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

**Health Resources and Services Administration**

Bureau of Primary Health Care

PLANNING GRANT APPLICATION

> Planning Grants in High Poverty Counties

*NEW LIMITED GRANT COMPETITION*

*HRSA 07-066*

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

**PROGRAM GUIDANCE**

Fiscal Year 2007

**Application Due Date in Grants.gov: May 16, 2007**

**Release Date: March 14, 2007**

[]{.mark}

> []{.mark}
>
> *Guidance and Programmatic Contact:*
>
> Preeti Kanodia
>
> Public Health Analyst
>
> Division of Policy and Development
>
> Telephone: 301/594-4300
>
> Fax: 301/594-4997
>
> preeti.kanodia@hrsa.hhs.gov

[]{.mark}

> Authority: Public Health Service Act, Title III, section 330, 42U.S.C.
> 254b

**EXECUTIVE SUMMARY:**

This application guidance details the expectations, eligibility
requirements, review criteria and awarding factors for organizations
seeking a grant to plan for the development of a comprehensive primary
care health center in a high poverty county[^1] in fiscal year (FY)
2007. In high poverty counties, planning grants are considered to be a
useful aid to the development of viable proposals to establish new
health center sites that will meet Federal requirements for governance,
community involvement, quality of care and financial feasibility. **This
is a limited competition with only those public or nonprofit private
entities, including tribal, faith-based and community organizations,
proposing to serve specific counties identified in Appendix H, eligible
to apply.**

Beginning in FY 2002, the first President's Health Centers Initiative
was established to significantly impact 1,200 communities by creating
new or expanded access points and increasing the number of patients
served by health centers. Building on these successes, a second health
centers initiative will continue to increase access to comprehensive
primary health care for the most vulnerable populations by targeting the
Nation's poorest counties through the Consolidated Health Center Program
(i.e., Community Health Center (CHC), Migrant Health Center (MHC),
Health Care for the Homeless (HCH), and Public Housing Primary Care
(PHPC) Programs) authorized under section 330 of the Public Health
Service (PHS) Act, as amended. The goal of the President's High Poverty
Counties Initiative is to increase access, to primary health care in the
Nation's poorest counties that can support a comprehensive health
center.

The President's High Poverty Counties Initiative is projected to contain
two components, Planning Grants and New Access Points. Subject to the
availability of funds, up to 25 High Poverty County planning grants may
be awarded in FY 2007. Additionally, in FY 2007, up to 120 new access
points in high poverty counties will be funded. The HRSA projects to
award a minimum of \$24 million for this activity in FY 2007 A separate
application guidance (HRSA-07-069) details the expectations, eligibility
requirements, review criteria and awarding factors for organizations
seeking a high poverty county new access point grant in FY 2007

Eligibility for both components is limited to a set of high poverty
counties that have been determined using two cohorts. One cohort
consists of counties with populations at or above 100,000 (high
population), and the other cohort consists of counties with populations
below 100,000 (low population). The low population counties have been
additionally screened by a provider need criteria. To be eligible, these
counties were required to exhibit a need of at least one additional
primary care provider, using a need standard of one primary care
provider for every 3,000 persons. Approximately 25 percent of the
eligible counties are from the high population cohort and 75 percent are
from the low population cohort. Eligibility for a planning grant under
this announcement is limited to those applications with proposed service
areas within one of the identified high poverty counties listed in
Appendix H

**All applicants requesting funding for a planning grant in a high
poverty county must use this guidance.** It should be reviewed
thoroughly prior to making a decision to apply. Competitive planning
applications will demonstrate the need for health services in the
community, include a brief description of the proposed planning project
including a brief history of the organization, present a sound proposal
to plan and develop a comprehensive section 330 complaint health center,
and demonstrate that the funding requested is appropriate and reasonable
given the scope of the planning project.

HRSA is ***requiring*** applicants for this funding opportunity to apply
electronically through Grants.gov, (http://www.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. Applicants must request an
exemption in writing from DGP Clearances@hrsa.gov, and provide details
as to why they are technologically unable to submit electronically
though the Grants.gov portal. HRSA and its Grants Application Center
(GAC) will only accept paper applications from applicants that received
prior written approval.

If you are seeking a written exemption, please be sure to provide DGP
with documentation that you attempted to submit your application through
Grants.gov. Documentation would consist of a Grants.gov tracking number
or case number or a "Rejected with Errors" notification from Grants.gov.
You will also need to provide them with the complete name and address of
the applicant organization; the name and address of the application
contact person, and the HRSA announcement number you are seeking funding
for.

**Applications must be submitted by 8:00 P.M. ET on May 16 2007 and
indicate the application is for HRSA-07-066: Planning Grants in High
Poverty Counties.** It is the responsibility of the applicant to ensure
that the complete application is submitted electronically by the
published due date and time. Applications will be considered on time if
submitted electronically by the due date and time, as shown only by the
electronic submission record. Applications submitted electronically
after the due date and time will not be accepted for processing and will
be returned without consideration.

If you have questions regarding the FY 2007 high poverty county planning
application and/or the review process described in this application
guidance please call Preeti Kanodia in the Division of Policy and
Development on (301) 594-4300 or email her at
PREETI.KANODIA@HRSA.HHS.GOV.

# Guidance Table of Contents {#guidance-table-of-contents .unnumbered}

[Guidance Table of Contents 2](#guidance-table-of-contents)

[I. Funding Opportunity Description and General Information
2](#funding-opportunity-description-and-general-information)

[Purpose 2](#__RefHeading___Toc161648785)

[Background 2](#background)

[Expected Results 2](#expected-results)

[II. Award Information 2](#award-information)

[Type of Award 2](#type-of-award)

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

[Maximum Grant Support 2](#maximum-grant-support)

[III. Eligibility Information 2](#eligibility-information)

[1. Eligible Applicants 2](#eligible-applicants)

[2. Cost Sharing 2](#cost-sharing)

[3. Other 2](#other)

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

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

[Application Materials 2](#application-materials)

[Application Preparation 2](#application-preparation)

[Pre-Application Conference Call 2](#pre-application-conference-call)

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

[Application Format Requirements 2](#application-format-requirements)

[Application Sequence 2](#application-sequence)

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

[Application Format 2](#application-format)

[3. Submission Dates and Times 2](#submission-dates-and-times)

[Application Due Dates 2](#__RefHeading___Toc161648807)

[Late applications 2](#late-applications)

[4. Intergovernmental Review 2](#intergovernmental-review)

[5. Funding Restrictions 2](#funding-restrictions)

[6. Other Submission Requirements 2](#other-submission-requirements)

[V. Application Review Information 2](#application-review-information)

[1. Review Criteria 2](#__RefHeading___Toc161648813)

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

[Funding Preferences 2](#funding-preferences)

[Other Awarding Factors 2](#other-awarding-factors)

[3. Anticipated Announcement and Award Dates
2](#anticipated-announcement-and-award-dates)

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

[1. Award Notices 2](#award-notices)

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

[Public Policy Issuance 2](#public-policy-issuance)

[Smoke Free Workplace 2](#smoke-free-workplace)

[3. Reporting 2](#__RefHeading___Toc161648823)

[VII. Agency and National Organization Contacts
2](#agency-and-national-organization-contacts)

[VIII. Tips for Writing a Strong Application
2](#tips-for-writing-a-strong-application)

[APPENDIX A: HRSA'S ELECTRONIC SUBMISSION USER GUIDE
2](#appendix-a-hrsas-electronic-submission-user-guide)

[User Guide Table of Contents 2](#user-guide-table-of-contents)

[1. Introduction 2](#introduction)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[2.6 Submit Signed Face Page 2](#submit-signed-face-page)

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

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

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

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

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

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

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

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

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

[3.4 Submit Signed Face Page 2](#submit-signed-face-page-1)

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

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

[4.1.1 Font 2](#font)

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

[4.1.3 Names 2](#names)

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

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

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

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

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

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

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

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

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

[6. FAQs 2](#faqs)

[6.1 Software 2](#software)

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

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

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

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

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

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

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

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

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

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

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

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

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

[APPENDIX B: REGISTERING AND APPLYING THROUGH GRANTS.GOV
2](#appendix-b-registering-and-applying-through-grants.gov)

[Appendix C: Guidelines For Developing the Work Plan and Budget
Presentation
2](#appendix-c-guidelines-for-developing-the-work-plan-and-budget-presentation)

[Guidelines For Developing the Work Plan
2](#guidelines-for-developing-the-work-plan)

[Sample Format for the Work Plan Presentation
2](#sample-format-for-the-work-plan-presentation)

[General Guidelines for Completion of the Budget Forms
2](#general-guidelines-for-completion-of-the-budget-forms)

[Sample Budget Narrative/Justification
2](#sample-budget-narrativejustification)

[Appendix D: 2](#appendix-d)

[Program Specific Forms 2](#program-specific-forms)

[FORM 1: PLANNING GRANT GENERAL INFORMATION WORKSHEET
2](#form-1-planning-grant-general-information-worksheet)

[FORM 2: COMMUNITY CHARACTERISTICS 2](#form-2-community-characteristics)

[Appendix E: 2](#appendix-e)

[Primary Care Association, Primary Care Office And National Organization
Contacts
2](#primary-care-association-primary-care-office-and-national-organization-contacts)

[I. PRIMARY CARE ASSOCIATIONS 2](#i.-primary-care-associations)

[II. PRIMARY CARE OFFICES 2](#ii.-primary-care-offices)

[NATIONAL ORGANIZATIONS 2](#national-organizations)

[Appendix F: 2](#appendix-f)

[Definitions For Planning Grant Applications
2](#definitions-for-planning-grant-applications)

[DEFINITIONS FOR PLANNING GRANT APPLICATIONS
2](#definitions-for-planning-grant-applications-1)

[Appendix G: 2](#appendix-g)

[Useful Reference Material 2](#useful-reference-material)

[COMPLIANCE CHECKLIST FOR NEW ACCESS POINT APPLICANTS Page 1 of 2
2](#compliance-checklist-for-new-access-point-applicants-page-1-of-2)

[COMPLIANCE CHECKLIST -- Page 2 of 2
2](#compliance-checklist-page-2-of-2)

[Appendix H: 2](#appendix-h)

[List of Eligible Counties 2](#list-of-eligible-counties)

[LIST OF ELIGIBLE COUNTIES FOR FY 2007
2](#list-of-eligible-counties-for-fy-2007)

[HIGH POVERTY COUNTY PLANNING GRANT APPLICATIONS
2](#high-poverty-county-planning-grant-applications)

# Funding Opportunity Description and General Information

## Purpose {#purpose .unnumbered}

The fiscal year (FY) 2007 final Congressional Appropriations resulted in
an increase of \$207 million for the Consolidated Health Center Program
authorized under section 330 of the Public Health Service (PHS) Act (42
U.S.C. 254b, as amended). Based on the final FY 2007 appropriation, the
Health Resources and Services Administration (HRSA) will be accepting
applications from organizations seeking a grant to plan for the
development of a comprehensive primary care health center in a high
poverty county.[^2] Subject to the availability of funds, up to 25 High
Poverty County planning grants may be awarded in FY 2007. In FY 2007, up
to 120 new access points in high poverty counties will be funded. The
HRSA projects to award a minimum of \$24 million for this activity in FY
2007 A separate application guidance (HRSA-07-069) details the
expectations, eligibility requirements, review criteria and awarding
factors for organizations seeking a high poverty county new access point
grant in FY 2007.

The Consolidated Health Center Program promotes the development and
operation of community-based primary health care service systems in
medically underserved areas and improves the health status of medically
underserved populations. Planning grants in high poverty counties will
demonstrate compliance with the programs' implementing regulations (42
CFR 51c.201-204), and demonstrate the need for health services in the
community. Applications will provide a brief description of the proposed
planning project including a brief history of the organization, present
a sound proposal to plan and develop a comprehensive section 330
compliant health center, and demonstrate that the funding requested is
appropriate and reasonable given the scope of the planning project.

**All applicants requesting funding for a planning grant in a high
poverty county must use this guidance.** It should be reviewed
thoroughly prior to making a decision to apply.

## Background {#background .unnumbered}

Programs administered by HRSA focus on ensuring the availability and
accessibility of essential primary and preventive health services to the
people who have the most limited access to services and face the
greatest barriers to care. HRSA is committed to the goal of improving
and expanding access to health care for all Americans nationwide, and
most importantly for the estimated 47 million uninsured people in the
United States who do not have adequate access to affordable, appropriate
primary and preventive health care. More than 50 million people live in
federally-designated medically underserved areas and lack access to a
private primary care provider.

Individually, each health center plays an important role and combined
they have had a critical impact on the health care status of underserved
and vulnerable populations throughout the United States (U.S.). At the
end of calendar year 2006, there were over 1000 federally-funded health
centers with more than 3,800 comprehensive primary care service sites
located in urban and rural underserved areas throughout the U.S. and its
territories. Over 14 million medically underserved and uninsured
patients receive high quality, cost-effective, culturally appropriate,
accessible and affordable preventive and primary health care services
through the federally-funded health centers.

Health centers funded through the Consolidated Health Center Program
provide services to the target population without regard to a person's
ability to pay. Health centers may serve the general community or
receive funding to provide services to a specific sub-population.

The Consolidated Health Center Program includes:

-   **Community Health Centers** (CHC) (section 330(e)) provide services
    to the general community, or all individuals within the service
    area.

-   **Migrant Health Centers** (MHC) (section 330(g)) provide services
    to migratory and seasonal farmworker individuals within the service
    area and their families.

-   **Health Care for the Homeless** (HCH) (section 330(h)) provide
    services to homeless individuals and families within the service
    area.

-   **Public Housing Primary Care** (PHPC) (section 330(i)) provide
    services to residents of one or more public housing developments
    within the service area and the surrounding areas as appropriate.

The President's Health Centers Initiative, which began in FY 2002, will
significantly impact 1,200 communities by creating new or expanded
access points and increasing the number of patients served by health
centers. Building on the success of the first Initiative, the
Consolidated Health Center Program will continue to increase access to
comprehensive primary health care for the most vulnerable populations by
targeting the Nation's poorest counties in this second health centers
initiative. The goal of the President's High Poverty Counties Initiative
is to increase access to primary health care in the Nation's poorest
counties that can support a comprehensive health center.

The President's High Poverty Counties Initiative contains two
components, Planning Grants and New Access Points. The list of counties
eligible to participate in this limited funding opportunity is included
in Appendix H, page
[100](#high-poverty-county-planning-grant-applications) of this
guidance. In order to determine the eligible list of counties, all U.S.
counties were identified using U.S. Census Bureau data (2000, 2005).
From this initial list, HRSA removed those counties with a health center
site located within its borders. The remaining counties were divided in
to two cohorts. One cohort consisted of counties with populations at or
above 100,000 (high population), and the other cohort consisted of
counties with populations below 100,000 (low population). The low
population counties were subject to an additional screen to demonstrate
the need for at least one additional primary care provider, using a need
standard of one primary care provider for every 3.000 persons[^3].
Counties in each cohort were identified based on percent of population
equal or less than 200% Federal Poverty Level (FPL). Approximately 25
percent of the eligible counties are from the high population cohort and
75 percent are from the low population cohort, and is limited to those
listed found in Appendix H of this guidance. US territories are not
eligible for the Initiative. The existence of a Rural Health Clinic or
Indian Health Service (IHS) facility does not impact the eligibility of
a county under this Initiative.

## Expected Results {#expected-results .unnumbered}

To assist organizations in their consideration of a planning grant
application to serve an underserved population or community in a high
poverty county, HRSA has identified several critical areas that should
be examined prior to developing an application.

[]{.mark}

Competitive planning applicants will **demonstrate compliance** with the
requirements of section 330(c)(1) of the PHS Act and the programs'
implementing regulations (42 CFR 51c.201-204) at the time of
application.

Competitive planning applicants will also **demonstrate the need** for
health services in the proposed service area, and how the proposed
project will further the communities progress in developing a
comprehensive section 330 compliant health center.

Competitive applicants will **present a sound and complete work plan**
for a one-year planning project, as well as any necessary future steps
to be taken to develop an operational health center. The proposed
planning project should focus on the following factors, as appropriate:

a.  Conducting a comprehensive needs assessment;

b.  Applying for MUA/MUP designation and/or other essential/required
    designations;

c.  Designing an appropriate health care service delivery model, based
    on the comprehensive needs assessment;

d.  Efforts to secure financial, professional, and technical assistance;

e.  Increasing community involvement in the development and/or
    operational stages of a comprehensive health center; and

f.  Developing linkages/building partnerships with other providers in
    the community.

At a minimum, the project should describe conducting a comprehensive
needs assessment, responsiveness to the needs assessment, appropriate
short- and long-term strategic planning, developing coordination and
collaborations with other providers of care, organizational capability
to manage the proposed planning project, and cost-effectiveness in the
planning project. Competitive applicants will respond thoroughly to the
review criteria presented in Section V (see page 27) of this guidance in
the presentation of their proposed planning grant project.

Competitive applicants will present a budget and **request Federal
funds** that are reasonable and appropriate based on the scope of work
proposed for the one-time planning grant. The budget should be
consistent with the work plan presented in the application. Approved
Federal funding levels will be reviewed and may be adjusted based on an
analysis of the budget and allowable cost factors. Applicants are
encouraged to carefully review Section IV (p.
[12](#application-and-submission-information)) of this document for
further clarification and instructions on the presentation of the budget
for planning grant applications.

[]{.mark}

Planning grant applicants should take future activities and
opportunities into consideration while developing a planning project, as
appropriate to meet the needs of the community. To this end, applicants
may also wish to review HRSA-07-069: New Access Points in High Poverty
Counties to familiarize themselves with the application expectations
under that opportunity.  Under HRSA-07-069, eligible applicants must
propose to establish a full-time, fixed delivery site located in a high
poverty county that will be operational within 120 days of award.
Additionally, organizations should keep in mind that HRSA is committed
to supporting up to 120 new access point awards in high poverty counties
in FY 2007. Therefore, after reviewing HRSA-07-069, organizations may
also consider submitting a high poverty county new access point
application as well as a planning grant if they meet both eligibility
requirements. Please review Section III and XX for additional
information about the eligibility and awarding factors if more than one
fundable application is received from the same eligible high poverty
county.

HRSA-07-069 will be eligible for a funding priority if the proposed
service area includes multiple counties (i.e., the target population
comes from other county(ies) in addition to the eligible high poverty
county). Please note that successful planning grant applicants will not
be given any preference or priority when applying under future New
Access Point funding opportunities. The HRSA-07-069 application guidance
is available online through the Grants.gov Web page, and the HRSA Web
page at: [www.hrsa.gov/grants](http://www.hrsa.gov/grants).

[]{.mark}

Applicants are encouraged to collaborate with the appropriate Primary
Care Associations, Primary Care Offices and/or National Organizations
(PCAs/PCOs/NOs -- see Appendix E, page [77](#appendix-e)) in developing
an application for a planning grant in a high poverty county.

[]{.mark}

# Award Information

## Type of Award {#type-of-award .unnumbered}

High poverty county planning grant awards support the planning and
development activities essential to establishing a full-time health
center service delivery site for the provision of comprehensive primary
and preventive health care services to underserved communities and
populations, in compliance with the applicable requirements of section
330 of the PHS Act. Planning grant applications are expected to
demonstrate compliance with the applicable requirements of section
330(c)(1) of the PHS Act and , the implementing regulations (42 CFR
51c.201-204).

## Summary of Funding {#summary-of-funding .unnumbered}

Subject to the availability of funding, up to 25 high poverty county
planning grant awards will be made in FY 2007.

## Maximum Grant Support {#maximum-grant-support .unnumbered}

BPHC has established a one-year project period, and an annual **cap of
\$80,000 for section 330 support** of high poverty county planning
grants. The cap is the **maximum amount of one-time section 330
funding** that can be requested for a high poverty county planning grant
application in FY 2007. Not all applicants approved and funded will
receive that amount. Applications requesting more than \$80,000 will be
considered non-responsive and will not be considered in the competition.

Under the Planning Grants in High Poverty Counties opportunity, Federal
funding CANNOT be requested for expenses related to land or facility
purchase, construction/alteration or renovation of a facility, or any
other facility related expenses that would cause a Federal interest to
be placed on land or a facility. Additionally, Federal funding
**CANNOT** be requested for any direct patient care and/or services
including:

-   The provision of patient care services or supplies that are
    ordinarily reimbursable (e.g., exams, therapy sessions,
    pharmaceuticals).

-   Primary care site development or service expansions (e.g. extended
    clinic hours).

-   Capital equipment used for reimbursable patient care and services
    (e.g., radiology equipment, ambulances).

[]{.mark}

It is expected that the request for Federal support and the budgets
presented in the application will be reasonable and appropriate based on
the proposed project. The budget should also be consistent with the work
plan presented in the application. Federal funding levels will be
reviewed prior to a final funding decision and may be adjusted based on
an analysis of the budget and allowable cost factors. See Section IV
(p.[12](#application-and-submission-information)) and Application C
(p.[67](#appendix-c-guidelines-for-developing-the-work-plan-and-budget-presentation))
of this application guidance for further information and instruction on
the development of the application budget.

# Eligibility Information

## 1. Eligible Applicants {#eligible-applicants .unnumbered}

Public or private nonprofit entities, including tribal, faith-based and
community organizations, may apply for a planning grant for the
development of a health center service delivery site in a high poverty
county.

[]{.mark}

An application will be considered eligible if it meets all of the
eligibility requirements listed below. Applications that do not meet
these eligibility requirements will not be accepted and will be returned
without further consideration.

[]{.mark}

1.  Applicant is a public or private, nonprofit entity.

[]{.mark}

2.  Application proposes a service area that is located within a high
    poverty county as identified in Appendix H (p.
    [[99]{.mark}](#appendix-h)).

3.  Application proposes one or more of the following planning
    activities associated with the development of a section 330
    compliant health center:

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(a) Conducting a comprehensive needs assessment;

(b) Applying for MUA/MUP designation and/or other essential
    designations;

(c) Designing an appropriate health care service delivery model, based
    on the comprehensive needs assessment;

(d) Efforts to secure financial, professional, and technical assistance;

(e) Increasing community involvement in the development and/or
    operational stages of a comprehensive health center; and

(f) Developing linkages/building partnerships with other providers in
    the community.

> []{.mark}

4.  Application requests one-time Federal section 330 funding, for the
    one-year project period, as presented in Budget Form SF 424A and
    accompanying Budget Justification, that **DOES NOT exceed the
    established annual cap of \$80,000.**

5.  Applicant must adhere to the 80-page limit on the length of the
    application when printed by HRSA. The page limit includes the
    narrative proposal, budget presentation, program specific forms,
    documents, and other attachments detailed on
    p.[16](#sf-424-non-construction-table-of-contents) of this
    guidance).

> Note: The page limit does NOT include the Tables of Contents or the
> PHS 5161-1 Standard Forms (i.e., SF 424 Face Page, SF 424a Budget for
> Non-Construction Programs, HHS Checklist, or Disclosure of Lobbying
> Activities).

6.  Applicant organizations may submit more than one planning grant
    application in FY 2007, ONLY IF each application proposes a separate
    and distinct planning project to serve different eligible counties.
    Each application must be complete and must be able to stand alone.

[]{.mark}

## 2. Cost Sharing {#cost-sharing .unnumbered}

Cost sharing or matching is not a requirement for this funding
opportunity. Under 42 CFR 51c.203, HRSA will take into consideration
whether and to what extent an applicant plans to secure and maximize
Federal, State, local and private resources to support the proposed
project. Please see the budget and budget justification sections of this
document (Section IV and Appendix C) for clarification and guidelines
pertaining to the presentation of the budget.

## 3. Other  {#other .unnumbered}

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

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

# Application and Submission Information

## 1. Address To Request Application Package {#address-to-request-application-package .unnumbered}

### Application Materials {#application-materials .unnumbered}

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 (DGP). Grantees must request an exemption in writing from
<DGPClearances@hrsa.gov>, and provide details as to why they are
technologically unable to submit electronically though the Grants.gov
portal. . As indicated in this guidance, HRSA and its Grants Application
Center (GAC) will only accept paper applications from applicants that
received prior written approval.

If you are seeking a written exemption, please be sure to provide DGP
with documentation that you attempted to submit your application through
Grants.gov. Documentation would consist of a Grants.gov tracking number
or case number or a "Rejected with Errors" notification from Grants.gov.
You will also need to provide them with the complete name and address of
the applicant organization; the name and address of the application
contact person, and the HRSA announcement number you are seeking funding
for.

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 and instructions may be obtained
from the following sites by:

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 appear in the "Application Format"
section below.

### Application Preparation {#application-preparation .unnumbered}

The entire application guidance and related materials should be reviewed
thoroughly prior to making a decision to apply for a high poverty county
planning grant. **All applicants requesting funds for a high poverty
county planning grant under section 330 of the PHS act must use PHS Form
5161-1 in conjunction with the forms and materials in this application
guidance.** The PHS 5161-1 forms contain additional general information
and instructions for grant applications, proposal narratives, and
budgets as prescribed by the Office of Management and Budget, therefore,
that information is not repeated in this document. Instructions for
preparing portions of the application that must accompany PHS Form
5161-1 appear in the "Application Format" section below.

It is recommended that applicants also thoroughly review the following
reference documents:

-   Health Care Safety Net Amendments of 2002, Public Law 107-251
    (section 330 of the PHS Act as amended)

-   PIN 98-12, **"**Implementation of the Section 330 Governance
    Requirements" (signed April 28, 1998)

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-   PIN 98-23, "Health Center Program Expectations" (signed August 17,
    1998)

-   PIN 98-24, "Amendment to PIN 97-27 Regarding Affiliation Agreements
    of Community and Migrant Health Centers" (signed August 17, 1998)

-   PIN 97-27, "Affiliation Agreements of Community and Migrant Health
    Centers" (signed July 22, 1997)

-   HRSA-07-069, "New Access Points in High Poverty Counties"

These documents and any others referenced in this grant application kit
are available on BPHC web page: http://www.bphc.hrsa.gov/pinspals/. PHS
Form 5161-1 is available for downloading from
http://www.hrsa.gov/grants/forms.htm.

Applicants are encouraged to thoroughly review the documents referenced
above prior to finalizing a decision to apply and/or preparing an
application for submission. In developing applications, applicants are
encouraged to work with the appropriate PCA, PCO and/or NO (See Appendix
E). **Applicants should provide all required information in the sequence
and format described in the instructions.** Information and data should
be accurate and consistent, and directions and written instructions
should be followed carefully and completely. **Applications not meeting
application requirements may be returned without processing or may
result in a low rating by the Objective Review Committee.**

**Only those materials/documents included with the application submitted
by the announced deadline will be considered**. Supplemental
materials/documents submitted after the application deadline will not be
included for consideration. Documents such as letters of support should
be submitted as part of the application. Letters of support sent
directly to DHHS, HRSA, or Bureau of Primary Health Care (BPHC) or sent
after the application deadline will [not]{.underline} be added to an
application.

### Pre-Application Conference Call {#pre-application-conference-call .unnumbered}

HRSA will hold a pre-application conference call for potential high
poverty county planning grant applicants. The conference call will
provide an overview of this program guidance and will include an
opportunity for organizations to ask questions regarding the planning
grants in high poverty counties funding opportunity, the expectations
for planning grants and the requirements of section 330-funded programs.
For the date, time, dial-in number and other information for this call,
please visit the President's High Poverty Counties Initiative website
at: <http://bphc.hrsa.gov/chc/pi2.htm>, or visit HRSA's Bureau of
Primary Health Care website at:
[http://bphc.hrsa.gov](http://bphc.hrsa.gov/).

## 2. Content And Form Of Application Submission {#content-and-form-of-application-submission .unnumbered}

### Application Format Requirements {#application-format-requirements .unnumbered}

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

### Application Sequence {#application-sequence .unnumbered}

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

## SF 424 Non Construction -- Table of Contents {#sf-424-non-construction-table-of-contents .unnumbered}

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.

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

  Grants.gov Lobbying Form          Required Certification   Not counted in the
  Form                              Regarding Lobbying       page limit.

  Budget Narrative    Form /        Supports the upload      Attachment required
  Attachment Form     Attachment    (attachment) of Line     to the form.
                                    Item Budget and          **Includes Line Item
                                    Narrative Budget         Budget, and
                                    Justification document   Narrative Budget
                                                             Justification.**
                                                             Merge into a single
                                                             document. The
                                                             uploaded attachment
                                                             is counted in the
                                                             page limit. Refer to
                                                             guidance for
                                                             detailed
                                                             instructions.
                                                             Provide table of
                                                             contents specific to
                                                             this document only
                                                             as the first page
                                                             (the attachment form
                                                             and table of
                                                             contents will not be
                                                             counted in the page
                                                             limit).

  Project Narrative   Form /        Supports the upload      Attachment required
  Attachment Form     Attachment    (attachment) of Project  to the form. The
                                    Narrative document       uploaded attachment
                                                             is counted in the
                                                             page limit. Refer to
                                                             guidance for
                                                             detailed
                                                             instructions.
                                                             Provide table of
                                                             contents specific to
                                                             this document only
                                                             as the first page
                                                             (the attachment form
                                                             and table of
                                                             contents will not be
                                                             counted in the page
                                                             limit).

  Budget Information  Form          Pages 1 & 2 budget for   Not counted in the
  for                               the request of Non       page limit.
  Non-Construction                  construction related     
  Programs (SF-424A)                funds                    

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

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

  Disclosure of       Form          Supports structured data Not counted in the
  Lobbying Activities               for lobbying activities, page limit.
  (SF-LLL)                          should be completed if   
                                    applicable               

  Attachments Form    Form /        Supports the upload      See following
                      Attachments   (attachment) of up to 15 attachment table for
                                    numbered attachments.    specific sequence
                                    This form only contains  and instructions.
                                    the attachment list      All uploaded
                                                             attachments ARE
                                                             counted in the page
                                                             limit. Required,
                                                             unless otherwise
                                                             specified below.
  -------------------------------------------------------------------------------

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

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

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

  -----------------------------------------------------------------------
  **Attachment     **Attachment Description (Program Guidelines)**
  Number**         
  ---------------- ------------------------------------------------------
  Attachment 1     Program Specific Form 1: General Information Worksheet

  Attachment 2     Program Specific Form 2: Community Characteristics

  Attachment 3     Project Work Plan

  Attachment 4     Project Organizational Chart

  Attachment 5     Service Area Map

  Attachment 6     Staffing Plan and Personnel Requirements

  Attachment 7     Job or Position Descriptions for Key Personnel

  Attachment 8     Biographical Sketches of Key Personnel

  Attachment 9     Other Contracts, agreements, etc. (As applicable)

  Attachment 10    Most recent independent financial audit

  Attachment 11    Articles of Incorporation

  Attachment 12    Internal Revenue Service (IRS) Tax Exempt
                   Certification or W-9 Form

  Attachment 13    Letters of Support

  Attachment 14    Other Relevant Documents (As applicable)

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

[]{.mark}

### Application Format {#application-format .unnumbered}

Note the following specific information related to your submission.

**i. 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.

*Please be sure to complete the PHS 5161-1, Form 424 Face Page as
follows:*

-   *Box 5a. Federal Entity Identifier: Grants.gov Tracking number (to
    be filled out prior to mailing in signed face page. See Appendix A
    for more information)*

-   *Box 5b. Federal Award Identifier: 10-digit grant number (H80...)
    found in box 4b from the most recent NGA, if applicable.*

-   *Box 8c. Applicant organization's DUNS number*

-   *Box 12 Funding Opportunity Number and Title: HRSA-07-066: Planning
    Grants in High Poverty Counties, respectively.*

-   *Box 15 Descriptive Title of Applicant's Project: Project Abstract
    needs to be uploaded here.*

-   *Box 16 Congressional Districts: Upload any additional congressional
    districts as applicable for the HRSA grant. [Not]{.underline}
    counted in the page limit.*

**DUNS Numbers**

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](http://www.hrsa.gov/grants/dunsccr.htm )
or call 1-866-705-5711. Please include the DUNS number in item 8c on the
application face page. Applications will not be reviewed without a DUNS
number.

Additionally, the applicant organization is required to register with
the Federal Government's Central Contractor Registry (CCR) in order to
do electronic business with the Federal Government. Information about
registering with the CCR can be found at
[http://www.hrsa.gov/grants/dunsccr.htm.](http://www.hrsa.gov/grants/dunsccr.htm.  )

**ii. Table of Contents**

For electronic applications no table of contents is necessary as it will
be generated by the system. For applicants that have received an
exemption from electronic submission, the application should be
presented in the order of the Table of Contents provided earlier. (Note:
the Table of Contents will not be counted in the page limit).

**iii. Application Checklist**

PHS Form 5161-1 (Pages 25-26) provided with the application package.

[]{.mark}

**iv. Budget**

Awards, on a competitive basis, will be for a one‑year budget period.
Budget presentations should be included for one year only. Applicants
must use the Budget Forms included in PHS 5161-1. **Applicants must
complete Application Form PHS 5161-1: SF 424A, Sections A, B, E, and, if
applicable, F**. Please see Appendix C for further guidance on
completing the budget presentation.

**v. Line Item Budget and Narrative Budget Justification**

The budget details the amounts requested for each line of the PHS Form
5161/SF 424A and how each item will support achievement of the proposed
objectives for the entire span of the one year budget and three year
project period. The narrative budget justification provides additional
information and detail to describe the line item budget.

*[Line Item Budget]{.underline}*

Provide a detailed line-item budget that describes the amounts requested
for each category (e.g. personnel costs, indirect costs, travel, etc.)
to explain the costs entered in standard form 424A of the Public Health
Service (PHS) 5161-1. **A sample line item budget is available in
Appendix C (page
[67](#appendix-c-guidelines-for-developing-the-work-plan-and-budget-presentation))
as a broad outline.** The budget justification must clearly describe
each cost element. 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.

*Please keep in mind that under this planning grant application, Federal
funding [CANNOT]{.underline} be requested for any direct patient care
and/or services including:*

-   *The provision of patient care services or supplies that are
    ordinarily reimbursable (e.g., exams, therapy sessions,
    pharmaceuticals)*

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-   *Primary care site development or service expansions (e.g. extended
    clinic hours)*

-   *Capital equipment used for reimbursable patient care and services
    (e.g., radiology equipment, ambulances)*

[]{.mark}

*[Narrative Budget Justification]{.underline}*

The narrative budget justification summarizes the budget for the entire
project period (one-year)*.* Applicants should provide a narrative
budget justification that describes how the categorical costs are
derived and the necessity and reasonableness of the proposed costs. The
accompanying narrative budget justification should specifically describe
**how each item will support the achievement of proposed
goals/objectives** and methodologies used to develop the identified
costs. The narrative budget justification MUST be concise. Do NOT use
the justification to expand the project narrative.

Budget justification narratives for the individual health center type
must be provided in sufficient detail to support one-step below the
object class category level, as described below. In addition, if there
are budget items for which costs are shared with other programs (e.g.,
HRSA programs or an Objective home health program administered by the
applicant organization), the basis for the allocation of costs between
federally supported programs and other Objective programs must be
explained.

Be certain to include the following in the narrative Budget
Justification. Additional information and detail may be provided in
narrative form as needed.

**Personnel Costs:** Please reference the 'Staffing Plan and Personal
Requirements' as justification for dollar figures. In general, personnel
costs should be explained by listing each staff member who will be
supported from requested grant funds, name (if possible), position
title, percent full time equivalency, annual salary, and the exact
amount requested for the project.

**Fringe Benefits:** Itemize the components that comprise the fringe
benefit rate, for example health insurance, taxes, life insurance,
retirement plan, tuition reimbursement, etc. In general, the fringe
benefits should be directly proportional to that portion of personnel
costs that are allocated for the project.

**Travel:** List travel costs according to local and long distance
travel. For local travel, the mileage rate, number of miles, reason for
travel and staff member/consumers completing the travel should be
outlined. The budget should also reflect the travel expenses associated
with participating in meetings and other proposed trainings or
workshops.

**Equipment:** List equipment costs and provide justification for the
need of the equipment to carry out the planning project'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. Only major (costing over \$5,000 per unit) equipment
items need to be itemized, with equipment costs and justifications.
Items costing less than \$5,000 should be aggregated with a brief
explanation and included under 'Supplies'.

**Supplies:** List the items that the planning project will use.
Categorize supplies according to type -- office, outreach/educational,
etc. Office supplies could include paper, pencils, and the like;
educational supplies may be pamphlets and educational videotapes.
Explain how the amounts were developed (e.g., training binders were
based on 50 potential staff at \$10 per binder to arrive at the \$500
appearing in the budget).

**Contractual (Subcontracts):** To the extent possible, all subcontract
budgets and justifications should be standardized, and contract budgets
should be presented by using the same object class categories contained
in the PHS 5161, SF 424A. Provide a clear explanation as to the purpose
of each contract, how the costs were estimated, and the specific
contract deliverables. Categorize substantive programmatic or
administrative contracts costs according to type (e.g., management
consultant, governance/outreach specialist, consultant costs for
technical assistance, etc.).

**Construction (Alteration and Renovation):**

Federal funding **CANNOT** be requested for expenses related to land or
facility purchase, construction/alteration or renovation of a facility,
or any other facility related expenses that would cause a Federal
interest to be placed on land or facility are considered ineligible
expenses under Planning Grants.

**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.
Itemize all costs in this category and explain in sufficient detail. In
most cases, legal fees, rent, insurance, dues, subscriptions, and audit
related costs would fall under this category.

**Indirect Costs**: Only those organizations with a pre-approved
federally negotiated indirect cost rate should include an indirect cost
rate in the budget presentation. Indirect costs are those costs incurred
for common or joint objectives which cannot be readily identified but
are necessary to the operations of the organization, e.g., the cost of
operating and maintaining facilities, depreciation, and administrative
salaries. For institutions subject to OMB Circular A-21, the term
"facilities and administration" is used to denote indirect costs. If an
organization applying for an assistance award does not have an indirect
cost rate, the applicant may wish to obtain one through HHS's Division
of Cost Allocation (DCA).  Visit DCA's website at: http://rates.psc.gov/
to learn more about rate agreements, the process for applying for them,
and the regional offices which negotiate them.

**vi. Staffing Plan and Personnel Requirements**

The staffing plan should be a brief narrative and/or table \[one page
maximum\] included in Attachment 6 which identifies the total personnel
and number of FTEs to staff the planning project and number to be
supported by the planning grant funds. Existing grantees should include
a staffing plan ONLY for the planning project. The staffing plan should
include education and experience qualifications and rationale for the
amount of time being requested for each staff position. Position
descriptions that include the roles, responsibilities, and
qualifications of proposed project staff must be included in Attachment
7. Copies of biographical sketches for any key employed personnel that
will be assigned to work on the proposed project must be included in
Attachment 8.

**vii. Assurances**

This form and detailed instructions are available in PHS Application
Form 5161-1 provided with the application package.

**viii. Certifications**

See *[Box 21]{.underline}* of the SF 424 Face Page and detailed
instructions available in the PHS Application Form 5161-1 provided with
the application package.

**ix. Project Abstract**

The project abstract should be single-spaced, limited to one page in
length, and provide a brief summary of the application. Because the
abstract is often distributed to provide information to the public and
Congress, please prepare this so that it is clear, accurate, concise,
and without reference to other parts of the application. It must include
a brief description of the proposed grant project including the needs to
be addressed, the proposed services, and the population group(s) to be
served. Please prepare the abstract so that it is clear, accurate,
concise, and *without reference to other parts of the application*.

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

-   Project title

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

-   Congressional district(s) for the applicant organization and the
    project (if different)

-   Types of HRSA funding requested

-   Existing Federal funding received (e.g., section 330 grant, ISDI,
    PCA, other cooperative agreement, etc.)

**x. Program Narrative**

The program narrative should be **a detailed description of the proposed
service area, and the applicant organization's proposed activities to
plan for and develop a comprehensive section 330 compliant health center
within the service area.** \[See Appendix F, Definitions, page
[91](#appendix-f), for a definition of target population and service
area.\] In general, this section includes a description of the proposed
service area, and the community's need for health services, the proposed
plan for developing a health center, the organization's capacity to
develop a health center and history with the community, and the
appropriateness of the federal funding requested. The program narrative
should be consistent with the Work Plan section.

All applicants should ensure that program narrative completely addresses
the specific elements in the Review Criteria (See Section V, page
[30](#_Ref145215423)). Throughout the program narrative, reference may
be made to exhibits and charts, as needed, in order to reflect
information about multiple sites and/or geographic or demographic data.
These exhibits and charts should be considered supplemental in nature,
and be included as part of the required/optional attachments.

This following provides a framework for the program narrative. It should
be succinct, self-explanatory and well organized so that reviewers can
understand the proposed project. Program narrative should be
organization using the following section headers:

***Introduction***

The introduction is intended to be a **brief synopsis** of the
community/target population(s), the applicant organization, and the
scope of the proposed project. The applicant should summarize the reason
for seeking a planning grant in high poverty county, need for health
services in the community and the organization's proposed response to
that need.

[]{.mark}

***NEED***

See Criterion 1: NEED in the Review Criteria Section (see page
[31](#_Ref145215457)) for the specific elements that should be
addressed.

***response***

See Criterion 2: RESPONSE in the Review Criteria Section (see page
[32](#_Ref145215470)) for the specific elements that should be
addressed.

***EVALUATIVE MEASURES***

See Criterion 3: EVALUATIVE MEASURES in the Review Criteria Section (see
page [34](#_Ref145215490)) for the specific elements that should be
addressed.

***impact***

See Criterion 4: IMPACT in the Review Criteria Section (see page
[34](#_Ref81217265)) for the specific elements that should be addressed.

***resources/capabilities***

See Criterion 5: RESOURCES/CAPABILITIES in the Review Criteria Section
(see page [34](#_Ref145215554)) for the specific elements that should be
addressed.

***support Requested***

See Criterion 6: SUPPORT REQUESTED in the Review Criteria Section (see
page [[34]{.mark}](#_Ref81217320)) for the specific elements that should
be addressed.

**xi. Program Specific Forms**

Please refer to Appendix D of this document (page [74](#appendix-d)) for
copies of the program specific forms. **All applicants for high poverty
county planning grant funding must submit the following two required
program specific forms.** The forms supply information in a concise and
consistent fashion. Please note that only the OMB forms, approved by the
U.S. Office of Management and Budget, should be submitted with the grant
application (included in this guidance application packet).

-   **FORM 1 -- General Information Worksheet --** see page
    [[75]{.mark}](#form-1-planning-grant-general-information-worksheet).
    Each applicant must complete the General Information Worksheet. This
    form provides a concise summary of information that is consistent
    with the budget, narrative, work plan and any other attachments.

-   **FORM 2 -- Community Characteristics --** see page
    [[76]{.mark}](#form-2-community-characteristics). Reports
    community-wide and target population data for the proposed service
    area for the most recent period for which data are available. Target
    population data should be a subset of the community-wide data and
    reflect the population the health center will serve. If information
    for your service area is not available, utilize data from US Census
    Bureau, local planning agencies, health departments and other local,
    State and national data sources. Estimates are acceptable.

**xii. Attachments**

Please provide the following items to complete the content of the
application. Please note that these are supplementary in nature, and are
not intended to be a continuation of the project narrative. Be sure each
attachment is clearly labeled. All forms and attachments are expected to
reflect the scope of the application submitted, as appropriate.

1)  **Attachment 1: Program Specific Form 1: General Information
    Worksheet**

2)  **Attachment 2: Program Specific Form 2: Community Characteristics**

3)  **Attachment 3: Project Work Plan**

A sample format is provided in Appendix C of this document. In general,
this section should be used to outline goals and objectives related to
the planning and development activities that will be undertaken to
establish a comprehensive health center in compliance with the
requirements of section 330 of the PHS Act. The work plan goals and
objectives should be *specific to the high poverty county planning grant
for which Federal section 330 funding is being requested*.

In addition to the table format for the work plan, applicants should
summarize the major aspects of the plan in a accompanying narrative and
include those issues that cannot be captured in the table format, (e.g.,
health care environmental changes, Medicaid/Medicare, and any other
factors that may have affected, or are expected to affect, progress for
implementing the planning project in either a positive or negative way).

The Work Plan should be formatted in the categories of Needs Assessment,
Service Delivery, Financial Assistance, Professional Staffing, Technical
Assistance, Community Development, and Governance. Applicants are
expected to address the following issues, as applicable, in the Work
Plan:

-   Comprehensive needs assessment and identification of the major
    health issues for the populations to be served.

-   Development of an appropriate service delivery model based on the
    needs assessment.

-   If other populations (e.g., migrant/seasonal agricultural workers,
    residents of public housing, homeless persons, low-income school
    children, etc.) may be included in the target population, activities
    related to the identification of the special access problems and the
    unique health care needs of these populations.

-   Facility planning and location selection.

-   Recruitment and retention of key management and other qualified
    staff.

-   Plans for attaining and maintaining long-term viability (i.e.,
    future requirements for space, securing other financial support,
    etc.)

-   Technical assistance and consultant activities.

-   Financial, management and administrative implications to the
    organization related to future operation of the health center.

-   Governance Board development, as necessary.

-   Developing community support.

-   Establishing collaborative working relationships with other area
    stakeholders (e.g., providers, service organizations, etc.).

4)  **Attachment 4: Project Organizational Chart**

Applicant should provide a one-page figure that depicts the
organizational structure including the governing board, key personnel,
staffing, subcontractors, consultants and other significant
collaborating organizations, as applicable.

5)  **Attachment 5: Service Area Map**

Applicants should include a map of the potential service area indicating
(as appropriate) designated MUAs/MUPs, other health care providers, and
the organization's potential point(s) of service within the area, if
known.

6)  **Attachment 6: Staffing Plan and Personnel Requirements**

Please see p. 19 above for more information about this brief \[one page
maximum\] narrative and/or table.

7)  **Attachment 7: Job or Position Descriptions for Key Personnel**

Applicant should provide position descriptions for all key personnel to
be that will be working on the planning project and elements of the
proposed work plan. It is recommended that the descriptions be one page
in length as much as is possible. Item 6 in the Program Narrative
section of the PHS Form 5161-1 provides some guidance on items to
include in a job description.

8)  **Attachment 8: Biographical Sketches of Key Personnel**

Include biographical sketches for persons occupying the key positions
described in Attachment 7, recommended not to exceed two pages in length
each. Applicants should also indicate any current vacancies in key
personnel. In the event that a biographical sketch is included for an
identified individual who is not yet hired, please include a letter of
commitment from that person with the biographical sketch.

9)  **Attachment 9: Other contracts, agreements, etc., as applicable or
    required.**

Provide any documents that describe substantive working relationships
between the applicant agency and other agencies and programs cited in
the proposal (e.g., contracted staff, management services contracts,
etc.). Documents that confirm actual or pending contractual agreements
should clearly describe the roles of the subcontractors and any
deliverable. Letters of agreements and contracts must be dated and
signed.

10) **Attachment 10: Most recent independent financial audit**

Audit information will be considered complete when it includes all
balance sheets, profit and loss statements, audit findings, management
letter and any noted exceptions. Organizations that have been
operational less than one year and do not have an audit may submit
monthly financial statements for the most recent six-month period if
available. For organizations with no audit/financial information
available, please provide a detailed explanation (e.g., organization has
been formed for the purposes of this planning grant application, etc.).

11) **Attachment 11: Articles of Incorporation**

The official signatory page of the Articles of Incorporation (State seal
page) is sufficient in lieu of the entire document. For organizations
that do not have signed Articles of Incorporation, submit proof that an
application has been submitted to the State for review.

12) **Attachment 12: Internal Revenue Service (IRS) Tax Exempt
    Certification &W-9 Form**

All applicant organizations must submit a copy of the IRS Tax Exempt
Certificate or a copy of the application for such certificate. The IRS
Tax Exempt Certification or a copy of the organization's W-9 Form must
be submitted to verify the organizational Employee Identification
Number. Please provide a detailed explanation if neither document is
available.

13) **Attachment 13: Letters of Support**

The applicant should include any dated letters of support as appropriate
to demonstrate support and commitment to the project. The applicant
should also include a one-page list of all additional support letters
not included in the application, but available onsite.

14) **Attachment 14: Other Relevant Documents, optional**

Applicants may include other attachments and documents to the
application, as applicable, to support the proposed project plan. Other
documents may include floor plans of the facility(ies), charts,
organizational brochures, etc.

**Applicants are reminded that failure to include all required documents
as part of the application may result in an application being considered
as incomplete or non-responsive. Applications are limited to no more
than 80 pages IN TOTAL including all required and optional documents.
Any application that exceeds the specified limits (80 pages when printed
by HRSA, approximately 10 MB) will be deemed non-compliant and will be
returned to the applicant without further consideration.** **It is
highly recommended that applicants print out the application before
submitting it electronically to ensure that it is within the 80-page
limit.**

## 3. Submission Dates and Times {#submission-dates-and-times .unnumbered}

### Application Due Dates  {#application-due-dates .unnumbered}

The due date for applications under this grant announcement is *May 16,
2007 at 8:00 P.M. ET*. Applications will be considered as meeting the
deadline if they are E marked on or before the due date. Please consult
Appendix A, Section 3 for detailed instructions on submission
requirements.

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

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

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

### Late applications {#late-applications .unnumbered}

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

## 4. Intergovernmental Review {#intergovernmental-review .unnumbered}

**The Consolidated Health Center program** 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.

**Public Health System Reporting Requirements**

Under these requirements (approved by the Office of Management and
Budget 0937-0195), the community-based non-governmental applicant must
prepare and submit a Public Health System Impact Statement (PHSIS) to
the head of the appropriate State and local health agencies in the
area(s) to be impacted no later than the Federal application due date.
The PHSIS should include:

> a\) A copy of the face page of the application (SF 424).

b\) A summary of the project, not to exceed one page, which provides:

-   A description of the proposed service area and the need for health
    services in that community,

-   A summary of the proposed activities, and

-   A description of the coordination planned with the appropriate State
    or local health agencies.

## 5. Funding Restrictions {#funding-restrictions .unnumbered}

Applicants responding to this announcement may NOT request one-time
funding greater than the allowable **cap of \$80,000**. Federal funding
levels will be reviewed prior to a final funding decision and may be
adjusted based on an analysis of the budget and allowable cost factors.
See Section IV and Attachment 2 of this application guidance for further
information and instruction on the development of the application
budget.

Federal funding **CANNOT** be requested for expenses related to land or
facility purchase, construction/alteration or renovation of a facility,
or any other facility related expenses that would cause a Federal
interest to be placed on land or facility.

Additionally, Federal funding **CANNOT** be requested for any direct
patient care and/or services including:

-   The provision of patient care services or supplies that are
    ordinarily reimbursable (e.g., exams, therapy sessions,
    pharmaceuticals)

```{=html}
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```
-   Primary care site development or service expansions (e.g. extended
    clinic hours)

-   Capital equipment used for reimbursable patient care and services
    (e.g., radiology equipment, ambulances)

## 6. Other Submission Requirements {#other-submission-requirements .unnumbered}

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 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 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 (AO) electronically submits the application to HRSA through
Grants.gov. However, to complete the submission requirements, a
hard-copy of the SF-424/5161 Face Sheet must be printed, signed, and
submitted to the HRSA Grants Application Center. The SF-424/5161 must be
printed from Grants.gov.

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

The HRSA Grants Application Center

The Legin Group, Inc.

Attn: *Planning Grants in High Poverty Counties*

Program Announcement No. HRSA-07-066

CFDA No. 93.224

910 Clopper Road

Suite 155 South

Gaithersburg, MD 20878

Telephone: 877-477-2123

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

It is incumbent on applicants to ensure that the AO is available to
submit the application to HRSA by the application due date. We will not
accept submission or re-submission of incomplete, rejected, or otherwise
delayed applications after the deadline. Please be sure to review
Section IV.1 for instructions if you would like to request a written
exemption from submitting electronically *prior* to 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.

# Application Review Information 

## 1. Review Criteria {#review-criteria .unnumbered}

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.

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

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

Wherever appropriate within the review criteria, applicants should
identify programs, training and technical assistance implemented to
improve health communications to foster healing relationships across
culturally diverse populations.

As appropriate within the review criteria, applicants should also
describe the program's or institution's strategic plan, 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 educate health care providers serving diverse patients,
families, and communities.

The six (6) Review Criteria for the planning grant funding opportunity
and maximum points awarded are as follows:

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

1.  []{#_Ref145215457 .anchor}Applicant describes the proposed service
    area for the planning project and identifies:

    a.  The census tracts, minor civil divisions, schools/school
        districts, etc., within the high poverty county, as appropriate;

    b.  Any Medically Underserved Area (MUA), Medically Underserved
        Population (MUP), High Impact Area, and/or Health Professional
        Shortage Area (HPSA) designations for the area, as applicable
        \[for more information see Definitions\].

    c.  The urban, rural, and/or sparsely populated composition of the
        service area.

2.  Applicant demonstrates that the service area is located within a
    high poverty county as identified in Appendix H (p. 97).

3.  Applicant describes the general population demographics and need in
    the community including a discussion of any sub-populations that
    services may be targeted (e.g., elderly population, immigrant
    population, migrant/seasonal farmworkers, homeless populations,
    residents of public housing, low-income school children/adolescents
    and their families).

4.  Applicant describes any major barriers to care (e.g., geographic,
    cultural, economic, etc.) and any significant changes that have
    created an increased need for services (e.g., hospital closing,
    recent immigrant influx, factory closing, natural disaster, etc.).

5.  Applicant describes the State/local health care environment
    including an understanding of the State implementation of SCHIP,
    1115, and 1915(b) waivers, State Medicaid prospective payment
    system, Medicaid managed care, State laws, current and proposed
    welfare reform initiatives, etc.

6.  Applicant discusses any existing health care providers (e.g.,
    hospital, health clinics, private providers, health department,
    etc.) in the targeted area of the high poverty county. A map of the
    area, indicating existing providers should be included in Attachment
    5.

**Criterion 2: RESPONSE (45 points)**

1.  []{#_Ref145215470 .anchor}Applicant describes the overall purpose of
    the proposed planning project, including a discussion of how these
    efforts relate to developing a comprehensive section 330 compliant
    health center.

[]{.mark}

2.  Applicant organization describes the proposed needs assessment that
    will be and/or was conducted for the population proposed to be
    served by the health center. The proposed needs assessment should
    focus special attention to the needs of the medically underserved
    population, specifically:

    a.  Health indices for the population of the area, (e.g., infant
        mortality rate, diabetes incidence, etc);

    b.  Economic factors affecting the population's access to health
        services, (e.g., percentage of the population with incomes at or
        below 200% of the poverty level, joblessness rate, estimated
        uninsured rate, etc.);

    c.  Demographic factors affecting the population's need and demand
        for health services, such as percentage of the population age 65
        and over, language ;

    d.  Health resources available to the population including access to
        primary care physicians (family practice, internal medicine,
        pediatrics, or obstetrics and gynecology) and resources and/or
        services of other public and private organizations within the
        proposed service area that are providing care to the target
        population(s); and

    e.  The capacity within the service area to sustain a comprehensive
        health center.

> **NOTE**: If the applicant organization has recently (within the last
> six months) conducted a needs assessment, a summary of the findings
> should be included in **Attachment 14**. The applicant must
> demonstrate that the conducted needs assessment incorporated the
> required elements as listed above, and/or describe plans to collect
> the additional information, as needed.
>
> \[For additional suggestions in developing a needs assessment, please
> review the Needs for Assistance (NFA) Worksheet found in HRSA-07-069:
> New Access Points in High Poverty Counties, and Data Resource Guide
> available online through the BPHC website at:
> <http://bphc.hrsa.gov/chc/>. The NFA Worksheet details the criteria
> high poverty county new access point applicants are required to use in
> assessing the needs of their proposed service area. The Data Resource
> Guide developed by the BPHC provides data sources and extrapolation
> examples for use in conjunction with the NFA Worksheet.\]

3.  The applicant demonstrates that the needs assessment has/will be
    used to evaluate the effectiveness of available resources and/or
    services in providing care to the target community/population, to
    determine if there is sufficient capacity with the existing
    providers to establish a new comprehensive delivery site.

4.  Applicant organization has included documentation that the proposed
    service area includes a designated MUA/MUP. If no designation
    exists, the applicant has described plans to obtain designation
    through this planning project. Applicant also discusses other
    essential/required designations as appropriate.

> Note: Under the Consolidated Health Center Program, MUA/P designation
> is not required for organizations funded only for MHC, HCH, and/or
> PHPC sites.

5.  Applicant describes the planning efforts that will be undertaken to
    develop an appropriate health center program to serve the needs of
    the proposed service area and target population as determined
    through the needs assessment. Applicant includes reference to
    specific goals and objectives within the workplan. Application
    should include a discussion of the applicant's consideration of the
    following as part of the planning efforts:

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```
(a) Service delivery setting/model (e.g., stand-alone site, school
    setting, mobile clinic, etc.);

(b) Culturally and linguistically appropriate care;

(c) Providing access to oral health, mental health, and substance abuse
    related services;

(d) Determining staffing needs (i.e., provider mix);

(e) Establishing appropriate administrative, fiscal and clinical
    policies and procedures;

(f) Identifying the MIS and billing system needs of the health center;

(g) Meeting compliance with section 330 requirements.

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```
6.  Applicant describes efforts to secure financial and professional
    assistance to support the planning activities, as appropriate.
    Applicant includes reference to specific goals and objectives within
    the workplan. Specifically, applicants should address efforts
    related to:

```{=html}
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```
(a) Securing other Federal/State/local/in-kind financial support for
    efforts related to developing and/or operating a comprehensive
    community based-health center (e.g., foundations, donated supplies
    or facilities, discounted/donated services, etc.).

(b) Recruitment and retention of appropriate providers and staff based
    on the cultural, linguistic, and health related needs of the
    community.

(c) Developing a strong management team (i.e., Chief Executive Officer,
    Medical Director, Chief Financial Officer, etc.) for the health
    center.

(d) Securing contracts/consultants to assist in the development stages
    of the health center.

```{=html}
<!-- -->
```
7.  Applicant describes any planning activities that will be initiated
    through the proposed project to gain or increase community support
    and involvement. The applicant should discuss community involvement
    activities in the development stages as well as plan for maintaining
    involvement once the health center is operational (e.g. community
    surveys, advisory board, health fair and outreach work, etc.).

8.  Applicant discusses development of a compliant governance structure
    as necessary, including recruiting Board members that are
    representative of the community to be served (e.g., appropriate
    racial, ethnic, and gender representation, minimum 51% consumer
    majority), Board training, developing section 330 compliant bylaws,
    etc.

> Note: Under the Consolidated Health Center Program statute,
> organizations funded only under MHC, HCH, and/or PHPC may be eligible
> to waive certain governance requirements \-- see PIN 98-12 for
> additional guidance.

9.  Applicant discusses efforts to establish linkages with other
    providers and potential stakeholders (e.g., health department, local
    hospital, university, schools, businesses, WIC program, homeless
    shelters, etc.) to enhance collaboration and coordination and
    prevent duplication of services within the community.

[]{.mark}

[]{.mark}

**Criterion 3: EVALUATIVE MEASURES (5 points)**

1.  []{#_Ref145215490 .anchor}Applicant describes how the comprehensive
    needs assessment will form the basis of strategic planning and
    future program decision-making.

2.  Applicant describes the process that will be used to evaluate the
    results of action steps, and to establish future goals and
    objectives. The applicant should include a discussion of the
    governing board, management staff, and community's involvement
    during the evaluation stages.

[]{.mark}

[]{.mark}

**Criterion 4: IMPACT (5 points)**

1.  []{#_Ref81217265 .anchor}Applicant describes how the planning grant
    will support organizational long term goals beyond the grant's one
    year project period.

[]{.mark}

[]{.mark}

**Criterion 5: RESOURCES/CAPABILITIES (20 points)**

1.  []{#_Ref145215554 .anchor}Applicant discusses why it is the
    appropriate entity to receive the planning funds and lead the
    planning and development efforts in the community (e.g., staff
    skills, capacity, clinical outcomes, cultural and linguistic
    competence, evaluation capabilities, etc.).

[]{.mark}

2.  Applicant describes prior experience and expertise of the
    organization and key staff in:

```{=html}
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```
(a) Working with the proposed service area/community(ies);

(b) Establishing and/or providing comprehensive health care;

(c) Community development.

[]{.mark}

3.  Applicant identifies unique characteristics and significant
    accomplishments of the organization.

[]{.mark}

4.  Applicant summarizes any prior Federal funding received by the
    organization, specifically funding through HRSA (i.e., section 330
    FQHC, network, PCA, HCAP, Ryan White, Rural Health, etc.). If the
    organization is currently receiving Federal funding, the applicant
    should demonstrate that the planning grant will not duplicate
    efforts, expectations, or outcomes that are supported by the
    existing Federal grant award; how the existing Federal grant award
    will [enhance]{.underline} the proposed planning activities; and how
    both awards will be coordinated to maximize efforts within the
    community.

5.  Applicant discusses the proposed staffing plan and demonstrates
    through attached Job Descriptions and Biographical Sketches that it
    is appropriate and adequate to successfully accomplish the goals of
    the planning project. For vacant positions, applicant describes the
    recruiting methods that will be used for hiring consultants/staff
    that will be needed for the planning project.

[]{.mark}

[]{.mark}

**Criterion 6: SUPPORT REQUESTED (15 points)**

1.  []{#_Ref81217320 .anchor}Applicant demonstrates in the budget
    presentation, one 12-month annualized budget which is appropriate
    and reasonable in terms of:

```{=html}
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```
(a) The soundness of the fiscal plan for assuring effective utilization
    of grant funds and maximizing non-grant revenue;

(b) The total resources required to achieve the goals and objectives of
    the planning project (i.e., total project budget);

(c) Utilization of other Federal, State, local, and private resources
    available for support of the planning project, to the extent
    feasible.

[]{.mark}

2.  Applicant demonstrates that the work plan goals and objectives are
    targeted and demonstrate appropriate financial planning in the
    development of the proposal and for the long-term success of the
    project.

3.  Applicant demonstrates that the costs associated with consultative
    services, if applicable, is appropriate and reasonable as a
    component of the overall plan.

## 2. Review and Selection Process {#review-and-selection-process .unnumbered}

All high poverty county planning grant applications will be reviewed
initially for eligibility (see Section III, page
[[11]{.mark}](#eligibility-information), for eligibility requirements),
completeness (see Section IV for Application Sequences for a list of
required documents to be submitted as part of the high poverty county
planning grant application) and responsiveness to the application.
**Those applications that are determined to be ineligible, incomplete or
non-responsive to the grant application guidance will be discarded
without further consideration.** Applicants are reminded that
applications are limited to no more than 80 pages in total including all
required and optional documents.

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

Applications that pass the initial HRSA eligibility screening will be
reviewed and rated by a panel based on the program elements and review
criteria presented in relevant sections of this program announcement.
The review criteria are designed to enable the review panel to assess
the quality of a proposed project and determine the likelihood of its
success.  The criteria are closely related to each other and are
considered as a whole in judging the overall quality of an application.
The funding preference (see below) will be determined by the reviewers
based on supporting documentation contained in the application.

[]{.mark}

HRSA reserves the right to review fundable applicants for compliance
with BPHC program expectations through a review of site visits, audit
data, Uniform Data System (UDS) or similar reports, Medicare/Medicaid
cost reports, external accreditation or performance review reports, and
other performance reports for current HRSA funding, etc. as applicable,
before a final recommendation for funding is made.

### Funding Preferences  {#funding-preferences .unnumbered}

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

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

> *Sparsely Populated Rural Frontier Areas*: In order to be considered
> for a funding preference, an applicant must demonstrate that the
> entire area being targeted for the planning and development of a
> comprehensive primary care delivery site has seven or fewer people per
> square mile (the area may not be broken into pieces (e.g., specific
> census tracts within the defined service area)). Applicants requesting
> consideration of a funding preference must indicate the request on
> FORM 1, and provide documentation indicating the entire area has seven
> or less people per square mile (e.g., information from the Census
> Bureau).

### Other Awarding Factors {#other-awarding-factors .unnumbered}

HRSA intends to achieve a wide distribution of planning grants in high
poverty county awards in FY 2007. In general, HRSA may consider the
following factors, in addition to the preference indicated above, in
making awards for planning grants in high poverty counties in FY 2007.

*RURAL/URBAN DISTRIBUTION OF AWARDS:*

Aggregate awards in FY 2007 to serve rural and urban areas may be made
to ensure that no more than 60 percent and no fewer than 40 percent of
the people served come from either rural or urban areas.

*GEOGRAPHIC CONSIDERATION:*

The goal of the HRSA in making this funding announcement is to expand
the current safety net on a national basis by targeting planning and
developmental efforts in areas not currently served by a funded health
center. Therefore, HRSA may consider geographic distribution when
deciding which applications to fund. No more than one High Poverty
County Planning Grant and one High Poverty County New Access Point (NAP)
award will be provided per eligible high poverty county over the High
Poverty Counties Initiative. Once a NAP grant has been awarded in a
particular county, that county is deemed ineligible for any future High
Poverty County NAP or Planning Grants.

*MULTIPLE APPLICATIONS TARGETING THE SAME ELIGIBLE COUNTY:*

In the event that a NAP (HRSA-07-069 or HRSA-07-067) and Planning Grant
(HRSA-07-066) application are submitted to address the same county in
the same fiscal year, no more than one application may be awarded a
grant for the eligible county. If a NAP and a Planning Grant application
targeting the same county are both recommended for funding, HRSA will
award a NAP grant.

*PERFORMANCE UNDER SECTION 330 PROGRAM EXPECTATIONS:*

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

*PROPORTIONATE DISTRIBUTION*

It is expected that the aggregate awards made in FY 2007 to support the
various types of health centers (i.e., 330(e) Community Health Centers,
330(g) Migrant Health Centers, 330(h) Health Care for the Homeless
Health Centers, and 330(i) Public Housing Primary Care Health Centers)
will be made to ensure continued proportionate distribution of funds
across the Consolidated Health Center Program.

## 3. Anticipated Announcement and Award Dates {#anticipated-announcement-and-award-dates .unnumbered}

Applications under HRSA-07-066 received by 8:00pm on May 16, 2007
deadline will be reviewed with funding decisions beginning on or about
September 1, 2007.

Applications submitted after the deadline will not be accepted for
processing and will be returned. It is the responsibility of the
applicant to ensure that the complete application is submitted through
Grants.gov by the published due date.

# Award Administration Information

## 1. Award Notices {#award-notices .unnumbered}

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.

## 2. Administrative and National Policy Requirements {#administrative-and-national-policy-requirements .unnumbered}

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate (available
online at: <http://www.gpoaccess.gov/cfr/>).

Beginning October 1, 2006, HRSA grant awards will be 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 {#public-policy-issuance .unnumbered}

**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/>.

### Smoke Free Workplace {#smoke-free-workplace .unnumbered}

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 {#reporting .unnumbered}

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

a.  **Audit Requirements**

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

b.  **Payment Management Requirements**

> Submit a quarterly electronic PSC-272 via the Payment Management
> System. The report identifies cash expenditures against the authorized
> funds for the grant. Failure to submit the report may result in the
> inability to access grant funds. The PSC-272 Certification page should
> be faxed to the PMS contact at the fax number listed on the 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** seven months after the award of
> funds.
>
> d\. **Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. As part of this agency-wide
> effort, HRSA grantees will be required to participate, where
> appropriate, in an on-site performance review of their HRSA funded
> program(s) by a review team from one of the ten OPR regional
> divisions. Grantees should expect to participate in a performance
> review at some point during their project period. When a grantee
> receives more than one HRSA grant, each of the grantee's HRSA funded
> programs will be reviewed during the same performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees will
> be required to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. In addition, performance reviews also
> provide an opportunity for grantees to offer direct feedback to the
> agency about the impact of HRSA policies on program implementation and
> performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

# Agency and National Organization Contacts

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

Shonda Gosnell

Division of Grants Management Operations

Office of Financial Assistance Management, HRSA

5600 Fishers Lane, Room 11 A-16

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:

Preeti Kanodia

New Access Point Program Coordinator

Division of Policy and Development

Bureau of Primary Health Care, HRSA

5600 Fishers Lane, Mailstop 17-61

Rockville, MD 20857

Telephone: 301-594-4300

Fax: 301-594-4997

Email: <preeti.kanodia@hrsa.hhs.gov>

Technical assistance regarding this funding announcement may be obtained
by contacting the appropriate State PCA, PCO or National Organization.
Please see Appendix E (page [77](#appendix-e) of this guidance for a
listing.

[Please direct ALL questions regarding Grants.gov to:]{.underline}

Grants.gov Customer Support

Telephone: 1-800-518-4726. Available from 7:00 a.m. to 9:00 p.m. ET,
excluding Federal holidays

Email: support@grants.gov

Online: http://www.grants.gov/CustomerSupport

Assistance with using HRSA EHBs may be obtained by contacting:

HRSA Call Center

Telephone: 1-877-GO4-HRSA (877-464-4772) Available between 9:00 am to
5:30 pm ET

Email callcenter@hrsa.gov

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

# 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]{.underline}](http://www.dunandbradstreet.com/)
or call 1-866-705-5711. Please include the DUNS number in item 8c on the
application face page.

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

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

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

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

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

**Be careful in the use of attachments.** Do not use the 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.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages 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 in your electronic submission 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 accepted.

# APPENDIX A: HRSA'S ELECTRONIC SUBMISSION USER GUIDE {#appendix-a-hrsas-electronic-submission-user-guide .unnumbered}

# User Guide Table of Contents {#user-guide-table-of-contents .unnumbered}

1\.
INTRODUCTION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....42

1.1. DOCUMENT PURPOSE AND
SCOPE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....42

1.2. DOCUMENT ORGANIZATION AND VERSION
CONTROL\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...42

2\. NONCOMPETING CONTINUATION
APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....42

2.1. PROCESS
OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....42

2.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) (IF NOT ALREADY
REGISTERED)...........................................................................\...\...\...\...\.....43

2.3. PROJECT DIRECTOR AND AUTHORIZING OFFICIAL NEED TO REGISTER WITH
HRSA EHBS (IF NOT ALREADY REGISTERED)
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....44

2.4. APPLY THROUGH [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....45

2.4.1 Find Funding
Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...45

2.4.2 Download Application Package
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....45

2.4.3 Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....45

2.4.4 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....45

2.4.5 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....45

2.5. VERIFY IN HRSA ELECTRONIC HANDBOOKS
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....46

2.5.1 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....46

2.5.2 Manage Access to Your Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....47

2.5.3 Check Validation
Errors\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...47

2.5.4 Fix Errors and Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....47

2.5.5 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....47

2.6. SUBMIT SIGNED FACE
PAGE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...47

3\. COMPETING
APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...48

3.1. PROCESS
OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....48

3.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) NOT ALREADY
REGISTERED)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....48

3.3. APPLY THROUGH
[[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....49

3.3.1 Find Funding
Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...49

3.3.2 Download Application
Package\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....49

3.3.3 Complete
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....49

3.3.4 Submit
Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....49

3.3.5 Verify Status of Application
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....50

3.4. SUBMIT SIGNED FACE PAGE
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....50

4\. GENERAL INSTRUCTIONS FOR APPLICATION
SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....51

4.1. NARRATIVE ATTACHMENT
GUIDELINES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....51

4.1.1
Font\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....51

4.1.2 Paper Size and
Margins\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....51

4.1.3
Names\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....51

4.1.4 Section Headings
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....51

4.1.5 Page
Numbering\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....51

4.1.6 Allowable Attachment or Document
Types\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....52

4.2. APPLICATION CONTENT ORDER (TABLE OF
CONTENTS)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...52

4.3. PAGE
LIMIT\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....52

5.0 CUSTOMER SUPPORT INFORMATION
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....53

5.1.1 Grants.gov Customer
Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....53

5.1.2 HRSA Call
Center\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....53

5.1.3 HRSA Program
Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....53

6.0
FAQs\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....53

6.1.
SOFTWARE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....53

6.1.1 What are the software requirements for using
Grants.gov?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...53

6.1.2 Why can\'t I download PureEdge Viewer onto my
machine?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....54

6.1.3 I have heard that Grants.gov is not Macintosh compatible. What do
I do if I use only a
Macintosh?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....54

6.1.4 What are the software requirements for HRSA
EHBs?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....54

6.1.5 What are the system requirements for using HRSA EHBs on a
Macintosh computer?\...\...\...\...\...\.....55

6.2. APPLICATION RECEIPT
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...55

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?
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....55

6.2.2 When do I need to submit my application?
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....55

6.2.3 What emails can I expect once I submit my application? Is email
reliable?\...\...\...\...\...\...\...\...\...\...\...\.....55

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

considered
\"late\"?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...56

6.3. APPLICATION
SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....56

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

objective
review?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....56

6.4 GRANT.GOV
HELP\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...56

#  {#section .unnumbered}

#  {#section-1 .unnumbered}

# 1. Introduction {#introduction .unnumbered}

##  {#section-2 .unnumbered}

## 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.

##  {#section-3 .unnumbered}

## 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.

#  {#section-4 .unnumbered}

# 2. Noncompeting Continuation Application {#noncompeting-continuation-application .unnumbered}

##  {#section-5 .unnumbered}

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

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

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

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

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

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

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

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

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

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

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

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

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

##  {#section-6 .unnumbered}

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

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

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

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

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

• Register the organization with Central Contractor Registry (CCR)

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

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

• Register an Authorized Organization Representative (AOR)

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

o Register the username and password with Grants.gov

o Get authorized as an AOR by your organization

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

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

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

##  {#section-7 .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.

##  {#section-8 .unnumbered}

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

###  {#section-9 .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!

###  {#section-10 .unnumbered}

### 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.

###  {#section-11 .unnumbered}

### 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.

###  {#section-12 .unnumbered}

### 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.

###  {#section-13 .unnumbered}

### 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".

##  {#section-14 .unnumbered}

## 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.

###  {#section-15 .unnumbered}

### 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.

###  {#section-16 .unnumbered}

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

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

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

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

###  {#section-17 .unnumbered}

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

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

###  {#section-18 .unnumbered}

### 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.

##  {#section-19 .unnumbered}

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

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

HRSA Grants Application Center

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

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

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

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

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

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

# 3. Competing Application {#competing-application .unnumbered}

##  {#section-20 .unnumbered}

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

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

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

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

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

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

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

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

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

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

##  {#section-21 .unnumbered}

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

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

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

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

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

• Register the organization with Central Contractor Registry (CCR)

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

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

• Register an Authorized Organization Representative (AOR)

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

o Register the username and password with Grants.gov

o Get authorized as an AOR by your organization

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

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

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

##  {#section-22 .unnumbered}

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

###  {#section-23 .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.

###  {#section-24 .unnumbered}

### 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.

###  {#section-25 .unnumbered}

### 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.

###  {#section-26 .unnumbered}

### 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.

###  {#section-27 .unnumbered}

### 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 <DGPClearances@hrsa.gov> and thoroughly explain the
situation; include a copy of the "Rejected with Errors" notification.

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

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

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

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

##  {#section-28 .unnumbered}

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

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

HRSA Grants Application Center

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

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

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

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

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

#  {#section-29 .unnumbered}

# 4. General Instructions for Application Submission {#general-instructions-for-application-submission .unnumbered}

-   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.

##  {#section-30 .unnumbered}

## 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.

###  {#section-31 .unnumbered}

### 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. 

###  {#section-32 .unnumbered}

### 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.)

###  {#section-33 .unnumbered}

### 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.

##  {#section-34 .unnumbered}

## 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.

#  {#section-35 .unnumbered}

# 5. Customer Support Information {#customer-support-information .unnumbered}

###  {#section-36 .unnumbered}

### 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>

###  {#section-37 .unnumbered}

### 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'

###  {#section-38 .unnumbered}

### 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.

#  {#section-39 .unnumbered}

# 6. FAQs {#faqs .unnumbered}

##  {#section-40 .unnumbered}

## 6.1 Software {#software .unnumbered}

###  {#section-41 .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.

###  {#section-42 .unnumbered}

### 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.

###  {#section-43 .unnumbered}

### 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 d 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>

###  {#section-44 .unnumbered}

### 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.

###  {#section-45 .unnumbered}

### 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.

##  {#section-46 .unnumbered}

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

###  {#section-47 .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.

###  {#section-48 .unnumbered}

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

###  {#section-49 .unnumbered}

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

**Competing Submissions:**

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

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

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

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

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

**Noncompeting Submissions:**

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

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

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

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

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

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

###  {#section-50 .unnumbered}

### 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 <DGPClearances@hrsa.gov> and thoroughly explain
the situation. Include a copy of the "Rejected with Errors" notification
you received from Grants.gov.

**Noncompeting Submissions:**

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

##  {#section-51 .unnumbered}

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

###  {#section-52 .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 section4.2 to ensure that your
application is presented in the right order and is compliant with all
the requirements.

##  {#section-53 .unnumbered}

## 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 {#appendix-b-registering-and-applying-through-grants.gov .unnumbered}

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

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

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

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

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

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

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

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

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

Step 1: Register your organization

Step 2: Register yourself as an Authorized Organization Representative

Step 3: Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](../www.grants.gov). Individual assistance is available
at [http://www.grants.gov/Support](http://www.grants.gov/Support  ) or
1-800-518-4726. 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.

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

The HRSA Grants Application Center

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

Program Announcement No. \[provide HRSA announcement number\]

CFDA No. \[provide the CFDA number\]

910 Clopper Road

Suite 155 South

Gaithersburg, MD 20878

Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

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

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

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

**Performance Measures for Competitive Applications**

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

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

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

####### Appendix C: Guidelines For Developing the Work Plan and Budget Presentation {#appendix-c-guidelines-for-developing-the-work-plan-and-budget-presentation .unnumbered}

## Guidelines For Developing the Work Plan {#guidelines-for-developing-the-work-plan .unnumbered}

The following components are intended for use in presenting the Work
Plan for Planning Grants in High Poverty Counties applicants. Presenting
the plan in \"landscape\" print format may facilitate easier reading and
usage. Please refer to 'Section IV: Application and Submission
Information' for more information about completing Work Plan.

In addition to the table format for the work plan, applicants should
summarize the major aspects of the plan in a accompanying narrative and
include those issues that cannot be captured in the table format, (e.g.,
health care environmental changes, Medicaid/Medicare, and any other
factors that may have affected, or are expected to affect, progress for
implementing the planning project in either a positive or negative way).

The Work Plan should be formatted in the categories of Needs Assessment,
Service Delivery, Financial Assistance, Professional Staffing, Technical
Assistance, Community Development, and Governance. Applicants are
expected to address the following issues, as applicable, in the Work
Plan:

-   Comprehensive needs assessment and identification of the major
    health issues for the populations to be served.

-   Development of an appropriate service delivery model based on the
    needs assessment.

-   If other populations (e.g., migrant/seasonal agricultural workers,
    residents of public housing, homeless persons, low-income school
    children, etc.) may be included in the target population, activities
    related to the identification of the special access problems and the
    unique health care needs of these populations.

-   Facility planning and location selection.

-   Recruitment and retention of key management and other qualified
    staff.

-   Plans for attaining and maintaining long-term viability (i.e.,
    future requirements for space, securing other financial support,
    etc.)

-   Technical assistance and consultant activities.

-   Financial, management and administrative implications to the
    organization related to future operation of the health center.

-   Governance Board development, as necessary.

-   Developing community support.

-   Establishing collaborative working relationships with other area
    stakeholders (e.g., providers, service organizations, etc.).

*Elements of the Work Plan Table*

**Problem/Need Statements** are clearly and specifically defined
descriptions of major needs or problems, quantified where possible. The
problem/need statements should tie into and flow from the overall
project description and the identified needs of the proposed service
area and/or target population(s).

**Column 1: Goals and Objectives.** Goals are relatively broad and
express a sense of a desired future state or direction. Goals should
address identified needs or problems and are usually long-term (1 year
or more). An example of a measurable goal is: *"To increase the percent
of pregnant users beginning prenatal care in the first trimester of
pregnancy from **49%** of the patient population to **85%** of the
patient population served by the health center within **5 years**."*

Objectives are descriptions of desired, measurable, time‑limited results
or outcomes and are usually short term (1 year or less). Objectives
(intended results or outcomes) are measures of progress towards a goal.
They can be used to identify an acceptable level of performance or
establish criteria for evaluation. An example of a measurable objective
is: *"To increase the percent of pregnant users beginning prenatal care
in the first trimester of pregnancy from **49%** of the patient
population to **52%** of the patient population served by the health
center within **12 months**."* Use an upper case letter (A\...) for each
goal and list corresponding objectives by number (1\...).

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

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

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

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

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

###### Sample Format for the Work Plan Presentation {#sample-format-for-the-work-plan-presentation .unnumbered}

This sample format is provided as a broad outline for the Work Plan
presentation. Additional information may be provided to fully describe
your proposal:

+----------+-------------+--------------+---------+---------+-------+
| Prob     |             |              |         |         |       |
| lem/Need |             |              |         |         |       |
| St       |             |              |         |         |       |
| atement: |             |              |         |         |       |
| C        |             |              |         |         |       |
| ommunity |             |              |         |         |       |
| support, |             |              |         |         |       |
| inv      |             |              |         |         |       |
| olvement |             |              |         |         |       |
| and      |             |              |         |         |       |
| buy-in   |             |              |         |         |       |
| is       |             |              |         |         |       |
| n        |             |              |         |         |       |
| ecessary |             |              |         |         |       |
| in       |             |              |         |         |       |
| de       |             |              |         |         |       |
| veloping |             |              |         |         |       |
| a        |             |              |         |         |       |
| communi  |             |              |         |         |       |
| ty-based |             |              |         |         |       |
| health   |             |              |         |         |       |
| center.  |             |              |         |         |       |
+----------+-------------+--------------+---------+---------+-------+
| Goals/Ob | Key Action  | Expected     | Data,   | Pers    | Com   |
| jectives | Steps       | Outcome      | Eva     | on/Area | ments |
|          |             |              | luation | Resp    |       |
|          |             |              | &       | onsible |       |
|          |             |              | Meas    |         |       |
|          |             |              | urement |         |       |
+----------+-------------+--------------+---------+---------+-------+
| A. To    | A.1 (a)     | A.1.(a) To   | A.1(a)  | A.1.(a) | A.    |
| gain     | Meet with   | participate  | The     | Ex      | 1.(a) |
| c        | local       | in at least  | number  | ecutive | Com   |
| ommunity | religious   | one local    | of      | D       | ments |
| support  | org         | activity     | events  | irector |       |
| for the  | anizations. | every month  | a       |         | A.    |
| health   |             |              | ttended | A.1.(b) | 1.(b) |
| center   | A.1.(b)     | A.1.(b)      |         | Pers    | Com   |
| planning | Action step | Expected     | A.1(b)  | on/Area | ments |
| ac       | 3 for       | Outcome      | Data,   |         |       |
| tivities | Objective 1 |              | Eval &  | A.1.(c) | A.    |
|          |             | A.1.(c)      | Meas    | Pers    | 1.(c) |
| A.1. To  | A.2.(a)     | Expected     |         | on/Area | Com   |
| have at  | Action step | Outcome      | A.1.(c) |         | ments |
| least    | 1 for       |              | Data,   | A.2.(a) |       |
| \$10,000 | Objective 2 | A.2.(a)      | Eval &  | Pers    | A.    |
| through  |             | Expected     | Meas    | on/Area | 2.(a) |
| local    | A.2 (b)     | Outcome      |         |         | Com   |
| and/or   | Action step |              | A.2.(a) | A.2.(b) | ments |
| in-kind  | 2 for       | A.2.(b)      | Data,   | Pers    |       |
| support  | Objective 2 | Expected     | Eval &  | on/Area | A.    |
| by 10/06 |             | Outcome      | Meas    |         | 2.(b) |
|          |             |              |         |         | Com   |
| A.2.     |             |              | A.2.(b) |         | ments |
| O        |             |              | Data,   |         |       |
| bjective |             |              | Eval    |         |       |
| (2)      |             |              | &Meas   |         |       |
+----------+-------------+--------------+---------+---------+-------+
| Prob     |             |              |         |         |       |
| lem/Need |             |              |         |         |       |
| St       |             |              |         |         |       |
| atement: |             |              |         |         |       |
| Well     |             |              |         |         |       |
| -managed |             |              |         |         |       |
| human    |             |              |         |         |       |
| r        |             |              |         |         |       |
| esources |             |              |         |         |       |
| are      |             |              |         |         |       |
| critical |             |              |         |         |       |
| to the   |             |              |         |         |       |
| success  |             |              |         |         |       |
| of any   |             |              |         |         |       |
| organ    |             |              |         |         |       |
| ization. |             |              |         |         |       |
+----------+-------------+--------------+---------+---------+-------+
| B.       | B.1.(a)     | B.1.(a)      | B.1.(a) | B.1.(a) | B.    |
| Obtain   | Action step | Expected     | Data,   | Pers    | 1.(a) |
| well-q   | 1 for       | Outcome      | Eva     | on/Area | Com   |
| ualified | Objective 1 |              | luation |         | ments |
| staff    |             | B.1.(b)      | &       | B.1.(b) |       |
| for      | B.1 (b)     | Expected     | Meas    | Pers    | B.    |
| health   | Action step | Outcome      | urement | on/Area | 1.(b) |
| center.  | 2 for       |              |         |         | Com   |
|          | Objective 1 | B.2.(a)      | B.1.(b) | B.2.(a) | ments |
| B.1.     |             | Expected     | Data,   | Ex      |       |
| Develop  | B.2.(a)     | Outcome      | Eva     | ecutive | B.    |
| of       | List        |              | luation | D       | 2.(a) |
| rec      | openings    | B.2.(b)      | &       | irector | Com   |
| ruitment | with State  | Interviews   | Meas    |         | ments |
| plan for | PCA and     | begin by     | urement | B.2.(b) |       |
| hiring   | National    | August 2006  |         | Pers    | B.    |
| cu       | or          |              | B.2.(a) | on/Area | 2.(b) |
| lturally | ganizations |              | List of |         | Com   |
| app      |             |              | all     |         | ments |
| ropriate | B.2 (b)     |              | r       |         |       |
| staff    | Hold        |              | elevant |         |       |
|          | interviews  |              | job     |         |       |
| B.2.     |             |              | posting |         |       |
| O        |             |              | sites.  |         |       |
| bjective |             |              |         |         |       |
| (2)      |             |              | B.2.(b) |         |       |
|          |             |              | Data,   |         |       |
| B.3.     |             |              | Eva     |         |       |
| O        |             |              | luation |         |       |
| bjective |             |              | &       |         |       |
| (3)      |             |              | Meas    |         |       |
|          |             |              | urement |         |       |
+----------+-------------+--------------+---------+---------+-------+
| C. Goal  | C.1.(a)     | C.1.(a)      | C.1.(a) | C.1.(a) | C.    |
|          | Action step | Expected     | Data,   | Pers    | 1.(a) |
| C.1.     | 1 for       | Outcome      | Eva     | on/Area | Com   |
| O        | Objective 2 |              | luation |         | ments |
| bjective |             | C.1.(b)      | &       | C.1.(b) |       |
| (1)      | C.1 (b)     | Expected     | Meas    | Pers    | C.    |
|          | Action step | Outcome      | urement | on/Area | 1.(b) |
|          | 2 for       |              |         |         | Com   |
|          | Objective 2 |              | C.1.(b) |         | ments |
|          |             |              | Data,   |         |       |
|          |             |              | Eva     |         |       |
|          |             |              | luation |         |       |
|          |             |              | &       |         |       |
|          |             |              | Meas    |         |       |
|          |             |              | urement |         |       |
+----------+-------------+--------------+---------+---------+-------+

## General Guidelines for Completion of the Budget Forms {#general-guidelines-for-completion-of-the-budget-forms .unnumbered}

This section explains the development and requirements for the
preparation and presentation of a budget submitted as part of a high
poverty county planning grant application for Federal support under the
Consolidated Health Center Program.

All high poverty county planning grant application budgets should be
developed based on the estimated funding needs to accomplish the
proposed project. The PHS 5161-1, SF 424A budget forms the basis for the
budget presentation that will enable reviewers to make judgments as to
the appropriateness and reasonableness of the proposed costs as they
relate to the program narrative and work plan.

Applicants should complete Sections A, B, E, and F (if F is applicable)
of PHS 5161-1: Standard Form (SF) 424A, and then provide a line item
budget using the budget categories in the SF 424A, Section B. Directions
for completing the SF 424 budget information may be found within the
Application Form PHS 5161-1.

In completing the grant application, an applicant should present one
complete 12-month budget justification and narrative. See 'Section IV:
Application and Submission Information' for more information about the
Budget and Budget Justification.

Application of Federal cost principles relates only to Federal grant
funds, as outlined in the Health Centers Consolidation Act of 1996.
Amounts in the budgets may be rounded (i.e., nearest whole dollar).

###### Sample Budget Narrative/Justification {#sample-budget-narrativejustification .unnumbered}

Instructions: The sample budget narrative shown below is provided as a
[broad outline]{.underline}. The examples used in this sample are for
illustrative purposes only. Please revise and amend this to best suit
the needs of your proposed network. Provide additional information as
per the Budget Justification guidelines in narrative form as
appropriate.

**[REVENUE]{.underline}:** [Federal Year 1]{.underline} [Non-Federal
Year 1]{.underline}

**PATIENT SERVICE INCOME** \$0

(including Pharmacy)

**LOCAL & STATE GRANTS** \$29,530

(Break out by fund source)

**LOCAL FUNDING** \$8,404

**FEDERAL PLANNING GRANT** \$80,000

**OTHER FEDERAL FUNDING** \$0

(Break out by fund source)

**TOTAL: REVENUE \$80,000 \$37,934**

**[EXPENSES]{.underline}:** [Federal Year 1]{.underline} [Non-Federal
Year 1]{.underline}

**PERSONNEL**: See Staffing Plan \$40,223 \$18,000

**FRINGE BENEFITS**: Break out each

portion of Fringe Benefits: \$11,409

FICA

Retirement, etc.

**TOTAL: PERSONNEL & FRINGE \$51,632 \$18,000**

**TRAVEL:**

Travel to meetings (\$ per attendees x \# of trips) \$858

Executive Director (2 meetings)

Management & Board \$

State and National Meetings \$1,020

Technical Assistance Workshop \$1,959

Governance Training \$568

Local Travel (# of trips @ organization's mileage rate) \$750

> **TOTAL: TRAVEL \$5,400 \$1032**

**EQUIPMENT:**

1 PC package and related software @ \$5025) \$5025

**TOTAL: EQUIPMENT \$5025**

**SUPPLIES:**

Office & Printing Supplies \$3.75 per encounter \$563

Educational Material (\$5.50 per video) \$ \$550

\$

**TOTAL: SUPPLIES \$2,000 \$602**

**Expenses Continued:** [Federal Year 1]{.underline} [Non-Federal Year
1]{.underline}

**CONTRACTUAL**

(Please describe with enough detail to justify the costs)

Housekeeping Services with LMN Company \$968

Consultant for Marketing Development \$

Technical Assistance for Board \$5,100

National search for Medical Director \$

**TOTAL: CONTRACTUAL \$9,043 \$13,300**

[]{.mark}

**OTHER**: [Year 1]{.underline}

Payroll Processing Services \$ \$850

Audit Services with JKL Company \$

Association Dues \$1,025

Building Contents Insurance \$

Telephone Service \$

Answering Services \$

Postage \$750

Utilities \$ \$900

Rent (describe per site) \$5,000

Any special taxes (describe) \$

Technical Assistance \$

**TOTAL: OTHER \$6,900 \$5,000**

**TOTAL: ALL BUDGET \$80,000 \$37,934**

####### Appendix D: {#appendix-d .unnumbered}

####### Program Specific Forms  {#program-specific-forms .unnumbered}

#####   {#section-54 .unnumbered}

##### FORM 1: PLANNING GRANT GENERAL INFORMATION WORKSHEET {#form-1-planning-grant-general-information-worksheet .unnumbered}

<table style="width:100%;">
<colgroup>
<col style="width: 25%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 11%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Applicant Name:</td>
<td colspan="8">     </td>
<td colspan="8">Name of Contact Person:</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td>Mailing/Street Address:</td>
<td colspan="8">     </td>
<td colspan="8">Title:</td>
<td colspan="3">     </td>
</tr>
<tr class="odd">
<td>City, State, Zip:</td>
<td colspan="8">     </td>
<td colspan="8">Email:</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td>Phone:</td>
<td colspan="8">     </td>
<td colspan="8">Fax:</td>
<td colspan="3">     </td>
</tr>
<tr class="odd">
<td colspan="4">Proposed Service Area (City(ies), State)</td>
<td colspan="16">     </td>
</tr>
<tr class="even">
<td colspan="8">All proposed COUNTIES within proposed service area:</td>
<td colspan="12">     </td>
</tr>
<tr class="odd">
<td colspan="8">Relevant ZIP CODES within proposed service area:</td>
<td colspan="12">     </td>
</tr>
<tr class="even">
<td colspan="20"><strong>PLEASE CHECK ONE ON EACH LINE:</strong></td>
</tr>
<tr class="odd">
<td colspan="9"> Private, Non Profit</td>
<td colspan="11"> Public Entity</td>
</tr>
<tr class="even">
<td colspan="3"> Medically Underserved Area (MUA)</td>
<td colspan="13"> Medically Underserved Population (MUP)</td>
<td colspan="4"> Applying for MUA/MUP</td>
</tr>
<tr class="odd">
<td> Urban</td>
<td colspan="8"> Rural</td>
<td colspan="11"> Sparsely Populated (persons/square mile:      )</td>
</tr>
<tr class="even">
<td colspan="20"><strong>PLEASE CHECK ALL THAT APPLY:</strong></td>
</tr>
<tr class="odd">
<td> Tribal Entity/Urban Indian</td>
<td colspan="6"> Public Health Dept</td>
<td colspan="5"> Hospital</td>
<td colspan="5"> Faith-Based Org</td>
<td colspan="2"> Local Govt</td>
<td> University</td>
</tr>
<tr class="even">
<td colspan="5"><strong>CURRENT RECIPIENT OF BPHC FUNDING?</strong></td>
<td colspan="5"> YES</td>
<td colspan="4"> NO</td>
<td colspan="6"><strong>IF YES, PLEASE CHECK ALL THAT
APPLY:</strong></td>
</tr>
<tr class="odd">
<td colspan="13"> Section 330 Grantee (i.e., CHC, MHC, HCH, or
PHPC)</td>
<td colspan="7" rowspan="2"><p> National Training/TA Cooperative
Agreement</p>
<p>Please Describe:      </p></td>
</tr>
<tr class="even">
<td> Primary Care Association</td>
<td colspan="12"> Other, Please Describe:      </td>
</tr>
<tr class="odd">
<td colspan="11"><strong>PREFERENCE REQUESTED</strong><br />
<em>Must provide Census Bureau documentation as evidence that the<br />
ENTIRE proposed Service Area is sparsely populated <strong>(7 of fewer
persons/sq.mi.)</strong></em></td>
<td colspan="4"></td>
<td colspan="3"><strong>Total Federal Funding Requested</strong></td>
<td colspan="2"><strong>Total Project Budget</strong></td>
</tr>
<tr class="even">
<td colspan="2">Service Area is Sparsely Populated
(persons/mile<sup>2</sup> :     )</td>
<td colspan="4"> YES</td>
<td colspan="5"> NO</td>
<td colspan="4">YEAR 1</td>
<td colspan="3">     </td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="20"><strong>PURPOSE OF PLANNING GRANT APPLICATION: (PLEASE
CHECK ALL THAT APPLY)</strong></td>
</tr>
<tr class="even">
<td colspan="20"> Conducting a comprehensive needs assessment</td>
</tr>
<tr class="odd">
<td colspan="20"> Applying for MUA/MUP designation and/or other
essential designations</td>
</tr>
<tr class="even">
<td colspan="20"> Designing an appropriate health care service delivery
model, based on the comprehensive needs assessment</td>
</tr>
<tr class="odd">
<td colspan="20"> Efforts to secure financial, professional, and
technical assistance</td>
</tr>
<tr class="even">
<td colspan="20"> Increasing community involvement in the development
and/or operational stages of a comprehensive health center</td>
</tr>
<tr class="odd">
<td colspan="20"> Developing linkages/building partnerships with other
providers in the community</td>
</tr>
</tbody>
</table>

![](media/image1.wmf){width="1.461111111111111in"
height="0.2902777777777778in"}

##### FORM 2: COMMUNITY CHARACTERISTICS {#form-2-community-characteristics .unnumbered}

**Instructions to Applicants**: Community-wide and target population
data should reflect all counties, cities, etc., in the applicant's
proposed scope of the project. Community-wide data should include the
total number of persons and the percent of the total population in the
proposed service area for each characteristic. Target population data is
a subset of the community-wide data, and includes the number of persons
and the percent of the total population the organization anticipates
**[targeting]{.underline}** for each characteristic. Estimates are
acceptable.

+-----------+-------------------------+-------+------+-------+------+
|           | **CHARACTERISTIC**      | *     |      | **T   |      |
|           |                         | *COMM |      | ARGET |      |
|           |                         | UNITY |      | POPUL |      |
|           |                         | W     |      | ATION |      |
|           |                         | IDE** |      | D     |      |
|           |                         |       |      | ATA** |      |
|           |                         | **D   |      |       |      |
|           |                         | ATA** |      | **\#  |      |
|           |                         |       |      | %**   |      |
|           |                         | **\#  |      |       |      |
|           |                         | %**   |      |       |      |
+-----------+-------------------------+-------+------+-------+------+
| RACE/     | White (non-Hispanic)    | **    | *    | **    | *    |
| ETHNICITY |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Black or                | **    | *    | **    | *    |
|           | African-American        |    ** | *    |    ** | *    |
|           | (non-Hispanic)          |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Hispanic                | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | American Indian or      | **    | *    | **    | *    |
|           | Alaskan Native          |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Asian                   | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Native Hawaiian or      | **    | *    | **    | *    |
|           | Other Pacific Islander  |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Other                   | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Total Population        | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
| INCOME AS | Below 100%              | **    | *    | **    | *    |
| A PERCENT |                         |    ** | *    |    ** | *    |
| OF        |                         |       |   ** |       |   ** |
| POVERTY   |                         |       |      |       |      |
| LEVEL     |                         |       |      |       |      |
+-----------+-------------------------+-------+------+-------+------+
|           | 100-199 percent         | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | 200 percent and above   | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Unknown                 | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
| PRIMARY   | Medicaid/Capitated      | **    | *    | **    | *    |
| THIRD     |                         |    ** | *    |    ** | *    |
| PARTY     |                         |       |   ** |       |   ** |
| PAYMENT   |                         |       |      |       |      |
| SOURCE    |                         |       |      |       |      |
+-----------+-------------------------+-------+------+-------+------+
|           | Medicaid/Not Capitated  | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Medicare                | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Other Public Insurance  | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Private Insurance,      | **    | *    | **    | *    |
|           | including capitation    |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | None/Uninsured          | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
| []{.mark} | Migrant/Seasonal        | **    | *    | **    | *    |
|           | Farmworkers and         |    ** | *    |    ** | *    |
| SPECIAL   | Families                |       |   ** |       |   ** |
| PO        |                         |       |      |       |      |
| PULATIONS |                         |       |      |       |      |
+-----------+-------------------------+-------+------+-------+------+
|           | Homeless People         | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | HIV/AIDS-infected       | **    | *    | **    | *    |
|           | Persons                 |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Persons with Mental     | **    | *    | **    | *    |
|           | Health/Substance Abuse  |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Residents of Public     | **    | *    | **    | *    |
|           | Housing                 |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | School Age Children     | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Infants Birth to 2      | **    | *    | **    | *    |
|           | years of Age            |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Women Age 25 - 44       | **    | *    | **    | *    |
|           |                         |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Persons Age 65 and      | **    | *    | **    | *    |
|           | Older                   |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+
|           | Other: **     **        | **    | *    | **    | *    |
|           | (Please Specify)        |    ** | *    |    ** | *    |
|           |                         |       |   ** |       |   ** |
+-----------+-------------------------+-------+------+-------+------+

![](media/image2.wmf){width="1.4618055555555556in"
height="0.23125in"}![](media/image2.wmf){width="1.4618055555555556in"
height="0.23125in"}![](media/image2.wmf){width="1.4618055555555556in"
height="0.23125in"}

####### Appendix E: {#appendix-e .unnumbered}

####### Primary Care Association, Primary Care Office And National Organization Contacts {#primary-care-association-primary-care-office-and-national-organization-contacts .unnumbered}

###### I. PRIMARY CARE ASSOCIATIONS {#i.-primary-care-associations .unnumbered}

ALABAMA

Al Fox

Executive Director

Alabama Primary Health Care Association

6008 E. Shirley Lane, Suite A

Montgomery, Alabama 36117

Phone: 334/271-7068

Fax: 334/271-7069

Email: [afox@alphca.com](mailto:AFOX@ALPHCA.COM)

<http://www.adph.org/aphca>

ALASKA

Marilyn Kasmar, RNC, MBA

Executive Director

Alaska Primary Care Association, Inc.

903 W. Northern Lights Blvd., Suite 105

Anchorage, Alaska 99503

Phone: 907/929-2722

Fax: 907/929-2734

Email: [marilyn@alaskapca.org](mailto:MARILYN@ALASKAPCA.ORG)

<http://www.alaskapca.org/>

ARIZONA

Joseph S. Coatsworth

Chief Executive Officer

Arizona Association of Community Health Center, Inc.

320 E. McDowell Street, Suite 225

Phoenix, Arizona 85004

Phone: 602/253-0090

Fax: 602/252-3620

Email: [coatsworth@aachc.org](mailto:COATSWORTH@AACHC.ORG)

<http://www.aachc.org/>

ARKANSAS

Sip B. Mouden

Executive Director

Community Health Centers of Arkansas, Inc.

420-A West 4th Street

North Little Rock, Arkansas 72114

Phone: 501/374-8225

Fax: 501/374-9734

Email: <sbmouden@CHC-AR.ORG>

<http://www.chc-ar.org/>

CALIFORNIA

Carmela Castellano-Garcia, Esq.

Chief Executive Officer

California Primary Care Association

1215 K Street, Suite 700

Sacramento, California 95814

Phone: 916/440-8170

Fax: 916/440-8172

Email: [ccastellano@cpca.org](mailto:CCASTELLANO@CPCA.ORG)

<http://www.cpca.org/>

COLORADO

Annette Kowall

Chief Executive Officer

Colorado Community Health Network

600 Grant Street, Suite 800

Denver, Colorado 80203

Phone: 303/861-5165, ext. 228

Fax: 303/861-5315

Email: [annette@cchn.org](mailto:ANNETTE@CCHN.ORG)

<http://www.cchn.org/>

COLORADO

Julie Hulstein

Executive Director

Community Health Association Mountain/Plains States

600 Grant Street, Suite 800

Phone: 303/861-5165, ext. 226

Fax: 303/861-5315

Denver, Colorado 80203

Email: [julie@champsonline.org](mailto:JULIE@CHAMPSONLINE.ORG)

<http://www.champsonline.org/chmp.htm>

CONNECTICUT

Evelyn A.Barnum, J.D.

Executive Director

Connecticut Primary Care Association

90 Brainard Road, Suite 101

Hartford, Connecticut 06114-1685

Phone: 860/727-0004

Fax: 860/727-8550

Email: [ebarnum@ctpca.org](mailto:EBARNUM@CTPCA.ORG)

<http://www.ctpca.org/>

DISTRICT OF COLUMBIA

Sharon Baskerville

Executive Director

District of Columbia Primary Care Association\
1411 K Street, NW, Suite 400

Washington, D.C. 20005

Phone: 202/638-0252

Fax: 202/638-4557

Email: [sbaskerville@dcpca.org](mailto:SBASKERVILLE@DCPCA.ORG)

<http://www.dcpca.org/>

FLORIDA

Andrew Behrman

Chief Executive Officer

Florida Association of Community Health Centers

433 N. Magnolia Drive

Tallahassee, Florida 32308-5083

Phone: 850/942-1822

Fax: 850/942-9902

Email: [abehrman@fachc.org](mailto:ABEHRMAN@FACHC.ORG)

<http://www.fachc.org/>

GEORGIA

Duane Kavka

Executive Director

Georgia Association for Primary Health Care, Inc.

44 Broad Street, NW, Suite 410

Atlanta, Georgia 30303

Phone: 404/659-2861

Fax: 404/659-2801

Email: [dkavka@gaphc.org](mailto:DKAVKA@GAPHC.ORG)

<http://www.gaphc.org/>

HAWAII

Beth Giesting

Executive Director

Hawaii Primary Care Association

345 Queens Street, Suite 601

Honolulu, Hawaii 96813-4718

Phone: 808/536-8442

Fax: 808/524-0347

Email: [bgiesting@hawaiipca.net](mailto:BGIESTING@HAWAIIPCA.NET)

<http://www.hawaiipca.net/>

IDAHO

Kathy Coumerilh

*Interim Executive Director*

Idaho Primary Care Association

1276 W. River Street, Suite 202

Boise, Idaho 83702

Phone: 208/345-2335

Fax: 208/386-9945

Email: <kathyc@idahopca.org>

<http://www.idahopca.org/>

ILLINOIS

Bruce A. Johnson

Chief Executive Officer

Illinois Primary Health Care Assn

225 S. College, Suite 200

Springfield, Illinois 62704

Phone: 217/541-7305

Fax: 217/-541-7306

Email: [bjohnson@iphca.org](mailto:BJOHNSON@IPHCA.ORG)

<http://www.iphca.org/>

INDIANA

Lisa Winternheimer

Executive Director

Indiana Public Health Care Assn, Inc.

1006 E. Washington Street, Suite 200

Indianapolis, Indiana 46202

Phone: 317/630-0845

Fax: 317/630-0849

Email: <lwinternheimer@ori.net>

<http://www.indianapca.org/>\
\
IOWA-NEBRASKA

Theodore J. Boesen, Jr.

Executive Director

Iowa-Nebraska Primary Care Association

601 E. Locust Street, Suite 102

Des Moines, Iowa 50309

Phone: 515/244-9610

Fax: 515/243-3566

Email: <ianepcatboesen@aol.com>

<http://www.ianepca.com/>

KANSAS

Karla Finnell, JD, MPH\
Executive Director

Kansas Association the Medically Underserved

112 SW 6th Street, Suite B

Topeka, Kansas 66604

Phone: 785/233-8483

Fax: 785/233-8403

Email: <kfinnell@kspca.org>

[http://www.kspca.org](http://www.kspca.org/)

KENTUCKY

Joseph E. Smith

Executive Director

Kentucky Primary Care Association

226 W. Main Street, 2^nd^ Floor

Frankfort, Kentucky 40602

Phone: 502/227-4379

Fax: 502/223-7654

Email: [jesmith@fewpb.net](mailto:JESMITH@FEWPB.NET)

[http://www.kypca.net](http://www.kypca.net/)

LOUISIANA

Rhonda L. Litt

Executive Director

Louisiana Primary Care Association, Inc.

4550 North Blvd, Suite 120

Baton Rouge, Louisiana 70806-0966

Phone: 225/324-0638

Fax: 225/927-7688\
Email: [**rhonda@lpca.net**](mailto:RHONDA@LPCA.NET)

[http://www.lpca.net](http://www.lpca.net/)

MAINE

Kevin Lewis

Executive Director

Maine Primary Care Association

73 Winthrop Street

Augusta, Maine 04330-5505

Phone: 207/621-0677

Fax: 207/621-0577

Email: [**kalewis@mepca.org**](mailto:KALEWIS@MEPCA.ORG)

<http://www.mepca.org/mepca/Home.asp>

MARYLAND/DELAWARE

Miguel Mcinnis, MPH

Chief Executive Officer

Mid-Atlantic Association of Community Health Centers

4483-B Forbes Boulevard

Forbes Center Building II

Lanham, Maryland 20706

Phone: 301/577-0097

Fax: 301/577-4789

Eml: [miguel.mcinnis@machc.com](mailto:MIGUEL.MCINNIS@MACHC.COM)

[http://www.machc.com](http://www.machc.com/)

MASSACHUSETTS

Jim W. Hunt Jr., MUA, CAE

President & Chief Executive Officer

Massachusetts League of Community Health Centers

100 Boylston Street, Suite 700

Boston, Massachusetts 02116

Phone: 617/426-2225

Fax: 617/426-0097

Email: [jhunt@massleague.org](mailto:JHUNT@MASSLEAGUE.ORG)\
<http://www.massleague.org/>

MICHIGAN

Kim Sibilsky

Executive Director

Michigan Primary Care Association

7215 Westshire Drive

Lansing, MI 48917

Phone: 517/381-8000

Fax: 517/381-8008

Email: [ksibilsky@mpca.net](mailto:KSIBILSKY@MPCA.NET)

[http://www.mpca.net](http://www.mpca.net/)

MINNESOTA

Rhonda Degelau

Executive Director

Minnesota Assn of Community Health Centers

1113 E. Franklin Avenue, Suite 211

Minneapolis, Minnesota 55404

Phone: 612/253-4715

Fax: 612/872-7849

Email: [rhonda.degelau@mnpca.org](mailto:RHONDA.DEGELAU@MNPCA.ORG)

[http://www.mnachc.org](http://www.mnachc.org/)

MISSISSIPPI

Robert M. Pugh, MPH

Executive Director

Mississippi Primary Health Care Assn

6400 Lakeover Road, Suite A

Jackson, Mississippi 39213

Phone: 601/981-1817

Fax: 601/981-1217

Email: [rmpugh@mphca.com](mailto:RMPUGH@MPHCA.COM)

<http://www.mphca.com/>

MISSOURI

Joseph Pierle, MPA

Executive Director

Missouri Primary Care Association

3325 Emerald Lane

Jefferson City, Missouri 65109

Phone: 573/636-4222

Fax: 573/636-4585

Email: [jpierle@mo-pca.org](mailto:JPIERLE@MO-PCA.ORG)

[http://www.mo-pca.org](http://www.mo-pca.org/)

MONTANA

Alan Strange, Ph.D.

Director

Montana Primary Care Association

900 North Montana Ave., Suite 3B

Helena, Montana 59601

Phone: 406/442-2750

Fax: 406/449-2460

Email: [astrange@mtpca.org](mailto:ASTRANGE@MTPCA.ORG)

<http://www.mtpca.org/>

NEVADA

Patricia Durbin

Executive Director

Great Basin Primary Care Association

515 W. 4^th^ Street

Carson City, Nevada 89703

Phone: 775/887-0417, ext. 101

Fax: 775/887-3562

Email: <PDurbin@gbpca.org>

[http://www.gbpca.org](http://www.gbpca.org/)

NEW HAMPSHIRE/VERMONT

Tess Stack Kuenning

Executive Director

New Hampshire Bi-State PCA

3 South Street

Concord, New Hampshire 03301

Phone: 603/228-2830

Fax: 603/228-2464

Email: [tkuenning@bistatepca.org](mailto:TKUENNING@BISTATEPCA.ORG)

<http://www.bistatepca.org/>

NEW JERSEY

Katherine Grant-Davis

Executive Director

New Jersey Primary Care Association

14 Washington Road, Suite 211

Princeton Junction, New Jersey 08550-1030

Phone: 609/275-8886

Fax: 609/936-7247

Email: <kgrantdavis@njpca.org>

[http://www.njpca.org](http://www.njpca.org/)

NEW MEXICO

David Roddy

Executive Director

New Mexico Primary Care Association

4545 McLeod, N.E., Suite D

Albuquerque, New Mexico 87109

Phone: 505/880-8882

Fax: 505/880-8885

Email: [droddy@nmpca.org](mailto:DRODDY@NMPCA.ORG)

<http://www.nmpca.org/>

NEW YORK

Elizabeth Swain

Executive Director

Community Health Center Association of New York State, Inc.

254 W. 31^st^ Street, 9th

New York, New York 10001\
Phone: 212/279-9686

Fax: 212/279-3851

Email: <eswain@chcanys.org>

<http://www.chcanys.org/>

NORTH CAROLINA

Sonya J. Bruton, MPA

Executive Director

North Carolina PHCA

2500 Gateway Center, Suite 100

Morrisville, North Carolina 27560

Phone: 919/297-0012

Fax: 919/469-1263

Email: <brutons@ncchca.org>

<http://www.ncphca.org/>

NORTH DAKOTA

Karen E. Larsen

Deputy Director

Community HealthCare Association of the Dakotas

1003 East Interstate Avenue, Suite 6

Bismarck, ND 58503

Phone: 701/221-9824

Fax: 701/221-0615

Email: <karen@communityhealthcare.net>

<http://www.communityhealthcare.net/>

OHIO

Shawn Frick

Executive Director

Ohio Association of Community Health Centers

4150 Indianola Avenue

Columbus, Ohio 43214-3214

Phone: 614/884-3101

Fax: 614/884-3108

Email: <sfrick@ohiochc.org>

<http://www.ohiochc.org/>

OKLAHOMA

Greta Shepherd-Stewart, MPH

Executive Director

Oklahoma Primary Care Association

4300 N. Lincoln Blvd, Suite 203

Oklahoma City, Oklahoma 73105

Phone: 405/424-2282

Fax: 405/242-1111

Email: [gshepherd@okpca.org](mailto:GSHEPHERD@OKPCA.ORG)

<http://www.okpca.org/>

OREGON

Craig Hostetler, MHA

Executive Director

Oregon Primary Care Association

110 SW Yamhill Street, Suite 3000

Portland, Oregon 97204

Phone: 503/228-8852

Fax: 503/228-9887

Email: <chostetler@orpca.org>

[http://www.orpca.org](http://www.orpca.org/)

PACIFIC BASIN

Clifford Chang

Executive Director

Pacific Islands Primary Care Assn

345 Queen Street, Suite 601

Honolulu, Hawaii 96813-4715

Tel: 808/536-8442 ext121\
Fax: 808/524-0347\
Email: <cchang@pacificislandspca.org>

PENNSYLVANIA

Henry Fiumelli

Executive Director

PA Forum for Primary Health Care

1035 Mumma Road, Suite 1

Wormleysburg, Pennsylvania 17043-1147

Phone: 717/761-6443

Fax: 717/761-8730

Email: [henry@paforum.com](mailto:HENRY@PAFORUM.COM)

<http://www.paforum.com/>

PUERTO RICO\
Alicia T. Suárez, M.A.

Exécutive Director

Asociacion de Salud Primaria de Puerto Rico, Inc.

201 De Diego Avenue, Suite 158

Plaza San Francisco

San Juan, Puerto Rico 00927

Telephone: 787/758-3411

Fax: 787/758-1736

Email: <acsppr@coqui.net>

[**http://saludprimariapr.org**](http://saludprimariapr.org/)

RHODE ISLAND

Kerrie Jones Clark

Executive Director

Rhode Island Health Center Association

235 Promenade Street, Suite 104

Providence, Rhode Island 02908

Phone: 401/274-1771

Fax: 401/274-1789

Email: [kclark@rihca.org](mailto:KCLARK@RIHCA.ORG)

[http://www.rihca.org](http://www.rihca.org/)

SOUTH CAROLINA

Lathran Woodard

Executive Director

South Carolina PHCA

2211 Alpine Road Extension

Columbia, South Carolina 29223

Phone: 803/788-2778

Fax: 803/788-8233

Email: [lathran@scphca.org](mailto:LATHRAN@SCPHCA.ORG)

<http://www.scphca.org/>

SOUTH DAKOTA

Scot Graff, MPA

Chief Executive Officer

Community Health Care Association of the Dakotas

1400 W. 22^nd^ Street

Sioux Falls, South Dakota 57105-1570

Phone: 605/357-1515

Fax: 605/357-1510

Email: [sgraff@usd.edu](mailto:SGRAFF@USD.EDU)

<http://www.communityhealthcare.net/>

TENNESSEE

Kathy Wood-Dobbins

Executive Director

Tennessee Primary Care Association

416 Wilson Pike Circle

Brentwood, Tennessee 37027-5203

Phone: 615/329-3836, ext.14

Fax: 615/329-3823

Email: [kathy@tnpca.org](mailto:KATHY@TNPCA.ORG)

<http://www.tnpca.org/>

TEXAS

Jose E. Camacho

Executive Director

Texas Association of Community Health Centers, Inc.

5900 Southwest Parkway, Bldg 3

Austin, Texas 78735

Phone: 512/329-5959

Fax: 512/329-9189

Email: [jcamacho@tachc.org](mailto:JCAMACHO@TACHC.ORG)

<http://www.tachc.org/>

UTAH

Bette Vierra

Executive Director

Assn of Community Health Centers

2570 West 1700 South, Suite 153

Salt Lake City, Utah 84104

Phone: 801/924-2846

Fax: 801/924-5563

Email: [bettevierra@auch.org](mailto:BETTEVIERRA@AUCH.ORG)

<http://www.auch.org/>

VERMONT/ NEW HAMPSHIRE

Tess Stack Kuenning

Executive Director

61 Elm Street

Montpellier, Vermont 05602-2818

Phone: 802/229-0002

Fax: 802/223-2336

Email: [tkuenning@bistatepca.org](mailto:TKUENNING@BISTATEPCA.ORG)

<http://www.bistatepca.org/>

VIRGINIA

Neal Graham

Chief Executive Officer

Virginia Primary Care Association, Inc.

6802 Paragon Place, Suite 625

Richmond, Virginia 23230\
Phone: 804/378-8801, ext. 17

Fax: 804/379-6593

Email: [ngraham@vpca.com](mailto:NGRAHAM@VPCA.COM)

<http://www.vpca.com/>

WASHINGTON

Ben Flores

Chief Executive Officer

Washington Assn of Community and Migrant Health Centers

2120 State Avenue, N.E., Suite 220

Olympia, Washington 98506

Phone: 360/786-9722

Fax: 360/786-9723\
Email: <bflores@wacmhc.org>

<http://www.wacmhc.org/>

NORTH WEST REGIONAL

Bruce Gray, MPA

Chief Executive Officer

Northwest Regional Primary Care Association

6512 23^rd^ Avenue, NW, Suite 305

Seattle, Washington 98117

Phone: 206/783-3004

Fax: 206/783-4311

Email: <bgray@nwrpca.org>

<http://www.nwrpca.org/>

WEST VIRGINIA\
Phil Schenk

Executive Director\
West Virginia Primary Care Association, Inc.\
1219 Virginia Street, East\
Charleston, West Virginia 25301\
Phone: 304/346-0032

Fax: 304/346-0033\
Email: [**phil@wvpca.org**](mailto:phil@wvpca.org)

[http://www.wvpca.org](http://www.wvpca.org/)

WISCONSIN

Stephanie Harrison

Executive Director

Wisconsin Primary Health Care Association

4600 American Parkway, Suite 204

Madison, Wisconsin 53718

Phone: 608/277-7477, ext 226;

Fax: 608/-277-7474

Email: <sharrison@wphca.org>

<http://www.wphca.org/>

WYOMING

Pat Monahan

Executive Director

Wyoming Primary Care Association

Post Office Box 113

Cheyenne, Wyoming 82003

Phone: 307/632-5743

Fax: 307/638-6103

Email: [wypca@wypca.org](mailto:WYPCA@WYPCA.ORG)

<http://www.wypca.org/>

###### II. PRIMARY CARE OFFICES {#ii.-primary-care-offices .unnumbered}

[]{.mark}

[Alabama]{.underline}

Primary Care & Rural Health State of Alabama

Alabama Department of Health

201 Monroe Street, P.O. Box 303017

Montgomery, AL 36130-3017

Phone: (334) 206-5396 Fax: (334) 206-5434

Web site: [www.adph.org/opcrh](http://www.adph.org/opcrh)

PCO Director (Interim): Charles Graves -- <cgraves@adph.state.al.us>

HPSA Contact: Cleve Money -- <cmoney@adph.state.al.us>

NHSC Contact: Charles Graves -- <cgraves@adph.state.al.us>

[Alaska]{.underline}

Health Planning and Systems Development

State of Alaska

Department of Health and Social Services

Office of the Commissioner

P.O. Box 110601

Juneau, AK 99811-0601

Phone: (907) 465-3091 Fax: (907) 465-6861

Web:
<http://www.hss.state.ak.us/commissioner/healthplanning/primarycare/pc_home.htm>

PCO Director: Mark Millard -- <mark_millard@health.state.ak.us>
(907)465-8534

HPSA Contact: Alice Rarig -- <alice_rarig@health.state.ak.us> --
(907)465-1285

NHSC Contact: Nancy Barros -- <nancy_barros@health.state.ak.us>
(907)465-1491

[Arizona]{.underline}

Office of Health Systems Development

Arizona Department of Health Services

1740 West Adams, Room 410

Phoenix, AZ 85007

Phone: (602) 542-1219 Fax: (602) 542-2011

PCO Director: Miriam Vega -- <vegami@azdhs.gov> -- (602)542-1436

NHSC: Fabian Valle -- <vallef@azdhs.gov> -- (602) 542-1066

Tanja James -- <jamest@azdhs.gov> -- (602) 542-1208

HPSA Contact: Colleen McGregor -- <mcgregc@azdhs.gov> -- (602)542-1219

[Arkansas]{.underline}

Office of Rural Health and Primary Care

Arkansas Department of Health and Human Services

P.O. Box 1437 -- H22

Little Rock, AR 72203-1437

Phone: See individual contacts Fax: (501) 280-4706

PCO Director and NHSC Contact: Bill Rodgers --
<William.rodgers@arkansas.gov> -- (501)280-4563

HPSA Contact: Randall Anderson -- <randall.anderson@arkansas.gov> --
(501) 280-4912

[California]{.underline}

Healthcare Workforce & Community Development Division

Office of Statewide Health Planning & Development

1600 9^th^ Street, Room 440

Sacramento, CA 95814

Phone: See individual contacts Fax: (916) 654-3138

Web site: [www.oshpd.ca.gov](http://www.oshpd.ca.gov/)

PCO Director: Angela L. Minniefield - <aminnief@oshpd.ca.gov> -
(916)653-0733

HPSA and NHSC Contact: Konder Chung -- <kchung@oshpd.ca.gov> -- (916)
654-2884

[Colorado]{.underline}

Primary Care Office

Colorado Department of Public Health & Environment

4300 Cherry Creek Drive, South

Denver, CO 80246-1530

Phone: See individual contacts Fax: (303) 758-3448

Web:
[www.cdphe.state.co.us/pp/primarycare/index.html](http://www.cdphe.state.co.us/pp/primarycare/index.html)

PCO Director, NHSC and HPSA Contact: Kitty Stevens --
<kitty.stevens@state.co.us-> (303)692-2582

NHSC Contact: Carla Woolford -- <carla.woolford@state.co.us> --
(303)692-2348

[Connecticut]{.underline}

Connecticut Department of Public Health

410 Capitol Avenue, Mail stop #11 PSI

Hartford, CT 06134-0308

Phone: (860) 509-8074

Fax: (860) 509-8403

PCO Director: Felicia Epps -- <Felicia.epps@po.state.ct.us> -- (860)
509-8019

HPSA Contact: Marijane Mitchell -- <marijane.mitchell@po.state.ct.us> --
(860)509-7668

NHSC Contact: Lisa Davis -- <lisa.davis@po.state.ct.us> -- (860)509-8061

[Delaware]{.underline}

Division of Public Health

Delaware Department of Health & Social Services

655 Bay Road, Suite 206

Dover, DE 19901

Phone: (302) 741-2960 Fax: (302) 741-2970

PCO Director, HPSA, and NHSC Contact: Kathy Collison --
<Katherine.collison@state.de.us>

[District of Columbia]{.underline}

DC Dept of Health, Primary Health Services

825 N. Capital Street, NE, Room 4160

Washington, DC 20002

Phone: See individual contacts Fax: (202) 535-1039

Web site: <http://doh.dc.gov/doh/site/default.asp>

PCO Dir: David Rose <david.rose@dc.gov> - (202) 442-8984

HPSA and NHSC Contact: Yavonne Vaughan -- <yavonne.vaughan@dc.gov> --
(202) 442-9380

[Florida]{.underline}

Division of Health Access and Tobacco

Office of Health Professional Recruitment

Florida Department of Health

4052 Bald Cypress Way, Bin C-15

Tallahassee, FL 32399-1735

Phone: 1-800-342-8660 (see individual extensions)

Fax: (850) 922-6296

Web site:
[www.doh.state.fl.us/workforce/recruit1/index.html](http://www.doh.state.fl.us/workforce/recruit1/index.html)

PCO Director: Gail Underwood -- <gail_underwood@doh.state.fl.us> -
extension 2709

HPSA and NHSC Contact: Lisa Marsh -- <lisa_marsh@doh.state.fl.us> --
extension 2703

[Georgia]{.underline}

State Office of Rural Health

Georgia Department of Community Health

502 South 7^th^ Street

Cordele, GA 31015-4214

Phone: See individual contacts Fax: (229) 401-3077

PCO Dir: Charles Owens <cowens@dch.state.ga.us>

\(229\) 401-3090

Tony Brown -- <tbrown@dch.state.ga.us> -- (229)401-3086

HPSA Contact: Dave Hartin -- <dhartin@dch.state.ga.us> -- (229)401-3095

NHSC Contact: Peggy McMillan -- <pmcmillan@dch.state.ga.us> --
(229)401-3088

[Hawaii]{.underline}

Dept of Health, Office of Planning Policy & Program Dev

1250 Punchbowl Street, Room 340

Honolulu, Hawaii 96813

Phone: See individual contacts Fax: (808) 586-4193

PCO Director: Valerie Yin - <valerie.yin@doh.hawaii.gov> - (808)586-4187

HPSA and NHSC Contact: Maile Burke -- <maile.burke@doh.hawaii.gov> --
(808)586-4188

[Idaho]{.underline}

State Office of Rural Health & Primary Care

Idaho Department of Health & Welfare

450 West State Street, 4^th^ Floor

Boise, ID 83720-0036

Phone: (208) 334-5993 Fax: (208) 332-7262

Web site: http://www.healthandwelfare.idaho.gov/site/3459/

PCO Director, HPSA and NHSC Contact: Laura Rowen --
<rowenl@idhw.state.id.us>

[Illinois]{.underline}

Center for Rural Health

Illinois Department of Public Health

535 West Jefferson Street

Springfield, IL 62761

Phone: (217) 782-1624 Fax: (217) 782-2547

Web site: [www.idph.state.il.us](http://www.idph.state.il.us/)

PCO Director: Marcia Franklin -- <marcia.franklin@illinois.gov>

HPSA Contact: Nolan Nosari -- <nnosari@idph.state.il.us>

NHSC Contact: Julie Casper -- <julie.casper@illinois.gov>

[Indiana]{.underline}

Indiana State Department of Health

2 North Meridian Street, Suite 8-B

Indianapolis, IN 46204-3006

Phone: (317) 233-7846 Fax: (317) 233-7761

[www.in.gov/isdh/publications/llo/shortages/shortage.htm](http://www.in.gov/isdh/publications/llo/shortages/shortage.htm)

PCO Director, HPSA and NHSC Contact: Patrick Durkin
<–pdurkin@isdh.IN.gov>

[Iowa]{.underline}

Iowa Department of Public Health

Bureau of Health Care Access

Lucas State Office Building

321 East 12^th^ Street, 5^th^ Floor

DesMoines, IA 50319-0075

Phone: (515) 281-7223 Fax: (515) 242-6383

Web: <http://www.idph.state.ia.us/hpcdp/primary_care.asp>

PCO Director, HPSA and NHSC Contact: Carl Kulczyk --
<ckulczyk@idph.state.ia.us>

[Kansas]{.underline}

Office of Local & Rural Health

Kansas Department of Health and Environment

1000 Southwest Jackson, Suite 340

Topeka, KS 66612

Phone: See individual contacts Fax: (785) 296-1231

Web site: <http://www.kdhe.state.ks.us/olrh/pc.htm>

PCO Director and NHSC Contact: Barbara Gibson --
<bgibson@kdhe.state.ks.us> -- (785)296-0613

HPSA and NHSC Contact: Barbara Huske -- <bhuske@kdhe.state.ks.us> --
(785)296-2742

[Kentucky]{.underline}

Department of Public Health

Health Care Access Branch

Division of Adult & Child Heath

275 East Main Street, HS2W-B

Frankfort, KY 40621

Phone: (502) 564-8966 (see individual extensions)

Fax: (502) 696-5231

Web site: <http://chfs.ky.gov/dph/ach/primarycare.htm>

PCO Director and NHSC Contact: John Hensley -- <john.hensley@ky.gov> --
extension 3773

HPSA Contact: Tammy Hutcherson -- <tammy.hutcherson@ky.gov> -- extension
3783

[Louisiana]{.underline}

Bureau of Primary Care and Rural Health

Louisiana Department of Health & Hospitals

1201 Capitol Access Road, 5^th^ Floor, or P.O. Box 2870

Baton Rouge, LA 70821-2870

Phone: See individual contacts Fax: (225) 342-5839

Web site:
[www.pcrh.dhh.louisiana.gov](http://www.pcrh.dhh.louisiana.gov/)

PCO Director and NHSC Contact: Gerrelda Davis -- <gdavis@dhh.la.gov> -
(225)342-1583

HPSA Contacts: Camille Turner -- <cturner@dhh.la.gov> -- (225)342-4702

Gayla Prentice -- <gprentic@dhh.la.gov> -- (225)342-0884

[Maine]{.underline}

Office of Rural Health & Primary Care

Maine Department of Health & Human Services

286 Water Street, Key Plaza

Augusta, ME 04333-0011

Phone: See individual contacts Fax: (207) 287-5431

Web site: <http://www.maine.gov/dhhs/bohodr/orhpcpge.htm>

PCO Director and NHSC Contact: Charles Dwyer --
<charles.dwyer@maine.gov> - (207)287-3287

HPSA Contact: Marc Coulombe -- <marc.coulombe@maine.gov> --
(207)287-5504

[Maryland]{.underline}

Department of Health and Mental Hygiene, PCO

201 West Preston Street

Baltimore, MD 21201

Phone: See individual contacts Fax: (410) 333-7501

PCO Director, HPSA and NHSC Contact: Antoinette Coward --
<cowarda@dhmh.state.md.us> -- (410)767-5602

[Massachusetts]{.underline}

Office of Primary Care, Mass Dept of Public Health

250 Washington Street, 5^th^ Floor

Boston, MA 02108-4619

Phone: See individual contacts Fax: (617) 624-6062

PCO Director: Julia Dyck -- <julia.dyck@state.ma.us> -- (617)624-5224

HPSA Contact: Janice Healey -- <janice.healey@state.ma.us> --
(617)624-5942

NHSC Contact: Nicole Watson -- <Nicole.watson@state.ma.us> --
(617)624-6051

[Michigan]{.underline}

Health Policy, Regulation, and Professions

Michigan Department of Community Health

Health Planning and Access to Care Section

Capitol View Building, 7^th^ Floor

201 Townsend

Lansing, MI 48913

Phone: See individual contacts Fax: (517) 241-1200

PCO Director: Lonnie Barnett -- <barnettl@michigan.gov> -- (517)241-2963

HPSA Contact: Ian Horste - <horstei@michigan.gov> -- (517)241-9947

NHSC Contact: Steve Creamer -- <creamers@michigan.gov> -- (517)241-9946

[Minnesota]{.underline}

Office of Rural Health and Primary Care

Minnesota Department of Health

P.O. Box 64882

St. Paul, MN 55164-0882

Phone: See individual contacts Fax: (651) 297-5808

Web site: <http://www.health.state.mn.us/divs/chs/orh_home.htm>

PCO Director and NHSC Contact: Debra Jahnke --
<debra.jahnke@health.state.mn.us> -- (651)282-6334

HPSA Contact: Lee Schutz -- <Leona.schutz@health.state.mn.us> --
(651)282-3853

[Mississippi]{.underline}

Mississippi Department of Health

P.O. Box 1700

Jackson, MS 39215-1700

Phone: (601) 576-7216 Fax: (601) 576-7530

PCO Director, HPSA and NHSC Contact: Alvin Harrion --
<aharrion@msdh.state.ms.us>

NHSC Contact: Debra Powell -- <dpowell@msdh.state.ms.us>

[Missouri]{.underline}

Office of Primary Care & Rural Health

Missouri Department of Health & Senior Services

920 Wildwood Drive

P.O. Box 570

Jefferson City, MO 65102-0570

Phone: 1-800-891-7415 Fax: (573) 522-8146

Web site: [http://www.dhss.mo.gov](http://www.dhss.mo.gov/)

PCO Director: Harold Kirbey -- <harold.kirbey@dhss.mo.gov>

NHSC and HPSA Contact: Joanna Adamson -- <joni.adamson@dhss.mo.gov>

[Montana]{.underline}

Montana Primary Care Office

Montana Department of Public Health & Human Sciences

P.O. Box 202951

Helena, MT 59620-2951

Phone: See individual contacts Fax: (406) 444-7465

PCO Director: John Schroeck -- <jschroeck@mt.gov> -- (406)444-3934

HPSA and NHSC Contact: James Nybo --
[jnybo@mt.gov](mailto:jnybo@state.mt.us) -- (406)444-3574

[Nebraska]{.underline}

Health and Human Services System

Office of Rural Health and Primary Care

301 Centennial Mall South

P.O. Box 95007

Lincoln, NE 68509-5007

Phone: (402) 471-0148 Fax: (402) 471-0180

Web site: [www.hhss.ne.gov/orh](http://www.hhss.ne.gov/orh)

PCO Director, HPSA and NHSC Contact: Thomas Rauner --
[thomas.rauner@hhss.ne.gov](mailto:thomas.rauner@hhss.state.ne.us)

[Nevada]{.underline}

Nevada State Health Division

Primary Care Development Center

3427 Goni Road, Suite 108

Carson City, NV 89706

Phone: (775)684-4220 (Main) Fax: (775) 684-4046

Web site: <http://health2k.state.nv.us/primary>

PCO Director and HPSA Contact: Mark Hemmings --
<mhemmings@nvhd.state.nv.us> -- (775)684-4041

NHSC Contact: Doug Schrauth -- <dschrauth@nvhd.state.nv.us> --
(775)684-4048

[New Hampshire]{.underline}

Rural Health and Primary Care

29 Hazen Drive

Concord, NH 03301

Phone: (603) 271-5934 Fax: (603) 271-4506

Web site:
[[http://www.dhhs.state.nh.us/DHHS/RHPC/pco.htm]{.underline}](http://www.dhhs.state.nh.us/DHHS/RHPC/pco.htm)

PCO Director, HPSA and NHSC Contact: Alisa Butler --
<agbutler@dhhs.state.nh.us>

[New Jersey]{.underline}

New Jersey Department of Health & Senior Services

50 East State Street, 6^th^ Floor

P.O. Box 364

Trenton NJ 08625-0364

Phone: (609) 292-1495 Fax: (609) 292-9599

PCO Director, HPSA and NHSC Contact: Linda Anderson --
<linda.anderson@doh.state.nj.us>

[New Mexico]{.underline}

New Mexico Department of Health

625 Silver, SW, Suite 201

Albuquerque, NM 87102

Phone: See individual contacts Fax: (505) 841-5885

PCO Director: Kim Kinsey -- <kenbaht.kinsey@state.nm.us> --
(505)841-5871

Harvey Licht -- <Harvey.licht@state.nm.us> -- (505)841-5869

HPSA and NHSC Contact: Roxanne Konst <–Roxanne.konst1@state.nm.us> --
(505)841-5867

[New York]{.underline}

New York Department of Health

Tower Building, Room 1084

Empire State Plaza

Albany, NY 12237-0053

Phone: (518) 473-4700 Fax: (518) 474-0572

Web site: [http://www.nyhealth.gov](http://www.nyhealth.gov/)

PCO Director: Barry Gray -- <bmg01@health.state.ny.us>

HPSA and NHSC Contact: Caleb Wistar -- <ccw01@health.state.ny.us>

[North Carolina]{.underline}

Office of Research, Demonstrations and Rural Health Development

North Carolina Department of Health & Human Services

311 Ashe Avenue

Raleigh, NC 27606

Phone: See individual contacts Fax: (919) 733-8300

PCO Director: Serge Dihoff -- <serge.dihoff@ncmail.net> -- (919)715-7632

HPSA Contact: Mark Suggs -- <mark.suggs@ncmail.net> -- (919)733-2040,
ext. 221

NHSC Contact: Wanda Green -- <wanda.green@ncmail.net> -- (919)733-1777

[North Dakota]{.underline}

Office of Community Assistance, ND Dept of Health

600 E. Boulevard, Department 301

Bismarck, ND 58505-0200

Phone: See individual contacts Fax: (701) 328-1890

PCO Dir: Gary Garland -- <ggarland@state.nd.us> -- (701)328-4839

HPSA Contact: Terry Lang -- <telang@medicine.nodak.edu> -- (701)858-6795

NHSC Contact: Mary Amundson -- <mamundson@medicine.nodak.edu> -
(701)777-4018

[Ohio]{.underline}

Primary Care and Rural Health Program, OH Dept of Health

246 North High Street, 6^th^ Floor

P.O. Box 118

Columbus, OH 43216-0118

Phone: See individual contacts Fax: (614) 995-4235

PCO Director: Coleen Schwartz -- <coleen.schwartz@odh.ohio.gov> --
(614)728-3700

HPSA Contact: Annette Oren -- <annette.oren@odh.ohio.gov> --
(614)466-7475

NHSC Contact: Geri Rousculp -- <geri.rousculp@odh.ohio.gov> --
(614)644-8496

[Oklahoma]{.underline}

Office of Primary Care

Oklahoma State Department of Health

1000 NE 10^th^ Street, Room 511

Oklahoma City, OK 73117

Phone: (405) 271-8428 Fax: (405) 271-5493

PCO Director, HPSA and NHSC Contact: Mike Brown - <mikebr@health.ok.gov>

[Oregon]{.underline}

Primary Care Office, Department of Human Services

Health Systems Planning

800 NE Oregon Street, Suite 930

Portland, OR 97232

Phone: (971) 673-1222 Fax: (971) 673-1299

PCO Director: Joel Young -- <joel.young@state.or.us> -- (971)673-1269

HPSA and NHSC Contact: Nancy Abrams -- <nancy.g.abrams@state.or.us> --
(971)673-1228

[Pennsylvania]{.underline}

Penn Dept of Health, Bureau of Health Planning

Division of Health Professions Development

Room 1033 Health & Welfare Building, 7^th^ & Forster Streets

Harrisburg, PA 17120

Phone: (717) 772-5298 Fax: (717) 705-6525

Web site:
[www.health.state.pa.us/pco](http://www.health.state.pa.us/pco)

PCO Director: Joseph May, III -- <jmay@state.pa.us>

HPSA Contacts: Barbara Bloom -- <bbloom@state.pa.us>

Diane Hergenrather -- <dhergenrat@state.pa.us>

NHSC Contact: Frederic Bowlan -- <fbowlan@state.pa.us>

[Puerto Rico]{.underline}

Puerto Rico Department of Health, Office of Federal Affairs

Room 131, Building A, PR Medical Center

P.O. Box 70139

San Juan, PR 00936-8139

Phone: (787) 274-7735 Fax: (787) 274-6864

PCO Director, HPSA and NHSC Contact: Nadia Gardana --
<ngardana@salud.gov.pr> -- (787)274-6833

[Rhode Island]{.underline}

Office of Primary Care, Rhode Island Department of Health

3 Capitol Hill, Room 408

Providence, RI 02908

Phone: See individual contacts Fax: (401) 222-4415

Web site: [www.health.ri.gov](http://www.health.ri.gov/)

PCO Director and NHSC Contact: Mary Anne Miller --
<maryanne.miller@health.ri.gov> -- (401)222-7625

HPSA Contact: Carla Lundquist -- <carla.lundquist@health.ri.gov> --
(401)222-7626

[South Carolina]{.underline}

Office of Primary Care, SC Dept of Health & Envn Control

Mills/Jarrett Complex, Box 101106

Columbia, SC 29211

Phone: (803) 898-0766 Fax: (803) 898-0445

PCO Director, HPSA and NHSC Contact: Mark Jordan --
<jordanma@dhec.sc.gov>

[South Dakota]{.underline}

Office of Rural Health, South Dakota Department of Health

207 E. Missouri Avenue, #1A

Pierre, SD 57501

Phone: See individual contacts Fax: (605) 773-2680

Web site: [www.ruralhealth.sd.gov](http://www.ruralhealth.sd.gov/)

PCO Director: Bernard Osberg -- <bernie.osberg@state.sd.us> --
(605)773-3366

HPSA and NHSC Contact: Josie Petersen -- <josie.petersen@state.sd.us> --
(605)773-3517

[Tennessee]{.underline}

Tennessee Department of Health

Cordell Hull Building

425 5^th^ Avenue, N, 6^th^ Floor

Nashville, TN 37247

Phone: (615) 741-0388 Fax: (615) 253-2100

PCO Director, NHSC and Interim HPSA Contact: Patrick Lipford --
<patrick.lipford@state.tn.us>

[Texas]{.underline}

Texas Department of State Health Services

1100 West 49^th^ Street, M328

Austin, TX 78726, Mail code: 1937

Phone: (512) 458-7518 Fax: (512) 458-7658

PCO Dir, HPSA and NHSC Contact: Connie Berry --
<connie.berry@dshs.state.tx.us>

NHSC Contact: Harvey Browning -- <Harvey.browning@dshs.state.tx.us>

[Utah]{.underline}

Office of Primary Care & Rural Health, Utah Dept of Health

P.O. Box 142005

Salt Lake City, UT 84114-2005

Phone: See individual contacts Fax: (801) 538-6387

Web site: <http://health.utah.gov/primarycare>

PCO Director: Don Beckwith -- <dbeckwith@utah.gov> -- (801)538-6818

HPSA Contact: Shelly Phillips -- <shellyphillips@utah.gov> --
(801)538-6217

NHSC Contact: Erin Olsen -- [elolsen@utah.gov](mailto:eolsen@utah.gov)
-- (801)538-6214

[Vermont]{.underline}

Division of Health Improvement, Office of Rural Health and Primary Care,
Vermont Department of Health

108 Cherry Street, P.O. Box 70

Burlington, VT 05402-0070

Phone: See individual contacts Fax: (802) 651-1634

Web site: [www.healthyvermonters.org](http://www.healthyvermonters.org/)

PCO Director: Denis Barton -- <dbarton@vdh.state.vt.us> -- (802)951-4006

NHSC and HPSA Contact: Terry Fisher - <tfisher@vdh.state.vt.us> --
(802)951-5179

[Virgin Island]{.underline}

Virgin Islands Primary Health Care Office

Government House

21-22 Kongens Gade

St. Thomas, VI 00802

Phone: (340) 715-1611 Fax: (340) 715-3219

PCO Director, HPSA and NHSC Contact: Lorna Sutton --
<lornali96@earthlink.net>

[Virginia]{.underline}

Virginia Department of Health

Office of Health Policy and Planning

109 Governors Street, Suite 1016 East, 10^th^ Floor

Richmond, VA 23219

Phone: See individual contacts Fax: (804) 864-7440

PCO Director: Rene
Cabral-Daniels--<rene.cabraldaniels@vdh.virginia.gov>- (804)864-7425

Norma Marrin -- <norma.marrin@vdh.virginia.gov> -- (804)864-7430

HPSA and NHSC Contact: Norma Marrin -- <norma.marrin@vdh.virginia.gov>
-- (804)864-7430

[Washington]{.underline}

Office of Community & Rural Health

Washington State Department of Health

P.O. Box 47834

Olympia, WA 98504-7834

Phone: See individual contacts Fax: (360) 664-9273

Web site: [www.doh.wa.gov/hsqa/ocrh](http://www.doh.wa.gov/hsqa/ocrh)

PCO Director and NHSC Contact: Mary Looker -- <mary.looker@doh.wa.gov>
-- (360)236-2808

HPSA Contact: Laura Olexa -- <laura.olexa@doh.wa.gov> -- (360)236-2811

[West Virginia]{.underline}

Division of Primary Care

Office of Community and Rural Health Services

350 Capitol Street, Room 515

Charleston, WV 25301-3716

Phone: See individual contacts Fax: (304) 558-1437

Web site: <http://www.wvochs.org/dpc/>

PCO Director: David Haden -- <davidhaden@wvdhhr.org> -- (304)558-7127

HPSA Contact: Martha Endres -- <marthendres@wvdhhr.org> -- (304)558-4384

NHSC Contact: Melissa Wheeler -- <melissawheeler@wvdhhr.org> --
(304)558-4383

[Wisconsin]{.underline}

Bureau of Local Health Support & Emergency Medical Services

Division of Public Health

1 West Wilson Street, Room 118

Madison, WI 53701

Phone: See individual contacts Fax: (608) 261-6392

PCO Director and HPSA Contact: Larry Gilbertson --
<gilbelm@dhfs.state.wi.us> - (608)266-8154

NHSC Contact: Kathie Lenzen -- <lenzekl@dhfs.state.wi.us> --
(608)264-6528

[Wyoming]{.underline}

Office of Rural Health

Wyoming Department of Health

Hathaway Building

6101 Yellowstone Road, Ste 510

Cheyenne, WY 82002

Phone: (307) 777-8940 Fax: (307) 777-8545

PCO Director: Lynne Weidel --
[lweide@state.wy.us](mailto:lweidel@state.wy.us) -- (307)777-6970

HPSA and NHSC Contact: Douglas Thiede -- <dthied@state.wy.us> --
(307)777-8651

###### NATIONAL ORGANIZATIONS {#national-organizations .unnumbered}

Rachna Nivas

Program Coordinator, Technical Assistance Program

Association of Asian Pacific Community Health Organizations

300 Frank Ogawa Plaza, Suite 620

Oakland, CA 94612

Phone: 510-272-9536

Email: info@aapcho.org

www.aapcho.org

George E. Hardy, Jr., M.D., M.P.H

Executive Director

Association of State and Territorial Health Officers

1275 K Street, N.W., Suite 800

Washington, DC 20005-4006

Phone: 202-371-9090

Email: ghardy@astho.org

www.astho.org

Karen Mountain, R.N., M.S.N, M.B.A.

Executive Director

Migrant Clinicians Network, Inc.

1002 Land Creek Cove

Austin, TX 78746

Phone: 512-327-2017

Email: kmountain@migrantclinician.org

[www.migrantclinician.org](http://www.migrantclinician.org/)

John Schlitt, MSW

Executive Director

National Assembly for School-Based Health Centers\
666 11th Street, N.W., Suite 735

Washington, DC 20001

Phone: 202-638-5872

Email: jschlitt@nasbhc.org

[www.nasbhc.org](http://www.nasbhc.org/)

Pamela J. Byrnes, PhD

Managed Growth Assistance Program

National Association of Community Health Centers

50 South Washington Avenue

Niantic, CT 06357

Ph:  860-739-9224

Fax: 860-691-1388

Email: pbyrnes@nachc.com

[www.nachc.com](http://www.nachc.com/)

Patrick Libbey

Executive Director

National Association of County and City Health Officials

1100 17th Street, N.W., 2nd Floor

Washington, DC 20036

Phone: 202-783-5550

Email: <plibbey@naccho.org>

[www.naccho.org](http://www.naccho.org/)

Bobbi Ryder

Executive Director

National Center for Farmworker Health

1770 FM 967

Buda, TX 78610

Phone: 512-312-2600

Email: [www.ncfh.org](http://www.ncfh.org/)

<ryder@ncfh.org>

Karen Rotondo

New Access Coordinator

National Healthcare for the Homeless Council

1716 Greenwood Avenue/P.O. Box 60427

Nashville, TN 37206-0427

Phone: 508-775-4375

Email: kerotondo@aol.com

[www.nhchc.org](http://www.nhchc.org/)

Rosemary McKenzie

Project Director

National Rural Health Association

One West Armour Boulevard, Suite 203

Kansas City, MO 64111-2087

Phone: 816-7563140

Email: <rmckenzie@nrharural.org>

[www.nrharural.org](http://www.nrharural.org/)

##### []{.mark} {#section-55 .unnumbered}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

####### Appendix F: {#appendix-f .unnumbered}

####### Definitions For Planning Grant Applications {#definitions-for-planning-grant-applications .unnumbered}

##### DEFINITIONS FOR PLANNING GRANT APPLICATIONS  {#definitions-for-planning-grant-applications-1 .unnumbered}

**BUDGET PERIOD**: is each 12-month period within an approved project
period (see below for definition).

**CULTURAL COMPETENCY:** Expectations outlined in Section I.B.2 of BPHC
PIN 98-23, Health Center Program Expectations, state that:

> *Health centers serve culturally and linguistically diverse
> communities and many serve multiple cultures within one center.
> Although race and ethnicity are often thought to be dominant elements
> of culture, Health Centers should embrace a broader definition to
> include language, gender, socio-economic status, sexual orientation,
> physical and mental capacity, age, religion, housing status, and
> regional differences. Organizational behaviors, practices, attitudes,
> and policies across all Health Center functions must respect and
> respond to the cultural diversity of communities and clients served.
> Health centers should develop systems that ensure participation of the
> diverse cultures in their community, including participation of
> persons with limited English-speaking ability, in programs offered by
> the Health Center. Health centers should also hire culturally and
> linguistically appropriate staff.*

BPHC encourages applicants to utilize existing, effective program
models, such as lay health worker or *Promotora de Salud* programs, to
incorporate the above strategies into their proposed programs. Lay
health worker/*Promotora de Salud* programs have been shown to be an
effective means of educating hard-to-reach populations, increasing
access to Health Centers through information and referrals, and
conducting follow up. Generally, these programs involve a full-time
staff coordinator who recruits, trains, and supervises a group of 8-10
part-time lay health workers who are members of the target population.
Trained lay health workers, in turn, provide education, referrals,
follow-up, case management, and other outreach to their fellow community
members.

**DISCOUNTS:** are provided to self-pay patients based on their ability
to pay. Those at or below the Federal poverty level receive 100%
discounts (but may pay a nominal fee). Discounts may also be applied to
co-payments for insured patients based on their ability to pay. Those
over 200% of poverty may not receive a discount.

**ENABLING SERVICES**: See Required Primary Care Services below.

**ENCOUNTER:** Encounters are a documented, face-to-face contact between
a user /patient and a provider who exercises Objective judgment in the
provision of services to the user/patient. To be included as an
encounter, services rendered must be documented.

**HOMELESS:** A homeless individual means an individual who lacks
housing (without regard to whether the individual is a member of a
family), including an individual whose primary residence during the
night is a supervised public or private facility that provides temporary
accommodations and an individual who is a resident in transitional
housing.

**MIGRATORY AND SEASONAL AGRICULTURAL WORKERS:** Migratory agricultural
worker means an individual whose principal employment is in agriculture,
who has so been employed within the last 24 months, and who establishes
for the purposes of such employment a temporary abode. Seasonal
agricultural worker means an individual whose principal employment is in
agriculture on a seasonal basis and who is not a migratory agricultural
worker.

**NEW ACCESS POINT:** A new access point is a new delivery site for the
provision of comprehensive primary and preventive health care services.
Every competitive new access point will demonstrate compliance with the
applicable requirements of section 330 of the PHS Act, the implementing
regulations and BPHC Program Expectations.

**PRIMARY CARE SERVICES**: See Required Primary Care Services below.

**PROJECT PERIOD:** is defined as the total time for which Federal grant
support has been approved. For planning grants, project periods are
limited to one year in length.

**REQUIRED PRIMARY CARE SERVICES**: Section 330 of the Public Health
Services the term "required primary health services" means:

\(i\) basic health services which, for the purposes of this section,
shall consist of -

> \(I\) health services related to family medicine, internal medicine,
> pediatrics, obstetrics, or gynecology that are furnished by physicians
> and where appropriate, physician assistants, nurse practitioners, and
> nurse midwives;
>
> \(II\) diagnostic laboratory and radiologic services;
>
> \(III\) preventive health services, including---
>
> (aa) prenatal and perinatal services;
>
> (bb) appropriate cancer screening;
>
> \(cc\) well-child services;
>
> (dd) immunizations against vaccine-preventable diseases;
>
> (ee) screenings for elevated blood lead levels, communicable diseases,
> and cholesterol;
>
> (ff) pediatric eye, ear, and dental screenings to determine the need
> for vision and hearing correction and dental care;
>
> (gg) voluntary family planning services; and
>
> (hh) preventive dental services;
>
> \(IV\) emergency medical services; and
>
> \(V\) pharmaceutical services as may be appropriate for particular
> centers;

\(ii\) referrals to providers of medical services (including specialty
referral when medically indicated) and other health-related services
(including substance abuse and mental health services);

\(iii\) patient case management services (including counseling,
referral, and follow-up services) and other services designed to assist
health center patients in establishing eligibility for and gaining
access to Federal, State, and local programs that provide or financially
support the provision of medical, social, housing, educational, or other
related services;

\(iv\) services that enable individuals to use the services of the
health center (including outreach and transportation services and, if a
substantial number of the individuals in the population served by a
center are of limited English-speaking ability, the services of
appropriate personnel fluent in the language spoken by a predominant
number of such individuals); and

\(v\) education of patients and the general population served by the
health center regarding the availability and proper use of health
services.

**SCOPE OF PROJECT:** is a description of the comprehensive health
center's total approved project, specifically defining the services,
sites, providers, target population(s), and service area(s), for which
grant funds may be used, in whole or in part. This total project
includes program income and other non-section 330 funds.

**SERVICE AREA:** is defined as a geographic area with precise
boundaries that is federally-designated, in whole or in part, as a MUA
or a MUP. The size of the service area should be appropriate to provide
services in a timely and appropriate fashion. Within the service area,
barriers to care should be overcome to the extent possible and the
applicant must provide access to anyone who seeks services. The
delineation of the service area should conform to relevant boundaries
(such as political subdivision, school districts, health and social
service programs) and should include a description of the service area
population.

**SERVICE SITE:** A site is any place where a health center provides
services to a defined geographic service area or population on a regular
(e.g., daily, weekly, or monthly), scheduled basis. There is no minimum
number of hours per week that services must be available. However, the
site must be operated as part of the health center's approved scope of
project. In order to be considered a site:

-   encounters must be generated at the site for the health center
    through documented face-to-face contact between patients and
    providers;

-   encounters are provided by health care providers who exercise
    Objective judgment in the provision of services to the patient;

-   services at the site must be provided on behalf of the health
    center, which retains control and authority over the provision of
    the services (e.g., as applicable, billing and Medical records).

**SLIDING DISCOUNT:** the percent discount is 100% for persons at or
below the poverty level and 0% for those over 200% of the Federal
poverty level. Organizations establish their own schedule of discounts
based on income and family size as it relates to the poverty with the
discount "sliding" downwards from 100% to 0%. The number of distinct
categories of discounts is chosen by the grantee.

**SPARSELY POPULATED RURAL AREAS:** Given the unique needs of sparsely
populated frontier areas, preference will be given to high poverty
county planning grant applications from these areas. Organizations
applying under the sparsely populated frontier areas classification
should describe their proposed service area in terms of population
density and must provide documentation clearly demonstrating their
**ENTIRE proposed service area** is classified as sparsely populated
(i.e., geographic area with 7 or less people per square mile).

In terms of project plan requirements, it is recognized that the
recommended level of staffing and/or services may not be supportable in
sparsely populated areas. Therefore alternative methods of providing
necessary support for isolated providers, including participation in
rural service delivery networks may be considered appropriate. For
example, health centers that by themselves may not be able to meet the
staffing recommendations and/or service requirements may, through formal
agreements regarding clinical and referral arrangements or strong
collaborative relationships with other local providers, be considered to
have met the staffing level recommendations and/or service requirements.

In addition, applicants from sparsely populated rural or frontier areas
may request a waiver from the governing board requirements (section
330(k)(3)(H)) under section 330(k)(3)(H)(iii). However, such applicants
must clearly demonstrate why the governing board requirements cannot be
met and must provide a documented plan for soliciting community input in
the development and operation of the new service delivery site. Under
section 330(p), sparsely populated area applicants may also receive
waivers regarding the mandatory provision of all required services and
the collection of certain fees.

**STRATEGIC PLANNING:** Sets the course for the organization's future
based on market and internal information.

**TARGET POPULATION:** A target population is usually a subset of the
entire service area population but may include all residents of the
service area. The description of the target population should include
the major health problems of the target population and should serve as
the basis for the center\'s service delivery plan. The target population
for a center may be composed of a particular ethnic/socio-economic group
or may be composed of a variety of different ethnic/socio-economic
groups. A target population may also be a sparsely populated rural or
frontier area. It may not, however, be limited in terms of age or
gender.

-   **For CHCs** target population refers to the individuals within the
    service area to whom the center will direct its service delivery
    plan.

-   **For MHCs** the target population refers to the migratory and
    seasonal farmworker individuals within the service area to whom the
    center will direct its service delivery plan.

-   **For HCHs** the target population refers to the homeless
    individuals within the service area to

-   whom the center will direct its service delivery plan.

-   **For PHPCs** the target population refers to the residents of one
    or more public housing developments and the surrounding areas as
    appropriate.

All health centers must provide access to the full-range of required
services for all life cycle groups. This requirement does not preclude a
more limited target population or range of services for a particular
service delivery site. In such a case, assurance must be provided that
all patients have access to the full-range of required services and
necessary supplemental services within the health center\'s current
service delivery capacity.

**USER/PATIENT:** Users/patients are individuals who have at least one
encounter during the year within the scope of activities supported by
any section 330 grant. Users/patients do not include individuals who
only have encounters such as outreach, community education services, and
other types of community-based services not documented on an individual
basis. Also, persons who only receive services from large-scale efforts
such as mass immunization programs, screening programs, and health fairs
are not users. Persons whose only contact with the grantee is to receive
WIC counseling and vouchers are not users/patients and the contact does
not generate an encounter.

#######  {#section-56 .unnumbered}

#######  {#section-57 .unnumbered}

#######  {#section-58 .unnumbered}

#######  {#section-59 .unnumbered}

#######  {#section-60 .unnumbered}

#######  {#section-61 .unnumbered}

#######  {#section-62 .unnumbered}

#######  {#section-63 .unnumbered}

#######  {#section-64 .unnumbered}

#######  {#section-65 .unnumbered}

####### Appendix G: {#appendix-g .unnumbered}

####### Useful Reference Material {#useful-reference-material .unnumbered}

##### COMPLIANCE CHECKLIST FOR NEW ACCESS POINT APPLICANTS Page 1 of 2 {#compliance-checklist-for-new-access-point-applicants-page-1-of-2 .unnumbered}

#####  {#section-66 .unnumbered}

+---+-----------------------------------------------------------+---+---+
|   |                                                           | * | * |
|   |                                                           | * | * |
|   |                                                           | Y | N |
|   |                                                           | E | O |
|   |                                                           | S | * |
|   |                                                           | * | * |
|   |                                                           | * |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Is the applicant organization a non-profit or public      |   |   |
| . | entity?                                                   |   |   |
|   |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization demonstrate the need for  |   |   |
| . | primary health care services in the community(ies) that   |   |   |
|   | make up its service area based on geographic,             |   |   |
|   | demographic, and economic factors?                        |   |   |
+---+-----------------------------------------------------------+---+---+
| 3 | Does the applicant organization serve, in whole or in     |   |   |
| . | part, a designated MUA or MUP? *(Requested, not required  |   |   |
|   | for HCH, PHPC or MHC applicants)*                         |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 4 | Does the applicant organization have a system of care     |   |   |
| . | that contributes to the availability, accessibility,      |   |   |
|   | quality, comprehensiveness and coordination of health     |   |   |
|   | services in the service area?                             |   |   |
+---+-----------------------------------------------------------+---+---+
| 5 | Does the applicant organization provide ready access for  |   |   |
| . | all persons to all of the required primary, preventive    |   |   |
|   | and supplemental health services, including oral health   |   |   |
|   | care, mental health care and substance abuse services     |   |   |
|   | without regard to ability to pay either directly on-site  |   |   |
|   | or through established arrangements?                      |   |   |
+---+-----------------------------------------------------------+---+---+
| 6 | Does the applicant organization provide all additional    |   |   |
| . | health services as appropriate and necessary?             |   |   |
|   |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 7 | Does the applicant organization have patient case         |   |   |
| . | management services (including counseling, referral and   |   |   |
|   | follow-up services) designed to assist health center      |   |   |
|   | patients in establishing eligibility for and gaining      |   |   |
|   | access to Federal, State and local programs that provide  |   |   |
|   | or financially support the provision of medical, social,  |   |   |
|   | educational or other related services?                    |   |   |
+---+-----------------------------------------------------------+---+---+
| 8 | Does the applicant organization collaborate appropriately |   |   |
| . | with other health and social service providers in their   |   |   |
|   | area?                                                     |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 9 | Are all contracted services (including management         |   |   |
| . | agreements, administrative services contracts, etc.)      |   |   |
|   | under the governance, administration, quality assurance   |   |   |
|   | and clinical management policies of the applicant         |   |   |
|   | organization?                                             |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Does the applicant organization arrange referrals to      |   |   |
| 0 | providers as may be appropriate to assure ready access    |   |   |
| . | for all persons to all of the required primary,           |   |   |
|   | preventive and supplemental health services without       |   |   |
|   | regard to ability to pay?                                 |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Are all services available to all persons in the service  |   |   |
| 1 | area or target population regardless of age, gender, or   |   |   |
| . | the patient's ability to pay?                             |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Does the applicant organization maintain a core staff of  |   |   |
| 2 | primary care providers appropriate for the population     |   |   |
| . | served?                                                   |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Are the primary care providers working at the health      |   |   |
| 3 | center licensed to practice in the State where the center |   |   |
| . | is located?                                               |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Have all providers been properly credentialed and         |   |   |
| 4 | privileged according to PINs 99-08 and 2001-11?           |   |   |
| . |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Do the applicant organization's physicians have admitting |   |   |
| 5 | privileges at their referral hospital(s), or other such   |   |   |
| . | arrangement to ensure continuity of care?                 |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Does the applicant organization use a charge schedule     |   |   |
| 6 | with a corresponding discount schedule based on income    |   |   |
| . | for persons between 100 percent and 200 percent of the    |   |   |
|   | Federal poverty level?                                    |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Is/will the new access point be open to provide services  |   |   |
| 7 | at the times that meet the needs of the majority of       |   |   |
| . | potential users?                                          |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+

![](media/image2.wmf){width="1.4618055555555556in" height="0.23125in"}

##### COMPLIANCE CHECKLIST -- Page 2 of 2 {#compliance-checklist-page-2-of-2 .unnumbered}

+---+-----------------------------------------------------------+---+---+
|   |                                                           | * | * |
|   |                                                           | * | * |
|   |                                                           | Y | N |
|   |                                                           | E | O |
|   |                                                           | S | * |
|   |                                                           | * | * |
|   |                                                           | * |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Does the applicant organization provide professional      |   |   |
| 8 | coverage during hours when the center is closed?          |   |   |
| . |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 1 | Does the applicant organization have clear lines of       |   |   |
| 9 | authority from the Board to a chief executive (President, |   |   |
| . | Chief Executive Officer or Executive Director) who        |   |   |
|   | delegates, as appropriate, to other management and        |   |   |
|   | professional staff?                                       |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization have systems which        |   |   |
| 0 | accurately collect and organize data for reporting and    |   |   |
| . | which support management decision-making and which        |   |   |
|   | integrate clinical, utilization and financial information |   |   |
|   | to reflect the operations and status of the organization  |   |   |
|   | as a whole?                                               |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization have accounting and       |   |   |
| 1 | internal control systems appropriate to the size and      |   |   |
| . | complexity of the organization reflecting Generally       |   |   |
|   | Accepted Accounting Principles (GAAP) and separating      |   |   |
|   | functions appropriate to organizational size to safeguard |   |   |
|   | assets?                                                   |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization maximize revenue from     |   |   |
| 2 | third party payers and from patients to the extent they   |   |   |
| . | are able to pay?                                          |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization have written billing,     |   |   |
| 3 | credit and collection policies and procedures?            |   |   |
| . |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization assure that an annual     |   |   |
| 4 | Objective financial audit is performed in accordance with |   |   |
| . | Federal audit requirements?                               |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization have a governing board    |   |   |
| 5 | that is composed of individuals, a majority of whom are   |   |   |
| . | being served by the organization and, who as a group,     |   |   |
|   | represent the individuals being serviced by the center?   |   |   |
|   | (May waived for HCH or PHPC applicants. See Form 6, Part  |   |   |
|   | B)                                                        |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the governing board have at least 9 but no more than |   |   |
| 6 | 25 members?                                               |   |   |
| . |                                                           |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Do the corporate bylaws require the governing board to    |   |   |
| 7 | meet at least one per month? (May be waived for HCH, MHC  |   |   |
| . | or PHPC applicants. See Form 6 -- Part B)                 |   |   |
|   |                                                           |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Does the applicant organization's corporate bylaws        |   |   |
| 8 | demonstrate that the governing board has the required     |   |   |
| . | authority and responsibility to oversee the operation of  |   |   |
|   | the center?                                               |   |   |
+---+-----------------------------------------------------------+---+---+
| 2 | Do the corporate bylaws include provisions that prohibit  |   |   |
| 9 | conflict of interest or the appearance of conflict of     |   |   |
| . | interest by board members, employees, consultants and     |   |   |
|   | those who provide services or furnish goods to the        |   |   |
|   | center?                                                   |   |   |
+---+-----------------------------------------------------------+---+---+

![](media/image2.wmf){width="1.4666666666666666in" height="5.0e-2in"}

####### Appendix H: {#appendix-h .unnumbered}

####### List of Eligible Counties  {#list-of-eligible-counties .unnumbered}

##### LIST OF ELIGIBLE COUNTIES FOR FY 2007 {#list-of-eligible-counties-for-fy-2007 .unnumbered}

##### HIGH POVERTY COUNTY PLANNING GRANT APPLICATIONS  {#high-poverty-county-planning-grant-applications .unnumbered}

**Alabama**

**Blount**

**Cleburne**

**Geneva**

**Lamar**

**Arkansas**

**Benton**

**Lincoln**

**Montgomery**

**Colorado**

**Elbert**

**Florida**

**Escambia**

**Glades**

**Marion**

**Okaloosa**

**Santa Rosa**

**Suwannee**

**Georgia**

**Banks**

**Bibb**

**Candler**

**Carroll**

**Crawford**

**Echols**

**Harris**

**Houston**

**Jones**

**Lincoln**

**Long**

**Marion**

**Montgomery**

**Murray**

**Richmond**

**Twiggs**

**Walker**

**Wilcox**

**Wilkinson**

**Idaho**

**Fremont**

**Illinois**

**Carroll**

**Cass**

**Cumberland**

**Marshall**

**Menard**

**Putnam**

**Stark**

**Indiana**

**Carroll**

**Clark**

**Elkhart**

**La Porte**

**Monroe**

**Newton**

**Owen**

**Posey**

**Vermillion**

**Warren**

**Iowa**

**Butler**

**Keokuk**

**Louisa**

**Worth**

**Kansas**

**Anderson**

**Elk**

**Kentucky**

**Allen**

**Anderson**

**Butler**

**Edmonson**

**Elliott**

**Gallatin**

**Knott**

**McCreary**

**McLean**

**Meade**

**Menifee**

**Todd**

**Webster**

**Louisiana**

**Bossier Parish**

**Cameron Parish**

**Grant Parish**

**Jackson Parish**

**Lafayette Parish**

**Livingston Parish**

**Plaquemines Parish**

**Red River Parish**

**Sabine Parish**

**St. Martin Parish**

**St. Tammany Parish**

**Union Parish**

**West Baton Rouge Parish**

**Michigan**

**Cass**

**Minnesota**

**Benton**

**Le Sueur**

**Marshall**

**Red Lake**

**Stearns**

**Mississippi**

**Smith**

**Yalobusha**

**Missouri**

**Hickory**

**Lincoln**

**Maries**

**Moniteau**

**Morgan**

**Osage**

**Ralls**

**Ray**

**Stone**

**Warren**

**Webster**

**Montana**

**Granite**

**Nebraska**

**Cass**

**Dixon**

**Thurston**

**Nevada**

**Storey**

**New York**

**Broome**

**Chautauqua**

**Jefferson**

**Niagara**

**Oneida**

**St. Lawrence**

**North Carolina**

**Buncombe**

**Catawba**

**Currituck**

**Davidson**

**Forsyth**

**Franklin**

**Gates**

**Guilford**

**Hyde**

**Iredell**

**Onslow**

**Perquimans**

**Randolph**

**Rowan**

**Stokes**

**Tyrrell**

**North Dakota**

**McHenry**

**Sargent**

**Ohio**

**Clark**

**Meigs**

**Morgan**

**Morrow**

**Wayne**

**Oklahoma**

**Alfalfa**

**Comanche**

**Sequoyah**

**Oregon**

**Linn**

**Pennsylvania**

**Blair**

**Centre**

**Lebanon**

**Lycoming**

**Sullivan**

**South Carolina**

**Pickens**

**South Dakota**

**Hanson**

**Jackson**

**Moody**

**Tennessee**

**Hickman**

**Lauderdale**

**Montgomery**

**Texas**

**Bell**

**Blanco**

**Callahan**

**Chambers**

**Coke**

**Coryell**

**Delta**

**Ector**

**Ellis**

**Falls**

**Grayson**

**Gregg**

**Guadalupe**

**Hays**

**Hudspeth**

**Johnson**

**Lee**

**Live Oak**

**Marion**

**Martin**

**Milam**

**Nueces**

**Red River**

**Sabine**

**Sherman**

**Smith**

**Taylor**

**Upshur**

**Van Zandt**

**Wilson**

**Virginia**

**Appomattox**

**Craig**

**Floyd**

**Goochland**

**Greene**

**Henry**

**King George**

**Louisa**

**Mathews**

**Pittsylvania**

**Powhatan**

**Richmond**

**Rockbridge**

**Surry**

**West Virginia**

**Doddridge**

**Wisconsin**

**Bayfield**

**Calumet**

**Pierce**

[^1]: For the purposes of this application guidance, the high poverty
    counties are ONLY those counties identified in Appendix H of this
    guidance. Eligibility for a planning grant under this announcement
    is limited to those applications with proposed service areas within
    one of the identified high poverty counties listed in Appendix H.

[^2]: For the purposes of this application guidance, the high poverty
    counties are ONLY those counties identified in Appendix H of this
    guidance. Eligibility for a planning grant under this announcement
    is limited to those applications with proposed service areas within
    one of the identified high poverty counties listed in Appendix H.

[^3]: American Medical Association Master File (2005), American
    Osteopathic Association Files (1999), American Association of Nurse
    Practitioners Files (2001), American Association of Physicians
    Assistants Files (2004)