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

**Health Resources and Services Administration**

*Office of Health Information Technology: Division of State and
Community Assistance*

***Electronic Health Record Implementation for Health Center Controlled
Networks (HCCNs)***

*NEW COMPETITION*

*Announcement Number HRSA-08-097*

**Catalog of Federal Domestic Assistance (CFDA) No. 93.224**

**PROGRAM GUIDANCE**

Fiscal Year *2008*

Letter of Intent Due Date: February 8, 2008

**Application Due Date in Grants.gov: March 21, 2008**

Release Date: *January 17*, 2008

Date of Issuance: *January 17*, 2008

> *Samantha Wallack*
>
> *Program Analyst*
>
> *Division of Health Information Technology*

*State and Community Assistance*

*Telephone: 301 443 4660*

> *Fax: 301 443 1330*
>
> [*samantha.wallack@hrsa.hhs.gov*](mailto:samantha.wallack@hrsa.hhs.gov)
>
> Authority: Public Health Service Act, Title III, Section 330(e)(1)(C),
> (42 U.S.C. 254b)

**Guidance Table of Contents**

[***I. Funding Opportunity Description***
4](#__RefHeading___Toc47265096)

[Purpose 4](#__RefHeading___Toc47265097)

[Background](#__RefHeading___Toc47265098) 6

[***II. Award Information***](#__RefHeading___Toc47265100) ***8***

1\. Type of Award 8

2\. [Summary of Funding 8](#__RefHeading___Toc47265102)

[***III. Eligibility Information*** 8](#__RefHeading___Toc47265103)

[1. Eligible Applicants](#__RefHeading___Toc47265104) 8

[2. Cost Sharing/Matching](#__RefHeading___Toc47265106) 9

[3. Other 9](#__RefHeading___Toc47265108)

[***IV. Application and Submission Information***
10](#__RefHeading___Toc47265110)

[1. Address to Request Application Package
10](#__RefHeading___Toc47265113)

[Application Materials](#__RefHeading___Toc47265114) 10

PreApplication Conference Call 11

[2. Content and Form of Application Submission
11](#refheading___toc47265115)

> [Application Format Requirements 11](#__RefHeading___Toc47265116)
>
> [Application Format 15](#__RefHeading___Toc47265117)

[i. Application Face Page 15](#__RefHeading___Toc47265118)

[ii. Table of Contents 15](#__RefHeading___Toc47265119)

[iii. Application Checklist 15](#__RefHeading___Toc47265120)

[iv. Budget 15](#__RefHeading___Toc47265121)

[v. Budget Justification 15](#__RefHeading___Toc47265122)

[vi. Staffing Plan and Personnel Requirements
19](#__RefHeading___Toc47265123)

[vii. Assurances 19](#__RefHeading___Toc47265124)

[viii. Certifications 19](#__RefHeading___Toc47265125)

[ix. Project Abstract 19](#__RefHeading___Toc47265126)

[x. Program Narrative 20](#__RefHeading___Toc47265128)

[xi. Attachments](#__RefHeading___Toc47265130)

[3. Submission Dates and Times 26](#__RefHeading___Toc47265131)

[4. Intergovernmental Review 27](#__RefHeading___Toc47265137)

[5. Funding Restrictions 27](#__RefHeading___Toc47265139)

[6. Other Submission Requirements 28](#__RefHeading___Toc47265140)

[***V. Application Review Information***
29](#__RefHeading___Toc47265142)

[1. Review Criteria 29](#__RefHeading___Toc47265143)

[2. Review and Selection Process 33](#__RefHeading___Toc47265144)

[3. Anticipated Announcement and Award Dates
33](#__RefHeading___Toc47265150)

[***VI. Award Administration Information***
33](#__RefHeading___Toc47265153)

[1. Award Notices 33](#__RefHeading___Toc47265154)

[2. Administrative and National Policy Requirements
33](#__RefHeading___Toc47265156)

[3. Reporting 34](#__RefHeading___Toc47265158)

[***VII. Agency Contacts*** 35](#__RefHeading___Toc47265160)

[***VIII. Other Information*** 36](#__RefHeading___Toc47265164)

[ix. Tips for Writing a Strong Application
38](#__RefHeading___Toc47265165)

APPENDIX A -- ELECTRONIC SUBMISSION GUIDE 42

APPENDIX B -- REGISTERING AND APPLYING THROUGH GRANTS.GOV 61

APPENDIX C- MEMORANDA OF AGREEMENT 68

APPENDIX D- RESOURCES FOR APPLICANTS 70

APPENDIX E- HRSA REQUIRED PERFORMANCE MEASURE CATEGORIES DESCRIPTIONS 76

[]{#__RefHeading___Toc47265096 .anchor}**I. Funding Opportunity
Description**

[]{#__RefHeading___Toc47265097 .anchor}**Purpose**

This grant program is under the auspices of the Health Resources and
Services Administration (HRSA), U.S. Department of Health and Human
Services (DHHS). Projects are overseen by HRSA's Division of Health
Information Technology (HIT) State and Community Assistance (DHITSCA)
within The Office of Health Information Technology (OHIT). The funding
for this opportunity is in accordance with Section 330(e)(1)(C) of the
Public Health Service (PHS) Act (42 U.S.C. 254b), as amended.

This grant program is to support Health Center Controlled Networks
(HCCNs). For the purpose of this guidance, an HCCN is defined as a
Network controlled by and acting on behalf of the health center(s), as
defined and funded under Section 330(e)(1)(C) of the PHS Act, as
amended. The term "controlled" means to have the authority collectively
to appoint a minimum of 51 percent of the board members in the Network.
The HCCN must consist of at least three collaborator organizations. Key
definitions such as member, network, functions, may be found in Section
VIII-Definitions.

The purpose of the funding opportunity is to support HCCNs in the new
implementation of Electronic Health Records (EHR) as a tool to improve
the quality of health care provided in health centers and to improve
individual and population health. In addition, the aims of this funding
opportunity support the creation of sustainable business models for
deploying HIT in HCCNs as well as enhancing the capacity of health
centers to engage in strategic partnerships that leverage other HIT
initiatives and resources (including knowledge, experience, and funding)
already present in their state(s) and/or community(s) and/or region(s)
and to participate in pay for performance.

HRSA is interested in HCCNs that have a strong history of collaboration,
specifically with integrating functions (as defined in Section VIII --
Definitions). It is not recommended that HIT be the first integrated
function among health centers.

HRSA also seeks projects with an active quality improvement program that
can provide evidence of using data to improve care and to demonstrate
the value and effectiveness of health centers in the marketplace. One
example of such a program is HRSA's Health Disparities Collaborative
Care Model (HDC), a Community Oriented Primary Health Care (COPC) model
for system change around quality improvement.

**Program Expectations**

Based on a strong history of collaboration and an active quality
improvement program, successful applicants will be expected to
demonstrate the impact of EHR on enhancing the effectiveness,
efficiency, safety and quality on their health center delivery system.

1.  **Effectiveness.** The extent to which integrating a clinical
    quality improvement program with HIT will improve both health
    outcomes and systems of care. For example, a Network may use
    clinical decision support systems to generate reminders that promote
    preventive care to help manage chronic diseases and to improve
    population health.

2.  **Efficiency.** The extent to which inefficiencies such as lost
    medical records, lab results,

> and inadequate appointment systems are eliminated through the
> combination of HIT
>
> and a clinical quality improvement program. Projects should be able to
> quantify
>
> projected return on investment related to time saved, increases in
> revenue and other
>
> potential savings related to the resources used on the investment as
> well as increased
>
> tracking and reporting of patient's quality and health outcomes.
>
> 3**. Safety and Quality.** The extent to which mechanisms, such as
> computerized provider

order entry (CPOE), enhance patient safety and improve risk management
practices by

preventing medication and other medical errors.

Applicants should know that this is not a planning grant but, rather, it
is for implementation. Further, implementation is indicated, in part, by
the number of providers engaged in populating and managing an EHR for
patients that shall occur through use of an on-site implementation team
comprised of staff from each project site that includes (but is not
limited to) clinicians and IT leadership. In addition, successful
applicants will be expected to procure within six months of the award
date and to demonstrate that an integrated and collaborative HIT
infrastructure will be developed through the following four phases:

1\. A **final** **planning phase** where the HCCN will finalize an EHR
implementation plan and complete contract negotiations with a vendor.
The implementation plan [shall not]{.underline} include extensive
planning activities that should already have been completed such as:
conducting readiness assessments, workflow analyses, due diligence in
selecting a vendor, business planning and the determination of specific
Network HIT function(s).

2\. A **testing phase** where the plan will be thoroughly tested and
modified as necessary. This grant may be used during this phase (and/or
during the final planning phase as well) to purchase software and
licenses, hardware, and to obtain implementation assistance and any
technical staffing necessary. The testing activities should reflect the
plans for implementation and roll out. The EHR roll out may begin by
site, by clinician and/or by specialty.

3\. An **infrastructure building phase** where grant funds will be used
to not only build infrastructure but also to help transition workflow. A
secure platform for communication and sharing of clinical and other key
data will be established during this phase. Projects should support the
move to a clinical information system through an integrated system with
a common architecture. This will provide the best clinical and
administrative solution to the marketplace and will eliminate both
disparate clinical database sources and the fragmentation of clinical
data and information. These data should facilitate the development of at
least five performance outcome measures, two of which HRSA defines to
include diabetes control and child immunization (see the appendix or the
evaluation section of this guidance for a description of these
performance measures).

> 4\. A **roll out** **phase** where the EHR will be implemented by
> participants of the EHR project in a coordinated and integrated
> approach and this will include adequacy of staffing at the network and
> site level. The EHR roll out may begin by site, by clinician and/or by
> specialty. These grant funds [shall not]{.underline} be used for the
> ongoing maintenance of technology.

The use of HRSA funds for the purchase of new EHR products is limited to
products and software that are Certification Commission for Healthcare
Information Technology (CCHIT) certified. CCHIT Certified products meet
basic standards for functionality, interoperability, and security. The
CCHIT certification program reduces risks of HIT investments by
providers and ensures that prescriptions can be sent and refilled
electronically, that laboratory results can be received in a standard
format, better drug interaction checking, more thorough patient
reporting and clinical management, and stronger security protections for
your patient data. For more information on CCHIT, go to
[www.cchit.org.](http://www.cchit.org./)

In addition, it is essential to conduct due diligence prior to your
purchase and to purchase systems with features needed to improve
population health, such as structured data collection, registry
functions, quality measures and reporting, and decision support tools.
We recommend that applicants review the functional specifications that
HRSA has created in procuring EHR software and products. The functional
specifications can be found at:
<http://www.hrsa.gov/healthit/ehrguidelines.htm>.

In addition, because this is a network model that focuses on integration
of functions, sharing of data to improve the health center operations,
and maximizing efficiencies, the use of a single vendor and platform is
strongly recommended within the network that is applying.

**Authority**

This grant program is under the auspices of the Health Resources and
Services Administration (HRSA), U.S. Department of Health and Human
Services (HHS). Projects are overseen by HRSA's Division of HIT State
and Community Assistance (DHITSCA) within the Office of Health
Information Technology. The funding for this opportunity is in
accordance with Section 330(e)(1)(C) of the Public Health Service (PHS)
Act (42 U.S.C. 254b), as amended.

**General Consideration**

In selecting applications for funding, special consideration will be
given to geographic distribution, including urban and rural.

**Background**

The mission of HRSA's OHIT is to enhance the quality and efficiency of
primary and preventive care in the health center delivery system through
the effective use of HIT. These enhancements should result in measurable
improvements in patient outcomes and in reductions in health
disparities. Common examples of HIT may include practice management
systems, disease registry systems, care management systems, clinical
messaging systems, personal health record systems, electronic health
record systems and health information exchanges. HRSA envisions HIT will
have an impact on its safety net community in the following ways:

a.  Enhance safety net providers' capacity to measure and effectively
    report on the quality of care and the health outcomes in health
    centers.

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b.  Reduce health care costs that result from inefficiency, medical
    errors, inappropriate care and incomplete information.

c.  Increase the availability and transparency of information related to
    the health care needs of the patient and support physician decision
    making.

d.  Prepare health centers and other safety net providers to participate
    in pay-for-performance plans/systems.

e.  Support the ability to provide a rapid response to both natural and
    man-made disasters, including those due to bioterrorist acts.

f.  Further develop continuity of care across settings for health center
    and for other safety net patients as they move from outpatient to
    urgent, emergency, and inpatient care.

To be successful in the health care arena, it is essential that health
centers have state of the art information systems. According to several
recent studies, health centers have quickly identified technology's
potential to improve the efficiency and quality of their patients' care.
This funding opportunity builds on health center innovations in chronic
care management, EHRs, patient registries, practice management systems,
and in quality improvement. HRSA's goal is not simply to collect data,
but to use the data to improve individual and population health. HRSA
views this funding opportunity as more of a Clinical Quality project,
than as an IT project; and therefore, envisions the outcome as improved
quality of care and health outcomes not just the implementation of an E
H R.

HRSA's experience has shown that it is cost effective to utilize the
HCCN model, often on a statewide or multi-market basis, to develop
information systems. These systems support the operation and
administration of health centers and other safety net providers in the
state or market. Over the years, HCCNs have increased access, enhanced
efficiency and provided higher performance value among safety net
providers. The development of federally supported HCCNs through HRSA
began with funding HCCNs in FY 1994. In response to both the changes in
the environment and to the lessons learned by previously funded HCCNs,
the focus of the Network program has been modified to continue the
evolutionary process. Over time, HCCNs have developed various
organizational and service delivery models. Areas of variation include
horizontal and vertical collaboration, the extent to which HCCNs
centralized functions previously operated at the health center level,
and the role of partnering with community health stakeholders.
[]{#__RefHeading___Toc47265100 .anchor}HRSA acknowledges that there are
many challenges and barriers involved with implementing successful EHR
adoption including the large financial investment. HCCNs are poised to
provide the expertise and experience needed to address many of the
barriers associated with EHR implementation, such as particularly in the
area of intellectual property and training.

HRSA is committed to ensuring access to quality health care for all.
Quality care means having access to services, information, materials
delivered by competent providers in a manner that factors in the
language needs, cultural richness, and also a diversity in populations
served. Quality also means that, where appropriate, data collection
instruments used should adhere to culturally competent and
linguistically appropriate norms. For additional information and
guidance, refer to the National Standards for Culturally and
Linguistically Appropriate Services in Health Care published by the U.S.
Department of Health and Human Services. This document is available
online at <http://www.omhrc.gov/CLAS>.

**II. Award Information**

**1. Type of Award**

Funding will be provided in the form of a grant.

**2. Summary of Funding**

This program will provide funding for Federal fiscal years 2008-2010.
Approximately \$1.5 million is expected to be available to fund up to
two awards. The project period may be up to three years in length, and
the funding shall not exceed \$1.9 million over the three year project
period. Funding in year one shall not exceed \$750,000 and funding
beyond the first year is dependent on the availability of appropriated
funds for HCCN's in subsequent fiscal years, grantee satisfactory
performance, and a decision that funding is in the best interest of the
Federal government. Funding provided in year two will be 15% less than
that awarded in year one; funding in year three will be 25% less than
that awarded in year two. HRSA expects that recipients will be able to
sustain the project beyond the project period and requests specific
information on sustainability and on the decreasing reliance on federal
funds for each year in the section of the guidance entitled: "Resolution
of Challenges."

Please see "Funding Restrictions" for information regarding allowable
use of funds.

[]{#__RefHeading___Toc47265103 .anchor}**III. Eligibility Information**

**1. Eligible Applicants**

Eligible applicants are limited to Section 330 grantees from one of the
following categories:

-   A Network controlled by and acting on behalf of the health
    center(s), as defined and funded under Section 330(e)(1)(C) of the
    PHS Act, as amended. At the request of all the member health
    centers, a Network may apply for direct funds if it is at least
    majority controlled and, as applicable, at least majority owned, by
    such health centers as defined and funded under Section
    330(e)(1)(C). For the purposes of this grant opportunity, the term
    "controlled" means to have the authority collectively to appoint a
    minimum of 51 percent of the Network's board members in the Network.

-   A health center, as defined and funded under Section 330 of the
    Public Health Service (PHS) Act (42 U.S.C. 254b), as amended,
    applying on behalf of a managed care Network or plan, that has
    received federal grants under subsection 330(e)(1)(A) for at least
    the two consecutive preceding years; or,

-   A health center as defined and funded under Section 330 of the
    Public Health Service (PHS) Act (42 U.S.C. 254b), as amended,
    applying on behalf of a practice management Network.

Networks must consist of at least three collaborator organizations and
be 51% controlled by health centers. If a health center applies for this
funding opportunity on behalf of the Network, then the health center
will count as one of the collaborating organizations. Three separate
organizations must be in place. For further information on what
constitutes this relationship see Section VIII-Definitions-Network
Members.

A managed care Network is one that is owned and controlled by the health
centers and negotiates managed care contracts for its members. A
practice management Network refers to the ongoing operations and
practices including financial, clinical, IT and other functions. A
Network may include organizations in addition to Section 330 grantees
that are community based and have similar goals and missions such as a
Federally Qualified Health Center Look- Alike, locally funded clinics,
etc.

**2. Cost Sharing and Matching**

Cost sharing and matching are not required components for this funding
opportunity. However, applicants are strongly encouraged to demonstrate
cost participation as an indicator of community and organizational
support for the project and also to delineate the likelihood that the
project will continue after Federal grant support has ended. Cost
participation may be in the form of cash or in-kind contributions (e.g.
equipment, personnel, building space, indirect costs). Applicants are
expected to maximize the use of non-Federal funds to the greatest extent
possible and to present a plan for decreasing dependence on Federal
funds each year of the grant to assure the long-term sustainability of
the program. Applicants are encouraged to explore the flexibility
provided under the recent self-referral safe harbor for Federally
Qualified Health Centers (FQHC) that protects remuneration in the form
of goods, items, services, donations, loans or combination thereof to a
qualifying health center from an individual or an entity. Applicants
should also describe how they will work with their proposed partners to
share costs. Note that the reasonableness of the total budget and the
extent to which other appropriate resources are obtained and leveraged
within the budget each year are both key elements in the review of the
proposed project.

**3. Other**

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

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

In order to increase access to comprehensive and preventative primary
care, eligible applicants are encouraged to invite HRSA grantees other
than those with 330 funds, (e.g. Ryan White, Maternal and Child Health,
rural providers, Healthy Start), as well as other entities that have a
similar primary care mission (public health departments, other
community-based clinics, and faith-based organizations) to participate
in the implementation of EHR.

All applicants must ensure that the community-based boards of the
collaborating centers/members are knowledgeable and supportive of the
Network's activities. All applicants are expected to have a Memorandum
of Agreement (MOA) signed by all CEOs and Board Chairs of the Network
members. (See the MOA Section 6.5 in Appendix as well as Definition of
Network Members in Section VIII).

Prospective grantees should be aware that they will be required to
participate in any agency performance review of the HRSA funded
program(s) by the Office of Performance Review (OPR). The purpose of
performance review is to improve the performance of HRSA funded
programs.

Throughout the application the applicant shall, wherever appropriate,
describe the program's or institution's strategic plan, policies, and
initiative(s) that demonstrate a commitment to providing culturally and
linguistically competent health care and to developing culturally and
linguistically competent health care providers, faculty, staff, and
program participants. This includes participation in, and, support of
programs that focus on cross-cultural health communication approaches as
strategies to educate health care providers serving diverse patients,
families, and communities.

[]{#__RefHeading___Toc47265110 .anchor}**IV. Application and Submission
Information**[]{#__RefHeading___Toc47265113 .anchor}

1**. Address to Request Application Package**

**Application Materials**

The application and submission process has changed significantly. HRSA
is ***requiring*** applicants for this funding opportunity to apply
electronically through Grants.gov. All applicants ***must*** submit in
this manner unless the applicant is granted a written exemption from
this requirement in advance by the Director of HRSA's Division of Grants
Policy. Grantees must request an exemption in writing from
<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:

(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>
>
> Instructions for preparing portions of the application that must
> accompany Application Form 5161-1 appears in the "Application Format"
> section below.

### Pre-Application Conference Call

HRSA will hold one pre-application conference call for potential
applicants. The conference call will provide an overview of this program
guidance and will include an opportunity for organizations to ask
questions. The pre-application call information is as follows:

• 2 PM ET on February 20, 2008

• Call in number: 888 282 0170

• Passcode: 1383464

The replay number for the pre application call is: 800 216 3053. The
replay recording will be available until March 21, 2008.

[]{#refheading___toc47265115 .anchor}**2. Content and Form of
Application Submission**[]{#__RefHeading___Toc47265116 .anchor}

**Application Format Requirements**

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

The total size of all uploaded files **may not exceed the equivalent of
80 pages when printed by HRSA, approximately 10 MB. This 80-page limit
includes the abstract, project and budget narratives, attachments, and
letters of commitment and support**. Standard forms are NOT included in
the page limit.

**Applications that exceed the specified limits (approximately 10 MB, or
that exceed 80 pages when printed by HRSA) will be deemed non-compliant.
All non-compliant applications will be returned to the applicant without
further consideration.**

**Application Format**

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

# SF 424 Non Construction -- Table of Contents

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

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

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

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

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

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

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

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

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

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

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

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

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

  Attachment 1-6      Attachment   Can be uploaded in Other Refer to the
                                   Attachments form 1-15    attachment table
                                                            provided below for
                                                            **specific**
                                                            sequence. Counted in
                                                            the page limit.
  ------------------------------------------------------------------------------

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

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

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

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

+------------------+---------------------------------------------------+
| **Attachment     | **Attachment Description (Program Guidelines)**   |
| Number**         |                                                   |
+==================+===================================================+
| Attachment 1     | Tables, charts, etc.                              |
+------------------+---------------------------------------------------+
| Attachment 2     | Staffing plan and personnel requirements; job     |
|                  | descriptions for key personnel:                   |
|                  |                                                   |
|                  | Provide a staffing plan that discusses the        |
|                  | staffing requirements necessary to accomplish the |
|                  | EHR implementation. Staffing needs should be      |
|                  | explained and should have a direct link to        |
|                  | activities proposed in the project narrative and  |
|                  | budget portion of your application. Provide the   |
|                  | job descriptions for key personnel listed in the  |
|                  | application. For purposes of this grant           |
|                  | application key personnel is defined as persons   |
|                  | funded by this grant or persons conducting        |
|                  | activities central to this grant program.         |
+------------------+---------------------------------------------------+
| Attachment 3     | Biographical sketches of key personnel:           |
|                  |                                                   |
|                  | Provide biographical sketches or resumes for      |
|                  | persons occupying the key positions described in  |
|                  | the application. Resumes and/or sketches should   |
|                  | be brief (1-2 pages). In the event that a         |
|                  | biographical sketch is included for an identified |
|                  | individual who is not yet hired, please include a |
|                  | letter of commitment from that person with the    |
|                  | biographical sketch.                              |
+------------------+---------------------------------------------------+
| Attachment 4     | Letters of agreement and/or descriptions of       |
|                  | proposed/existing contracts.                      |
+------------------+---------------------------------------------------+
| Attachment 5     | Project organizational chart:                     |
|                  |                                                   |
|                  | Provide an organizational chart of the Network    |
|                  | that depicts the relationship among the members   |
|                  | and includes the governing board.                 |
+------------------+---------------------------------------------------+
| Attachment 6     | Other relevant documents (i.e. dated letters of   |
|                  | support). Be sure each additional attachment is   |
|                  | clearly labeled. Include only letters of support  |
|                  | which specifically indicate a commitment to the   |
|                  | project.                                          |
+------------------+---------------------------------------------------+

[]{#__RefHeading___Toc47265117 .anchor}**Application Format**

i.  []{#__RefHeading___Toc47265118 .anchor}***Application Face Page***

> 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.*224*.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm> or call 1-866-705-5711.
> Please include the DUNS number item 8c on the application face page.
> Applications ***will not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization is required to register with
> the Federal Government's Central Contractor Registry (CCR) in order to
> do electronic business with the Federal Government. Information about
> registering with the CCR can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm>.

ii. []{#__RefHeading___Toc47265119 .anchor}***Table of Contents***

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

iii. []{#__RefHeading___Toc47265120 .anchor}***Application Checklist***

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

iv. []{#__RefHeading___Toc47265121 .anchor}***Budget***

    Questions about the budget or fiscal matters should be directed to
    the Agency's Grants Management Specialist for the program as listed
    under guidance "Section VII- Agency Contacts." The budget forms (PHS
    5161-1, SF 424A, pages 1 and 2) that are part of the application
    should be included in this section of the application. The budget
    justification narrative should remain under "Section v- Budget
    Justification" of the application.

    **Budget Information and Instructions for Completing the SF 424A**

    **NOTE:** Please follow the instructions found here rather than
    using the information found in PHS Form 5161-1.

    For Section A and Section B below, view both sections as separate
    pages; the columns do not align for these sections.

> **[SF 424A]{.underline}: [Section A -- Budget Summary]{.underline}**
>
> Line 1, Column a: Enter EHR Grant Program.
>
> Line 1, Column b: Enter 93.224.
>
> Line 1, Columns c and d: Leave blank (not applicable for new
> applications).
>
> Line 1, Columns e and f: Enter the Project Costs for the first year of
> the project
>
> (FY 2008) from Federal and non-Federal Sources.
>
> Line 1, Column g: Enter the total for Columns "e" and "f".
>
> Line 2-5: Enter "Year 2" on line two with the corresponding request
> for federal in 2e and projected nonfederal for Year 2 in 2f with the
> total in 2g. Do the same for "Year 3" on the third line.
>
> **[SF 424A]{.underline}: [Section B -- Budget
> Categories]{.underline}**
>
> Section B: Include Federal break-down of expenses only.
>
> Line 6, column marked 1: Enter the amount of Federal support requested
> for each Object Class Category, rows "a" through "h" for program year
> one. Enter the total of "a" through "h" into row "i".
>
> **Note:** See funding restrictions under Use of Funds section.
>
> Columns marked 2 and 3: Repeat above for line 6 for program year two
> and for program year three respectively.
>
> Line 6, Item j (Indirect Costs): Specify the amount of Indirect
> Charges. For indirect costs, note: if requesting indirect costs then
> include a copy of your indirect cost rate agreement with the Division
> of Cost Allocation as an attachment with the application. If the
> applicant does not have an indirect cost rate agreement negotiated,
> but plans to negotiate one as soon as notification of an award occurs,
> then it is possible to request up to 10% of direct salaries and wages
> ONLY. If the recipient fails to provide a timely proposal, indirect
> costs paid in anticipation of establishment of a rate will be
> disallowed. Refer to <http://rates.psc.gov/> for further information.
>
> Line 6, Item k: The amount on Line 6 "k", should be the same as the
> amount in Section A, Line 1, Column "e" above, and Block 15a of the
> Face Page, SF-424.
>
> Line 7, Column 1: Leave blank.
>
> **[SF 424A]{.underline}: [Section C -- Non-Federal
> Resources]{.underline}**
>
> Line 8, Column a: Enter EHR Grant Program.
>
> Line 8, Columns b, c, and d: Enter the value of cash and in-kind
> contributions contributed by the applicant, State and other sources
> and insert the total(s) in Column "e". These figures correspond with
> those on the Face Page, Blocks 15 "b", "c", "d", and "e".
>
> Line 12, Column e: Enter the total of Columns "b", "c", and "d". This
> amount should be the same as that shown in Section A, Line 1, Column
> "f".
>
> Use Column "a" rows to label each program year (one year per line)
> with corresponding projections in columns "b", "c", "d" and "e".
>
> **[SF 424A]{.underline}: [Section D -- Forecasted Cash
> Needs]{.underline}**
>
> This section does not apply. Leave this section blank.
>
> **[SF 424A]{.underline}: [Section E -- Budget Estimates of Federal
> Funds Needed For Balance of the Project]{.underline}**
>
> Leave blank.
>
> **[SF 424A]{.underline}: [Section F -- Other Budget
> Information]{.underline}**
>
> Lines 21-23 can be left blank. This information is identified in the
> narrative justification.
>
> **[General Budget Information]{.underline}**
>
> [Indirect Costs]{.underline}
>
> 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 the applicant
> does not have an indirect cost rate, you 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. (See Section B line 6, item j note included earlier).

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 will support the achievement of proposed objectives. The
> budget period is for ONE year. However, the applicant must submit
> one-year budget justifications for [each]{.underline} of the
> subsequent project period years (usually one to three years or more)
> at the time of application The budget should show decreasing reliance
> on the grant resources over the life of the project. Specifically, the
> budget must reflect a 15% decrease in funding for year two and a 25%
> decrease from the year two funding for the final year three of the
> project. The maximum award in year one shall not exceed \$750,000;
> thus total funds over three years shall not exceed \$1.9 million. Line
> item information must be provided to explain the costs entered in
> Application Form 5161-1. Note: the budget can include funding for EHR
> related expenses such as decision support staff for analysis of
> measures at the Network level; grant funds do not cover staff at a
> health center level. **The budget justification must clearly describe
> each cost element and explain how each cost contributes to meeting the
> project's objectives as stated in the work plan section.** Be very
> careful about showing how each item in the "other" category is
> justified. The budget justification MUST be concise. Do NOT use the
> justification to expand the project narrative.
>
> ***Budget for Multi-Year Grant Award-Required, if applicable***
>
> This announcement is inviting applications for project periods up to 3
> years. Awards, on a competitive basis, will be for a one‑year budget
> period, although project periods may be for 3 years. Applications for
> continuation grants funded under these awards beyond the one-year
> budget period but within the 3 year project period will be entertained
> in subsequent years on a noncompetitive basis, subject to availability
> of funds, satisfactory progress of the grantee compliance with
> statutory and regulatory grant requirements, and a determination that
> continued funding would be in the best interest of the Government.
>
> Include the following in the Budget Justification narrative:
>
> *Personnel Costs: Personnel costs should be explained by listing each
> staff member who will be supported from funds, name (if possible),
> position title, percent full time equivalency, annual salary, and
> requested support.*
>
> *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. Expenses such as airfare, lodging, per diem, etc. should be
> broken down by amount and number of days as applicable. The budget
> should also reflect the travel expenses associated with participating
> in meetings and other proposed trainings or workshops such as an
> annual HRSA grantee meeting.*
>
> *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. Please note
> that the Federal definition of equipment is \$5,000 or more per unit
> 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 each contract budgets
> should be presented by using the same object class categories
> contained in the Standard Form 424A. Provide a clear explanation as to
> the purpose of each contract, how the costs were estimated, and the
> specific contract deliverables.*
>
> *Other: Put all costs that do not fit into any other category into
> this category and provide and explanation of each cost in this
> category. In some cases, grantee rent, utilities and insurance fall
> under this category if they are not included in an approved indirect
> cost rate.)*

[]{#__RefHeading___Toc47265123 .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]{.underline} that include the roles,
> responsibilities, and qualifications of [proposed]{.underline} project
> staff must be included in Attachment 2. Copies of [biographical
> sketches]{.underline} for any key [employed]{.underline} personnel
> that will be assigned to work on the proposed project must be included
> in Attachment 3 and CV's must be submitted for the project director.
>
> Wherever appropriate, describe a plan to recruit and retain staff,
> health care providers, faculty, and students with demonstrated
> experience serving the specific target population and familiarity with
> the culture and literacy level of the particular target group.

vii. []{#__RefHeading___Toc47265124 .anchor}***Assurances***

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

viii. []{#__RefHeading___Toc47265125 .anchor}***Certifications***

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

ix. []{#__RefHeading___Toc47265126 .anchor}***Project Abstract***

> Provide a summary of the application. Because the abstract is often
> distributed to provide information to the public and to Congress,
> please prepare this so that it is clear, accurate, concise, and
> without reference to other parts of the application. It must include a
> brief description of the proposed grant project including:

a.  The overall summary scope of the project by filling in the following
    statements: The total number of organizations impacted by this
    proposal are Y, of which X are Section 330 grantees. The total
    number of sites impacted by this proposal are Y of which X are
    Section 330 sites. The total number of patients impacted by this
    proposal are Y of which X are Section 330 patients.

b.  A description of the disparities and unmet needs of the population
    in the scope outlined above.

c.  A description of the clinical impact of implementing the EHR upon
    the target population.

> []{.mark}

*Please place the following at the top of the abstract:*

-   *Project Title*

-   *Applicant Name*

-   *Address*

-   *Contact Phone Numbers (Voice, Fax)*

-   *E-Mail Address*

-   *Web Site Address, if applicable*

x.  []{#__RefHeading___Toc47265128 .anchor}***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***

> The applicant should briefly describe the overall purpose of the
> proposed project.

-   ***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 intends to address. This section should help reviewers
> understand the community and/or organization that will be served by
> the proposed project.*
>
> Below are some suggestions to include in this section.
>
> A. [Project Scope:]{.underline} Describe the population the project
> intends to impact. The intended target population of this project
> might be different than that of the applicant's Network membership.
> Using a table format, include the specific project participants [by
> site]{.underline} as follows: Organization, Type of Entity (if 330,
> provide UDS #; if non-330 HRSA program, indicate specific
> bureau/office), \# patients, \# provider FTE (if 330, use lines 1-15
> in UDS see:http://bphc.hrsa.gov/uds/manual/table5.htm), #software
> licenses over the project period, and, if appropriate, date MOA
> signed.
>
> B. [Marketplace Assessment]{.underline}: Describe factors affecting
> the success of the project. Stronger applicants will include the
> reimbursement environment such as managed care, Medicaid, Medicare,
> pay for performance, other sources of funding available to the Network
> such as the infusion of state money for HIT related efforts,
> coordination of this project with other national, regional, state
> and/or local HIT initiatives. Stronger applicants will provide a
> thorough description of the primary care service delivery environment
> including the composition of the local health care delivery matrix and
> the collaboration (HIT and non-HIT) among participating health centers
> and other providers of care at the state and local level (i.e.
> community hospitals, university medical centers, state and local
> health departments, managed care organizations, private providers).

-   ***RESPONSE***

> Describe methods that will be used to meet the program requirements
> and expectations in this grant announcement. The project plan should
> be supported by a multi-year work plan that shows how the adoption of
> an EHR will support the organizations' business and clinical
> operations. Below are some suggested areas to address:
>
> A. [Vision:]{.underline} Describe the extent to which the proposed
> technology will increase health
>
> outcomes and allow for population health management, including a
> commitment to serving
>
> the specific target population and familiarity with the culture and
> literacy level of the
>
> particular target group.
>
> B. [Strategic Planning]{.underline}: Provide a brief overview of the
> project's multi-year strategic
>
> planning process and evidence that this is part of the participating
> centers' long term strategic
>
> and business plans. Note: Completion of a detailed strategic/financial
> planning document is
>
> not required for this application. However, grantees will be required
> to submit a detailed
>
> strategic/financial plan as part of the Year 2 non-competing
> continuation proposal should
>
> funding be available in FY 2009.
>
> C. [Network versus Health Center HIT Functions:]{.underline} Identify
> the specific HIT functions the
>
> Network will provide related to this project versus the functions that
> will remain at the health
>
> center level. Applicants should remember this is a Network model.
>
> D. [Deployment]{.underline}:
>
> **1. Readiness:** Provide evidence of the readiness of the Network to
> apply for an implementation grant in terms of pre-planning activities
> conducted such as due diligence in vendor selection, workflow
> analysis, clinical and leadership buy in. If the applicant Network is
> going to join an already existing HCCN or will subcontract with the
> network then include due diligence in that selection process. Again,
> this is an implementation grant and, thus, the vendor procurement
> should take place in six months from award date of a successful
> applicant.
>
> []{.mark}
>
> **2. Key Features to Improve Patient Care in a Health Center:**
> Provide evidence that
>
> the system selected will include key features essential to caring for
> populations, such as
>
> registry functions, decision support tools, and quality measures
> reporting. That is, the
>
> applicant should include evidence that reports can be generated from
> the system(s) to
>
> document population based health outcomes. Provide evidence that there
> is knowledge of
>
> technical requirements and a rational for cost-effective deployment
> and operation in a
>
> health center environment that includes consideration of various
> feasible alternatives.   []{.mark}
>
> []{.mark}
>
> **3. Standards and Interoperability:** Describe how
> the proposed technology complies
>
> with existing federal and industry standards (such as CCHIT
> certification), including any
>
> functional requirements the Network outlined that may be specific to
> health centers. The
>
> applicant should outline the steps it will take to integrate
> the proposed EHR with other IT
>
> systems such as practice management systems. 

Data should be integrated using a common structure, business rules and
practices in order

to facilitate a future health information exchange across a state or a
regional

marketplace.  Include information, as it is available, related to plans
to interface with

entities in and external to the network and indicate how such plans are
included in the

business model and/or in the strategic plan. 

> []{.mark}

4.  **Patient** **Privacy**: Describe the actions to be taken to assure
    the privacy of patients and

> clinicians using the system and the confidentiality of information
> transmitted via the

system. Include a description of how the applicant will comply with
Federal and

State privacy and confidentiality, including HIPAA regulations
(implementing the

> Health Insurance Portability and Accountability Act of 1996 - see

<http://www.hhs.gov/ocr/hipaa/> ).

[]{.mark}

> **5. Implementation Process:** Describe how the implementation will
> take place. Will it be by specialty, by site, or by provider panel?
> Include a description of the implementation team comprised of staff
> from each project site that includes (but is not limited to)
> clinicians and IT leadership.
>
> E. [Work Plan]{.underline}: Describe the activities or steps that will
> be used to achieve and evaluate the scope of the proposed project. Use
> a time line that includes each activity and identifies responsible
> staff. Applicants should structure their work plan in a table format
> according to the aforementioned phases (planning, testing,
> infrastructure, and roll out) that identifies:

1.  **Goals** -- how clinical and business practices will look after
    implementation (i.e. the desired end product);

2.  **Objectives**;

3.  **Key action steps** for each objective;

4.  **Responsible entity** (person, committees, etc.);

5.  **Timetable**;

6.  **Cost by objective** (if appropriate, be clear in this section what
    portion of the funds requested are proposed to support other HCCN
    functions).

> F. [Resolution of Challenges]{.underline}: Discuss the challenges that
> are likely to be encountered in designing and implementing the
> activities described in the Work Plan. Describe approaches that will
> be used to resolve such challenges. Challenges to consider include,
> but are not limited, to the following:
>
> 1\. **Collaboration and sharing of data**: Integrating functions among
> different organizations while meeting their diverse needs in terms of
> size, organizational capacity and finances can easily go astray if the
> members do not all agree in advance and do not have a common set of
> principles and history of working together. Due to the complexity of
> HIT, it is not recommended to have HIT as the first ever integrated
> function among centers.
>
> 2\. **Clinician Acceptance, Support, and Involvement:** It is
> imperative to have clinician involvement throughout the planning,
> implementation, and continuous evaluation of any HIT system. It is
> important that clinicians have an understanding of the challenges in
> project implementation and that they demonstrate competence and
> willingness to meet those challenges. It is critical to commit
> resources for training staff and technical support to operate and
> maintain the system. It is important that the Network assure the
> technology is integrated into clinician practice and that issues of a
> potential decrease in productivity during implementation are planned
> for prior to implementation. In addressing this challenge, the
> applicant should provide HRSA with information on how the clinical
> staff has been substantially involved in all stages of planning and in
> issues such as customization, interfaces, and in training.
>
> 3\. **Consumer Acceptance, Support and Involvement**: It is imperative
> to have consumer involvement throughout the planning, implementation,
> and continuous evaluation of any HIT system. Be sure to include
> policies and initiatives that demonstrate a commitment to providing
> culturally and linguistically competent health care and developing
> culturally and linguistically competent health care providers,
> faculty, staff, and program participants. This includes participation
> in, and, support of programs that focus on cross-cultural health
> communication approaches as strategies to education health care
> providers serving diverse patients, families, and communities.
>
> 4\. **Contingency Planning and Business Recovery Process in the event
> of a business interruption at the Network level:** Include information
> on the development of back up systems in the event of event that could
> occur by chance or unforeseen circumstances related to the Network,
> such as a disaster, to ensure the continuity of EHR implementation and
> continuity of care (24/7).

-   ***EVALUATIVE MEASURES***

> The applicant should provide a balanced set of at least five proposed
> performance measures (process and outcome) that reflect improved
> health outcomes and systems of care. The applicant should also
> describe the method to monitor and evaluate the project results. Each
> measure must have baseline data at the time of application; this will
> allow computation of percentage increases in measures overtime. The
> applicant may create three of the performance indicators, but at least
> two indicators must be those related to child immunization and
> diabetes control as defined by HRSA. The three selected measures can
> consist of additional indicators for diabetes and for child
> immunization; the measures need to be uniform among the health centers
> in the project. Applicants must be able to track measures at the
> individual health center level. The definitions for these measures
> are:
>
> Child Immunization - % of children 2 years of age, with 4 DTaP, 3
> OPV/IPV, 1 X MMR, 3X HepB, 3XHib (and Varicella)
>
> Diabetes control - % of patients with either Type 1 or Type 2 diabetes
> whose HBA1c is \> 9%.
>
> The applicant should also describe its customer satisfaction process
> here to include how issues are addressed, how often, how formal, etc.

-   ***IMPACT***

> **A. Overall**: Describe the quantifiable difference that the project
> expects to make on the business and on the clinical operations of the
> participating organizations. That is, address what change in clinical
> practice the Network is seeking to make. Explain how the Network will
> know whether or not such change is an improvement. Since implementing
> EHR is a challenging endeavor, it is important that this be part of
> both an organization's strategic plan and its business plan
>
> **B. Sustainability:** This is a three year grant. Grant funds will
> not pay for ongoing operational and maintenance cost. It is important
> that the Network and its participating health centers have a plan for
> how the project will be sustained during and after a period of Federal
> grant funding, especially the ongoing maintenance and operational
> costs. Identify and define the Network relationship(s) (legal or
> other) that will bind the entities in implementing the proposed
> activities and will promote the sustainability of the EHR adoption
> after the grant funding ends. Provide a brief overview of the
> financial capabilities and financing of the EHR development project,
> with an emphasis on sustainability following the full drawdown of
> Federal funds. In addition, the applicant may wish to expand on the
> challenge of implementing an HIT initiative in a constantly changing
> marketplace.
>
> **C. Replicable Model**: Describe how the model of implementation (not
> the system itself) could be replicated. Describe any other methodology
> considerations that denote success indicators for this project such as
> shared learning, shared clinical protocols, and supportive financial
> environment towards establishing economies of scale.

-   ***RESOURCES AND CAPABILITIES***

A. **Adequacy of staff and management:** Describe the plan for managing
the project. The application should designate both a project director
who has day-to-day responsibility for the technical, administrative,
evaluation, and financial aspects of the project and a principal
investigator, who has overall responsibility for the project. The
project director may be the same as the principal investigator. Describe
how the applicant has analyzed the adequacy of its technical staff and
explain how this system will be maintained once it is up and running.
The adequacy of technical staff is critical for successful
implementation. To ensure the EHR is facilitating the organization's
clinical objectives, it is important that the technical project director
work closely with the lead clinician. The grantee's strategy to improve
patient health outcomes should always inform technical decisions
regarding the EHR.

> B. **CIO, Leadership, and Key Staff:** Include evidence that a CIO and
> helpdesk is already in place. Provide a short description of the
> responsibilities of key staff members, and note the full-time
> equivalent (FTE) each staff person must devote to the project.
> Identify who in a leadership position, within the application
> organization, will be involved in the project and describe what
> his/her specific role and time commitment will be.
>
> C. **Organizational Information**: Provide organizational information
> on the applicant's current mission, structure, vision, and activities.
> Describe how these contribute to its ability to execute the program
> requirements. Some areas to consider are:
>
> 1\. **Past experience with strong engagement in quality improvement
> programs:** Provide a brief description and documentation of results
> from participation in the Health Disparities Collaboratives or
> equivalent clinical quality improvement program. Results do not just
> include the participation in the Collaboratives, but rather the actual
> use of data to improve care. Examples of results include the centers'
> success in decreasing their average Hemoglobin A1C or increase their
> immunization or other preventive care rates. Include any lessons
> learned that can be applied to developing an integrated HIT. Remember
> this is not about the technology; it is about using the technology
> effectively to improve the centers' operation.
>
> 2**. Ability to foster collaboration internal to the Network,
> particularly around the sharing of data.** If appropriate, expand on
> the challenges mentioned earlier around fostering collaboration and
> sharing data among diverse organizations. The applicant may choose to
> include a description of how it may foster a vision and cohesion
> within the Network. The applicant may also choose to discuss the
> relationship between all partners/HCCNs members/sub-contractors on the
> project including the level of involvement of the boards among the
> Network members in the planning, development and performance of the
> proposed project. Elements of internal collaboration include:
>
> a\. Business arrangement among network entities;
>
> b\. Demonstrated commitment to the development, implementation, and
> operation of the Network. Commitment includes time, financial support,
> expertise, and other resources devoted to achieving the goals and
> objectives of the Network and of the EHR implementation project.
>
> c\. Signed MOA inclusive of all elements as outlined in Appendix C.
>
> d\. An explanation as to the appropriateness of the entity as an
> internal collaborator to the Network and what expertise they bring to
> the Network.
>
> e\. An outline of the roles and responsibilities, within the Network,
> of each member.
>
> f\. A description of the governance structure for the Network that
> demonstrates there is an effective, independent Network-driven
> leadership in place. Applicants must demonstrate that the governing
> body, rather than an individual network member, will make financial
> and programmatic decisions.
>
> 3**. Ability to foster collaboration external to the Network:**
> Describe the ability of the organization to build partnerships outside
> of its Network and how these partnerships will further the success of
> the project. Include information on the ability of this organization
> to build partnerships with state and/or local entities, neighboring
> HCCNs, and/or the State Primary Care Association. Elements of external
> collaboration include (a-f) described above only modified to pertain
> to entities external to the membership of the Network.

xi. ***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 Attachment3, 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.
    Memoranda of Agreement must be dated and shall include elements,
    including a description of the process for resolving member
    conflicts, as outlined in the appendix.*

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

[]{#__RefHeading___Toc47265131 .anchor}**3. Submission Dates and Times**

**Notification of Intent to Apply**

> An applicant is eligible to apply even if no letter of intent is
> submitted. Receipt of Letters of Intent will *not* be acknowledged.
>
> The letter should identify the applicant organization and its intent
> to apply, and briefly describe the proposal to be submitted. The
> letter is not to exceed two pages.

This letter should be sent by February 8, 2008, by mail or fax to:

Director, Division of Independent Review

HRSA Grants Application Center (GAC)

HRSA-08-097

The Legin Group, Inc.

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

*Fax: 877/477-2345*

**Application Due Date**

The due date for applications under this grant announcement is March 21,
2008 *at 8:00 P.M. ET*. **Applications will be considered as meeting the
deadline if they are E marked on or before the due date. Please consult
Appendix A, Section 3 for detailed instructions on submission
requirements.**

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

[]{#__RefHeading___Toc47265137 .anchor}**4. Intergovernmental Review**

> Electronic Health Record Implementation for Health Center Controlled
> HCCNs is a program 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___Toc47265139 .anchor}**5. Funding Restrictions**

> *Applicants responding to this announcement may request funding for a
> project period of up to three years in length, at no more than
> \$750,000 in year one or \$1.9 million over 3 years. Awards to support
> projects beyond the first budget year will be contingent upon
> Congressional appropriation, satisfactory progress in meeting the
> project's objectives, and a determination that continued funding would
> be in the best interest of the government. Any funding in year two
> will be 15% less than that of year one and in year three, will be 25%
> less than that of year two.*

[Use of Funds]{.underline}

> Funds awarded under this program may be used to purchase or lease
> equipment, which may include data and information systems as well as
> training and technical assistance related to the provision of HIT
> services. Funds may also be used for the initial purchase of software.
> The use of HRSA funds to purchase new EHR products is limited to
> CCHIT-certified products. Federal funds may not be used for recurring
> costs such as rent, software and hardware maintenance,
> telecommunications, and utilities or for individual collaborator
> purposes such as equipment purchase at the member level or member
> staffing, etc. Funds for this grant may not be used for direct patient
> care. Funds may not be used to upgrade existing systems. Reviewers
> will consider the budget's dependency solely on federal funds. HRSA
> recommends that these grant funds comprise no more than 60 percent of
> the total approved cost of the project (sum of the HRSA share and the
> non-Federal share); with approximately 40 percent of the total costs
> of the proposal being supported with other funds.
>
> It is understood that HIT may be related to other HCCN functions such
> as clinical, quality and financial management. To the extent the
> applicant demonstrates that other HCCN functions will enhance the HIT
> role in practice and quality improvement, HRSA will consider
> supporting up to 20% of the federal proposed budget for these
> functions.
>
> []{#__RefHeading___Toc47265140 .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.
>
> Applications will be considered as having met the deadline if the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time.
>
> **It is incumbent on applicants to ensure that the AO is available to
> submit the application to HRSA by the application due date. We will
> [not]{.underline} accept submission or re-submission of incomplete,
> rejected, or otherwise delayed applications after the deadline.**
>
> **Again, please understand that we will not consider additional
> information and/or materials submitted after your initial application.
> You must therefore ensure that all materials are submitted together.
> Further information on the HRSA electronic submission policy can be
> obtained at <http://www.hrsa.gov/grants/electronicsubmission,htm>.**

**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.

-   (**10 points) NEED**

-   **(30 points) RESPONSE**

-   **(10 points) EVALUATIVE MEASURES**

-   **(10 points) IMPACT**

-   **(30 points) RESOURCES/CAPABILITIES**

-   **(10 points) SUPPORT REQUESTED**

> Applicants should pay strict attention to addressing all these
> criteria, as they are the basis upon which the reviewers will evaluate
> their application.

-   **NEED** (10 points): *The extent to which the application describes
    the problem and associated contributing factors to the problem as
    well as the anticipated impact that this project will have on
    specific health outcome measures for patients served by the
    grantee.* In addition, [program is interested in the extent to which
    the applicant:]{.underline}

    1.  Describes project relationship to environment and marketplace
        assessments.

    2.  Provides evidence project is linked to community HIT
        initiatives.

    3.  Describes primary care service delivery environment.

    4.  Describes unmet health needs description and documentation.
        Provides demographic data cited to support the information
        provided.

    5.  Includes description of clinical changes that will result from
        EHR implementation to address need.

    6.  Clearly identifies the target population that the project will
        impact. In a table format, provides the names of the
        participating organization sites (if a 330, their UDS number, if
        another HRSA program, the name of the funding bureau or office),
        number of patients, FTEs, and number of licenses.

    7.  Includes factors affecting public and private reimbursement
        environment.

    8.  Describes other HIT funding available to the Network.

-   **RESPONSE** (30 points): *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
    described in the application are capable of addressing the problem
    and of attaining the project objectives.* In addition, [program is
    interested in the extent to which the applicant:]{.underline}

> ***Methodology*** (5 points) *Vision and Long Term Strategic
> Planning.*

1.  Provides a vision for how the proposed technology will increase
    health outcomes and allow for population health management.

2.  Describes methods to meet the program requirement and expectations.

3.  Provides evidence project is part of the applicant's long term
    business and clinical strategy.

4.  Clearly identifies the specific HIT function(s) that will occur at
    the network level versus the health center.

> ***Deployment*** (10 points) *Procedures for implementing EHR.*

5.  Provides very clear evidence of planning activities that have been
    completed such as due diligence, workflow analysis, clinician and
    consumer involvement etc.  Includes a description of training that
    has or that will occur related to the EHR implementation.

6.  Provides information on the vendor selection process such that the
    product selected includes essential key features to improve patient
    care in a health center, such as registry functions, decision
    support tools, and population based health outcomes system reports
    capability.

7.  Describes how the proposed technology complies with existing federal
    and industry standards, such as CCHIT certification and assure
    patient privacy and confidentiality.

8.  Describes how the proposed technology with integrate with other IT
    systems in the center such as the PMS.

9.  Describes some forethought as to future plan for interfaces and
    connectivity to outside entities such as lab and pharmacy, and
    possibly hospitals.

10. Describes a cost-effective deployment and operation rationale and
    feasible alternatives. Provides evidence of ability to have onsite
    implementation team in place that is comprised of staff from each
    project site that includes (but is not limited to) clinicians and IT
    leadership.

> ***Work Plan** (5 points)* *Describe the activities or steps that will
> be used to achieve*
>
> *and evaluate the scope of the proposed project.*

11. Creates a meaningful work plan table by phase (planning, testing,
    infrastructure, and roll out).

12. Outlines very clear action steps and responsible entities.

13. Outlines a timetable that is reasonable for the project.

> ***Resolution of Challenges** (10 points) Approaches that will be used
> to resolve*
>
> *challenges in designing and implementing work plan activities.*

14. Describes how the network will collaborate and share data.

15. Describe the business recovery process in the event of an
    interruption at the Network level including the development of
    backup systems to ensure EHR implementation and continuity of care.

16. Provide evidence of clinician acceptance, support, and involvement
    including:

-   Clinician involved in planning, implementation, and continuous
    evaluation.

-   Clinicians understanding of challenges in implementation.

-   Clinicians demonstrating competence and willingness to meet those
    challenges.

-   Staff training and system operation and maintenance technical
    support resources.

-   Planning to address decreased productivity during implementation.

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-   **EVALUATIVE MEASURES** (10 points): *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.* In addition, [program is interested in
    the extent to which the applicant provides]{.underline}:

    1.  Data collection instruments that adhere to culturally competent
        and linguistically appropriate norms.

    2.  Solid baseline data provided in the application.

    3.  Five performance outcome measures two of which HRSA defines to
        include diabetes control and child immunization (see the
        appendix or the evaluation section of this guidance for a
        description of these performance measures). A description of the
        customer satisfaction process.

-   **IMPACT** (10 points): *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 degree to which the project
    activities are replicable. The effectiveness of the plans for
    sustainability beyond the Federal Funding*. [Program is interested
    in the extent to which the applicant]{.underline}:

    1.  Submitted a proposal that will impact the business and clinical
        operations of the participating organizations in terms of
        efficiency, effectiveness and safety.

    2.  Replicablity: Describes how the model of implementation is
        replicable.

    3.  Sustainability: Describes the plans for sustainability beyond
        federal funding.

-   **RESOURCES/CAPABILITIES** (30 points): *The extent to which project
    personnel (including clinical, financial administrative, IS) are
    qualified by training and/or experience to implement and carry out
    the projects. The capabilities of the applicant organization, and
    quality and availability of facilities and personnel to fulfill the
    needs and requirements of the proposed project.* In addition,
    [program is interested in the extent to which the
    applican]{.underline}t:

1.  Describes how Network leaders have experience in large scale IT
    design and roll out, including having a CIO in place, customer
    service, managing vendor products and relationships, and the ability
    to foster collaboration among diverse organizations particularly
    around the sharing of data.

2.  Consists of participating organizations that are experienced with
    progressive clinical quality improvement programs, such as using and
    demonstrating the use of such results of the HDCs to improve the
    clinical and business operations.

3.  Involves clinicians from across the Network in the planning and
    implementation of all HIT activities across the centers.

4.  Describes it experience in integrating, sharing, or collaborating
    among different organizations.

5.  Demonstrates commitment (as evidenced by the contribution of time,
    resources, cash, etc.) from each of the collaborators in the
    strategic planning process, work plan, budget spreadsheet and
    accompanying narrative and MOA.

6.  Identifies adequate governance structure in its MOA and provides
    evidence of an appropriate governance/committee/advisory structure
    for the project. Also, the extent to which the applicant's MOA
    describes process and ability for governance structures to address
    and resolve conflict among members. (See Appendix C).

7.  Substantiates and describes elements of collaboration for both
    internal and external collaborators to include: business
    arrangements, measurable commitment, an outline of the roles and
    responsibilities within or with the Network for each member or
    entity, and expertise brought to the Network.

-   **SUPPORT REQUESTED** (10 points): *The reasonableness of the
    proposed budget in relation to the objectives, the complexity of the
    activities, and the anticipated results. The budget must reflect the
    funding specifications to include a 15% decrease in year two from
    year one and a 25% decrease in year three from year two; year one
    funding shall not exceed \$750,000.* In addition, [program is
    interested in the extent to which the applicant]{.underline}:

    1.  Proposes a reasonable budget in relation to the objective,
        complexity of the activities, and anticipated results (including
        the number of organizations and sites that will have adopted the
        EHR with the federal investment).

    2.  Demonstrates decreasing reliance on the Federal funding by the
        end of the project period, such as securing nonfederal funds to
        support the project, including the contributions, provided by
        the members.

    3.  Delineates non -HIT supported functions (if applicable).

> **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 qualify of an
> application.

**3. Anticipated Announcement and Award Dates**

> The anticipated date of award for the Electronic Health Record
> Implementation for HCCNs is September 1, 2008.

**VI. Award Administration Information**

[]{#__RefHeading___Toc47265154 .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, 2008.

[]{#__RefHeading___Toc47265156 .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.

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

**PUBLIC POLICY ISSUANCE**

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

**3. Reporting**

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

a.  **Audit Requirements**

> Comply with the requirements of Section 330(q) of the Public Health
> Service Act, as amended, for an independent annual financial audit of
> any books, accounts, financial records, files, and other papers and
> property which relate to the disposition or use of the funds received
> under the grant.

b.  **Payment Management Requirements**

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

c.  **Status Reports**

> 1\. Submit a **Financial Status Report**. A financial status report is
> required within 90 days of the end of each grant year. The report is
> an accounting of expenditures under the project that year. 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.
>
> d\. **Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. As part of this agency-wide
> effort, HRSA grantees will be required to participate, where
> applicable, 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___Toc47265160 .anchor}**VII. Agency Contacts**

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

Attn: Shonda Gosnell, Grants Management Specialist

HRSA Division of Grants Management Operations, OFAM

Parklawn Building, Room 11A-02

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443-4238

Fax: 301-443-6686

Email: sgosnell@hrsa.gov

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

Samantha Wallack

Program Analyst

Health Resources and Services Administration

Office of Health Information Technology

Division of State and Community Assistance

Parklawn Building, Room 7C- 26

5600 Fishers Lane

Rockville, MD 20857

Telephone: (301) 443-4660

Fax: (301) 443-1330

Email: Samantha.wallack@hrsa.hhs.gov

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

Samantha Wallack

Program Analyst

Health Resources and Services Administration

Office of Health Information Technology

Division of State and Community Assistance

Parklawn Building, Room 7C- 26

5600 Fishers Lane

Rockville, MD 20857

Telephone: (301) 443-4660

Fax: (301) 443-1330

Email: Samantha.wallack@hrsa.hhs.gov

[]{#__RefHeading___Toc47265164 .anchor}**VIII. Other Information**

### DEFINITIONS

For purposes of this guidance, the following definitions will be used.

**Assessments:** Generally, assessments form the basis or justification
for a proposal including identification of the specific strengths and
weaknesses of the marketplace and collaborators in light of the
Network's mission and goals. A readiness assessment should evaluate the
administrative, clinical, financial, etc., capabilities--- resources,
skills, and systems---of each of the participants in the delivery
system. These assessments should be completed prior to submission of an
application (evidence should be included in the application, that this
activity has in inherent in the organizations business and strategic
plan. This is NOT a planning grant.

**Certification Commission for Healthcare Information Technology
(CCHIT**): CCHIT Certified products meet basic standards for
functionality, interoperability, and security. CCHIT certification
program reduces risks of HIT investments by providers, ensures
compatibility of HIT products and plays a role in protecting patients'
privacy and personal health information.

**Chronic Care Model**: The Chronic Care Model is a population-based
model that relies on knowing which health center (330) patients have an
illness, assuring that they receive evidence-based care, and actively
aiding them to participate in their own care, having critical clinical
information and productivity system to guide and inform care, and a care
system based on patterns of need and clinical outcomes. For more
information, see
[[http://www.healthdisparities.net/hdc/html/about.hdcModels.aspx]{.underline}](http://www.healthdisparities.net/hdc/html/about.hdcModels.aspx)
or
[http://www.improvingchroniccare.org](http://www.improvingchroniccare.org/).

**Collaborators or Network Members:** Entities (such as health centers,
safety net providers, hospitals, universities, etc.) that have a
relationship evidenced by **ALL** of the following: (i) business
arrangement, (ii) commitment to the development, implementation, and
operation of the proposed Network, and (iii) a signed MOA. This
commitment includes time, financial support, expertise, and other
resources devoted to achieving the goals and objectives of the Network.

**Core Area:** Core area encompasses one of the following:
administrative, clinical, managed care, financial, and information
systems. HCCNs can be engaged in activities around all of the core areas
as long as they are appropriate to the respective marketplace and the
available resources.

**Electronic Health Record (EHR):** A real-time patient health record
that can be used to aid clinicians in decision-making. The EHR can
automate and streamline a clinician's workflow, ensuring that all
clinical information is communicated. It can also prevent delays in
response that result in gaps in care. The EHR can also support the
collection of data for uses other than clinical care, such as billing,
quality management, outcome reporting, and public health disease
surveillance and reporting.

**Functions:** A function is identified as a specific activity within
one of the core areas as defined above. For example, within the core
area of clinical activities, a function may include the sharing of
common clinical protocols and guidelines among Network members; within
the core area of administration, a function may include centralization
of credentialing across the Network. HCCNs can be engaged in a number of
functions within a core area(s) as long as they are appropriate to the
respective marketplace and the available resources.

**Health Center Controlled Network (HCCN):** Network controlled by and
acting on behalf of the health center(s), as defined and funded under
section 330(e)(1)(C) of the PHS Act. The term "controlled" means to have
the authority collectively to appoint a minimum of 51 percent of the
Network's board members in the Network. The network must consist of at
least 3 collaborators organizations.

**Health Disparities Collaborative (HDC):** provides a systems-approach
proactive way of caring for people with chronic illness by implementing
two models: the Chronic Care Model, and the Model for Improvement. The
population-based Chronic Care Model requires knowing which patients have
an illness or need preventive services, ensures delivery of
evidence-based care, and actively aids patients and families to
participate in their own care. It consists of six basic elements, which
include patient self-management, clinical decision support, delivery
system design, clinical information systems, health care organization
and community resources and policies, and enables health centers to test
changes and implement improvements in each of these components. The
Model for Improvement is a rapid-cycle approach to testing possible
improvements while documenting how the quality improvements are being
institutionalized.

**Health Information Exchange:** The mobilization of healthcare
information electronically across organizations within a region or
community.

**Health Information Technology:** The application of information
processing involving both computer hardware and software that deals with
the storage, retrieval, sharing, and use of health care information,
data, and knowledge for communication and decision making.

**Horizontal Integration:** Includes activities designed to improve
operational efficiencies among a group of Health Centers or a group of
Health Centers and other primary care safety net providers within the
same marketplace having a similar mission.

**Integrating, Integrated:** To make into a whole by bringing all parts
together; to join with something else. \[Integrating/integrated can also
be used interchangeably with consolidating/consolidated.\]

**Marketplace:** A geographic area where the majority of health care
services (primary, hospital, and specialty services) for a defined
population are located. This geographic area is usually considerably
broader than the current service area of an individual health center and
includes an expanded patient population, as well as a broader range of
payers and providers.

**Marketplace Analysis:** A dynamic, iterative process that
systematically assesses the supply and demand for a defined
service(s)/product(s) in a specific marketplace and makes an estimate of
future opportunities and challenges in that marketplace.

**Network:** A group of safety net providers (a minimum of three
collaborators/members) collaborating horizontally or vertically to
improve access to care, enhance quality of care, and achieve cost
efficiencies through the redesign of practices to integrate services,
optimize patient outcomes, or negotiate managed care contracts on behalf
of the participating members.

**Outcome Indicators:** Outcome indicators are specific items of data
that are tracked to measure how well a Network is achieving an outcome
over a defined period of time. For additional information on outcome
indicators, please refer to the ISDI web site
(<http://www.bphc.hrsa.gov/CHC/CHCInitiative.asp>).

**Outcomes:** Outcomes describe the benefits or changes for individuals
or populations as a result of Network activities. They may relate to
behavior, skills, knowledge, attitudes, conditions or other attributes.
For example, an outcome would be a 20 percent increase in the number of
low-income parents getting their children immunized after receiving
information through a Network sponsored public awareness campaign.

**Personal Health Record (PHR):** An electronic application through
which individuals can maintain and manage their health information (and
that of others for whom they are authorized) in private, secure, and
confidential environment.

**Provider:** A provider is the individual who assumes primary
responsibility for assessing the patient and documenting services in the
patient\'s record.

(See *Bureau of Primary Health Care Uniform Data Systems Manual 2006*
for full definition of the term "provider" at:
http://bphc.hrsa.gov/uds/manual2006.htm#\_Toc147890372).

**Statewide:** A Network is considered statewide if it has **every** 330
funded community health center in the State as a member.

**Vertical Integration:** Includes activities designed to achieve
improvements in the continuum of care through the integration of primary
specialty, and hospital services for current and/or planned patients of
federally-supported and other safety net programs.

**ix. Tips for Writing a Strong Application**

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

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\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 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
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 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)

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

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

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

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

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

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

##  {#section .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.

### 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.

-   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.

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

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

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

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

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

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# 4. General Instructions for Application Submission

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

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

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

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

### 4.1.1 Font  {#font .unnumbered}

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

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

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

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

### 4.1.3 Names {#names .unnumbered}

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

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

Please put all section headings flush left in bold type.

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

**Electronic Submissions**

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

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

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

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

**Electronic Submissions**

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

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

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

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

HRSA uses two standard packages from Grants.gov.

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

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

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

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

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

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

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

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

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

# 5. Customer Support Information

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

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

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

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

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

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

Please visit HRSA EHBs for online help. Go to:

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

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

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

# 

# 6. FAQs

## 6.1 Software {#software .unnumbered}

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

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

**System Requirements:**

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

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

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

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

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

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

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

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

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

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

Grants.gov website states:

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

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

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

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

IE 6.0 and above is the recommended browser.

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

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

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

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

**Competing Submissions:**

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

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

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

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

**Noncompeting Submissions:**

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

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

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

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

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

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

**Appendix B -- Registering and Applying Through Grants.gov**

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

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

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

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

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

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

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

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

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

Step 1: Register your organization

Step 2: Register yourself as an Authorized Organization Representative

Step 3: Get authorized by your organization to submit grants

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

Follow this checklist to complete your registration---

1\. Register Your Organization

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

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

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

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

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

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

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

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

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

**REGISTER YOUR ORGANIZATION**

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

**Obtain your organization's DUNS number**

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

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

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

**Register your organization with CCR**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**Formal Submission of the Electronic Application**

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

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

**Performance Measures for Competitive Applications**

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

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

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

**APPENDIX C: MEMORANDA OF AGREEMENT**

A fully executed MOA submitted with the application (as Attachment 4)
should address the following:

> a\. Specific documentation for a methodology of collaborator/Network
> member investment of resources including in-kind, staff, cash, etc.
>
> b\. Evidence that the members are exploring certain function(s) at a
> collaborative/shared/integrated level (as appropriate).
>
> c\. Evidence of long-term commitment (i.e., 3 to 5 years).
>
> d\. Health center and member board buy-in as evidenced by signatures
> of all CEOs and board chairs.

A MOA signed by all CEOs and Board Chairs of the Network members should
include or address, at a minimum, the following:

> 1\. In the MOA, an applicant's governing board should explicitly
> certify or identify the following:

a.  The collaborating health centers are participating in the
    development, or further development, of an EHR development project
    as defined above.

b.  The collaborating health centers are participating in the
    development of an integrated EHR.

c.  The mission of the Network is to ensure access for the medically
    underserved, including the uninsured and underinsured.

d.  The EHR development project is comprised of three or more health
    center members.

e.  The provision of services/programs through the EHR development
    project will not result in the diminution of the level or quality of
    health services currently being provided to the medically
    underserved population.

f.  An individual whose primary responsibility is the work plan and
    overall leadership of the Network.

> 2\. A description of the governance/decision-making of the Network,
> including composition of boards/advisory committees. \[NOTE: Health
> center collaborators must maintain a minimum of 51 percent control
> over the Network.\]

a.  The MOA should describe how leadership of the activities will be
    managed, including identification of the individual with
    responsibility for overseeing the implementation of the work plan.

b.  The MOA should provide clear roles and responsibilities for
    clinician and consumer involvement regarding the proposed work plan.

c.  A description of the role (if any) of such structures in resolving
    conflict among diverse members of a Network.

> 3\. A statement that establishes concrete commitment of resources from
> each of the collaborators to the development, or further development,
> of the EHR and the Network (cash, annual dues, membership fees,
> full-time equivalents, in-kind resources, etc.). Indicate if
> commitment is annual, one-time, etc.
>
> 4\. A description of the EHR development project's goals, objectives,
> and timetable.
>
> 5\. A description of the EHR development project's membership policies
> (i.e., membership renewals, penalties, terminations, amendments).

APPENDIX D: Resources for Applicants

**[Federal Government Agencies/Organizations]{.underline}**

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

http://www.hrsa.gov/healthit/

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.

**Agency for Healthcare Research and Quality**

http://healthit.ahrq.gov/

The mission of Agency for Healthcare Research and Quality is to improve
the quality, safety, efficiency, and effectiveness of health care for
all Americans.

**Department of Veterans Affairs**

http://www1.va.gov/vha_oi/

The goal of the Department of Veterans Affairs is to provide excellence
in patient care, veterans\' benefits and customer satisfaction.

**Indian Health Service\
**http://www.ihs.gov/CIO/InfoTech_index.asp

The mission of the Indian Health Service is to raise the physical,
mental, social, and spiritual health of American Indians and Alaska
Natives to the highest level.

**Office of the National Coordinator for Health Information Technology
(ONC)**

http://www.hhs.gov/healthit/

The Office of the National Coordinator for Health Information Technology
provides leadership for the development and nationwide implementation of
an interoperable health information technology infrastructure to improve
the quality and efficiency of health care and the ability of consumers
to manage their care and safety.

**Health Alert Network (HAN)**

http://www2a.cdc.gov/han/Index.asp

The Network is a project being developed at the Centers for Disease
Control and Prevention (CDC) as part of its Public Health Emergency
Preparedness & Response Program. The project is intended to ensure
communications capacity at all local and state health departments
through full Internet connectivity and training. That capacity will
ensure the ability to broadcast and receive health alerts at every level
of the public health system.

**Health Disparities Collaborative**

http://www.healthdisparities.net

The Health Disparities Collaborative Web site is home for a community of
learners who are committed to improving systems of health care. Using
the methodology of the Planned Care Model and the Model for Improvement
in the context of Community Oriented Primary Care, health centers are
making a positive difference in the lives of hundreds of thousands of
Americans.

**National Committee on Vital and Health Statistics (NCVHS)**

http://www.ncvhs.hhs.gov/

The NCVHS is the advisory body to HHS and Congress on health information
policy. NCVHS has taken a critical leadership role in driving the
creation of a National Health Information Network, including the
creation of the report \"Information for Health: A Strategy for Building
a National Health Information Network,\" which was published in November
2001. The Chair of the committee\'s health information Network workgroup
is John R. Lumpkin, MD, MPH. The lead staff member to the workgroup is
Mary Jo Deering, PhD.

**National Electronic Disease Surveillance System (NEDSS)**

http://www.cdc.gov/nedss/

The system is an initiative that promotes the use of data and
information system standards to advance the development of efficient,
integrated, and interoperable surveillance systems at federal, state and
local levels. This broad initiative is designed to facilitate the
electronic transfer of appropriate information from clinical information
systems in the health care industry to public health departments, reduce
provider burden in the provision of information, and enhance both the
timeliness and quality of information provided.

**National Immunization Program (NIP)**

http://www.cdc.gov/nip/

The program is committed to promoting the development and maintenance of
state- and community-based computerized registries that capture
immunization information on all children. Working with the National
Vaccine Advisory Committee (NVAC), NIP has identified minimum core
immunization data elements that enable consistent data collection by
immunization registry systems.

**Public Health Information Network (PHIN)**

http://www.cdc.gov/PHIN/

The Network is a framework for crosscutting and unifying data streams
for the early detection of public health issues and emergencies. PHIN is
composed of five key components: detection and monitoring, data
analysis, knowledge management, alerting and response. Through defined
data and vocabulary standards and strong collaborative relationships,
the Public Health Information Network will enable consistent exchange of
response, health and disease tracking data among public health partners.

**[Industry & Trade Associations\
]{.underline}**

**American Health Information Management Association (AHIMA)\
**http://www.ahima.org/

The association represents the community of professionals engaged in
health information management, providing support to members and
strengthening the industry and profession. It represents more than
45,000 specially educated health information management professionals
who work throughout the healthcare industry. These professionals serve
the healthcare industry and the public by managing, analyzing and
utilizing data vital for patient care-and making it accessible to
healthcare providers when needed to diagnose, treat and care for
patients.

**American Medical Informatics Association (AMIA)**

http://www.amia.org/

The association has a membership of individuals, institutions and
corporations dedicated to developing and using information technologies
to improve health care. AMIA was formed in 1990 by the merger of three
organizations: the American Association for Medical Systems and
Informatics, the American College of Medical Informatics, and the
Symposium on Computer Applications in Medical Care. The 3,200 members of
AMIA include physicians, nurses, computer and information scientists,
biomedical engineers, medical librarians, and academic researchers and
educators. AMIA is the official United States representative
organization to the International Medical Informatics Association.

**American Nursing Informatics Association**

http://www.ania.org/

The organization provides a forum and Networking opportunities for
nurses working in healthcare informatics, facilitating the integration
of data and knowledge to support care of patients and decision-making
for nurses and other providers. The group focuses on integrating nursing
science, computer science and information science to manage and
communicate data and information in nursing practice.

**Association of Medical Directors of Information Systems (AMDIS)**

http://www.amdis.org/

The association is a forum for growth and development of chief medical
information officers and other physicians entering positions of
responsibility in medical informatics and information technology. AMDIS
presents lessons learned from leaders in the field today, provides a
body of information needed to be an effective information systems leader
and acts as a vehicle to forge important industry connections.

**College of Healthcare Information Management Executives (CHIME)**

http://www.cio-chime.org/

The association\'s aims are to serve the professional needs of
healthcare chief information officers and to advance the strategic
application of information technology in innovative ways that improve
the effectiveness of healthcare delivery. CHIME provides Networking,
education and career development while also supporting easy access to
current IT trends, research and information pertaining to the use of IT
in healthcare.

**Healthcare Information and Management Systems Society (HIMSS)**

http://www.himss.org

The association is focused on providing leadership for the optimal use
of healthcare information technology and management systems by framing
public policy and industry practices through initiatives in advocacy,
education and professional development. Among the initiatives are a
series of new programs to support and accelerate healthcare standards
development, definition of an electronic medical record and involvement
of the healthcare IT vendor community in building a minimum set of
functions and features into IT software products.

**National Association of Health Data Organizations (NAHDO)**

http://www.nahdo.org/

The association is a membership organization dedicated to strengthening
the nation\'s health information system. NAHDO serves as a broker of
expertise for the development and enhancement of statewide and national
health information systems. NAHDO brings together a Network of state,
federal, and private sector technical and policy leaders and consultants
to expand health systems development and shape responsible health
information policies.

**National Alliance for Health Information Technology (NAHIT)**

http://www.nahit.org

The alliance is a diverse partnership of leaders from all healthcare
sectors working to advance the adoption and implementation of healthcare
information technology to achieve measurable improvements in patient
safety, quality and efficiency. The alliance acts as a convener in the
efforts to achieve consensus on IT standards and other important issues,
bringing together senior executives to overcome barriers and accumulate
a critical Network of technical and intellectual knowledge and
leadership.

**[Healthcare Foundations/Research-based Organizations]{.underline}**

**All Kids Count (AKC)\
**http://www.allkidscount.org/connections-akc.html

This project, funded by the Robert Wood Johnson Foundation, started in
1992 with the development and implementation of immunization registries.
The current phase is one of communication and integration to foster
integration/linkage of child health information systems, specifically
including immunization registries and other systems that have both
clinical and Public health importance. One of its major activities is
AKC Connections, a collaboration of state and local health departments
moving toward integration of health information systems such as
immunization registries and screening initiatives for certain childhood
problems.

**California HealthCare Foundation\
**http://www.chcf.org/topics/index.cfm?topic=CL108

The California HealthCare Foundation is an independent philanthropy
committed to improving the way health care is delivered and financed in
California, and helping consumers make informed health care and coverage
decisions. Formed in 1996, our goal is to ensure that all Californians
have access to affordable, quality health care.

**Center for Health Information Technology**

http://www.centerforhit.org/

The center, a division of the American Academy of Family Physicians
(AAFP), promotes and facilitates adoption and optimal use of health
information technology among AAFP members and other office-based
clinicians. Initial work is focused on overcoming barriers of high cost,
complexity and lack of standardization, all of which stand in the way of
small medical practices attempting to acquire and effectively use IT in
their offices.

**Certification Commission for Healthcare Information Technology**

http://www.cchit.org/

*The mission of* Certification Commission for Healthcare Information
Technology **is t***o accelerate the adoption of health information
technology by creating an efficient, credible and sustainable product
certification program.*

**Connecting for Health**

http://www.connectingforhealth.org/

Connecting for Health is a public-private collaborative of the Markle
Foundation that will advance an interconnected, electronic national
health information infrastructure by focusing on adopting national
clinical data standards for interoperability, ensuring secure and
private transmission of medical information and working to understand
consumers\' needs and expectations from an interconnected health
information system.

**The EHealth Initiative**

http://www.ehealthinitiative.org/

This public-private sector collaborative effort for public health
focuses on bringing about an interconnected electronic health
information infrastructure by promoting the adoption of clinical data
standards and interoperability. The initiative of more than 100 members
includes involvement of the Centers for Disease Control and Prevention
(CDC), the Centers for Medicare and Medicaid Services (CMS), public
health agencies, providers, standards organizations, and health care IT
suppliers. Among its aims is to develop and implement strategies to
transmit electronic data of public health importance (for example lab
results, microbiology results, orders, and chief complaint data) using
interoperable standards and the CDC\'s National Electronic Disease
Surveillance System (NEDSS).

**National Center for Emergency Medicine Informatics**

http://www.ncemi.org/

The not-for-profit center is focused on advancement of emergency
medicine through the application of information technology. The
organization is driven by the belief that the greatest advances in
medicine over the next two decades will result from the application of
the tools and principles of information science to the problems of
clinical medicine. New developments in informatics will drive advances
in clinical care, medical administration, medical research, and medical
education.

**Public Health Informatics Institute**

http://www.phii.org/

The Public Health Informatics Institute is a program of the Robert Wood
Johnson Foundation whose goal is to foster collaboration among public
health agencies in the conception, design, acquisition, and deployment
of software tools in order to eliminate redundant efforts, speed up
development processes and reduce costs. Current initiatives include
defining common requirements and developing tools to exchange
information on a)Defining Common Requirements-jointly sponsored with
APHL, a group of 16 state and local public health laboratories have
joined together to address the urgent need to update or acquire new
public health laboratory information management systems to enhance
bioterrorism preparedness. b) Developing The Exchange-a web-enabled tool
to assist public health agencies in making effective IT investment
decisions by rating vendor products and their capabilities. Partners:
ASTHO, NACCHO, APHL, NAPHSIS, CSTE, APHCIO

**APPENDIX E:**

**HRSA REQUIRED PERFORMANCE MEASURE CATEGORIES DESCRIPTIONS**

**HRSA Clinical Performance Measure Subset**

Note: Applicants are strongly encouraged to consult the most current
"HRSA Clinical Core Measures Instructions Guide" for further information
on updates and on the specifications of the measures.

**PREVENTION**

** **

** [PRENATAL ]{.underline}**

> **FIRST TRIMESTER CARE**
>
> *Percentage of pregnant women beginning prenatal care in the first
> trimester*
>
> **Numerator**: Number of patients who began prenatal care in the first
> trimester.
>
> **Denominator**: Number of patients who entered prenatal care during
> the measurement year.

**[HIV PERINATAL PREVENTION]{.underline}**

> **HIV SCREEN- PREGNANT WOMEN**
>
> *Percentage of patients who were screened for HIV infection during the
> first or second prenatal care visit*
>
> **Numerator**: Number of patients who were screened for HIV infection
> during the first or second prenatal care visit
>
> **Denominator**: All patients seen for 2 prenatal visits during the
> measurement year.

**[CANCER]{.underline}**

> **BREAST CANCER**
>
> *Percentage of women 40-69 years of age who had a mammogram*
>
> **Numerator:** One or more mammograms during the measurement year or
> the year prior to the measurement year.
>
> **Denominator:** All female patients aged 42-69 years of age at the
> beginning of the measurement year or year prior to the measurement
> year.
>
> ***OR***
>
> **CERVICAL CANCER**
>
> *Percentage of women 21-64 years of age who received one or more Pap
> tests*
>
> **Numerator:** One or more Pap tests during the measurement year or
> the two years prior to the measurement year.
>
> **Denominator:** All female patients age 24 -64 years of age during
> the measurement year.
>
> ***OR***
>
> **COLORECTAL CANCER**
>
> *Percentage of adults 50-80 years of age who had an appropriate
> screening for colorectal cancer.*
>
> **Numerator:** One or more screenings for colorectal cancer.
>
> **Denominator:** All patients age 51-80 years during the measurement
> year.

**[IMMUNIZATIONS]{.underline}**

> **AGE APPROPRIATE IMMUNIZATIONS**
>
> *Percentage of patients with appropriate immunizations documented
> according to age & risk group. (Or, as per ACIP\* and/or NVAC
> guidelines)*
>
> **CHILDREN**
>
> *Percentage of children 2 years of age with appropriate immunizations*
>
> **Numerator:** Number of children who have received 4xDTaP/DT, 3xIPV,
> 1xMMR, 3xHiB, 3xHepB, 1xVZV, and 4x PCV vaccines.
>
> **Denominator:** All children who turn two years of age during the
> measurement year.
>
> ***OR***
>
> **ADULT**
>
> *Percentage of patients ≥ 50 to 64 years of age who have received
> influenza vaccine.*
>
> **Numerator:** Number of patients who received influenza vaccination
> from September through February of the year prior to the measurement
> period.
>
> **Denominator:** All patients ≥ 50 to 64 years of age at the beginning
> of the one-year measurement period.
>
>  
>
> *** OR***
>
> *** *Older ADULT**
>
> *Percentage of patients ≥ 65 years of age who have received influenza
> vaccine.*
>
> **Numerator:** Number of patients who received influenza vaccination
> from September through February of the year prior to the measurement
> period.
>
> **Denominator:** All patients ≥  65 years of age and older at the
> beginning of the one-year measurement period.
>
> *** OR***
>
> **GERIATRICS**
>
> *Percentage of patients ≥ 65 years of age who have ever received
> pneumococcal vaccine*.
>
> **Numerator:** Number of patients who have ever received pneumococcal
> vaccine.
>
> **Denominator:** All patients 65 years and older in the measurement
> year.
>
> ***OR***
>
> **HIV/AIDS \[DRAFT\]**
>
> *Percentage of patients with HIV infection who completed the
> vaccinations series for Hepatitis B.*
>
> **Numerator:** Number of patients with HIV/AIDS who were vaccinated
> for Hepatitis B (vaccine Bx3 vaccinations). Note: The patient is
> numerator compliant if they have documentation of three completed
> Hepatitis B vaccinations with different dates of service.
>
> **Denominator:** All patients with HIV/AIDS see within in the
> measurement year with documented susceptibility to Hepatitis B or an
> unknown Hepatitis B virus status.

**CHRONIC DISEASE MANAGEMENT**

**DIABETES**

> **HbA1c CONTROL**
>
> *Percentage of adult patients with type 1 or 2 diabetes, with most
> recent hemoglobin A1c (HbA1c) greater than 9% (poor control); equal to
> or less than 9% and greater than 7%; and, a final value for those with
> hemoglobin A1C levels less than or equal to 7%. *
>
> **Numerator:** Number of adult patients whose most recent hemoglobin
> A1c level during the measurement year is:

a.  greater than 9% (poor control);

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a.  equal to or less than 9% and greater than 7%;

b.  less than or equal to 7%.

                Numerator can be selected as (a.) or all or some of (b.)
and (c.).

> **Denominator:** Number of adult patients 18-75 years of age as of
> December 31 of the measurement year with a diagnosis of type 1 or 2
> diabetes.   The denominator is the same for each numerator.
>
> .

**CARDIOVASCULAR -HYPERTENSION**

> **CARDIOVASCULAR- HYPERTENSION**
>
> *Percentage of adult patients, 18 years and older, with diagnosed
> hypertension (HTN) whose blood pressure (BP) was less than 140/90
> (adequate control).*
>
> **Numerator:** Patients with last systolic blood pressure measurement
> less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg
> during the measurement year.
>
> **Denominator:** All patients ≥ 18 years of age as of December 31 of
> the measurement year with diagnosis of hypertension (HTN).