RefHeading___Toc128466314)

[IV. Application and Submission Information
3](#__RefHeading___Toc128466315)

[1. Address to Request Application Package 3](#Application_materials)

[Application Materials 3](#__RefHeading___Toc128466317)

[2. Content and Form of Application Submission
3](#__RefHeading___Toc128466318)

[**Application Format Requirements** 3](#__RefHeading___Toc128466319)

[**Application Format** 3](#__RefHeading___Toc128466320)

[**i.** **Application Face Page** 3](#__RefHeading___Toc128466323)

[**ii.** **Table of Contents** 3](#__RefHeading___Toc128466324)

[**iii.** **Application Checklist** 3](#__RefHeading___Toc128466325)

[**iv.** **Budget** 3](#__RefHeading___Toc128466326)

[**v.** **Budget Justification** 3](#__RefHeading___Toc128466327)

[**vi.** **Staffing Plan and Personnel Requirements**
3](#__RefHeading___Toc128466328)

[**vii.** **Assurances** 3](#__RefHeading___Toc128466329)

[**viii.** **Certifications** 3](#__RefHeading___Toc128466330)

[**ix.** **Project Abstract** 3](#__RefHeading___Toc128466331)

[**x.** **Program Narrative** 3](#__RefHeading___Toc128466332)

**xi. Program Specific**
..............................................................................\...\...\...\...\...\...\...\...\...\...\...\...\.....
18

[**xii.** **Appendices** 3](#__RefHeading___Toc128466334)

[3. Submission Dates and Times 3](#__RefHeading___Toc128466335)

[4. Intergovernmental Review 3](#Application_materials)

[5. Funding Restrictions 3](#__RefHeading___Toc128466340)

[6. Other Submission Requirements 3](#__RefHeading___Toc128466341)

[V. Application Review Information 3](#__RefHeading___Toc128466342)

[1. Review Criteria](#__RefHeading___Toc128466344) 24

[2. Review and Selection Process 3](#__RefHeading___Toc128466345)

[3. Anticipated Announcement and Award Dates
3](#__RefHeading___Toc128466349)

[VI. Award Administration Information 3](#__RefHeading___Toc128466350)

[1. Award Notices 3](#__RefHeading___Toc128466351)

[2. Administrative and National Policy Requirements
3](#__RefHeading___Toc128466352)

[3. Reporting 3](#Award_OtherReportingRequirements)

[Performance Standards for Special Projects of Regional or National
Significance (SPRANS) and Other MCHB Discretionary Projects
3](#__RefHeading___Toc128466354)

[**Performance Measures and Program
Data**](#__RefHeading___Toc128466355)

[**Post-Award Reporting**](#__RefHeading___Toc128466356)

[Performance Review 3](#__RefHeading___Toc128466358)

[VII. Agency Contacts 3](#__RefHeading___Toc128466359)

[VIII. Other Information 3](#__RefHeading___Toc128466360)

[ix. Tips for Writing a Strong Application
3](#__RefHeading___Toc128466361)

[APPENDIX A: HRSA's Electronic Submission User Guide
3](#__RefHeading___Toc128466362)

[1. Introduction 3](#introduction)

[1.1 Document Purpose and Scope 3](#document-purpose-and-scope)

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

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

[2.1 Process Overview 3](#process-overview)

[2.2 Grantee Organization Needs to Register With Grants.gov (if not
already registered) -- See Appendix B
3](#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)
3](#project-director-and-authorizing-official-need-to-register-with-hrsa-ehbs-if-not-already-registered)

[2.4 Apply through Grants.gov 3](#apply-through-grants.gov)

[2.4.1 Find Funding Opportunity 3](#find-funding-opportunity)

[2.4.2 Download Application Package 3](#download-application-package)

[2.4.3 Complete Application 3](#complete-application)

[2.4.4 Submit Application 3](#submit-application)

[2.4.5 Verify Status of Application 3](#verify-status-of-application)

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

[2.5.1 Verify Status of Application 3](#verify-status-of-application-1)

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

[2.5.3 Check Validation Errors 3](#check-validation-errors)

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

[2.5.5 Submit Application 3](#submit-application-1)

[2.6 Submit Signed Face Page 3](#submit-signed-face-page)

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

[3.1 Process Overview 3](#process-overview-1)

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

[3.3 Apply through Grants.gov 3](#apply-through-grants.gov-1)

[3.3.1 Find Funding Opportunity 3](#find-funding-opportunity-1)

[3.3.2 Download Application Package 3](#download-application-package-1)

[3.3.3 Complete Application 3](#complete-application-1)

[3.3.4 Submit Application 3](#submit-application-2)

[3.3.5 Verify Status of Application 3](#verify-status-of-application-2)

[3.4 Submit Signed Face Page 3](#submit-signed-face-page-1)

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

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

[4.1.1 Font 3](#font)

[4.1.2 Paper Size and Margins 3](#paper-size-and-margins)

[4.1.3 Names 3](#names)

[4.1.4 Section Headings 3](#section-headings)

[4.1.5 Page Numbering 3](#page-numbering)

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

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

[4.3 Page Limit 3](#page-limit)

[5. Customer Support Information 3](#customer-support-information)

[5.1.1 Grants.gov Customer Support 3](#grants.gov-customer-support)

[5.1.2 HRSA Call Center 3](#hrsa-call-center)

[5.1.3 HRSA Program Support 3](#hrsa-program-support)

[6. FAQs 3](#faqs)

[6.1 Software 3](#software)

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

[6.1.2 Why can't I download PureEdge Viewer onto my machine?
3](#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?
3](#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?
3](#what-are-the-software-requirements-for-hrsa-ehbs)

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

[6.2 Application Receipt 3](#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?
3](#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?
3](#when-do-i-need-to-submit-my-application)

[6.2.3 What emails can I expect once I submit my application? Is email
reliable?
3](#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\"?
3](#if-a-resubmission-is-required-because-of-grants.gov-system-problems-will-these-be-considered-late)

[6.3 Application Submission 3](#application-submission)

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

[6.4 Grants.gov 3](#grants.gov)

**[Appendix B-E:]{.underline}**

[Appendix B -- Registering and Applying Through
Grants.gov...............3](#__RefHeading___Toc128466422)

**Appendix C- Mch
pyramid...........................................................................53**

**Appendix D- mch perfomance
measures....................................................58**

**APPENDIX E -- mch fiNancial and demographic
forms...........................\...63**

**Executive Summary**

Under this announcement, the *Fetal Alcohol Spectrum Disorders* grant
will fund one project to continue the demonstration program on Fetal
Alcohol Spectrum Disorders (FASD) begun two years ago by the Bureau of
Primary Health Care. The successful applicant will be expected to
continue to coordinate services between the National Organization on
Fetal Alcohol Syndrome and community health centers to improve the
prevention, identification, and support of individuals with fetal
alcohol syndrome. In addition, the successful applicant will engage and
include maternal and child health sites in this successful
demonstration.

[]{#__RefHeading___Toc128466305 .anchor}**I. Funding Opportunity
Description**

[]{#Funding_purpose .anchor}

**Purpose**

This announcement solicits applications for the *Fetal Alcohol Spectrum
Disorders* grant program. The purpose of this grant is to continue the
demonstration program between the National Organization on Fetal Alcohol
Syndrome and HRSA's community health centers using a learning
collaborative model to improve the prevention, identification and
support of individuals with fetal alcohol syndrome. In addition, this
grant will engage and include maternal and child health sites in this
successful demonstration.

[]{#__RefHeading___Toc128466307 .anchor} **Background**

The Health Resources and Services Administration (HRSA), an agency of
the U.S. Department of Health and Human Services, is the primary Federal
agency for improving access to health care services for people who are
uninsured, isolated or medically vulnerable. Comprised of six bureaus
and 14 offices, HRSA provides leadership and financial support to health
providers in every state and U.S. territory. HRSA grantees provide
health care to uninsured people, people living with HIV/AIDS and
pregnant women, mothers and children. They train health professionals
and improve systems of care in rural communities.

HRSA oversees organ, tissue and bone marrow donation. It supports
programs that compensate individuals harmed by vaccination, and
maintains databases that protect against health care malpractice and
health care waste, fraud and abuse.

Since 1943, the agencies that were HRSA precursors have worked to
improve the health of needy people. HRSA was created in 1982 when the
Health Resources Administration and the Health Services Administration
were merged.

The Maternal and Child Health Bureau (MCHB) is a component of the Health
Resources Services Administration (HRSA) within the Department of Health
and Human Services. The MCHB mission is to provide national leadership
and to work in partnership with States, communities, public-private
partners, and families to strengthen the maternal and child health
infrastructure, assure the availability and use of medical homes, and
build knowledge and human resources in order to assure continued
improvement in the health, safety and well-being of the maternal and
child health population. The maternal and child health population
includes all pregnant women, infants, children, adolescents and their
families.

The Bureau of Primary Health Care (BPHC), a component of HRSA received a
hard earmark included in fiscal year (FY) 2005 budget for the National
Organization on Fetal Alcohol (NOFAS) to integrate to fetal alcohol
spectrum disorders (FASD) prevention, identification and intervention
into the community health care (CHC) system. In FY05 NOFAS worked with
BPHC on training five CHCs about FASD using a learning collaborative
model.

In FY 06, MCHB was given a SPRANS set-aside with Congressional direction
to continue to coordinate the work NOFAS and the CHCs had begun in FY
2005, and to expand the process to include maternal and child health
sites. A competition was held and a one year cooperative agreement was
awarded to continue this work.

In FY 07, MCHB was again given a SPRANS set-aside with Congressional
direction to continue to coordinate the work of NOFAS and the CHCs using
a learning collaborative model and to continue to work with maternal and
child health sites.

[Overview of Fetal Alcohol Spectrum Disorders]{.underline}:

With an incidence rate of approximately 1 in 1,000 live births, Fetal
Alcohol Syndrome (FAS) is one of the nation's most detrimental and
completely preventable birth defects. Annually, approximately 4 million
infants are born with prenatal alcohol exposure and 1,000 to 4,000 with
FAS. FAS is a permanent condition that causes one or more disabilities
including problems with learning, memory, attention span, communication,
vision, and/or hearing; it affects every aspect of an individual's and
their family's life. Fetal Alcohol Spectrum Disorder (FASD) is a
nondiagnostic term that encompasses the range of potential adverse
effects to the individual whose mother drank alcohol during that
pregnancy. FASD includes FAS, fetal alcohol effects (FAE),
alcohol-related neurodevelopmental disorder (ARND), and alcohol-related
birth defects (ARBD). FASDs are completely preventable if a woman
abstains from alcohol during pregnancy making it imperative that
outreach and education are undertaken and sustained to prevent further
devastation (CDC, 2005).

Health care providers can be instrumental in influencing the behaviors
of pregnant women, but this critical intervention time is often missed
by providers. Data from CDC's Behavioral Risk Factor Surveillance System
indicates that only 23% of binge drinkers had not been spoken to about
their alcohol use. Many health care providers and their staff have
unfounded beliefs concerning alcohol use during pregnancy. Some promote
moderate drinking and not abstinence. Others view screening as a means
of identifying pregnant women with a substance abuse problem and not as
a step towards the prevention of alcohol use during pregnancy.
Additionally, many medical care providers frequently voice feeling
overwhelmed by growing expectations for screenings and intervention
protocols for multiple issues without adequate compensation (Kennedy,
2004).

Many children who have less severe forms of FASD do not receive a
diagnosis until school age or are never identified. Difficulties in
locating these children occur because of the reluctance of mothers to
admit using alcohol during pregnancy and many mothers are still unaware
that alcohol consumption during pregnancy is unsafe. Other problems with
FASD identification are the scarcity of trained dysmorphologist to
identify children affected at birth and the lack of specific
neurocognitive or behavioral tests to identify individuals affected by
FASD throughout the lifespan.

It is estimated that anywhere from 14 to 22.5 percent of women report
drinking some alcohol while pregnant. Identifying women who are drinking
during pregnancy is clearly important, but the lack of public education
about the danger of alcohol consumption during pregnancy is a bigger
issue. Asking questions about drinking patterns before pregnancy
frequently provides a more accurate measure of first trimester
consumption than asking how much a woman is currently drinking. A woman
may not report her alcohol consumption for a variety of reasons, but
screening instruments are available for providers for identifying a
range of alcohol use, including any current prenatal alcohol
consumption, pre-pregnancy risk drinking and lifetime alcohol diagnoses
(NIAAA, 2005).

FASD remains a substantial public health, medical and educational
problem despite major research efforts to clarify the mechanisms of
alcohol's teratological effects, increased efforts at prevention, and
studies to address adverse health problems resulting from prenatal
alcohol exposure. Early detection, education, and intervention are
essential to attain positive outcomes for individuals who manifest signs
of FASD as well as assisting women to address drinking problems and to
abstain from alcohol during pregnancy.

[]{#__RefHeading___Toc128466308 .anchor}**II. Award Information**

[]{#__RefHeading___Toc128466309 .anchor}**1. Type of Award**

> Funding will be provided through a 1-year cooperative agreement with
> MCHB/HRSA. Under this cooperative agreement, the grantee will be
> expected to continue to coordinate activities between NOFAS and BPHC's
> community health centers and to expand these services to maternal and
> child health sites.

[]{.mark}

[]{#__RefHeading___Toc128466310 .anchor}**2. Summary of Funding**

[]{.mark}

> Approximately \$976,500 is available to fund one (1) grantee for a
> 12-month period of performance beginning September 1, 2007.
>
> **[Elements of FASD Cooperative Agreement:]{.underline}**
>
> The successful applicant will enter into a cooperative agreement with
> HRSA to address health service gaps related to FASD.
>
> [Under the terms of this agreement, Federal responsibilities
> include:]{.underline}

-   Participation in meetings conducted during the period of the
    Cooperative Agreement;

-   Participation in the preparation and final approval of project
    information prior to dissemination;

-   Participation in disseminating information on project activities;

-   Ongoing review of activities and procedures established and
    implemented for accomplishing the proposed project;

> \- Assistance with the identification and linkage with relevant MCH,
> Federal, and State grant programs and other entities to achieve the
> project's mission;

-   Assistance in the establishment of State and Federal interagency
    partnerships, collaboration, and cooperation that may be necessary
    for carrying out the project; and

-   Project monitoring and technical assistance as appropriate per HRSA
    grants policy and procedures.

> [Program requirements of the recipient of this Cooperative Agreement
> include:]{.underline}

-   Monitor and evaluate project activities to determine if
    activities/approaches are being delivered in a timely manner with an
    emphasis quality service delivery;

-   Timely completion of activities approved by HRSA that were proposed
    in response to application review criteria listed in this
    application guidance;

-   Providing technical assistance and training opportunities; and
    produce and disseminate materials including publishing articles as
    appropriate;

-   Update training materials quarterly based on new findings;

-   Participation in face-to-face meetings and conference calls with the
    Federal Office conducted during the period of the cooperative
    agreement;

-   Collaboration with the Federal Office on ongoing review of
    activities, procedures and budget items, information/publication
    prior to dissemination, and contracts;

-   Providing technical assistance on FASD to CHCs and MCH sites;

-   Collaboration with Title V and MCH sites in selected states;

-   Adapting training materials for MCH sites;

-   Facilitating coordination of activities between CHCs and MCH sites;
    and

-   Creating a system of prevention, identification and support of
    individuals with FASD in CHCs and MCH sites.

    []{#__RefHeading___Toc128466311 .anchor}**III. Eligibility
    Information**

    **1. Eligible Applicants**

> *Any public or private entity, including an Indian tribe or tribal
> organization (as defined at 25 U.S.C. 450B), and faith and
> community-based organizations are eligible to apply.*
>
> *Successful applicants will have significant experience with issues
> relating to FASD.  Applicants are strongly encouraged to demonstrate
> such experience through their application. *
>
> *Successful applicants will also have substantive experience providing
> training using technical assistance and/or other productive activities
> with BPHC and with their CHCs in the area of perinatal alcohol use and
> identification and treatment of FASD.  In addition, applicants should
> be able to demonstrate substantial experience with MCH programs.*

 

[]{#__RefHeading___Toc128466313 .anchor}**2. Cost Sharing/Matching**

None required.

[]{#__RefHeading___Toc128466314 .anchor}**3. Other**

> Only one cooperative agreement will be funded in FY07.
>
> Applications that exceed the ceiling amount (\$976,500) will be
> considered non-responsive and will not be considered for funding under
> this announcement.
>
> Any application that fails to satisfy the deadline requirements
> referenced in *Section IV.3* will be considered non-responsive and
> will not be considered for funding under this announcement.

[]{#__RefHeading___Toc128466315 .anchor}**IV. Application and Submission
Information**

[]{#Application_materials .anchor}

**1. Address to Request Application Package**

[]{#__RefHeading___Toc128466317 .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. These forms contain 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___Toc128466318 .anchor}**2. Content and Form of
Application Submission**

[]{#__RefHeading___Toc128466319 .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.**

[]{#__RefHeading___Toc128466320 .anchor}**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 and based on items submitted electronically by
the applicant.

When providing any electronic attachment with several pages, add table
of content page specific to the attachment.

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

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

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

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

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

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

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

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

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

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

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

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

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Tables, Charts, etc. Merge similar documents into a
                      single document. Where several pages are expected
                      in the attachment, place a table of content cover
                      page specific to the attachment. Table of content
                      page will not be counted in the page limit.

  Attachment 2        Job descriptions for key personnel. Merge similar
                      documents into a single document. Where several
                      pages are expected in the attachment, place a table
                      of content cover page specific to the attachment.
                      Table of content page will not be counted in the
                      page limit.

  Attachment 3        Biographical Sketches of Key Personnel. Merge
                      similar documents into a single document. Where
                      several pages are expected in the attachment, place
                      a table of content cover page specific to the
                      attachment. Table of content page will not be
                      counted in the page limit.

  Attachment 4        Letters of Agreement and/or Description of
                      Proposed/Existing Contracts. Merge similar
                      documents into a single document. Where several
                      pages are expected in the attachment, place a table
                      of content cover page specific to the attachment.
                      Table of content page will not be counted in the
                      page limit.

  Attachment 5        Project Organizational Chart

  Attachment 6        Other Relevant Documents not specified elsewhere in
                      this Table of Contents. Merge similar documents
                      into a single document. Where several pages are
                      expected in the attachment, place a table of
                      content cover page specific to the attachment.
                      Table of content page will not be counted in the
                      page limit.
  -----------------------------------------------------------------------

> Note the following specific information related to your submission.

[]{#__RefHeading___Toc128466323 .anchor}**i. Application Face Page**

> Use Public Health Service (PHS) Application Form 5161-1 provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance, the Catalog of Federal Domestic
> Assistance Number is 93.110.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> <http://www.hrsa.gov/grants/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](http://www.hrsa.gov/grants/ccr.htm).

[]{#__RefHeading___Toc128466324 .anchor}**ii. 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___Toc128466325 .anchor}**Application
Checklist**

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

**iv.** []{#__RefHeading___Toc128466326 .anchor}**Budget**

> Use Application Form 5161-1 provided with the application package.
>
> *Please complete Sections A, B, E, and F, and then provide a line item
> budget for each grant year using the budget categories in the SF
> 424A.*

[]{#__RefHeading___Toc128466327 .anchor}**v. 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 would support the achievement of proposed objectives.
> The budget period is for ONE year. Line item information must be
> provided to explain the costs entered in PHS 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.
>
> [Include the following in the Budget Justification
> narrative]{.underline}:
>
> Personnel Costs: Personnel costs should be explained by listing each
> staff member who will be supported from funds, name (if possible),
> position title, percent full time equivalency, annual salary, and the
> exact amount requested for each project year.
>
> 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
> participating in meetings and other proposed trainings or workshops.
>
> Equipment: List equipment costs and provide justification for the need
> of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items that meet the definition of equipment (a unit cost of
> \$5000 and a useful life of one or more years).
>
> Supplies: List the items that the project will use. In this category,
> separate office supplies from medical and educational purchases.
> Office supplies could include paper, pencils, and the like; medical
> supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately.
>
> Subcontracts: To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> []{.mark}
>
> 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.)

[]{#__RefHeading___Toc128466328 .anchor}**vi. Staffing Plan and
Personnel Requirements**

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Position descriptions that include the roles,
> responsibilities, and qualifications of proposed project staff must be
> included in the Attachments. Copies of biographical sketches for any
> key employed personnel that will be assigned to work on the proposed
> project must be included in Attachment 3*.*

[]{#__RefHeading___Toc128466329 .anchor}**vii. Assurances**

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

[]{#__RefHeading___Toc128466330 .anchor}**viii. Certifications**

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

[]{#__RefHeading___Toc128466331 .anchor}**ix. Project Abstract**

> Submitting an abstract for competing application is fulfilled by
> completing Form 6 in Appendix G. Directions for completion of Form 6
> are found in Appendix D. The abstract (Form 6) should be attached to
> the application.
>
> The abstract will be utilized extensively by reviewers; therefore, it
> is essential that the abstract reflect the most critical points of the
> application. In addition, project abstracts of all approved and funded
> applications will be distributed to MCHB grantee, Title V programs,
> academic institution, and government agencies.

[]{#__RefHeading___Toc128466332 .anchor}**x. Program Narrative**

> This section provides a comprehensive framework and description of all
> aspects of the proposed program. It should be succinct,
> self-explanatory and well organized so that reviewers can understand
> the proposed project.

Use the following section headers for the Narrative:

-   Introduction

> This section should briefly describe the purpose of the proposed
> project. (Refer to the Needs section in Review Criteria)

-   NEEDS ASSESSMENT

> This section outlines the needs of your community and/or organization.
> 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. Please discuss
> any relevant barriers in the service area that the project hopes to
> overcome. This section should help reviewers understand the community
> and/or organization that will be served by the proposed project.
> (Refer to the Needs section in Review Criteria)

-   Methodology

> Propose methods that will be used to meet each of the previously
> described program requirements and expectations in this grant
> announcement. (Refer to the Methodology section in Review Criteria)

-   Work Plan

> Describe the activities or steps that will be used to achieve each of
> the activities proposed in the methodology section. Use a time line
> that includes each activity and identifies responsible staff. (Refer
> to the Evaluative Measures, Impact and Resources/Capabilities sections
> in the Review Criteria)

-   Resolution of Challenges

> Discuss challenges that are likely to be encountered in designing and
> implementing the activities described in the Work Plan, and approaches
> that will be used to resolve such challenges. (Refer to the Impact
> section in the Review Criteria)

-   Evaluation and Technical Support Capacity

> Describe current experience, skills, and knowledge, including
> individuals on staff, materials published, and previous work of a
> similar nature. (Refer to the Evaluative Measures section in the
> Review Criteria.

-   Organizational Information

> Provide information on the applicant agency's current mission and
> structure, scope of current activities, and an organizational chart,
> and describe how these all contribute to the ability of the
> organization to conduct the program requirements and meet program
> expectations. (Refer to the Support Requested in the Review Section)
>
> []{.mark}

xi. ***Program Specific Forms***

> *1) Performance Standards for Special Projects of Regional or National
> Significance (SPRANS) and Other MCHB Discretionary Projects*
>
> The Health Resources and Services Administration (HRSA) has modified
> its reporting requirements for SPRANS projects, CISS projects, and
> other grant programs administered by the Maternal and Child Health
> Bureau (MCHB) to include national performance measures that were
> developed in accordance with the requirements of the Government
> Performance and Results Act (GPRA) of 1993 (Public Law 103-62). This
> Act requires the establishment of measurable goals for Federal
> programs that can be reported as part of the budgetary process, thus
> linking funding decisions with performance. Performance measures for
> States have also been established under the Block Grant provisions of
> Title V of the Social Security Act, the MCHB's authorizing
> legislation. Performance measures for other MCHB-funded grant programs
> have been approved by the Office of Management and Budget and are
> primarily based on existing or administrative data that projects
> should easily be able to access or collect. An electronic system for
> reporting these data elements has been developed and is now available.

2)  *Performance Measures for the **Fetal Alcohol Spectrum Disorders**
    Grant Program and*

> *Submission of Administrative Data*

To prepare applicants for reporting requirements, administrative data
collection requirements are presented in the **Appendix D** of this
guidance.

> []{.mark}

[]{#__RefHeading___Toc128466334 .anchor}**xii. 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.

1)  Attachment 1: Tables, Charts, etc.

> To give further details about the proposal.

2)  Attachment 2: Job Descriptions for Key Personnel

> Keep each to one page in length as much as is possible. Item 6 in the
> Program Narrative section of the PHS 5161-1 Form provides some
> guidance on items to include in a job description.

3)  Attachment 3: Biographical Sketches of Key Personnel

> Include biographical sketches for persons occupying the key positions
> described in Attachment 2, not to exceed two pages in length. In the
> event that a biographical sketch is included for an identified
> individual who is not yet hired, please include a letter of commitment
> from that person with the biographical sketch.

4)  Attachment 4: Letters of Agreement and/or Description(s) of
    Proposed/Existing Contracts (project specific) Provide any documents
    that describe working relationships between the applicant agency and
    other agencies and programs cited in the proposal. Documents that
    confirm actual or pending contractual agreements should clearly
    describe the roles of the subcontractors and any deliverable.
    Letters of agreements must be dated.

5)  Attachment 5: Project Organizational Chart

> Provide a one-page figure that depicts the organizational structure of
> the project, including subcontractors and other significant
> collaborators.

6)  Attachment 6: Other Relevant Documents

> Include here any other documents that are relevant to the application,
> including letters of supports. Letters of support must be dated.
>
> **Include only letters of support which specifically indicate a
> commitment to the project/program (in-kind services, dollars, staff,
> space, equipment, etc.) Letters of agreements and support must be
> dated. List all other support letters on one page.**

[]{#__RefHeading___Toc128466335 .anchor}

**3. Submission Dates and Times**

**Application Due Date**

The due date for applications under this grant announcement is July 20,
2007 *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.**

**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**

[]{.mark}

> The Fetal Alcohol Spectrum Disorders 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.

[]{#__RefHeading___Toc128466340 .anchor}**5. Funding Restrictions**

> []{.mark}
>
> *Applicants responding to this announcement may request funding for a
> project period of one (1) year, at no more than \$976,500 per year.
> Applicants that submit budgets that exceed the \$976,500 per year
> maximum will be deemed ineligible and not be considered for funding.*
>
> *Funds under this announcement may not be used for the following
> purposes:*

No Supplantation**:** Federal funds may only be used to supplement and
not supplant other Federal or non-Federal funds that would otherwise be
made available to the project.

Shared Staffing**:** Applicants proposing to utilize the same director
or contractual staff across multiple grants/programs (e.g., CISS,
SPRANS, HS, State Title V block grant, WIC) should assure that the
combined funding for each position does not exceed 100% FTE. If such an
irregularity is found, funding will be reduced accordingly.

Shared Equipment**:** Applicants proposing to purchase equipment which
will be used across multiple grants/programs (e.g., CISS, SPRANS, HS,
State Title V block grant, WIC) should pro-rate the costs of the
equipment across programs and show the calculation of this pro-ration in
their justification. If an irregularity is found where equipment is
being used by other programs without reimbursement, funding will be
reduced accordingly.

Cash Stipends/Incentives**:** Funds cannot be utilized for cash
stipends/monetary incentives given to clients to enroll in project
services. However, funds can be used to facilitate participation in
project activities (e.g. day care/transportation costs/tokens to attend
prenatal/ well child clinic visits), as well as for services rendered to
the project (e.g., adolescent peer mentors).

Purchase of Vehicles**:** Projects should not allocate funds to buy
vehicles for the transportation of clients, but rather lease vehicles or
contract for these services.

Lobbying**:** Federal funds cannot be used to lobby the Executive or
Legislative branches of the Federal Government in connection with the
Healthy Start Initiative. All applicants should review and sign page 18
of PHS 5161-1 (Rev. 7/00) certifying that project funds are not being
used for lobbying activities. Pursuant to Section 1352 of Title 31,
United States Code, all grantees must now disclose any lobbying
undertaken with non-Federal (non-appropriated funds). If non-Federal
funds are being used for lobbying activities, grantees must disclose
this information by completing Standard Form LLL \"Disclosure of
Lobbying Activities\", page 27 of PHS 5161-1 (Rev.7/00).

> []{.mark}

[]{#__RefHeading___Toc128466341 .anchor}**6. Other Submission
Requirements**

> As stated in Section IV.1, except in rare cases HRSA will no longer
> accept applications for grant opportunities in paper form. Applicants
> submitting for this funding opportunity are ***required*** to submit
> ***electronically*** through Grants.gov. To submit an application
> electronically, please use the
> [http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
> Grants.gov you will be able to download a copy of the application
> package, complete it off-line, and then upload and submit the
> application via the Grants.gov site.
>
> As soon as you read this, whether you plan on applying for a HRSA
> grant later this month or later this year, it is incumbent that your
> organization ***immediately register*** in Grants.gov and become
> familiar with the Grants.gov site application process. If you do not
> complete the registration process you will be unable to submit an
> application. The registration process can take up to one month, so you
> need to begin immediately.
>
> To be able to successfully register in Grants.gov, it is necessary
> that you complete all of the following required actions:
>
> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider
>
> Instructions on how to register, tutorials and FAQs are available on
> the Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
> Assistance is also available from the Grants.gov help desk at
> <support@grants.gov> or by phone at 1-800-518-4726.
>
> More specific information, including step-by-step instructions on
> registering and applying, can be found in Appendix B of this guidance.
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA
> through Grants.gov. However, to complete the submission requirements,
> a hard-copy of the SF-424/5161 Face Sheet must be printed, signed, and
> submitted to the HRSA Grants Application Center. The SF-424/5161 must
> be printed from Grants.gov.
>
> For an application submitted electronically, the signed SF-424/5161
> must be sent to the HRSA GRANTS APPLICATION CENTER at the following
> address and received by HRSA by no later than five days after the date
> of submission in Grants.gov:
>
> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: Fetal Alcohol Spectrum Disorders
>
> Program Announcement No. HRSA-07-144
>
> CFDA No. 93.110
>
> 910 Clopper Road, Suite 155 South
>
> Gaithersburg, MD 20878
>
> Telephone: 877-477-2123
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time, and (2) the signed SF-424/5161 Face Sheet
> is received by HRSA no later than five days after the date of
> submission in Grants.gov.
>
> **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.**

[]{#__RefHeading___Toc128466342 .anchor}**V. Application Review
Information**

> 1\. Review Criteria
>
> Procedures for assessing the technical merit of grant applications
> have been instituted to provide for an objective review of
> applications and to assist the applicant in understanding the
> standards against which each application will be judged. Critical
> indicators have been developed for each review criterion to assist the
> applicant in presenting pertinent information related to that
> criterion and to provide the reviewer with a standard for evaluation.
> Review criteria are outlined below with specific detail and scoring
> points.
>
> Review Criteria are used to review and rank applications. The *Fetal
> Alcohol Spectrum Disorders* grant program has 7 review criteria.
>
> ***Need (20%):** The extent to which the application describes the
> problem and associated contributing factors to the problem.*
>
> **a.** The extent to which the applicant has demonstrated the ability
> to coordinate services between the NOFAS and the CHCs and maternal and
> child health sites to improve the prevention, identification, and
> support of individuals with FAS.
>
> **b.** The extent to which the proposed plan addresses the documented
> need(s) of the targeted population including attention to the cultural
> and linguistic needs of consumers.
>
> ***Response (15%):** The extent to which the proposed project responds
> to the "purpose" included in the program description. The clarity of
> the proposed goals and objectives and their relationship to the
> identified project. The extent to which the activities (scientific or
> other) described in the application are capable of addressing the
> problem and attaining the project objectives.*
>
> **a.** The extent to which the project objectives incorporate the
> specific program competition's purpose (Fetal Alcohol Spectrum
> Disorders) and are measurable, logical, and appropriate in relation to
> both the specific problems and interventions identified.
>
> **b.** The extent to which the activities proposed for each
> intervention appear feasible and likely to contribute to the
> achievement of the project's objectives within each budget period.
>
> **c.** The extent to which the project is linked to the BPHC's
> community health care system; and the maternal and child health care
> system in the participating states.
>
> ***Evaluative Measures (10%):** The effectiveness of the method
> proposed to monitor and evaluate the project results. Evaluative
> measures must be able to assess (1) to what extent the program
> objectives have been met and (2) to what extent these can be
> attributed to the project.*
>
> **a.** The extent to which each proposed methodology is either
> congruent to or
>
> linked with the scopes of the core interventions (screening,
> assessment, case management, training and referral) learned from the
> learning collaborative to prevent, identify and provide intervention
> for persons with FASD.
>
> **b.** The extent to which the proposed evaluation plan measures
> program
>
> performance, is well organized, adequately described, utilizes sound
>
> evaluation methodologies, and complies with MCHB's evaluation protocol
> for its discretionary grants.
>
> ***Impact (10%):** The extent and effectiveness of plans for
> dissemination of project results, and/or the extent to which project
> results may be national in scope and/or the degree to which a
> community is impacted by delivery of health services, and/or the
> degree to which the project activities are replicable, and/or the
> sustainability of the program beyond Federal funding.*
>
> **a.** The extent to which the proposed plan will enhance activities
> already underway in five CHCs that participated in the learning
> collaborative and expand it to other CHCs.
>
> **b.** The extent to which the proposed plan will integrate services
> and lessons learned from the Risky Drinking Collaborative into the
> maternal and child health care system.
>
> ***Resources/Capabilities (20%):** The extent to which project
> personnel are qualified by training and/or experience to implement and
> carry out the project. The capabilities of the applicant organization,
> and quality and availability of facilities and personnel to fulfill
> the needs and requirements of the proposed project. For competing
> continuations, past performance will also be considered.*
>
> **a*. ***The extent to which the proposed approach delineates the
> interventions included in the plan, and identifies the actual or
> anticipated agencies and resources which will be used to implement
> those strategies.
>
> **b.** The demonstration of substantive experience of the agency to
> carry out and oversee a complex and integrated training program.
>
> **c.** The extent to which the applicant has demonstrated an ability
> to maximize and coordinate existing resources, monitor contracts, and
> acquire additional resources.
>
> **d.** The extent to which the applicant's fiscal and programmatic
> contract monitoring system demonstrates their ability to implement and
> monitor their program.
>
> ***Support Requested (15%):** The reasonableness of the proposed
> budget in relation to the objectives, the complexity of the
> activities, and the anticipated results.*
>
> **a.** The extent to which the proposed budget is realistic,
> adequately justified, and consistent with the proposed project plan.
>
> **b.** The extent to which the costs of administration and evaluation
> are reasonable and proportionate to the costs of service provision.
>
> **c.** The degree to which the costs of the proposed project are
> economical in relation to the proposed service utilization.
>
> ***Linkage with Title V, Local MCH Agencies, and Other Community Stake
> Holders (10%):***
>
> **a.** The extent of actual or planned involvement of the State Title
> V, local MCH, and other agencies serving the proposed project area is
> clearly evident.
>
> **b.** The extent to which the project is consonant with overall State
> efforts to develop comprehensive community-based systems of services,
> and focuses on service needs identified in the State's MCH Services
> Title V- Five Year Comprehensive Needs Assessment and Block Grant
> Plan.

[]{#__RefHeading___Toc128466345 .anchor}**2. Review and Selection
Process**

> The Division of Independent Review is responsible for managing
> objective reviews within HRSA. Applications competing for federal
> funds receive an objective and independent review performed by a
> committee of experts qualified by training and experience in
> particular fields or disciplines related to the program being
> reviewed. In selecting review committee members, other factors in
> addition to training and experience may be considered to improve the
> balance of 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.

3.  []{#__RefHeading___Toc128466349 .anchor}**Anticipated Announcement
    and Award Dates**

    September 1, 2007 is the anticipated date of award.

    []{#__RefHeading___Toc128466350 .anchor}**VI. Award Administration
    Information**

    []{#__RefHeading___Toc128466351 .anchor}**1. Award Notices**

> 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, 2007.

[]{#__RefHeading___Toc128466352 .anchor}**2. Administrative and National
Policy Requirements**

> Successful applicants must comply with the administrative requirements
> outlined in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92
> (governmental), as appropriate.
>
> All HRSA grant awards are now 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}

**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}]{.mark}

**3. Reporting**

> The successful applicant under this guidance must comply with the
> following reporting and review
>
> **a. Audit Requirement**
>
> 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 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**
>
> 1\. Submit a **Financial Status Report**. 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;
>
> 2\. Submit a **Progress Report**(s). Further information will be
> provided in the award notice.
>
> []{.mark}

[]{#__RefHeading___Toc128466354 .anchor}**d. Performance Standards for
Special Projects of Regional or National Significance (SPRANS) and Other
MCHB Discretionary Projects**

The Health Resources and Services Administration (HRSA) has modified its
reporting requirements for SPRANS projects, CISS projects, and other
grant programs administered by the Maternal and Child Health Bureau
(MCHB) to include national performance measures that were developed in
accordance with the requirements of the Government Performance and
Results Act (GPRA) of 1993 (Public Law 103-62). This Act requires the
establishment of measurable goals for Federal programs that can be
reported as part of the budgetary process, thus linking funding
decisions with performance. Performance measures for States have also
been established under the Block Grant provisions of Title V of the
Social Security Act, the MCHB's authorizing legislation. Performance
measures for other MCHB-funded grant programs have been approved by the
Office of Management and Budget and are primarily based on existing or
administrative data that projects should easily be able to access or
collect.

**\
1. Performance Measures and Program Data**

> To prepare applicants for these reporting requirements, the designated
> performance measures for this program and other program data
> collection are presented in the appendices of this guidance.

**2. Performance Reporting**

> Successful applicants receiving grant funds will be required, within
> 120 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 the appendices of this
> guidance.** **This requirement entails the provision of budget
> breakdowns in the financial forms based on the grant award amount, the
> project abstract and other grant summary data as well as providing
> objectives for the performance measures.
>
> Performance reporting is conducted for each grant year of the project
> period. Grantees will be required, within 120 days of the NGA, to
> enter HRSA's EHBs and complete the program specific forms. This
> requirement includes providing expenditure data, finalizing the
> abstract and grant summary data as well as finalizing
> indicators/scores for the performance measures.
>
> **3. Final Year Performance Reporting**
>
> Successful applicants receiving grant funding will be required, within
> 120 days from the end of the project period, to electronically
> complete the program specific data forms that appear in the appendices
> of this guidance. The requirement includes providing expenditure data
> for the final year of the project period, the project abstract and
> grant summary data as well as final indicators/scores for the
> performance measures.

[]{#__RefHeading___Toc128466358 .anchor}**e. 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 are 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>.

[]{#__RefHeading___Toc128466359 .anchor}**VII. Agency Contacts**

> Applicants may obtain additional information regarding business,
> administrative, or fiscal issues related to this grant announcement by
> contacting:
>
> Michele Smith, Public Health Analyst/Grants Management Specialist

HRSA Division of Grants Management Operations

Parklawn Building, Room 11A-16

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443 1583

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

John H. McGovern

Senior Project Officer

Division of Healthy Start and Perinatal Services

Maternal and Child Health Bureau, HRSA

Parklawn Building, Room 18-12

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301 443-5805

Fax: 301 594-0186

Email: jmcgovern@hrsa.gov

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

Michele Smith, Public Health Analyst/Grants Management Specialist

HRSA Division of Grants Management Operations

Parklawn Building, Room 11 A-16

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443-1583

[]{#__RefHeading___Toc128466360 .anchor}**VIII. Other Information**

Applicants should be familiar with HRSA's supported community programs.

[]{#__RefHeading___Toc128466361 .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. Keep the
> review criteria in mind when writing the application.
>
> **Start preparing the application early.** Allow plenty of time to
> gather required information from various sources.
>
> **Follow the instructions in this guidance carefully.** Place all
> information in the order requested in the guidance. If the information
> is not placed in the requested order, you may receive a lower score.
>
> **Be brief, concise, and clear.** Make your points understandable.
> Provide accurate and honest information, including candid accounts of
> problems and realistic plans to address them. If any required
> information or data is omitted, explain why. Make sure the information
> provided in each table, chart, attachment, etc., is consistent with
> the proposal narrative and information in other tables.
>
> **Be organized and logical.** Many applications fail to receive a high
> score because the reviewers cannot follow the thought process of the
> applicant or because parts of the application do not fit together.
>
> **Be careful in the use of attachments.** Do not use the appendices
> for information that is required in the body of the application. Be
> sure to cross-reference all tables and attachments to the appropriate
> text in the application.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> pages are numbered (including appendices) and that page limits are
> followed. Limit the use of abbreviations and acronyms, and define each
> one at its first use and periodically throughout 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___Toc128466362 .anchor}APPENDIX A: HRSA's Electronic
Submission User Guide

User Guide Table of Contents

1\. INTRODUCTION
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

1.1. DOCUMENT PURPOSE AND
SCOPE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

1.2. DOCUMENT ORGANIZATION AND VERSION
CONTROL\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2\. NONCOMPETING CONTINUATION
APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.1. PROCESS
OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) (IF NOT ALREADY
REGISTERED)...................................................................................................\...\...\...\.....

2.3. PROJECT DIRECTOR AND AUTHORIZING OFFICIAL NEED TO REGISTER WITH
HRSA EHBS

(IF NOT ALREADY REGISTERED)
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.4. APPLY THROUGH [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.4.1 Find Funding
Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2.4.2 Download Application Package
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.4.3 Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2.4.4 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

2.4.5 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

2.5. VERIFY IN HRSA ELECTRONIC HANDBOOKS
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

2.5.1 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

2.5.2 Manage Access to Your Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2.5.3 Check Validation
Errors\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.5.4 Fix Errors and Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

2.5.5 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

2.6. SUBMIT SIGNED FACE
PAGE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3\. COMPETING
APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.1. PROCESS
OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

3.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) NOT ALREADY
REGISTERED)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.3. APPLY THROUGH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.3.1 Find Funding
Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.3.2 Download Application
Package\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.3.3 Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.3.4 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

3.3.5 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

3.4. SUBMIT SIGNED FACE PAGE
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

4\. GENERAL INSTRUCTIONS FOR APPLICATION
SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

4.1. NARRATIVE ATTACHMENT
GUIDELINES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

4.1.1
Font\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

4.1.2 Paper Size and
Margins\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

4.1.3
Names\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

4.1.4 Section Headings
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

4.1.5 Page
Numbering\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

4.1.6 Allowable Attachment or Document
Types\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

4.2. APPLICATION CONTENT ORDER (TABLE OF
CONTENTS)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

4.3. PAGE
LIMIT\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

5.0 CUSTOMER SUPPORT INFORMATION
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

5.1.1 Grants.gov Customer
Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

5.1.2 HRSA Call
Center\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

5.1.3 HRSA Program
Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

6.0
FAQs\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.1.
SOFTWARE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.1.1 What are the software requirements for using
Grants.gov?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

6.1.2 Why can\'t 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?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
\...\...\...\.....

6.1.4 What are the software requirements for HRSA
EHBs?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.1.5 What are the system requirements for using HRSA EHBs on a
Macintosh computer?\...\...\...\...\...

6.2. 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?
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

6.2.2 When do I need to submit my application?
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.2.3 What emails can I expect once I submit my application? Is email
reliable? \...\...\...\...\...\...\...\...\...\.....

6.2.4 If a resubmission is required because of Grants.gov system
problems, will these be

considered
\"late\"?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

6.3. APPLICATION
SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.3.1 How can I make sure that my electronic application is presented in
the right order for

objective
review?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

6.4 GRANT.GOV
HELP\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

# 

## 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)

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

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

## 2.2 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)

o Obtain a username and password from the Grants.gov Credential Provider

o Register the username and password with Grants.gov

o Get authorized as an AOR by your organization

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

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

##  {#section-1 .unnumbered}

## 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.

###  {#section-2 .unnumbered}

### 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.

## 2.6 Submit Signed Face Page {#submit-signed-face-page .unnumbered}

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

HRSA Grants Application Center

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

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

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

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

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

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

## 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.

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

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

## 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)

o Obtain a username and password from the Grants.gov Credential Provider

o Register the username and password with Grants.gov

o Get authorized as an AOR by your organization

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

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

## 3.4 Submit Signed Face Page {#submit-signed-face-page-1 .unnumbered}

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

HRSA Grants Application Center

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

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

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

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

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

## 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-4 .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.

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

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

**Noncompeting Submissions:**

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

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

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

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

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

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

### 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___Toc128466422 .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
[DGPClearances@hrsa.gov](../DGPClearances@hrsa.gov%20) 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
1-800-447-8477. Grants.gov also provides a variety of support options
through online Help including Context-Sensitive Help, Online Tutorials,
FAQs, Training Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

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

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

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

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

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

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

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

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

The Grants.gov/Apply feature includes a simple, unified application
process to enable applicants to apply for grants online. The information
applicants need to understand and execute the steps is at
http://www.grants.gov/GetStarted. 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.

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

The HRSA Grants Application Center

The Legin Group, Inc.

Attn: \[provide Grants.gov Tracking Number\]

> Program Announcement No. \[provide HRSA announcement number\]
>
> CFDA No. \[provide the CFDA number\]

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

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

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

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

**Performance Measures for Competitive Applications**

Many HRSA guidances include specific data forms and require performance
measure reporting. If the completion of performance measure information
is indicated in this guidance, successful applicants receiving grant
funds will be required, within 30 days of the Notice of Grant Award
(NGA), to register in HRSA's Electronic Handbooks (EHBs) and
electronically complete the program specific data forms that appear in
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.

##  {#section-5 .unnumbered}

## Appendix C: MCH Pyramid

## CORE PUBLIC HEALTH SERVICES 

## DELIVERED BY MCH AGENCIES

![](media/image1.jpeg){width="6.25in" height="6.71875in"}

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

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

## Appendix D: Program Specific Information -- MCH Performance Measures

## **Performance Measure 10** The degree to which MCHB supported programs have incorporated cultural competence elements into their policies, guidelines, contracts and training {#performance-measure-10-the-degree-to-which-mchb-supported-programs-have-incorporated-cultural-competence-elements-into-their-policies-guidelines-contracts-and-training .unnumbered}

## **Performance Measure 21 The percentage of women participating in MCHB supported programs requiring a referral, who receive a completed referral** {#performance-measure-21-the-percentage-of-women-participating-in-mchb-supported-programs-requiring-a-referral-who-receive-a-completed-referral .unnumbered}

+-----------------------------------+-----------------------------------+
| **10 PERFORMANCE MEASURE**        | The degree to which MCHB          |
|                                   | supported programs have           |
| **Goal 2: Eliminate Health        | incorporated cultural competence  |
| Barriers & Disparities**          | elements into their policies,     |
|                                   | guidelines, contracts and         |
| **(Develop and promote health     | training.                         |
| services and systems of care      |                                   |
| designed to eliminate disparities |                                   |
| and barriers across MCH           |                                   |
| populations)**                    |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Cultural Competence** |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase the number of MCHB    |
|                                   | supported programs that have      |
|                                   | integrated cultural competence    |
|                                   | into their policies, guidelines,  |
|                                   | contracts and training.           |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which MCHB          |
|                                   | supported programs have           |
|                                   | incorporated cultural competence  |
|                                   | elements into their policies,     |
|                                   | guidelines, contracts and         |
|                                   | training.                         |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 23     |
|                                   | elements that demonstrate         |
|                                   | cultural competency. Please check |
|                                   | the degree to which the elements  |
|                                   | have been implemented. The answer |
|                                   | scale is 0-69. Please keep the    |
|                                   | completed checklist attached.     |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.23:       |
|                                   | Increase the proportion of States |
|                                   | and jurisdictions that have       |
|                                   | service systems for children with |
|                                   | or at risk for chronic and        |
|                                   | disabling conditions as required  |
|                                   | by Public Law 101-239.            |
|                                   |                                   |
|                                   | Related to Objective 23.11        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of State and local     |
|                                   | public health agencies that meet  |
|                                   | national performance standards    |
|                                   | for essential public health       |
|                                   | services.                         |
|                                   |                                   |
|                                   | Related to Objective 23.15        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of Federal, Tribal,    |
|                                   | State, and local jurisdictions    |
|                                   | that review and evaluate the      |
|                                   | extent to which their statutes,   |
|                                   | ordinances, and bylaws assure the |
|                                   | delivery of essential public      |
|                                   | health services.                  |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
|                                   |                                   |
|                                   | -   There is no existing national |
|                                   |     data source to measure the    |
|                                   |     extent to which MCHB          |
|                                   |     supported programs have       |
|                                   |     incorporated cultural         |
|                                   |     competence elements into      |
|                                   |     their policies, guidelines,   |
|                                   |     contracts and training.       |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Over the last decade, researchers |
|                                   | and policymakers have emphasized  |
|                                   | the central influence of cultural |
|                                   | values and cultural/linguistic    |
|                                   | barriers: health seeking          |
|                                   | behavior, access to care, and     |
|                                   | racial and ethnic disparities. In |
|                                   | accordance with these concerns,   |
|                                   | cultural competence objectives    |
|                                   | have been: (1) incorporated into  |
|                                   | the MCHB strategic plan; and (2)  |
|                                   | in guidance materials related to  |
|                                   | the Omnibus Budget Reconciliation |
|                                   | Act of 1989 (OBRA '89), which is  |
|                                   | the legislative mandate that      |
|                                   | health programs supported by MCHB |
|                                   | Children with Special Health Care |
|                                   | Needs (CSHCN) provide and promote |
|                                   | family centered, community‑based, |
|                                   | coordinated care.                 |
+-----------------------------------+-----------------------------------+

**DATA COLLECTION FORM**

**PERFORMANCE MEASURE #10**

Using a scale of 0-3, please rate the degree to which your grant program
has incorporated the following cultural competence elements into your
policies, guidelines, contracts and training.

+------+------+------+------+------------------------------------------+
| *    | *    | *    | *    | **Element**                              |
| *0** | *1** | *2** | *3** |                                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CORE FUNCTIONS:** Our organization     |
|      |      |      |      | incorporates the following culturally    |
|      |      |      |      | competent core function elements:        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Performs needs/assets assessments    |
|      |      |      |      |     with the culturally diverse groups   |
|      |      |      |      |     we serve.                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Collects and analyzes data according |
|      |      |      |      |     to different cultural groups (e.g.   |
|      |      |      |      |     race, ethnicity, language).          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Designs services to meet the needs   |
|      |      |      |      |     of culturally diverse groups (e.g.   |
|      |      |      |      |     use of traditional healers, flexible |
|      |      |      |      |     times of services, language          |
|      |      |      |      |     services).                           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Uses data on different groups for    |
|      |      |      |      |     program development.                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Considers barriers and the provision |
|      |      |      |      |     of appropriate strategies to address |
|      |      |      |      |     them.                                |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Evaluates and monitors quality       |
|      |      |      |      |     services (via customer satisfaction  |
|      |      |      |      |     surveys, focus groups, chart         |
|      |      |      |      |     reviews).                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in the core          |
|      |      |      |      | functions? *None\_\_\_ Informal\_\_\_    |
|      |      |      |      | Formal\_\_\_ In process\_\_\_*           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **TRAINING/HUMAN RESOURCES**: Our        |
|      |      |      |      | organization incorporates the following  |
|      |      |      |      | culturally competent training/human      |
|      |      |      |      | resource elements:                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Employs a culturally diverse and     |
|      |      |      |      |     linguistically and culturally        |
|      |      |      |      |     competent staff.                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Ensures the provision of training,   |
|      |      |      |      |     both in orientation and ongoing      |
|      |      |      |      |     professional development, for staff, |
|      |      |      |      |     volunteers, contractors and          |
|      |      |      |      |     subcontractors in the area of        |
|      |      |      |      |     cultural and linguistic competence.  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in training and      |
|      |      |      |      | human resources?                         |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with informal community     |
|      |      |      |      | leaders/groups (e.g. natural networks,   |
|      |      |      |      | informal leaders, spiritual leaders,     |
|      |      |      |      | ethnic media, family advocacy groups) in |
|      |      |      |      | various aspects of the following         |
|      |      |      |      | categories::                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with families of culturally |
|      |      |      |      | diverse groups in various aspects of the |
|      |      |      |      | following categories:                    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the above   |
|      |      |      |      | mentioned collaborative activities?      |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **RESOURCE ALLOCATION:** Our             |
|      |      |      |      | organization's allocation of resources   |
|      |      |      |      | adequately meets the unique access,      |
|      |      |      |      | information and service needs of         |
|      |      |      |      | culturally diverse groups in the         |
|      |      |      |      | following program areas:                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Planning                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Implementation                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/Monitoring (e.g. customer |
|      |      |      |      |     satisfaction surveys, focus groups)  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the         |
|      |      |      |      | allocation of fiscal resources for the   |
|      |      |      |      | needs and services for culturally        |
|      |      |      |      | diverse groups?                          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CONTRACTS:** Our agency puts language  |
|      |      |      |      | in contracts that addresses our goals to |
|      |      |      |      | incorporate cultural competence for      |
|      |      |      |      | culturally and linguistically diverse    |
|      |      |      |      | groups in the following areas**:**       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Needs/assets assessments             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Outreach                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Specialized services                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Training for                         |
|      |      |      |      |     contractors/subcontractors           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Sufficient funds to support 1-e      |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Reporting requirements for a-e       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support monitoring  |
|      |      |      |      | of contractors/ subcontractors?          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑69 score)
\_\_\_\_\_\_\_\_\_\_

+-----------------------------------+-----------------------------------+
| **21 PERFORMANCE MEASURE**        | The number of women participating |
|                                   | in MCHB supported programs        |
| **Goal 3: Assure Quality of       | requiring a referral, who receive |
| Care**                            | a completed referral.             |
|                                   |                                   |
| **(Develop and promote health     |                                   |
| services and systems that assure  |                                   |
| appropriate follow-up services)** |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Women's Health**      |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | Increase the percentage of        |
|                                   | completed referrals for women     |
|                                   | participating in MCHB supported   |
|                                   | programs in need of services.     |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The number of women participating |
|                                   | in MCHB supported programs        |
|                                   | requiring a referral, who receive |
|                                   | a completed referral.             |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | **Numerator:**                    |
|                                   |                                   |
|                                   | Unduplicated number of MCHB       |
|                                   | funded program participants who   |
|                                   | have completed service            |
|                                   | referral(s)                       |
+-----------------------------------+-----------------------------------+
|                                   | **Denominator:**                  |
|                                   |                                   |
|                                   | Unduplicated number of MCHB       |
|                                   | funded program participants who   |
|                                   | have a need for which a referral  |
|                                   | was made for health service(s).   |
+-----------------------------------+-----------------------------------+
|                                   | A "completed service referral" is |
|                                   | defined as a client who received  |
|                                   | the services from provider(s) to  |
|                                   | whom she was referred either      |
|                                   | within or outside of the MCHB     |
|                                   | program/agency. The purpose of    |
|                                   | these referrals can be either     |
|                                   | treatment-related (e.g., AIDS or  |
|                                   | substance abuse treatment,        |
|                                   | domestic violence counseling) or  |
|                                   | preventive (e.g., family          |
|                                   | planning, WIC, depression         |
|                                   | screening/ referral, early        |
|                                   | intervention services).           |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.5 :       |
|                                   | Reduce maternal illness and       |
|                                   | complications due to pregnancy    |
|                                   |                                   |
|                                   | Related to Objective 16.17:       |
|                                   | Increase abstinence from alcohol, |
|                                   | cigarettes, and illicit drugs     |
|                                   | among pregnant women.             |
|                                   |                                   |
|                                   | Related to Objective 21.3:        |
|                                   | Increase to at least 95% the      |
|                                   | proportion of pregnant women and  |
|                                   | infants who receive               |
|                                   | risk-appropriate care.            |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Provider and MCHB program     |
|                                   |     patient records.              |
|                                   |                                   |
|                                   | ```{=html}                        |
|                                   | <!-- -->                          |
|                                   | ```                               |
|                                   | -   Projects will need to have a  |
|                                   |     process to verify a completed |
|                                   |     referral.                     |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | In order to be effective, health  |
|                                   | services must ensure that a       |
|                                   | client's risks are identified and |
|                                   | that they receive services that   |
|                                   | address their identified needs    |
|                                   | and are referred appropriately.   |
|                                   | There is no impact if the         |
|                                   | referral is not                   |
|                                   | completed/services not obtained.  |
+-----------------------------------+-----------------------------------+

## Appendix E: Program Specific Information -- MCH Financial and Demographic Forms

## The following Financial and Demographic forms are required to be completed for this non-competing continuation application. Refer to Section IV.B.6.b for information on completing these forms.  {#the-following-financial-and-demographic-forms-are-required-to-be-completed-for-this-non-competing-continuation-application.-refer-to-section-iv.b.6.b-for-information-on-completing-these-forms. .unnumbered}

## **Form 1**: MCHB Project Budget Details and Instructions {#form-1-mchb-project-budget-details-and-instructions .unnumbered}

## **Form 2**: Project Funding Profile and Instructions {#form-2-project-funding-profile-and-instructions .unnumbered}

## **Form 3:** Budget Details by Types of Individuals Served {#form-3-budget-details-by-types-of-individuals-served .unnumbered}

## **Form 4**: Project Budget and Expenditures: By Types of Services and Instructions {#form-4-project-budget-and-expenditures-by-types-of-services-and-instructions .unnumbered}

## **Form 5:** Number of Individuals Served (Unduplicated) by Type of Individual and Source of Primary Insurance Coverage {#form-5-number-of-individuals-served-unduplicated-by-type-of-individual-and-source-of-primary-insurance-coverage .unnumbered}

## **Form 6**: Maternal and Child Health Discretionary Grant Project Abstract and Instruction {#form-6-maternal-and-child-health-discretionary-grant-project-abstract-and-instruction .unnumbered}

## **Form 7**: Discretionary Grant Project Summary Data and Instructions {#form-7-discretionary-grant-project-summary-data-and-instructions .unnumbered}

**FORM 1**

**MCHB PROJECT BUDGET DETAILS FOR FY \_\_\_\_\_\_\_**

+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
| * | * |       |                    |                     |     |    |
| 1 | M |       |                    |                     |     |    |
| . | C |       |                    |                     |     |    |
| * | H |       |                    |                     |     |    |
| * | B |       |                    |                     |     |    |
|   | G |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | W |       |                    |                     |     |    |
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|   | R |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
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|   | N |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
| * | * |       |                    |                     |     |    |
| 2 | U |       |                    |                     |     |    |
| . | N |       |                    |                     |     |    |
| * | O |       |                    |                     |     |    |
| * | B |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
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+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
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|   |   | PRANS |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | CISS  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
|   |   | SSDI  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
|   |   | Absti |                    |                     |     |    |
|   |   | nence |                    |                     |     |    |
|   |   | Educ  |                    |                     |     |    |
|   |   | ation |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 5\)   |                    |                     | \$  |    |
|   |   | He    |                    |                     |     |    |
|   |   | althy |                    |                     |     |    |
|   |   | Start |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 6\)   |                    |                     | \$  |    |
|   |   | EMSC  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 7\)   |                    |                     | \$  |    |
|   |   | Bi    |                    |                     |     |    |
|   |   | oterr |                    |                     |     |    |
|   |   | orism |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 8\)   |                    |                     | \$  |    |
|   |   | Trau  |                    |                     |     |    |
|   |   | matic |                    |                     |     |    |
|   |   | Brain |                    |                     |     |    |
|   |   | I     |                    |                     |     |    |
|   |   | njury |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 9\)   |                    |                     | \$  |    |
|   |   | State |                    |                     |     |    |
|   |   | Title |                    |                     |     |    |
|   |   | V     |                    |                     |     |    |
|   |   | Block |                    |                     |     |    |
|   |   | Grant |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
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|   |   | ther: |                    |                     |     |    |
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|   | s |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 1\)   |                    |                     | \$  |    |
|   |   | HIV   |                    |                     |     |    |
|   |   | /AIDS |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | Pr    |                    |                     |     |    |
|   |   | imary |                    |                     |     |    |
|   |   | Care  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
|   |   | H     |                    |                     |     |    |
|   |   | ealth |                    |                     |     |    |
|   |   | P     |                    |                     |     |    |
|   |   | rofes |                    |                     |     |    |
|   |   | sions |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
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|   |   | ther: |                    |                     |     |    |
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|   |   | CMS   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | SSI   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
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|   |   | gricu |                    |                     |     |    |
|   |   | lture |                    |                     |     |    |
|   |   | (     |                    |                     |     |    |
|   |   | WIC/o |                    |                     |     |    |
|   |   | ther) |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
|   |   | ACF   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 5\)   |                    |                     | \$  |    |
|   |   | CDC   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 6\)   |                    |                     | \$  |    |
|   |   | S     |                    |                     |     |    |
|   |   | AMHSA |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 7\)   |                    |                     | \$  |    |
|   |   | NIH   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 8\)   |                    |                     | \$  |    |
|   |   | Educ  |                    |                     |     |    |
|   |   | ation |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 9\)   |                    |                     | \$  |    |
|   |   | O     |                    |                     |     |    |
|   |   | ther: |                    |                     |     |    |
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|   |   |       |                    |                     | \$  |    |
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+---+---+-------+--------------------+---------------------+-----+----+

**INSTRUCTIONS FOR COMPLETION OF FORM 1**

**MCH BUDGET DETAILS FOR FY \_\_\_\_**

Line 1. Enter the amount of the Federal MCHB grant award for this
project.

Line 2. Enter the amount of carryover from the previous year's award, if
any (the unobligated balance).

Line 3. Indicate if matching funds are required by checking the
appropriate choice. If matching funds are required, enter the total
amount of the matching funds received or committed to the project. List
the amounts by source on lines 3A through 3D as appropriate. Do not
include "overmatch" funds. Any additional funds over and above the
amount required for matching purposes should be reported in Line 4.
Where appropriate, include the dollar value of in-kind contributions.

Line 4. Enter the amount of other funds received for the project, by
source on Lines 4A through 4E, specifying amounts from each source. Do
not include those amounts included in Line 3 above. Also include the
dollar value of in-kind contributions.

Line 5. Enter the sum of lines 1 through 4

Line 6. Line 6. Enter the amount of other Federal funds received on the
appropriate lines (A.1 through C.9) **other** than the MCHB grant award
for the project. Such funds would include those from other Departments,
other components of the Department of Health and Human Services, or
other MCHB grants or contracts.

Line 6 C.1. Enter only project funds from the Center for Medicare and
Medicaid Services. Exclude Medicaid reimbursement, which is considered
Program Income and should be included on Line 3C or 4C.

If lines 6A.10, 6B.4, or 6C.9 are utilized, specify the source(s) of the
funds in the order of the amount provided, starting with the source of
the most funds. If more space is required, add a footnote at the bottom
of the page showing additional sources and amounts.

Line 7. Enter the sum of Lines 6A.1 through 6C.9.

NOTE: MCHB Training Grants must fill out Section "V. Detailed Budget" of
the currently approved SF-424 in addition to this form.

**FORM 2**

**PROJECT FUNDING PROFILE**

<table style="width:100%;">
<colgroup>
<col style="width: 1%" />
<col style="width: 11%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
</tr>
<tr class="odd">
<td><strong>1</strong></td>
<td><p><u>MCHB Grant</u></p>
<p><u>Award</u> <u>Amount</u></p>
<p><em>Line 1, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>2</strong></td>
<td><p><u>Unobligated Balance</u></p>
<p><em>Line 2, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="odd">
<td><strong>3</strong></td>
<td><p><u>Matching Funds</u></p>
<p><u>(If required)</u></p>
<p><em>Line 3, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>4</strong></td>
<td><p><u>Other Project Funds</u></p>
<p><em>Line 4, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="odd">
<td><strong>5</strong></td>
<td><p><u>Total Project Funds</u></p>
<p><em>Line 5, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>6</strong></td>
<td><p><u>Total Federal Collaborative Funds</u></p>
<p><em>Line 7, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
</tbody>
</table>

**INSTRUCTIONS FOR THE COMPLETION OF FORM 2**

**PROJECT FUNDING PROFILE**

**Instructions:**

> Complete all required data cells. If an actual number is not
> available, use an estimate. Explain all estimates in a footnote.
>
> The form is intended to provide at a glance funding data on the
> estimated budgeted amounts and actual expended amounts of an MCH
> project.
>
> For each fiscal year, the data in the columns labeled Budgeted on this
> form are to contain the same figures that appear on the Application
> Face Sheet and Lines 1 through 7 of Form 1. The lines under the
> columns labeled Expended are to contain the actual amounts expended
> for each grant year that has been completed.

**FORM 3**

> **BUDGET DETAILS BY TYPES OF INDIVIDUALS SERVED**

**For Projects Providing Direct Health Care, Enabling, or
Population-based Services**

+---------------+------------+------------+------------+------------+
|               | **         |            | **         |            |
|               | FY\_\_\_\_ |            | FY\_\_\_\_ |            |
|               | \_\_\_\_** |            | \_\_\_\_** |            |
+---------------+------------+------------+------------+------------+
| **Target      | \$         | \$         | \$         | \$         |
| Po            | Budgeted   | Expended   | Budgeted   | Expended   |
| pulation(s)** |            |            |            |            |
+---------------+------------+------------+------------+------------+
| Pregnant      |            |            |            |            |
| Women         |            |            |            |            |
|               |            |            |            |            |
| (All Ages)    |            |            |            |            |
+---------------+------------+------------+------------+------------+
| Infants       |            |            |            |            |
|               |            |            |            |            |
| (Age 0 to     |            |            |            |            |
| 1year)        |            |            |            |            |
+---------------+------------+------------+------------+------------+
| Children      |            |            |            |            |
|               |            |            |            |            |
| (Age 1year to |            |            |            |            |
| 24 years)     |            |            |            |            |
+---------------+------------+------------+------------+------------+
| CSHCN Infants |            |            |            |            |
|               |            |            |            |            |
| (Age 0-1 year |            |            |            |            |
| )             |            |            |            |            |
+---------------+------------+------------+------------+------------+
| CSHCN         |            |            |            |            |
| Children      |            |            |            |            |
|               |            |            |            |            |
| (Age 1 year   |            |            |            |            |
| to 24 years)  |            |            |            |            |
+---------------+------------+------------+------------+------------+
| Non-pregnant  |            |            |            |            |
| Women         |            |            |            |            |
|               |            |            |            |            |
| (Age 22 and   |            |            |            |            |
| over          |            |            |            |            |
+---------------+------------+------------+------------+------------+
| Other         |            |            |            |            |
+---------------+------------+------------+------------+------------+
| **TOTAL**     |            |            |            |            |
+---------------+------------+------------+------------+------------+

> **INSTRUCTIONS FOR COMPLETION OF FORM 3**
>
> **BUDGET DETAILS BY TYPES OF INDIVIDUALS SERVED**

**[For Projects Providing Direct Health Care, Enabling, or
Population-based Services]{.underline}**

If the project provides direct health care services, complete all
required data cells. If an actual number is

not available make an estimate. Please explain all estimates in a
footnote.

All ages are to be read from x [to]{.underline} y, [not]{.underline}
including y. For example, infants are those from birth [to]{.underline}
1, and

children are from age 1 [to]{.underline} 22.

Enter the budgeted and expended amounts for the appropriate fiscal year,
for each targeted population

group. Note that the Total for each column is to be the same as that
appearing in Line 5, Form 1, and in

Line 5, Form 2.

Enter the expended amounts for the appropriate fiscal year that has been
completed for each target

population group. Note that these figures are to be the actual amounts
expended; new projects will not

have data in "Expended" columns.

> **Form 3 Worksheet**
>
> **BUDGET/EXPENDITURE BREAKDOWN FOR SUBCATEGORIES OF INDIVIDUALS
> SERVED\
> For Projects Providing Direct Health Care, Enabling, or
> Population-based Services**

+-------------+-------------+-------------+-------------+-------------+
|             | **Year 1**  |             | **Year 2**  |             |
+-------------+-------------+-------------+-------------+-------------+
| Target      | > Budgeted  | > Expended  | > Budgeted  | > Expended  |
| Population  |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **Pregnant  |             |             |             |             |
| Women (All  |             |             |             |             |
| Ages)**     |             |             |             |             |
|             |             |             |             |             |
| *(Line 1,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Pregnant    |             |             |             |             |
| Women       |             |             |             |             |
|             |             |             |             |             |
| (All Ages)  |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Pregnant    |             |             |             |             |
| Women       |             |             |             |             |
|             |             |             |             |             |
| (All Ages)  |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **Infants   |             |             |             |             |
| (Age 0 to 1 |             |             |             |             |
| year)**     |             |             |             |             |
|             |             |             |             |             |
| *(Line 2,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Infants     |             |             |             |             |
|             |             |             |             |             |
| (0 to 1     |             |             |             |             |
| year)       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Infants     |             |             |             |             |
|             |             |             |             |             |
| (0 to 1     |             |             |             |             |
| year)       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **Children  |             |             |             |             |
| (Age 1 year |             |             |             |             |
| to 24       |             |             |             |             |
| years)**    |             |             |             |             |
|             |             |             |             |             |
| *(Line 3,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| Age 12      |             |             |             |             |
| months      |             |             |             |             |
| through 23  |             |             |             |             |
| months      |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| Age 12      |             |             |             |             |
| months      |             |             |             |             |
| through 23  |             |             |             |             |
| months      |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| Age 24      |             |             |             |             |
| months      |             |             |             |             |
| through 4   |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| Age 24      |             |             |             |             |
| months      |             |             |             |             |
| through 4   |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| (No         |             |             |             |             |
| n-pregnant) |             |             |             |             |
| Age 5 years |             |             |             |             |
| through 23  |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Children    |             |             |             |             |
| (No         |             |             |             |             |
| n-pregnant) |             |             |             |             |
| Age 5 years |             |             |             |             |
| through 23  |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **CSHCN     |             |             |             |             |
| Infants     |             |             |             |             |
| (Age 0 to 1 |             |             |             |             |
| year)**     |             |             |             |             |
|             |             |             |             |             |
| *(Line 4,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Infants (0  |             |             |             |             |
| to 1 year)  |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Infants (0  |             |             |             |             |
| to 1 year)  |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **CSHCN     |             |             |             |             |
| Children    |             |             |             |             |
| (Age 1 year |             |             |             |             |
| to 24       |             |             |             |             |
| years)**    |             |             |             |             |
|             |             |             |             |             |
| *(Line 5,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| Age 12      |             |             |             |             |
| months      |             |             |             |             |
| through 23  |             |             |             |             |
| months      |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| Age 12      |             |             |             |             |
| months      |             |             |             |             |
| through 23  |             |             |             |             |
| months      |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| Age 24      |             |             |             |             |
| months      |             |             |             |             |
| through 4   |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| Age 24      |             |             |             |             |
| months      |             |             |             |             |
| through 4   |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| (No         |             |             |             |             |
| n-pregnant) |             |             |             |             |
| Age 5 years |             |             |             |             |
| through 23  |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| CSHCN       |             |             |             |             |
| Children    |             |             |             |             |
| (No         |             |             |             |             |
| n-pregnant) |             |             |             |             |
| Age 5 years |             |             |             |             |
| through 23  |             |             |             |             |
| years       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **N         |             |             |             |             |
| on-Pregnant |             |             |             |             |
| Women (Age  |             |             |             |             |
| 22 years    |             |             |             |             |
| and Over)** |             |             |             |             |
|             |             |             |             |             |
| *(Line 6,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| N           |             |             |             |             |
| on-pregnant |             |             |             |             |
| Women (All  |             |             |             |             |
| Ages)       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| N           |             |             |             |             |
| on-pregnant |             |             |             |             |
| Women (All  |             |             |             |             |
| Ages)       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **Other**   |             |             |             |             |
|             |             |             |             |             |
| *(Line 7,   |             |             |             |             |
| Form 3)*    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Program     |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Other       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| Community   |             |             |             |             |
| P           |             |             |             |             |
| articipant: |             |             |             |             |
| Other       |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **Total**   |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+

> **FORM 4**

**PROJECT BUDGET AND EXPENDITURES**

**By Types of Services**

+---+------------------------+--------+---+--------+---+--------+---+--------+
|   |                        | **FY   |   |        |   | **FY   |   |        |
|   |                        | \_\_\_ |   |        |   | \_\_\_ |   |        |
|   |                        | \_\_** |   |        |   | \_\_** |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
|   | **[TYPES OF            | **     |   | **     |   | **     |   | **     |
|   | S                      | [Budge |   | [Expen |   | [Budge |   | [Expen |
|   | ERVICES]{.underline}** | ted]{. |   | ded]{. |   | ted]{. |   | ded]{. |
|   |                        | underl |   | underl |   | underl |   | underl |
|   |                        | ine}** |   | ine}** |   | ine}** |   | ine}** |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Direct Health Care  | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * | (Basic Health Services |        |   |        |   |        |   |        |
| * | and                    |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Health Services for    |        |   |        |   |        |   |        |
|   | CSHCN.)                |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Enabling            | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| I |                        |        |   |        |   |        |   |        |
| . | (Transportation,       |        |   |        |   |        |   |        |
| * | Translation,           |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
|   | Outreach, Respite      |        |   |        |   |        |   |        |
|   | Care, Health           |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Education, Family      |        |   |        |   |        |   |        |
|   | Support                |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Services, Purchase of  |        |   |        |   |        |   |        |
|   | Health                 |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Insurance, Case        |        |   |        |   |        |   |        |
|   | Management,            |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | and Coordination with  |        |   |        |   |        |   |        |
|   | Medicaid,              |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | WIC and Education.)    |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Population-Based    | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| I |                        |        |   |        |   |        |   |        |
| I | (Newborn Screening,    |        |   |        |   |        |   |        |
| . | Lead                   |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
| * | Screening,             |        |   |        |   |        |   |        |
|   | Immunization, Sudden   |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Infant Death Syndrome  |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Counseling, Oral       |        |   |        |   |        |   |        |
|   | Health,                |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Injury Prevention,     |        |   |        |   |        |   |        |
|   | Nutrition, and         |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Outreach/Public        |        |   |        |   |        |   |        |
|   | Education.)            |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Infrastructure      | \$     |   | \$     |   | \$     |   | \$     |
| * | Building               |        |   |        |   |        |   |        |
| I | S                      |        |   |        |   |        |   |        |
| V | ervices]{.underline}** |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * | (Needs Assessment,     |        |   |        |   |        |   |        |
| * | Evaluation, Planning,  |        |   |        |   |        |   |        |
|   | Policy Development,    |        |   |        |   |        |   |        |
|   | Coordination, Quality  |        |   |        |   |        |   |        |
|   | Assurance, Standards   |        |   |        |   |        |   |        |
|   | Development,           |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Monitoring, Training,  |        |   |        |   |        |   |        |
|   | Applied Research,      |        |   |        |   |        |   |        |
|   | Systems of Care, and   |        |   |        |   |        |   |        |
|   | Information Systems.)  |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | ######### **TOTAL**    | \$     |   | \$     |   | \$     |   | \$     |
| * |                        |        |   |        |   |        |   |        |
| V |                        |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+

**INSTRUCTIONS FOR THE COMPLETION OF FORM 4**

**PROJECT BUDGET AND EXPENDITURES BY TYPES OF SERVICE**S

Complete all required data cells. If an actual number is not available,
make an estimate. Please explain all estimates in a footnote.
Administrative dollars should be allocated to the appropriate level(s)
of the pyramid on lines I, II, II or IV. If an estimate of
administrative funds use is necessary, one method would be to allocate
those dollars to Lines I, II, III and IV at the same percentage as
program dollars are allocated to Lines I through IV.

Note: Lines I, II and II are for projects providing services. If grant
funds are used to build the infrastructure for direct care delivery,
enabling or population-based services, these amounts should be reported
in Line IV (i.e., building data collection capacity for newborn hearing
screening).

Line I [Direct Health Care Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Direct Health Care Services** are those services generally delivered
> one-on-one between a health professional and a patient in an office,
> clinic or emergency room which may include primary care physicians,
> registered dietitians, public health or visiting nurses, nurses
> certified for obstetric and pediatric primary care, medical social
> workers, nutritionists, dentists, sub-specialty physicians who serve
> children with special health care needs, audiologists, occupational
> therapists, physical therapists, speech and language therapists,
> specialty registered dietitians. Basic services include what most
> consider ordinary medical care, inpatient and outpatient medical
> services, allied health services, drugs, laboratory testing, x-ray
> services, dental care, and pharmaceutical products and services. State
> Title V programs support - by directly operating programs or by
> funding local providers - services such as prenatal care, child health
> including immunizations and treatment or referrals, school health and
> family planning. For CSHCN, these services include specialty and
> sub-specialty care for those with HIV/AIDS, hemophilia, birth defects,
> chronic illness, and other conditions requiring sophisticated
> technology, access to highly trained specialists, or an array of
> services not generally available in most communities.

Line II [Enabling Services]{.underline} - enter the budgeted and
expended amounts for the appropriate fiscal year completed and budget
estimates only for all other years.

> **Enabling Services** allow or provide for access to and the
> derivation of benefits from, the array of basic health care services
> and include such things as transportation, translation services,
> outreach, respite care, health education, family support services,
> purchase of health insurance, case management, coordination of with
> Medicaid, WIC and educations. These services are especially required
> for the low income, disadvantaged, geographically or culturally
> isolated, and those with special and complicated health needs. For
> many of these individuals, the enabling services are essential - for
> without them access is not possible. Enabling services most commonly
> provided by agencies for CSHCN include transportation, care
> coordination, translation services, home visiting, and family
> outreach. Family support activities include parent support groups,
> family training workshops, advocacy, nutrition and social work.

Line III [Population-Based Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Population Based Services** are preventive interventions and
> personal health services, developed and available for the entire MCH
> population of the State rather than for individuals in a one-on-one
> situation. Disease prevention, health promotion, and statewide
> outreach are major components. Common among these services are newborn
> screening, lead screening, immunization, Sudden Infant Death Syndrome
> counseling, oral health, injury prevention, nutrition and
> outreach/public education. These services are generally available
> whether the mother or child receives care in the private or public
> system, in a rural clinic or an HMO, and whether insured or not.

Line IV [Infrastructure Building Services]{.underline} - enter the
budgeted and expended amounts for the appropriate fiscal year completed
and budget estimates only for all other years.

> **Infrastructure Building Services** are the base of the MCH pyramid
> of health services and form its foundation. They are activities
> directed at improving and maintaining the health status of all women
> and children by providing support for development and maintenance of
> comprehensive health services systems and resources including
> development and maintenance of health services standards/guidelines,
> training, data and planning systems. Examples include needs
> assessment, evaluation, planning, policy development, coordination,
> quality assurance, standards development, monitoring, training,
> applied research, information systems and systems of care. In the
> development of systems of care it should be assured that the systems
> are family centered, community based and culturally competent.

Line V [Total]{.underline} -- enter the total amounts for each column,
budgeted for each year and expended for each year completed.

**FORM 5**

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) Program Participants\***

**By Type of Individual and Source of Primary Insurance Coverage**

######## For Projects Providing Direct Health Care, Enabling or Population-based Services

**Reporting Year\_\_\_\_\_\_\_\_**

#########  **Table 1** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| *         | **     | **T    | **Title | **Title | **Pri   | **N   |
| *Pregnant | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| Women     | Se     |        |         |         |         |       |
| Served**  | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Pregnant  |        |        |         |         |         |       |
| Women     |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| (All      |        |        |         |         |         |       |
| Ages)     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 15-19     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 20-24     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 25-34     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 35-44     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 45 +      |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 2** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **C       | **     | *      | **Title | **Title | **Pri   | **N   |
| hildren** | Number | *Total | XIX %** | XXI %** | vate/** | one** |
|           | Se     | Se     |         |         |         |       |
| *         | rved** | rved** |         |         | **Other | **%** |
| *Served** |        |        |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Infants   |        |        |         |         |         |       |
| \<1       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Children  |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| 1 to 24   |        |        |         |         |         |       |
| yr        |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 12-24     |        |        |         |         |         |       |
| months    |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 25        |        |        |         |         |         |       |
| months-   |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| 4 years   |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 5-9       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 15-19     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 20-24     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 3** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **CSHCN** | **     | **T    | **Title | **Title | **Pri   | **N   |
|           | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| *         | Se     |        |         |         |         |       |
| *Served** | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Infants   |        |        |         |         |         |       |
| \<1 yr    |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Children  |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| 1 to 24   |        |        |         |         |         |       |
| yr        |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 12-24     |        | []{    | []      | []      | []      | []{.  |
| months    |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 25        |        | []{    | []      | []      | []      | []{.  |
| months-   |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
|           |        |        |         |         |         |       |
| 4 yrs     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 5-9       |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 20-24     |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+

########  

######## FORM 5 Continued

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED)**

**By Type of Individual and Source of Primary Insurance Coverage**

########  For Projects Providing Direct Health Care, Enabling or Population-based Services

**Reporting Year\_\_\_\_\_**

**Table 4** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **Women** | **     | **T    | **Title | **Title | **Pri   | **N   |
|           | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| *         | Se     |        |         |         |         |       |
| *Served** | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Women 24+ |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 24-29     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 30-34     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 35-44     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 45-54     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 55-64     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 65+       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 5** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+----------+---------+---------+-------+
| **Other** | **Nu   | **T    | **Title  | **Title | **Pri   | **N   |
|           | mber** | otal** | XIX**    | XXI**   | vate/** | one** |
|           |        |        |          |         |         |       |
|           | **Se   | **Se   | **%**    | **%**   | **Other | **%** |
|           | rved** | rved** |          |         | %**     |       |
+-----------+--------+--------+----------+---------+---------+-------+
|           |        |        |          |         |         |       |
+-----------+--------+--------+----------+---------+---------+-------+

> Table 6 (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+----------+--------+---------+-------+
| #####     | **Nu   | **T    | **Title  | *      | **Pri   | **N   |
| ## TOTALS | mber** | otal** | XIX**    | *Title | vate/** | one** |
|           |        |        |          | XXI**  |         |       |
|           | **Se   | **Se   | **%**    |        | **Other | **%** |
|           | rved** | rved** |          | **%**  | %**     |       |
+-----------+--------+--------+----------+--------+---------+-------+
|           |        |        |          |        |         |       |
+-----------+--------+--------+----------+--------+---------+-------+

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 5**

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) PROGRAM PARTICIPANTS\***

**By Type of Individual and Source of Primary Insurance Coverage**

**[For Projects Providing Direct Health Care, Enabling or
Population-based Services]{.underline}**

Enter data into all required (unshaded) data cells. If an actual number
is not available, make an estimate. Please explain all estimates, in a
footnote. Do not enter data into shaded cells.

**[Note]{.underline}** that ages are expressed as either x to y,
[not]{.underline} through y (i.e., 1 to 22, meaning from age 1 [up
to]{.underline} age 22, but not including 22) or x -- y (i.e., 1 -- 4)
meaning age 1 [through]{.underline} age 4. Also, symbols are used to
indicate directions. For example \<1 means less than 1, or from birth up
to, but not including age 1. On the other hand, 45+ means age 45 and
over.

1\. At the top of the form, on the Line Reporting Year, enter the year
for which the data applies.

2.  In Column (a) for all tables, enter the unduplicated count of
    individuals who received a direct service from the project
    regardless of the primary source of insurance coverage. These
    services would generally be included in the top three levels of the
    MCH pyramid (the fourth, or base level, would generally not contain
    direct services) and would include individuals served by total
    dollars reported on Line 5 of Forms 1 and 2.

3\. In Column (b), enter the total number of the individuals summed from
Column (a). Column (b) will be summed automatically and entered into the
appropriate data cell for Tables 1, 2, 3, and 4. For Table 5, enter the
Total number of Other individuals served, i.e., males. For Table 6,
enter the sum of Column (b) from Table 1, 2, 3, 4, and 5.

4.  In the remaining columns report, for all tables, the percentage of
    those individuals receiving direct health care, enabling or
    population-based services, the percentage who have as their primary
    source of coverage:

> Column (c): Title XIX (includes Medicaid expansion under Title XXI)

Column (d): Title XXI

Column (e): Private or other coverage

Column (f) None

> These may be estimates. If individuals are covered by more than one
> source of insurance, they should be listed under the column of their
> [primary]{.underline} source.

**FORM 6**

**MATERNAL & CHILD HEALTH DISCRETIONARY GRANT**

**PROJECT ABSTRACT**

**FOR FY\_\_\_\_**

**PROJECT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**I. PROJECT IDENTIFIER INFORMATION**

1\. Project Title:

> 2\. Project Number:
>
> 3\. E-mail address:

**II. BUDGET**

1\. MCHB Grant Award \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 1, Form 2)

2\. Unobligated Balance \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 2, Form 2)

3\. Matching Funds (if applicable) \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 3, Form 2)

4\. Other Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 4, Form 2)

5\. Total Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 5, Form 2)

**III. TYPE(S) OF SERVICE PROVIDED (Choose all that apply)**

\[ \] Direct Health Care Services

> \[ \] Enabling Services
>
> \[ \] Population-Based Services
>
> \[ \] Infrastructure Building Services

IV. **PROJECT DESCRIPTION OR EXPERIENCE TO DATE**

> A. Project Description

1.  Problem (in 50 words, maximum):

2.  Goals and Objectives: (List up to 5 major goals and time-framed
    objectives per goal for the project)

> Goal 1:

Objective 1:

Objective 2:

Goal 2:

Objective 1:

Objective 2:

Goal 3:

Objective 1:

Objective 2:

Goal 4:

Objective 1:

Objective 2:

Goal 5:

Objective 1:

Objective 2:

3.  Activities undertaken to meet project goals

4.  Specify the primary *Healthy People 2010* objectives(s) (up to
    three) which this project addresses:

> a\.
>
> b\.
>
> c\.

5\. Coordination (List the State, local health agencies or other
organizations involved in the project and their roles)

6\. Evaluation (briefly describe the methods which will be used to
determine whether process and outcome objectives are met)

B.  Continuing Grants ONLY

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1.  Experience to Date (For continuing projects ONLY):

2.  Website URL and annual number of hits

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```
V.  **KEY WORDS**

**VI. ANNOTATION**

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 6**

**PROJECT ABSTRACT**

**NOTE:** All information provided should fit into the space provided in
the form. The completed form should be no more than 3 pages in length.
Where information has previously been entered in forms 1 through 5, the
information will automatically be transferred electronically to the
appropriate place on this form.

**Section I -- Project Identifier Information**

Project Title: List the appropriate shortened title for the project.

Project Number: This is the number assigned to the project when funded,
and will, for new projects, be filled in later.

E-mail address: Include electronic mail addresses

**Section II -- Budget -** These figures will be transferred from Form
1, Lines 1 through 5.

**Section III - Types of Services**

Indicate which type(s) of services your project provides, checking all
that apply (consistent with Form 5)

**Section IV -- Program Description OR Current Status (DO NOT EXCEED THE
SPACE PROVIDED)**

A. New Projects only are to complete the following items:

1.  A brief description of the project and the problem it addresses such
    as preventive and primary care services for pregnant women, mothers,
    and infants; preventive and primary care services for children; and
    services for Children with Special Health Care Needs.

2.  Up to 5 goals of the project, in priority order. Examples are: To
    reduce the barriers to the delivery of care for pregnant women, to
    reduce the infant mortality rate for minorities and "services or
    system development for children with special healthcare needs." MCHB
    will capture annually every project's top goals in an information
    system for comparison, tracking, and reporting purposes; you must
    list at least 1 and no more than 5 goals. For each goal, list the
    two most important objectives. The objective must be specific (I.e.,
    decrease incidence by 10%) and time limited (by 2005).

3.  List the primary Healthy people 2010 goal(s) that the project
    addresses.

4.  Describe the programs and activities used to attain the goals and
    objectives, and comment on innovation, cost, and other
    characteristics of the methodology, proposed or are being
    implemented. Lists with numbered items can be used in this section.

5.  Describe the coordination planned and carried out, in the space
    provided, if applicable, with appropriate State and/or local health
    and other agencies in areas(s) served by the project.

6.  Briefly describe the evaluation methods that will be used to assess
    the success of the project in attaining its goals and objectives.

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B.  For continuing projects ONLY:

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1.  Provide a brief description of the major activities and
    accomplishments over the past year (not to exceed 200 words).

2.  Provide website and number of hits annually, if applicable.

**Section V -- Key Words**

> Key words describe the project, including populations served. Choose
> key words from the included list.

**Section VI -- Annotation**

> Provide a three- to five-sentence description of your project that
> identifies the project's purpose, the needs and problems, which are
> addressed, the goals and objectives of the project, the activities,
> which will be used to attain the goals, and the materials, which will
> be developed.

**FORM 7**

**DISCRETIONARY GRANT PROJECT**

**SUMMARY DATA**

1.  **Project Service Focus**

> \[ \] Urban/Central City \[ \] Suburban \[ \] Metropolitan Area (city
> & suburbs)
>
> \[ \] Rural \[ \] Frontier \[ \] Border (US-Mexico)

2.  **Project Scope**

> \[ \] Local \[ \] Multi-county \[ \] State-wide
>
> \[ \] Regional \[ \] National

3.  **Grantee Organization Type**

> \[ \] State Agency

\[ \] Community Government Agency

\[ \] School District

\[ \] University/Institution Of Higher Learning (Non-Hospital Based)

\[ \] Academic Medical Center

\[ \] Community-Based Non-Governmental Organization (Health Care)

\[ \] Community-Based Non-Governmental Organization (Non-Health Care)

\[ \] Professional Membership Organization (Individuals Constitute Its
Membership)

\[ \] National Organization (Other Organizations Constitute Its
Membership)

\[ \] National Organization (Non-Membership Based)

\[ \] Independent Research/Planning/Policy Organization

\[ \] Other
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

4.  **Project Infrastructure Focus** (from MCH Pyramid) if applicable

\[ \] Guidelines/Standards Development And Maintenance

\[ \] Policies And Programs Study And Analysis

\[ \] Synthesis Of Data And Information

\[ \] Translation Of Data And Information For Different Audiences

\[ \] Dissemination Of Information And Resources

\[ \] Quality Assurance

\[ \] Technical Assistance

\[ \] Training

\[ \] Systems Development

\[ \] Other

**5. Products and Dissemination**

  -------------------------------------------------------- --------------
  **PRODUCTS**                                             **NUMBER**

  Peer reviewed Journal Article                            

  Book/Chapter                                             

  Report/Monograph                                         

  Presentation                                             

  Doctoral Dissertation                                    

  Other:                                                   
  -------------------------------------------------------- --------------

**6. Demographic Characteristics of Project Participants for Clinical
Services Projects**

+-----------+--------+------+--------+--------+-------+-------+-----+---+
|           | **RACE |      |        |        |       | **E   |     |   |
|           | (In    |      |        |        |       | THNIC |     |   |
|           | dicate |      |        |        |       | ITY** |     |   |
|           | all    |      |        |        |       |       |     |   |
|           | that   |      |        |        |       |       |     |   |
|           | ap     |      |        |        |       |       |     |   |
|           | ply)** |      |        |        |       |       |     |   |
+===========+========+======+========+========+=======+=======+=====+===+
|           | Am     | A    | Black  | Native | White | His   | Not |   |
|           | erican | sian | or     | Ha     |       | panic | Hi  |   |
|           | Indian |      | A      | waiian |       | or    | spa |   |
|           | or     |      | frican | or     |       | L     | nic |   |
|           | Alaska |      | Am     | Other  |       | atino |     |   |
|           | Native |      | erican | P      |       |       | or  |   |
|           |        |      |        | acific |       |       | Lat |   |
|           |        |      |        | Is     |       |       | ino |   |
|           |        |      |        | lander |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Pregnant  |        |      |        |        |       |       |     |   |
| Women     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
| with      |        |      |        |        |       |       |     |   |
| Special   |        |      |        |        |       |       |     |   |
| Health    |        |      |        |        |       |       |     |   |
| Care      |        |      |        |        |       |       |     |   |
| Needs     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Women     |        |      |        |        |       |       |     |   |
|           |        |      |        |        |       |       |     |   |
| (Not      |        |      |        |        |       |       |     |   |
| Pregnant) |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Other     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| TOTALS    |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+

7.  **Clients' Primary Language(s)**

    **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

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

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

8.  **Resource/TA and Training Centers ONLY**

    Answer all that apply.

    a.  Characteristics of Primary Intended Audience(s)

> \[ \] Policy Makers/Public Servants
>
> \[ \] Consumers

\[ \] Providers/Professionals

b\. Number of Requests Received/Answered: \_\_\_/\_\_\_\_

c.  Number of Continuing Education credits provided: \_\_\_\_\_\_\_

d.  Number of Individuals/Participants Reached: \_\_\_\_\_\_\_

e.  Number of Organizations Assisted: \_\_\_\_\_\_\_

f.  Major Type of TA or Training Provided:

> \[ \] continuing education courses,

\[ \] workshops,

\[ \] on-site assistance,

\[ \] distance learning classes

\[ \] other

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 7**

**PROJECT SUMMARY**

**NOTE:** All information provided should fit into the space provided in
the form. Where information has previously been entered in forms 2
through 9, the information will automatically be transferred
electronically to the appropriate place on this form.

**Section 1 -- Project Service Focus**

Select all that apply

**Section 2 -- Project Scope**

Choose the one that best applies to your project.

**Section 3 -- Grantee Organization Type**

Choose the one that best applies to your organization.

**Section 4 -- Project Infrastructure Focus**

If applicable, choose all that apply.

**Section 5 -- Products and Dissemination**

Indicate the number of each type of product resulting from the project.

**Section 6 -- Demographic Characteristics of Project Participants (for
Clinical Services Projects)**

Please fill in each of the cells as appropriate.

**Section 7 -- Clients Primary Language(s) (for Clinical Services
Projects)**

Indicate which languages your clients speak as their primary language,
other than English. List up to three.

**Section 8 -- Resource/TA and Training Centers (Only)**

Answer all that apply.