Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Services Grant Program for Residential Treatment for Pregnant and
Postpartum Women**

**Short Title: Pregnant and Postpartum Women (PPW)**

[]{.mark}

**(Initial Announcement)**

**Request for Applications (RFA) No. TI-08-009**

[]{.mark}

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications are due by March 18, 2008.**   |
| Deadline**           |                                               |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Applicants must comply with E.O. 12372 if   |
| Review**             | their State(s) participates. Review process   |
|                      | recommendations from the State Single Point   |
| **(E.O. 12372)**     | of Contact (SPOC) are due no later than 60    |
|                      | days after application deadline.**            |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by application deadline. Comments from Single |
| (PHSIS)/Single State | State Agency are due no later than 60 days    |
| Agency               | after application deadline.**                 |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

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

H. Westley Clark, M.D., J.D., M.P.H. Terry L. Cline, Ph.D.

Director Administrator

Center for Substance Abuse Treatment Substance Abuse and Mental Health

Substance Abuse and Mental Health Services Administration

Services Administration

**Table of Contents**

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

[1. INTRODUCTION 4](#introduction)

[2. EXPECTATIONS 4](#expectations)

[II. AWARD INFORMATION 15](#award-information)

[III. ELIGIBILITY INFORMATION 16](#eligibility-information)

[1. ELIGIBLE APPLICANTS 16](#eligible-applicants)

[2. COST SHARING 16](#cost-sharing)

[3. OTHER 16](#other)

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

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

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

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

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

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

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

[V. APPLICATION REVIEW INFORMATION 25](#application-review-information)

[1. EVALUATION CRITERIA 25](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 33](#review-and-selection-process)

[VI. ADMINISTRATION INFORMATION 34](#administration-information)

[1. AWARD NOTICES 34](#award-notices)

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

[3. REPORTING REQUIREMENTS 35](#reporting-requirements)

[VII. AGENCY CONTACTS 36](#agency-contacts)

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

[Appendix B -- Guidance for Electronic Submission of Applications
39](#appendix-b-guidance-for-electronic-submission-of-applications)

[Appendix C -- Statement of Assurance
42](#appendix-c---statement-of-assurance)

[Appendix D -- Sample Logic Model 43](#appendix-d-sample-logic-model)

[Appendix E -- Logic Model Resources
45](#appendix-e-logic-model-resources)

[Appendix F -- Confidentiality and Participant Protection
46](#appendix-f-confidentiality-and-participant-protection)

[Appendix G -- Funding Restrictions
50](#appendix-g-funding-restrictions)

[Appendix H -- Sample Budget and Justification
52](#appendix-h-sample-budget-and-justification)

**Executive Summary:**

The Substance Abuse and Mental Health Services Administration, Center
for Substance Abuse Treatment is accepting applications for fiscal year
(FY) 2008 for the Residential Treatment for Pregnant and Postpartum
Women (PPW) program. The purpose of these grants is to expand the
availability of comprehensive, high quality residential treatment,
recovery support, and family services for pregnant and postpartum women
(postpartum refers to the period after childbirth up to 12 months) who
suffer from alcohol and other drug problems, and their minor children
impacted by perinatal and environmental effects of maternal substance
use and abuse. In addition, grantees are encouraged to include fathers
of the children, partners of the women, and other extended family
members of the women and children in treatment in the target population
when their inclusion in non-residential treatment services is deemed
appropriate and beneficial.

#  {#section .unnumbered}

**Funding Opportunity Title:** Pregnant and Postpartum Women (PPW)

**Funding Opportunity Number:** TI-08-009

**Due Date for Applications:** March 18, 2008

**Anticipated Total Available Funding:** \$7.87 million

**Estimated Number of Awards:** 16

**Estimated Award Amount:** Up to \$500,000

**Length of Project Period:** Up to 3 years

**Eligible Applicants:** Domestic public and private nonprofit entities

> \[See Section III-1 of this RFA for complete eligibility
> information.\]

# FUNDING OPPORTUNITY DESCRIPTION

## INTRODUCTION

The Substance Abuse and Mental Health Services Administration, Center
for Substance Abuse Treatment is accepting applications for fiscal year
(FY) 2008 for the Residential Treatment for Pregnant and Postpartum
Women (PPW) program. The purpose of these grants is to expand the
availability of comprehensive, high quality residential treatment,
recovery support, and family services for pregnant and postpartum women
(postpartum refers to the period after childbirth up to 12 months) who
suffer from alcohol and other drug problems, and their minor children
impacted by perinatal and environmental effects of maternal substance
use and abuse. In addition, grantees are encouraged to include fathers
of the children, partners of the women, and other extended family
members of the women and children in treatment in the target population
when their inclusion in non-residential treatment services is deemed
appropriate and beneficial.

PPW is one of SAMHSA's services grant programs. SAMHSA's services grants
are designed to address gaps in substance abuse services and/or to
increase the ability of States, units of local government, American
Indian/Alaska Native tribes and tribal organizations, and community- and
faith-based organizations to help specific populations or geographic
areas with serious, emerging substance abuse problems. SAMHSA intends
that its services grants result in the delivery of services as soon as
possible after award. Service delivery should begin by the 4^th^ month
of the project [at the latest]{.underline}.

PPW grants are authorized under Section 508 of the Public Health Service
Act, as amended. This announcement addresses Healthy People 2010 focus
area 26 (Substance Abuse).

## 2. EXPECTATIONS {#expectations .unnumbered}

**2.1 Background**

[]{.mark}

In 1992, in accordance with the statutory authority, section 508 of the
Public Health Service Act, SAMHSA developed a gender and culturally
specific residential treatment program for pregnant and postpartum
women. Providing comprehensive services to women during pregnancy
significantly improves the lives of women, children, and their families.
Such services are also important after birth, since the effects of
alcohol and drug use continue to have negative consequences for women,
their children, and the entire family.

Over the years, the conceptualization of the program has evolved. While
keeping the needs of the women and their minor children at the core, the
concept is more inclusive of the treatment needs of the family as a
whole. This family-centered treatment approach builds on the strength
and resources of the entire family, supports sustained recovery for
individual family members, and improves overall family functioning.

For purposes of this grant announcement, residential treatment programs
are programs that offer organized substance abuse treatment services for
women and their minor children that feature a planned regimen of care in
a safe 24-hour residential setting with staff supervision. If any
treatment services are provided off-site, they must be well-coordinated
and integrated to ensure that specific aspects of the individual
treatment plan and services for the children can be addressed in both
facilities. Such services must be coupled with access to primary health,
mental health and social services for pregnant and postpartum women who
suffer from alcohol and drug use problems, and for their minor children
impacted by perinatal and environmental effects of maternal substance
use and abuse. These systems of care must be designed to improve the
overall treatment outcomes for the woman, her children, and the family
unit as a whole. When minor children cannot reside in the treatment
facility with their mother, and there are no other current living
arrangements available, alternative safe and appropriate accommodations
for the children must be arranged in consultation with the mother. For
those minor children who do not reside in the treatment facility, it is
important that they receive required interventions and services and are
actively engaged in the treatment process with their mothers.

Applicants must also screen and assess clients for the presence of
co-occurring substance use (abuse and dependence) and mental disorders
and use the information obtained from the screening and assessment to
develop appropriate treatment approaches for the persons identified as
having such co-occurring disorders. For more information on the process
of selecting screening instruments to identify co-occurring substance
use and mental disorders, go to

<http://www.coce.samhsa.gov/products/cod_presentations.aspx>.

As of fall 2007, approximately 1.4 million men and women have been
deployed to serve in Operation Enduring Freedom (OEF) and Operation
Iraqi Freedom (OIF) in support of the Global War on Terror.  Individuals
returning from Iraq and Afghanistan are at increased risk for suffering
post-traumatic stress and other related disorders.  Experts estimate
that up to one-third of returning veterans will need mental health
and/or substance abuse treatment and related services.  In addition, the
family members of returning veterans have an increased need for related
support services.  To address these concerns, SAMHSA strongly encourages
all applicants to consider the unique needs of returning veterans and
their families in developing their proposed project. 

**2.2 Target Population**

Low-income (as defined by federal poverty definitions) women, age 18 and
over, who are pregnant, postpartum (the period after childbirth up to 12
months), and their minor children, age 17 and under, who have limited
access to quality health services are the target population for the PPW
program. SAMHSA/CSAT has identified traditionally underserved
populations, especially racial and ethnic minority women, as an
important subpopulation. SAMHSA/CSAT is especially concerned about the
high morbidity and mortality rates of pregnant women and their infants
among African Americans. In addition, grantees are encouraged to include
fathers of the children, partners of the women, and other extended
family members of the women and children in treatment in the target
population when their inclusion in non-residential treatment services is
deemed to be appropriate and beneficial.

2.3 Program Goals

The PPW program is intended to provide cost effective, comprehensive
residential substance abuse treatment services for women and their minor
children and services for other family members that can be sustained
over time. The service system must address the individual needs of the
target population, preserve and support the family unit, and provide a
safe and healthy environment for family members. The PPW program is
designed to:

-   Decrease the use and/or abuse of prescription drugs, alcohol,
    tobacco, illicit and other harmful drugs (e.g., inhalants) among
    pregnant and postpartum women;

-   Increase safe and healthy pregnancies; improve birth outcomes; and
    reduce related effects of maternal drug abuse on infants and
    children;

-   Improve the mental and physical health of the women and children;

-   Improve family functioning, economic stability, and quality of life;
    and

-   Decrease involvement in and exposure to crime, violence, sexual and
    physical abuse, and child abuse and neglect.

**2.4 Minimum Qualifications**

In accordance with Section 508 of the Public Health Service Act, the
Single State Agency (SSA) for substance abuse must send a letter
certifying that:

-   The applicant has the capacity to carry out the program described in
    this Request for Applications (RFA);

-   The plans of the applicant for such a program (i.e., the
    application) are consistent with the policies of the SSA regarding
    the treatment of substance abuse; and

-   

-   The applicant, or any entity through which the applicant will
    provide required services, meets all applicable local, city, county
    and State licensure or certification requirements regarding the
    provision of the services involved. \[NOTE: If the applicant
    provides services in a State or community where licensure,
    accreditation, or certification is not required, the SSA must attest
    to this.\]

The letter from the SSA providing these certifications must be included
as **Appendix 1.** Applications that do not include the certifications
letter will not be considered for an award.

2.5 Program Requirements

[General Agreements for Providing Services]{.underline}

Section 508 of the Public Health Service Act mandates that the required
services are available to the women entering the program. SAMHSA
requires that services also be made available for the minor children and
family members of both the women and their minor children, as
appropriate. Therefore, in Section C: Proposed Implementation Approach,
of the applicant's Project Narrative (see Section V of this RFA)
applicants must provide a statement agreeing to meet the following three
requirements, and demonstrate their capacity to do so:

1.  Services will be provided in a residential setting, in the language
    and cultural context that is most appropriate, and the program will
    be operated at a location that is accessible to the population
    served;

2.  The minor children will reside with the mother in such facilities,
    if the mother so requests. Efforts will be made to include as many
    children of the mother as is possible in the residential facility;
    and

3.  The grantee will provide the services directly or through formal
    agreements with other public or non-profit private entities.

The applicant is required to develop comprehensive individualized and
family service plans to meet the needs of each family member and the
family unit as a whole. These plans must be developed in consultation
with the woman and her family, as appropriate. Service plans must

include individual, group, and family counseling, as appropriate, as
well as follow-up relapse prevention, and supplemental treatment and
recovery support services, as required.

To demonstrate that a comprehensive service system is in place to meet
the complex needs of families, applicants must have Memoranda of
Understanding (MOUs) or Memoranda of Agreements (MOAs) with key agencies
and organizations, such as local public housing authorities (for
permanent housing for families), child welfare, health, mental health,
and child serving agencies, family court, criminal justice, employment
and education programs.

In **Appendix 8**, you must provide MOUs or MOAs with key agencies and
organizations in the applicant's network of providers.

[Required Supplemental/Recovery Support Services]{.underline}

The following services are either required under Section 508, or are
services that SAMHSA believes are necessary for comprehensive substance
abuse treatment for women, their children, and family members.

These services must be provided either by the grantee or through
MOUs/MOAs with providers in the network.

Women

-   Outreach, engagement, pre-treatment, screening, and assessment;

-   Detoxification;

-   Substance abuse education, treatment, and relapse prevention;

-   Medical, dental, other physical health care services, including
    diabetes, hypertension, prenatal and postpartum health care; and
    referrals for necessary hospital services;

-   Training in parenting and life skills;

-   Education, screening, counseling, and treatment of hepatitis,
    HIV/AIDS, other STDs, and related issues;

-   Mental health assessment and treatment;

-   Trauma-informed services, including assessment and interventions for
    emotional, sexual, and physical abuse;

-   Employment readiness, training, and placement;

-   Education and tutoring assistance for obtaining a GED and higher
    education;

-   Childcare during periods in which the woman is engaged in therapy or
    in other necessary health or rehabilitative activities;

-   Transportation and other wraparound services; and

-   Peer-to-peer recovery support activities such as groups, mentoring,
    and coaching.

Children

-   Screenings and developmental diagnostic assessments regarding the
    social, emotional, cognitive, and physical status of the infants and
    children;

-   Therapeutic interventions, including child care, counseling, play
    and art therapy, occupational, speech and physical therapies;

-   Pediatric health care, including immunizations, and treatment for
    asthma, diabetes, hypertension, and any perinatal effects of
    maternal substance abuse, e.g., HIV;

-   Social services and financial supports;

-   Education and recreational services;

-   Mental health and trauma services; and

-   Substance abuse education and prevention.

Family

-   Engagement of the family in the treatment process including
    individual and family counseling/therapy;

-   Alcohol and drug education;

-   Parenting training;

-   Family strengthening and reunification; and

-   Referral services for substance abuse, social, psychological,
    vocational and medical services.

*Case Management*

-   Coordination of services;

-   Assessment and monitoring of the extent to which required services
    are appropriate for women and children;

-   Assistance with community reintegration, before and after discharge,
    including referrals to appropriate resources; and

-   Assistance in accessing resources from Federal, State, and local
    programs that provide a range of treatment services, including
    substance abuse, health, mental health, housing, employment,
    education and training.

[Residential Treatment Phase and Length of Stay]{.underline}

The project may propose a residential phase for a specific time frame,
e.g., 3, 6, 9, or 12 months. The selected treatment phase should be
consistent with the applicant's experience with, and knowledge of, the
target population and what is reflected in the literature for women who
have previously used such services. Applicants should use information
about length of stay for this target population to more accurately
estimate the number of women to be served by the project.

Ultimately, a woman's length of stay in the residential treatment phase
should be guided by her individual service plan. While there may be some
exceptions, SAMHSA/CSAT recommends that the residential treatment phase
not exceed 12 months.

[Phase-in Plan]{.underline}

In **Appendix 2,** you are required to include a detailed phase-in plan
with timelines and a reasonable budget for the phase-in period. The
phase-in time may not exceed 3 months after the award.

[Reimbursement for Services]{.underline}

In **Appendix 3,** you must state whether or not you will seek
reimbursements from the client and/or from Medicaid. If you intend to
receive such reimbursements, you must attest to your willingness to meet
the requirements noted below under Status as a Medicaid Provider and
Imposition of Charges.

*Status as a Medicaid Provider*: Except for institutions for mental
diseases as defined in section 1905(i) of the Social Security Act,
applicants must show, in the case of any authorized treatment service
available pursuant to the State plan approved under title XIX of the
Social Security Act, that:

-   The services will be provided directly, the applicant has entered
    into a participation agreement under the State plan, and the
    applicant is qualified to receive payments under this plan;
    [or]{.underline}

-   The applicant has or will enter into an agreement with a public or
    nonprofit private entity under which the entity will provide the
    service, the entity has entered into a participation agreement under
    the State plan and the entity is qualified to receive payments under
    the plan. This participation agreement shall be waived if the entity
    does not, in providing health care services, impose a charge or
    accept reimbursement from any third-party payor, including
    reimbursement under an insurance policy or under any Federal or
    State health benefits plan. (For further details see Section
    508(e)(2) (A), (B), and (C) of the Public Health Services Act.)

*Imposition of Charges*. If a charge is imposed for the provision of
authorized services to an eligible woman, such charge---

-   Will be made according to a schedule of charges that is made
    available to the public;

-   Will be adjusted to reflect the income of the woman involved; and

-   Will not be imposed on any such woman with an income of less than
    185 percent of the official poverty line, as established by the
    Director of Management and Budget (OMB) and revised by the Secretary
    in accordance with section 673 (2) of the Omnibus Budget
    Reconciliation Act of 1981.

[Other Award Requirements]{.underline}

*Technical Assistance:* SAMHSA/CSAT will provide post award support to
grantees through technical assistance on administrative, programmatic,
and evaluation issues; data collection, analysis and interpretation; and
development of reports, products, and publications.

*Facility Licensing:* The residential treatment facility must meet all
State and local building, housing, health, safety and fire code
regulations, as well as other applicable State and local child-care and
residential facility licensing requirements. **Residential facility
licensure requirements differ from those of treatment provider licensure
discussed in this RFA in Section I-2.4 Minimum Qualifications.**
Licensing requirements for facilities offering group residential care
for infants and children are sometimes stringent, and may extend to
staffing patterns with implications for the number and characteristics
of the project staff. If the applicant [does not]{.underline} have
control of a currently operating facility and plans to lease a
space/facility, then the applicant must have a written agreement with
the owner of the space/facility to lease this space to the applicant
upon award (**Letter of Agreement must be provided in Appendix 4**). If
the applicant intends to lease a space/facility upon award, the
space/facility must already have been inspected and meet the
requirements for a residential program as certified by the appropriate
State agency.

In identifying a facility, the applicant must be particularly sensitive
to the public health needs of the target population, including
vulnerability for TB, hepatitis, asthma, and environmental issues
related to lead, asbestos, and mold.

Documentation of compliance with residential facility licensure
requirements must be provided in the application in **Appendix 4.**

*Notification:* Within 30 days of receipt of an award, the grantee must
notify the Single State Agency (SSA) and local governmental unit
responsible for administering substance abuse treatment services. This
notification assists State and local authorities in coordinating
substance abuse treatment activities within their communities.

*Collaboration:* Accessing housing suitable for project activities may
be facilitated by advance collaborations, memoranda of understanding
(MOUs)/agreements (MOAs) with local Public Housing Authorities (PHAs).
The Housing and Urban Development (HUD) Handbook 7465.1 REV 2, dated
August 1987 (CH. 6) permits a PHA to designate select units for
occupancy by members of a specific target population, and/or contract
with a social service provider to manage certain dwelling units, if it
so chooses. A PHA may also submit a request for authorization from HUD
to lease/modify dwelling space for non-dwelling purposes such as a
substance abuse treatment center. PHAs and providers considering such
approaches should discuss their proposals with the local HUD Field
Office prior to the development of an application, and obtain any
relevant assurances.

*Continued Funding Considerations:* Grantees will be responsible for
ensuring that all direct providers of services involved in the proposed
continuum of care are in compliance with local, city, county, and State
licensing, certification and accreditation requirements, and that all
MOUs/MOAs and subcontracts within the system of care remain current and
active.

######## **2.6 Infrastructure Development (maximum 15% of total grant award)**  {#infrastructure-development-maximum-15-of-total-grant-award .unnumbered}

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

######## Although services grant funds must be used primarily for direct services, SAMHSA recognizes that infrastructure changes may be needed to implement the services or improve their effectiveness. You may use up to 15% of the total services grant award for the following types of infrastructure development, if necessary to support the direct service expansion of the grant project, such as: {#although-services-grant-funds-must-be-used-primarily-for-direct-services-samhsa-recognizes-that-infrastructure-changes-may-be-needed-to-implement-the-services-or-improve-their-effectiveness.-you-may-use-up-to-15-of-the-total-services-grant-award-for-the-following-types-of-infrastructure-development-if-necessary-to-support-the-direct-service-expansion-of-the-grant-project-such-as .unnumbered}

-   Developing partnerships with other service providers for service
    delivery.

-   Enhancing your computer system, management information system (MIS),
    electronic health records, etc.

[]{.mark}

-   Training/workforce development to help your staff or other providers
    in the community identify mental health or substance abuse issues or
    provide effective services consistent with the purpose of the grant
    program.

    7.  **Using Evidence-Based Practices**

SAMHSA's services grants are intended to fund services or practices that
have a demonstrated evidence base and that are appropriate for the
target population. An evidence-based practice, also called EBP, refers
to approaches to prevention or treatment that are validated by some form
of documented scientific evidence. In your application, you will need
to:

-   Identify the evidence-based practice you propose to implement.

-   Identify and discuss the evidence that shows that the practice is
    effective. \[See note below.\]

-   Discuss the population(s) for which this practice has been shown to
    be effective and show that it is appropriate for [your]{.underline}
    target population(s). \[See note below.\]

> **Note: SAMHSA recognizes that EBPs have not been developed for all
> populations and/or service settings. For example, certain
> interventions for American Indians/Alaska Natives, rural or isolated
> communities, or recent immigrant communities may not have been
> formally evaluated and, therefore, have a limited or nonexistent
> evidence base. In addition, other interventions that have an
> established evidence base for certain populations or in certain
> settings may not have been formally evaluated with other
> subpopulations or within other settings. Applicants proposing to serve
> a population with an intervention that has not been formally evaluated
> with that population are encouraged to provide other forms of evidence
> that the practice(s) they propose is appropriate for the target
> population. Evidence may include unpublished studies, preliminary
> evaluation results, clinical (or other professional association)
> guidelines, findings from focus groups with community members, etc.
> You may describe your experience either with the target population or
> in managing similar programs. Information in support of your proposed
> practice needs to be sufficient to demonstrate the appropriateness of
> your practice to the people reviewing your application.**

-   Document the evidence that the practice you have chosen is
    appropriate for the outcomes you want to achieve.

-   Explain how the practice you have chosen meets SAMHSA's goals for
    this grant program.

-   Describe any modifications/adaptations you will need to make to this
    practice to meet the goals of your project and why you believe the
    changes will improve the outcomes. We expect that you will implement
    your evidence-based service/practice in a way that is as close as
    possible to the original service/practice. However, SAMHSA
    understands that you may need to make minor changes to the
    service/practice to meet the needs of your target population or your
    program, or to allow you to use resources more efficiently. You must
    describe any changes to your proposed service/practice that you
    believe are necessary for these purposes. You may describe your own
    experience either with the target population or in managing similar
    programs. However, you will need to convince the people reviewing
    your application that the changes you propose are justified.

-   Explain why you chose this evidence-based practice over other
    evidence-based practices.

*Resources for Evidence-Based Practices:*

You will find information on evidence-based practices in SAMHSA's *Guide
to Evidence-Based Practices on the Web* at
[www.samhsa.gov/ebpwebguide](http://www.samhsa.gov/ebpwebguide). SAMHSA
has developed this Web site to provide a simple and direct connection to
Web sites with information about evidence-based interventions to prevent
and/or treat mental and substance use disorders. The *Guide* provides a
short description and a link to dozens of Web sites with relevant
evidence-based practices information -- either specific interventions or
comprehensive reviews of research findings.

Please note that SAMHSA's Guide to Evidence-Based Practices also
references another SAMHSA Web site, the National Registry of
Evidence-Based Programs and Practices (NREPP). NREPP is a searchable
database of interventions for the prevention and treatment of mental and
substance use disorders. NREPP is intended to serve as a decision
support tool, not as an authoritative list of effective interventions.
*Being included in NREPP, or in any other resource listed in the Guide,
does not mean an intervention is "recommended" or that it has been
demonstrated to achieve positive results in all circumstances.* You must
document that the selected practice is appropriate for the specific
target population and purposes of your project.

In addition to the Web site noted above, you may provide information on
research studies to show that the services/practices you plan to
implement are evidence-based. This information is usually published in
research journals, including those that focus on minority populations.
If this type of information is not available, you may provide
information from other sources, such as unpublished studies or documents
describing formal consensus among recognized experts.

7.  **Data Collection and Performance Measurement**

All SAMHSA grantees are required to collect and report certain data so
that SAMHSA can meet its obligations under the Government Performance
and Results Act (GPRA).  Grantees will be required to report performance
in several areas relating to the client's substance use, family and
living condition, employment status, social connectedness, access to
treatment, retention in treatment and criminal justice status.  This
information will be gathered using the data collection tool referenced
below.  The collection of these data will enable CSAT to report on the
National Outcome Measures (NOMs) which have been defined by SAMHSA as
key priority areas relating to substance use.

Applicants must document their ability to collect and report the
required data in "Section E: Performance Assessment and Data" of their
applications.  Grantees must collect and report data using the
Discretionary Services Client Level GPRA tool, which can be found at
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/) (click
on 'Data Collection Tools/Instructions'), along with instructions for
completing it.  Hard copies are also available in the application kits,
which you can request from the SAMHSA Information Line at 1-877-SAMHSA7
\[TDD: 1-800-487-4889.\]

GPRA data must be collected in a face-to-face interview at baseline
(i.e., the client's entry into the project), discharge, and 6 months
post the baseline.  GPRA data must be entered into the GPRA Web system
within 7 business days of the forms being completed.  In addition, 80%
of the participants must be followed up.  GPRA data are to be collected
and then entered into CSAT's GPRA Data Entry and Reporting System
(www.samhsa-gpra.samhsa.gov). 

Training and technical assistance on data collecting, tracking, and
follow-up, as well as data entry, will be provided by CSAT.

######## **2.9 Performance Assessment** {#performance-assessment .unnumbered}

Grantees are required to conduct a process evaluation and participate in
a cross-site evaluation, conducted by CSAT, using a common protocol that
has been approved by OMB. You must consider your process evaluation plan
and participation in the cross-site when preparing the project budget.
Grantees are required to participate in all technical assistance and
training activities designed to support the cross-site activity.

The process evaluation should be designed to provide regular feedback to
the project to improve services. Process evaluation must measure change
relating to project goals and objectives over time compared to baseline
information. Control or comparison groups are not required.

Process components should address issues such as:

-   How closely did implementation match the plan?

-   What types of deviation from the plan occurred?

-   What led to the deviations?

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

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

The cross-site evaluation will measure the outcomes of treatment at each
grantee site on women and their minor children. SAMHSA/CSAT will use
this information to document and report the extent to which the goals of
the RFA were achieved, as mandated by Congress. Grantees must collect
data on the women and their minor children who participate in treatment
over the three-year life of the project. Data on women and their minor
children will be collected for up to twelve months following intake and
at discharge. Much of the data required for the assessment are routinely
collected by the projects as part of their own program management
efforts. However, common data collection tools need to be used in order
to ensure comparability of data gathered across projects. In addition,
data will be gathered periodically from project staff to document any
changes that might have occurred in the interventions.

This cross-site evaluation seeks to show that from treatment intake to
treatment discharge:

-   There was a decrease in the use and/or abuse of prescription drugs,
    alcohol, tobacco, and illicit drugs among pregnant and postpartum
    women across the projects.

-   Women and minor children in these projects experienced improvement
    in their mental and physical health, and family functioning.

-   There was decreased involvement and intent for involvement, in
    crime, violence, and abuse of all kinds, both as victims and
    perpetrators.

-   There was improvement in quality of life from the client's
    perspective related to health, social functioning, and environmental
    support.

-   There was a decrease in barriers to accessing treatment resulting in
    early entry into treatment in the first trimester of their pregnancy
    and a decrease in barriers to accessing project-related services.

Data collection tools approved for the PPW program are listed below. You
may download them from the SAMHSA Web site at
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/).

-   Child Data Collection Tool

-   Allen Barriers to Treatment

-   Ferrans and Powers Quality of Life Index

-   BASIS 24 Survey

-   Denver Developmental Screening Inventory II

-   Child Well Being Scales

-   CRAFFT

-   Middle Childhood Developmental Assessment Guide

-   Adolescent Developmental Assessment Guide

-   Women's Discharge Tool

-   Children's Discharge Tool

-   Family Recovery Support Services Tool

**No more than 20% of the total grant award may be used for data
collection, performance measurement, and performance assessment, e.g.,
activities required in Sections I-2.8 and 2.9.**

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

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

# AWARD INFORMATION

**Funding Mechanism:** Grants

**Anticipated Total Available Funding:** \$7.87 million

**Estimated Number of Awards:** 16

**Estimated Award Amount:** Up to \$500,000

**Length of Project Period:** Up to 3 years

**Proposed budgets cannot exceed \$500,000 in total costs (direct and
indirect) in any year of the proposed project.** **Applicants should be
aware that Congress funded this program in the FY 2008 appropriation for
SAMHSA even though funding for the program was not requested in the FY
2008 President's budget. Funding beyond FY 2008 is not guaranteed.
SAMHSA is allowing applicants to submit proposals for 2 additional
budget years for planning purposes and for technical assistance in
sustainability activities.**

# ELIGIBILITY INFORMATION

## ELIGIBLE APPLICANTS

> Eligible applicants are domestic public and private nonprofit
> entities. For example, State and local governments, federally
> recognized American Indian/Alaska Native tribes and tribal
> organizations, urban Indian organizations, public or private
> universities and colleges; and community- and faith-based
> organizations may apply. The statutory authority for this program
> prohibits grants to for-profit agencies. PPW grantees funded September
> 29, 2006 (FY 2006) are ineligible to apply under this grant
> announcement.

## COST SHARING 

Non-Federal Matching Funds are required under the statutory authority
(Section 508 of the Public Health Service Act) for the PPW program.
Non-Federal contributions are required and may be in cash or in-kind,
fairly evaluated. The matching funds must not be less than \$1 for each
\$9 of Federal funds provided in years one and two, and not less than
\$1 for each \$3 of Federal funds in any subsequent year. Matching funds
must meet the same test of allowability as costs charged to Federal
grants. Sources of matching funds are State and local governmental
appropriations (non-Federal), foundations, and other private non-profit
or for-profit organizations. In-kind contributions may include
facilities, equipment, or services used in direct support of the
project.

[]{.mark}

In **Appendix 5** of the application, you must provide a letter from the
funding source(s) attesting that the matching funds are available, and
are not derived from Federal sources. Applications that do not contain
documentation (in **Appendix 5**) that non-Federal matching funds are
available will not be considered for an award.

## OTHER

1.  **Additional Eligibility Requirements**

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

2.  **Evidence of Experience and Credentials**

> SAMHSA believes that only existing, experienced, and appropriately
> credentialed organizations with demonstrated infrastructure and
> expertise will be able to provide required services quickly and
> effectively. You must meet three additional requirements related to
> the provision of services.
>
> The three requirements are:

-   A provider organization for direct client substance abuse treatment
    services appropriate to the grant must be involved in the proposed
    project. The provider may be the applicant or another organization
    committed to the project. More than one provider organization may be
    involved;

-   Each direct service provider organization must have at least 2 years
    experience (as of the due date of the application) providing
    relevant services in the geographic area(s) in which services are to
    be provided (official documents must establish that the organization
    has provided relevant services for the [last 2 years]{.underline});
    and

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

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

In **Appendix 6** of your application, you must: (1) identify at least
one experienced, licensed service provider organization; (2) include a
list of all direct service provider organizations that have agreed to
participate in the proposed project, including the applicant agency if
the applicant is a treatment or prevention service provider
organization; and (3) include the Statement of Assurance (provided in
Appendix C of this announcement), signed by the authorized
representative of the applicant organization identified on the face-page
(SF 424 v2) of the application, attesting that all participating service
provider organizations:

-   meet the 2-year experience requirement;

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

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

In addition, if, following application review, your application's score
is within the funding range, the GPO will call you and request that the
following documentation be sent by overnight mail:

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

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

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

If the GPO does not receive this documentation within the time
specified, the application will not be considered for an award.

# APPLICATION AND SUBMISSION INFORMATION 

## ADDRESS TO REQUEST APPLICATION PACKAGE 

You may request a complete application kit from the SAMHSA Information
Line at 1-877-SAMHSA7 \[TDD: 1-800-487-4889\].

You also may download the required documents from the SAMHSA Web site at
[www.samhsa.gov/grants/apply.aspx](http://www.samhsa.gov/grants/apply.aspx)

Additional materials available on this Web site include:

-   a grant writing technical assistance manual for potential
    applicants;

-   standard terms and conditions for SAMHSA grants;

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

-   a list of certifications and assurances referenced in item 21 of the
    SF 424 v2.

## CONTENT AND FORM OF APPLICATION SUBMISSION

1.  **Application Kit**

SAMHSA application kits include the following documents:

-   PHS 5161-1 (revised July 2000) -- Includes the face page (SF 424
    v2), budget forms, assurances, certification, and checklist. You
    must use the PHS 5161-1. **Applications that are not submitted on
    the required application form will be screened out and will not be
    reviewed.**

-   Request for Applications (RFA) -- Provides a description of the
    program, specific information about the availability of funds, and
    instructions for completing the grant application. This document is
    the RFA. The RFA will be available on the SAMHSA Web site
    ([[www.samhsa.gov/grants/index.aspx]{.underline}](../www.samhsa.gov/grants/index.aspx))
    and a synopsis of the RFA is available on the Federal grants Web
    site ([www.Grants.gov](http://www.Grants.gov/)).

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

1.  **Required Application Components**

Applications must include the required ten application components (Face
Page, Abstract, Table of Contents, Budget Form, Project Narrative and
Supporting Documentation, Appendices, Assurances, Certifications,
Disclosure of Lobbying Activities, and Checklist).

-   **Face Page --** SF 424 v2 is the face page. This form is part of
    the PHS 5161-1. \[Note: Applicants must provide a Dun and Bradstreet
    (DUNS) number to apply for a grant or cooperative agreement from the
    Federal Government. SAMHSA applicants are required to provide their
    DUNS number on the face page of the application. Obtaining a DUNS
    number is easy and there is no charge. To obtain a DUNS number,
    access the Dun and Bradstreet Web site at
    [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
    1-866-705-5711. To expedite the process, let Dun and Bradstreet know
    that you are a public/private nonprofit organization getting ready
    to submit a Federal grant application.\]

-   **Abstract** -- Your total abstract should not be longer than 35
    lines. It should include the project name, population to be served
    (demographics and clinical characteristics),
    strategies/interventions, project goals and measurable objectives,
    including the number of people to be served annually and throughout
    the lifetime of the project, etc. In the first five lines or less of
    your abstract, write a summary of your project that can be used, if
    your project is funded, in publications, reporting to Congress, or
    press releases.

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

-   **Budget Form** -- Use SF 424A, which is part of the PHS 5161-1.
    Fill out Sections B, C, and E of the SF 424A. A sample budget and
    justification is included in Appendix H of this document.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A
    through E. Sections A-E together may not be longer than 30 pages.
    (Remember that if your Project Narrative starts on page 5 and ends
    on page 35, it is 31 pages long, not 30 pages.) More detailed
    instructions for completing each section of the Project Narrative
    are provided in "Section V -- Application Review Information" of
    this document.

    The Supporting Documentation provides additional information
    necessary for the review of your application. This supporting
    documentation should be provided immediately following your Project
    Narrative in Sections F through I. There are no page limits for
    these sections, except for Section H, Biographical Sketches/Job
    Descriptions. Additional instructions for completing these sections
    are included in Section V under "Supporting Documentation."
    Supporting documentation should be submitted in black and white (no
    color).

####### Appendices 1 through 10 -- Use only the appendices listed below. If your application includes any appendices not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Appendices 1-7, and 10 combined. There are no page limitations for Appendices 8 and 9. Do not use appendices to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do.

-   **Appendix 1:** A letter signed by the SSA certifying that the three
    requirements listed in Section I-2.4 of this RFA, Minimum
    Qualifications section, have been met.

-   **Appendix 2: Phase-in Plan**. Include a detailed phase-in plan with
    timelines and a reasonable budget for the phase-in period. The
    phase-in time may not exceed 3 months after the award.

-   **Appendix 3:** Certifications of the applicant's intent to comply
    with Section 508 requirements regarding Status as a Medicaid
    Provider and Imposition of Charges. See Section I-2.5, Program
    Requirements, Reimbursement for Services section.

-   **Appendix 4: Facility**. Provide documentation that the facility
    meets all State and local building, housing, health, safety and fire
    code regulations, as well as other applicable State and local child
    care and residential facility licensing. If applicable, i.e., you
    are going to lease space/facility upon award, provide a letter of
    agreement with the owner of the facility to be leased.

-   **Appendix 5:** Letter from the funding source attesting that the
    matching funds are available and are not derived from Federal
    sources.

-   **Appendix 6:** (1) Identification of at least one experienced,
    licensed service provider organization; (2) a list of all direct
    service provider organizations that have agreed to participate in
    the proposed project, including the applicant agency, if it is a
    treatment service provider organization; (3) the Statement of
    Assurance (provided in Appendix C of this announcement) signed by
    the authorized representative of the applicant organization
    identified on the face page of the application, that assures SAMHSA
    that all listed providers meet the 2-year experience requirement,
    and that if the application is within the funding range for an
    award, the applicant will send the GPO the required documentation
    within the specified time; (4) letters of commitment/support.

-   **Appendix 7:** Letter to the SSA

-   **Appendix 8: Memoranda of Understanding or Agreements (MOUs and
    MOAs)** with key agencies and organizations in the network of
    providers.

-   **Appendix 9: Copies of all Data Collection Instruments/Interview
    Protocols** that you propose to use.

-   **Appendix 10:** **Copies of Consent Forms.** If consent forms are
    not in English, provide English translations.

    -   **Assurances** -- Non-Construction Programs. You must read the
        list of assurances provided on the SAMHSA Web site or in the
        application kit before signing the face page (SF 424 v2) of the
        application. You are also required to complete the Assurance of
        Compliance with SAMHSA Charitable Choice Statutes and
        Regulations Form SMA 170. This form will be posted on SAMHSA's
        Web site with the RFA and provided in the application kits.

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-   **Certifications** -- You must read the list of certifications
    provided on the SAMHSA Web site or in the application kit before
    signing the face page (SF 424 v2) of the application.

-   **Disclosure of Lobbying Activities** -- You must submit Standard
    Form LLL found in the PHS 5161-1. Federal law prohibits the use of
    appropriated funds for publicity or propaganda purposes, or for the
    preparation, distribution, or use of the information designed to
    support or defeat legislation pending before the Congress or State
    legislatures. This includes "grass roots" lobbying, which consists
    of appeals to members of the public suggesting that they contact
    their elected representatives to indicate their support for or
    opposition to pending legislation or to urge those representatives
    to vote in a particular way. If no lobbying is to be disclosed, mark
    N/A on the form.

-   **Checklist** -- Use the Checklist found in PHS 5161-1. The
    Checklist ensures that you have obtained the proper signatures,
    assurances and certifications. If you are submitting a paper
    application, the Checklist should be the last page.

2.3 Application Formatting Requirements

**Please refer to Appendix A, *Checklist for Formatting Requirements and
Screenout Criteria for SAMHSA Grant Applications*, for SAMHSA's basic
application formatting requirements. Applications that do not comply
with these requirements will be screened out and will not be reviewed.**

## SUBMISSION DATES AND TIMES 

Applications are due by close of business on **March 18, 2008**. Hard
copy applications are due by 5:00 PM (EST). Electronic applications are
due by 11:59 PM (EST). **Hand carried applications will not be accepted.
Applications may be shipped using only DHL, Federal Express (FedEx),
United Parcel Service (UPS), or the United States Postal Service
(USPS).**

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

**Your application must be received by the application deadline or it
will not be considered for review.** Please remember that mail sent to
Federal facilities undergoes a security screening prior to delivery. You
are responsible for ensuring that you submit your application so that it
will arrive by the application due date and time.

If an application is mailed to a location or office (including room
number) that is not designated for receipt of the application and, as a
result, the designated office does not receive your application by the
deadline, your application will be considered late and ineligible for
review.

SAMHSA will not accept or consider any applications sent by facsimile.

SAMHSA accepts electronic submission of applications through
[www.Grants.gov](http://www.Grants.gov/). Please refer to Appendix B for
"Guidance for Electronic Submission of Applications."

## INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS

This grant program is covered under Executive Order (EO) 12372, as
implemented through Department of Health and Human Services (DHHS)
regulation at 45 CFR Part 100. Under this Order, States may design their
own processes for reviewing and commenting on proposed Federal
assistance under covered programs. Certain jurisdictions have elected to
participate in the EO process and have established State Single Points
of Contact (SPOCs). A current listing of SPOCs is included in the
application kit and can be downloaded from the Office of Management and
Budget (OMB) Web site at
[www.whitehouse.gov/omb/grants/spoc.html](http://www.whitehouse.gov/omb/grants/spoc.html).

-   Check the list to determine whether your State participates in this
    program. You **do not** need to do this if you are an American
    Indian/Alaska Native tribe or tribal organization.

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

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

    -   The SPOC should send any State review process recommendations to
        the following address within 60 days of the application
        deadline. **For United States Postal Service:** Crystal
        Saunders, Director of Grant Review, Office of Program Services,
        Substance Abuse and Mental Health Services Administration, Room
        3-1044, 1 Choke Cherry Road, Rockville, MD **20857**. ATTN: SPOC
        -- Funding Announcement No. **TI-08-009**. Change the zip code
        to **20850** if you are using another delivery service.

In addition, if you are a community-based, non-governmental service
provider and you are not transmitting your application through the
State, you must submit a Public Health System Impact Statement
(PHSIS)[^1] to the head(s) of appropriate State or local health agencies
in the area(s) to be affected no later than the application deadline.
The PHSIS is intended to keep State and local health officials informed
of proposed health services grant applications submitted by
community-based, non-governmental organizations within their
jurisdictions. If you are a [State or local government or American
Indian/Alaska Native tribe or tribal organization, you are not subject
to these requirements]{.underline}.

The PHSIS consists of the following information:

-   a copy of the face page of the application (SF 424 v2); and

-   a summary of the project, no longer than one page in length, that
    provides: 1) a description of the population to be served; 2) a
    summary of the services to be provided; and 3) a description of the
    coordination planned with appropriate State or local health
    agencies.

For SAMHSA grants, the appropriate State agencies are the Single State
Agencies (SSAs) for substance abuse and mental health. A listing of the
SSAs can be found on SAMHSA's Web site at
[www.samhsa.gov](http://www.samhsa.gov/). If the proposed project falls
within the jurisdiction of more than one State, you should notify all
representative SSAs.

If applicable, you [must]{.underline} include a copy of a letter
transmitting the PHSIS to the SSA in **Appendix 7, "Letter to the
SSA**." The letter must notify the State that, if it wishes to comment
on the proposal, its comments should be sent not later than 60 days
after the application deadline to the following address. **For United
States Postal Service:** Crystal Saunders, Director of Grant Review,
Office of Program Services, Substance Abuse and Mental Health Services
Administration, Room 3-1044, 1 Choke Cherry Road, Rockville, MD
**20857**. ATTN: SSA -- Funding Announcement No. **TI-08-009**. Change
the zip code to **20850** if you are using another delivery service.

In addition:

-   Applicants may request that the SSA send them a copy of any State
    comments.

-   The applicant must notify the SSA within 30 days of receipt of an
    award.

## FUNDING LIMITATIONS/RESTRICTIONS

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents, which are available at
[www.samhsa.gov/grants/management.aspx](http://www.samhsa.gov/grants/management.aspx):

-   Institutions of Higher Education: OMB Circular A-21

-   State and Local Governments and Federally Recognized Indian Tribal
    Governments: OMB Circular A-87

-   Nonprofit Organizations: OMB Circular A-122

-   Hospitals: 45 CFR Part 74, Appendix E

In addition, SAMHSA's PPW grant recipients must comply with the
following funding restrictions:

-   No more than 15% of the total grant award may be used for developing
    the infrastructure necessary for expansion of services.

-   No more than 20% of the total grant award may be used for data
    collection and performance assessment, including incentives for
    participating in the required data collection follow-up.

**SAMHSA grantees must also comply with SAMHSA's standard funding
restrictions, which are included in** **Appendix G**.

## OTHER SUBMISSION REQUIREMENTS

You may submit your application in either electronic or paper format:

**[Submission of Electronic Applications]{.underline}**

SAMHSA accepts electronic submission of applications through
[www.Grants.gov](http://www.Grants.gov/). Electronic submission is
voluntary. No review points will be added or deducted, regardless of
whether you use the electronic or paper format.

To submit an application electronically, you must use the
[www.Grants.gov](http://www.Grants.gov/) apply site. You will be able to
download a copy of the application package from
[www.Grants.gov](http://www.Grants.gov/), complete it off-line, and then
upload and submit the application via the Grants.gov site. E-mail
submissions will not be accepted.

**Please refer to Appendix B for detailed instructions on submitting
your application electronically.**

**[Submission of Paper Applications]{.underline}**

You must submit an original application and 2 copies (including
appendices). The original and copies must not be bound. Do not use
staples, paper clips, or fasteners. Nothing should be attached, stapled,
folded, or pasted.

Send applications to the address below:

**For United States Postal Service:**

> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**

Change the zip code to **20850** if you are using another delivery
service.

Do not send applications to other agency contacts, as this could delay
receipt. Be sure to include "**PPW -- TI-08-009**" in item number 12 on
the face page (SF 424 v2) of any paper applications. If you require a
phone number for delivery, you may use (240) 276-1199.

**Hand carried applications will not be accepted. Applications may be
shipped using only DHL, Federal Express (FedEx), United Parcel Service
(UPS), or the United States Postal Service (USPS).**

**SAMHSA will not accept or consider any applications sent by
facsimile.**

# APPLICATION REVIEW INFORMATION

##  {#section-2 .unnumbered}

## EVALUATION CRITERIA

The Project Narrative describes what you intend to do with your project
and includes the Evaluation Criteria in Sections A-E below. Your
application will be reviewed and scored according to the
[quality]{.underline} of your response to the requirements in Sections
A-E.

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

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

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

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-   Reviewers will be looking for evidence of cultural competence in
    each section of the Project Narrative, and will consider how well
    you address the cultural competence aspects of the evaluation
    criteria when scoring your application. SAMHSA's guidelines for
    cultural competence can be found on the SAMHSA Web site at
    [www.samhsa.gov](http://www.samhsa.gov/). Click on "Grants/Applying
    for a New SAMHSA Grant/Guidelines for Assessing Cultural
    Competence."

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-   The Supporting Documentation you provide in Sections F-I and
    Appendices 1-10 will be considered by reviewers in assessing your
    response, along with the material in the Project Narrative.

-   The number of points after each heading is the maximum number of
    points a review committee may assign to that section of your Project
    Narrative. Although scoring weights are not assigned to individual
    bullets, applicants are encouraged to respond to each bulleted
    statement.

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

-   Describe the target population and the geographic area to be served,
    and justify the selection of both. Include the numbers to be served
    annually and through the lifetime of the project, as well as
    demographic information.

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

• Non-tribal applicants must show that identified needs are consistent
with priorities of the State or county that has primary responsibility
for the service delivery system.

-   Fully describe existing services, including the number and type of
    current treatment services/slots/beds available and the number of
    people [currently]{.underline} being served in the target area and
    in the applicant organization. Include the number of people on a
    waiting list, if there is one.

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

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

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-   Identify the evidence-based service/practice that you propose to
    implement for the women, children, fathers of children, partners of
    women and extended family members, and the source of your
    information. (See Section I-2.7, Using Evidence-Based Practices.)
    Discuss the evidence that shows that this practice is effective with
    the target population. If the evidence is limited or non-existent
    for the target population, provide other information to support your
    selection of the intervention for the target population.

-   Document the evidence that the practice you have chosen is
    appropriate for the outcomes you want to achieve.

-   Identify and justify any modifications or adaptations you will need
    to make to the proposed practice to meet the goals of your project
    and why you believe the changes will improve the outcomes.

-   Explain why you chose this evidence-based practice over other
    evidence-based practices. If this is not an evidence-based practice,
    explain why you chose this intervention over other interventions.

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

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

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

-   Describe your strategies to preserve and reunite families, including
    specific family interventions and approaches that will stabilize and
    strengthen family relationships.

-   Describe how the proposed services or practices, including your
    strategies to preserve and reunite families, will be implemented for
    the women, their minor children, fathers of the children, partners
    of the women, and the extended family members of the women and
    children.

-   Describe the proposed service/practice for the children and
    demonstrate that it addresses gender, age, culture and
    developmentally appropriate services for the following age
    groups: 1) birth to three; 2) four to six; 3) seven to ten; and 4)
    eleven to seventeen.

-   Discuss the target population's language, beliefs, norms and values,
    as well as socioeconomic factors that must be considered in
    delivering programs to this population, and how the proposed
    approach addresses these issues.

-   State your agreement to comply with Section 508 of the Public Health
    Service Act. Demonstrate your capacity to meet the three
    requirements listed in this RFA in Section I-2.5 Program
    Requirements, under General Agreements for Providing Services.

-   Describe your plans for providing the required supplemental/recovery
    support services listed in Section I-2.5 Program Requirements, in
    this RFA. Identify the services that will be provided at the
    residential treatment site, and those that will be provided in the
    community by partners in the network. In **Appendix 6**, include a
    list of the service provider organizations.

-   Describe how you will screen and assess clients for the presence of
    co-occurring substance use (abuse and dependence) and mental
    disorders and use the information obtained from the screening and
    assessment to develop appropriate treatment approaches for the
    persons identified as having such co-occurring disorders.

-   State your agreement to coordinate and integrate services to
    accomplish your comprehensive service system. Describe the process
    used to achieve service coordination and integration among the
    network of providers, including how off-site providers will
    participate in treatment planning, service delivery, quality
    assurance, monitoring, and evaluating effectiveness. Include MOUs
    and MOAs in **Appendix 8.**

-   Show that the necessary groundwork (e.g., planning, consensus
    development, development of MOUs/MOAs, identification of potential
    facilities) has been completed or is near completion so that the
    project can be implemented and service delivery can begin as soon as
    possible and no later than [4 months]{.underline} after grant award.

-   Provide a realistic time line for the project (chart or graph)
    showing key activities, milestones, and responsible staff. Timelines
    must include phase-in activities that will be implemented no later
    than 3 months after award. Phase-in activities may include
    alterations and renovations, hiring and training staff, purchasing
    equipment, cross-training the network of providers, and admissions
    of first clients. \[Note: The time line should be part of the
    Project Narrative. It should not be placed in an appendix.\]

-   Clearly state: 1) the unduplicated number of women; 2) the estimated
    number of children; and 3) the estimated number of other family
    members you propose to serve (annually and over the entire project
    period) with grant funds, including the types and numbers of
    services to be provided and anticipated outcomes.

-   Describe the strategies for identifying and engaging women early in
    their pregnancies for maximum benefit of the mothers and infants
    (e.g., the first trimester), and retaining them in treatment.
    Discuss your plans to engage other family members when appropriate
    and beneficial, including fathers of the children, partners of the
    women, and extended family members in the treatment process.

-   Describe how project planning, implementation and assessment will
    include client input. If an advisory board is proposed, identify the
    role and responsibilities of the board.

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-   Describe how the project components will be embedded within the
    existing service delivery system, including other SAMHSA-funded
    projects, if applicable. Identify any other organizations that will
    participate in the proposed project. Describe their roles and
    responsibilities and demonstrate their commitment to the project.
    Include letters of commitment from community organizations
    supporting the project in **Appendix 6**.

-   Describe your treatment planning process for developing
    comprehensive individualized and family service plans to meet the
    needs of each family member, and the family unit as a whole.
    Describe your strategies for including the women and appropriate
    family members in the treatment planning process while ensuring a
    safe and healthy environment. Service plans must include individual,
    group, and family counseling, as appropriate, as well as follow-up
    relapse prevention, and supplemental treatment and recovery support
    services, as required.

-   Describe the plan to address stigma associated with substance abuse
    and health related issues such as HIV/AIDS to facilitate successful
    reintegration into the community.

-   Describe the continuing care component, including relapse prevention
    and strategies to access meaningful employment and permanent, safe,
    drug-free and affordable housing. Address special issues related to
    women who have been involved with the criminal justice system.
    Identify continuing care services you will provide to minor
    children, and other family members.

-   Discuss your plan to encourage participation of fathers of the
    children and partners of the women as well as extended family
    members of the women and the children in treatment when deemed to be
    appropriate and beneficial.

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

-   Describe your plan to continue the project after the funding period
    ends. Also describe how program continuity will be maintained when
    there is a change in the operational environment (e.g., staff
    turnover, change in project leadership) to ensure stability over
    time.

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

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-   Discuss the capability and experience of the applicant organization
    and other participating organizations with similar projects and
    populations. Demonstrate that the applicant organization and other
    participating organizations have linkages to the target population
    and ties to grassroots/community-based organizations that are rooted
    in the culture and language of the target population.

-   Provide a complete list of staff positions for the project, showing
    the role of each and their level of effort and qualifications.
    Include the Project Director and other key personnel, such as
    treatment/prevention personnel.

-   Discuss how key staff have demonstrated experience in serving the
    target population and are familiar with the culture and language of
    the target population. If the target population is multicultural and
    multilinguistic, describe how the staff are qualified to serve this
    population.

-   Describe the resources available for the proposed project (e.g.,
    facilities, equipment), and provide evidence that services will be
    provided in a location that is adequate, accessible, compliant with
    the Americans with Disabilities Act (ADA), and amenable to the
    target population. If the ADA does not apply to your organization,
    please explain why.

    **Section E: Performance Assessment and Data (15 points)**

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-   Document your ability to collect and report on the required
    performance measures as specified in Section I-2.8 of this RFA.
    Describe your plan for data collection, management, analysis and
    reporting. Specify and justify any additional measures or
    instruments you plan to use for your grant project.

    -   Describe how data will be used to manage the project and assure
        continuous quality improvement.

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-   Document your ability to collect and report data in accordance with
    all the required cross-site evaluation requirements as specified in
    Section I-2.9 of this RFA.

-   Provide a per-person or unit cost of the project to be implemented,
    based on the applicant's actual costs and projected costs over the
    life of the project. You can calculate this figure by: 1) taking the
    total cost of the project over the lifetime of the grant and
    subtracting 20% for data and performance assessment; 2) dividing
    this number by the total unduplicated number of persons to be
    served. Applicants must state whether or not the per person costs
    are within the following reasonable ranges by treatment modality. 
    Applicants must also discuss the reasonableness of the per person
    costs.  If proposed costs exceed reasonable ranges, a detailed
    justification must be provided.

Program Costs. The following are considered reasonable ranges by
treatment modality:

-   Residential: \$3,000 to \$10,000

-   Outpatient (Non-Methadone): \$1,000 to \$5,000

-   Outpatient (Methadone): \$1,500 to \$8,000

-   Intensive Outpatient: \$1,000 to \$7,500

-   Screening/Brief Intervention/Brief Treatment/Outreach/Pretreatment
    Services: \$200 to \$1,200

-   Drug Court Programs (regardless of client treatment modality):
    \$3,000 to \$5,000

-   Peer Recovery Support Services: \$1,000 to \$2,500

> The outreach and pretreatment services cost band applies only to
> outreach and pretreatment programs that do not offer treatment
> services but operate with a network of substance abuse treatment
> facilities. Treatment programs that add outreach and pretreatment
> services to a treatment modality or modalities are expected to fall
> within the cost band for that treatment modality.

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

**SUPPORTING DOCUMENTATION**

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

**Section G:** Budget Justification, Existing Resources, Other Support.
You must provide a narrative justification of the items included in your
proposed budget, as well as a description of existing resources and
other support you expect to receive for the proposed project. Be sure to
show that no more than 15% of the total grant award will be used for
infrastructure development, if necessary, and that no more than 20% of
the total grant award will be used for data collection and performance
assessment. An illustration of a budget and narrative justification is
included in Appendix H of this document.

####### Section H: Biographical Sketches and Job Descriptions.  {#section-h-biographical-sketches-and-job-descriptions. .unnumbered}

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

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

-   Information on what should be included in biographical sketches and
    job descriptions can be found on page 22, Item 6, in the Program
    Narrative section of the PHS 5161-1 instruction page, available on
    the SAMHSA Web site.

    **Section I:** Confidentiality and SAMHSA Participant
    Protection/Human Subjects: You must describe procedures relating to
    Confidentiality, Participant Protection and the Protection of Human
    Subjects Regulations in Section I of your application, using the
    guidelines provided below. Number range CHAPTER

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

Because of the confidential nature of the work in which many SAMHSA
grantees are involved, it is important to have safeguards protecting
individuals from risks associated with their participation in SAMHSA
projects. All applicants must address the seven bullets below. Appendix
F of this RFA provides a more detailed discussion of issues applicants
should consider in addressing these seven bullets. If some are not
applicable or relevant to the proposed project, simply state that they
are not applicable and indicate why. In addition to addressing these
seven bullets, read the section that follows entitled Protection of
Human Subjects Regulations to determine if the regulations may apply to
your project. If so, you are required to describe the process you will
follow for obtaining Institutional Review Board (IRB) approval. While we
encourage you to keep your responses brief, there are no page limits for
this section and no points will be assigned by the Review Committee.
Problems with confidentiality, participant protection, and the
protection of human subjects identified during peer review of the
application must be resolved prior to funding.

-   Identify foreseeable risks or adverse effects due to participation
    in the project and/or in the data collection (performance
    assessment) activities (including physical, medical, psychological,
    social, legal, and confidentiality) and provide your procedures for
    minimizing or protecting participants from these risks. Identify
    plans to provide guidance and assistance in the event there are
    adverse effects to participants.

-   Describe the target population and explain why you are including or
    excluding certain subgroups. Explain how and who will recruit and
    select participants.

-   State whether participation in the project is voluntary or required.
    If you plan to provide incentives/compensate participants, specify
    the type (e.g., money, gifts, coupons), and the value of any such
    incentives. Provide justification that the use of incentives is
    appropriate, judicious, and conservative and that incentives do not
    provide an "undue inducement" which removes the voluntary nature of
    participation. Incentives should be the minimum amount necessary to
    meet the programmatic and performance assessment goals of the grant.
    Applicants should determine the minimum amount that is proven to be
    effective by consulting with existing local programs and reviewing
    the relevant literature. In no case may the value of an incentive
    paid for with SAMHSA discretionary grant funds exceed \$20. (See
    Appendix F: Confidentiality and Participant Protection.)

-   Describe data collection procedures, including sources (e.g.,
    participants, school records) and the data collecting setting (e.g.,
    clinic, school). Provide copies of proposed data collection
    instruments and interview protocols in **Appendix 9** of your
    application, "Data Collection Instruments/Interview Protocols."
    State whether specimens such as urine and/or blood will be obtained
    and the purpose for collecting the specimens. If applicable,
    describe how the specimens and process will be monitored to ensure
    both the safety of participants and the integrity of the specimens.

-   Explain how you will ensure privacy and confidentiality of
    participants' records, data collected, interviews, and group
    discussions. Describe where the data will be stored, safeguards
    (e.g., locked, coding systems, storing identifiers separate from
    data), and who will have access to the information.

-   Describe the process for obtaining and documenting consent from
    adult participants and assent from minors along with consent from
    their parents or legal guardians. Provide copies of all consent
    forms in **Appendix 10** of your application, "Sample Consent
    Forms." If needed, give English translations.

-   Discuss why the risks are reasonable compared to expected benefits
    from the project.

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

SAMHSA expects that most grantees funded under this announcement will
not have to comply with the Protection of Human Subjects Regulations (45
CFR 46), which requires Institutional Review Board (IRB) approval.
However, in some instances, the applicant's proposed performance
assessment design may meet the regulation's criteria of research
involving human subjects. For assistance in determining if your proposed
performance assessment meets the criteria in 45 CFR 46, Protection of
Human Subjects Regulations, refer to the SAMHSA decision tree on the
SAMHSA Web site, under "Applying for a New SAMHSA Grant,"
<http://www.samhsa.gov/grants/apply.aspx>.

Applicants whose projects must comply with the Human Subjects
Regulations must, in addition to the bullets above, fully describe the
process for obtaining IRB approval. While IRB approval is not required
at the time of grant award, these grantees will be required, as a
condition of award, to provide documentation that an Assurance of
Compliance is on file with the Office for Human Research Protections
(OHRP). IRB approval must be received in these cases prior to enrolling
clients in the project. General information about Human Subjects
Regulations can be obtained through OHRP at <http://www.hhs.gov/ohrp>,
or <ohrp@osophs.dhhs.gov>, or (240) 453-6900. SAMHSA--specific questions
should be directed to the program contact listed in Section VII of this
announcement.

## REVIEW AND SELECTION PROCESS

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

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by
    peer reviewers and, when applicable, approved by the Center for
    Substance Abuse Treatment's National Advisory Council;

-   a letter (in **Appendix 1**) from the SSA certifying that the three
    requirements listed in Section I-2.4, Minimum Qualifications, have
    been met;

-   a letter (in **Appendix 5**) from the funding source(s) attesting
    that the matching funds are available and are not derived from
    federal sources;

-   availability of funds; and

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

SAMHSA/CSAT will make no more than one award per applicant per
geographic community.

# ADMINISTRATION INFORMATION

## AWARD NOTICES 

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

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

If you are approved for funding, you will receive an **additional**
notice through postal mail, the Notice of Grant Award, signed by
SAMHSA's Grants Management Officer. The Notice of Grant Award is the
sole obligating document that allows you to receive Federal funding for
work on the grant project.

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

## ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS 

-   If your application is funded, you must comply with all terms and
    conditions of the grant award. SAMHSA's standard terms and
    conditions are available on the SAMHSA Web site at
    http://[www.samhsa.gov/grants/management.asp](http://www.samhsa.gov/grants/management.aspx)x.

-   If your application is funded, you must also comply with the
    administrative requirements outlined in 45 CFR Part 74 or 45 CFR
    Part 92, as appropriate. For more information see the SAMHSA Web
    site
    (http://[www.samhsa.gov/grants/management.aspx](http://www.samhsa.gov/grants/management.aspx)).

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

    -   actions required to be in compliance with confidentiality and
        participant protection/human subjects requirements;

    -   requirements relating to additional data collection and
        reporting;

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

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

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

-   Grant funds cannot be used to supplant current funding of existing
    activities. "Supplant" is defined as replacing funding of a
    recipient's existing program with funds from a Federal grant.

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

## REPORTING REQUIREMENTS

In addition to the data reporting requirements listed in Section I-2.8,
you must comply with the following reporting requirements:

1.  **Progress and Financial Reports**

-   You will be required to submit annual and final progress reports, as
    well as annual and final financial status reports.

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-   Because SAMHSA is extremely interested in ensuring that treatment
    and prevention services can be sustained, your progress reports
    should explain plans to ensure the sustainability of efforts
    initiated under this grant.

-   If your application is funded, SAMHSA will provide you with
    guidelines and requirements for these reports at the time of award
    and at the initial grantee orientation meeting after award. SAMHSA
    staff will use the information contained in the reports to determine
    your progress toward meeting its goals.

    1.  **Government Performance and Results Act (GPRA)**

The Government Performance and Results Act (GPRA) mandates
accountability and performance-based management by Federal agencies. To
meet the GPRA requirements, SAMHSA must collect performance data (i.e.,
"GPRA data") from grantees. The performance requirements for SAMHSA's
PPW grant program are described in Section I-2.7 of this document under
"Data Collection and Performance Measurement."

2.  **Publications**

If you are funded under this grant program, you are required to notify
the Government Project Officer (GPO) and SAMHSA's Publications Clearance
Officer (240-276-2130) of any materials based on the SAMHSA-funded grant
project that are accepted for publication.

In addition, SAMHSA requests that grantees:

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

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

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

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

# AGENCY CONTACTS

For questions about program issues contact:

Linda White Young

Public Health Advisor

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 5-1081

Rockville, Maryland 20857

\(240\) 276-1581

<linda.white-young@samhsa.hhs.gov>

For questions on grants management issues contact:

### 

Kathleen Sample

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 7-1089

Rockville, Maryland 20857

\(240\) 276-1407

<kathleen.sample@samhsa.hhs.gov>

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

*SAMHSA's goal is to review all applications submitted for grant
funding. However, this goal must be balanced against SAMHSA's obligation
to ensure equitable treatment of applications. For this reason, SAMHSA
has established certain formatting requirements for its applications.
**If you do not adhere to these requirements, your application will be
screened out and returned to you without review.***

-   Use the PHS 5161-1 application form.

-   Applications must be received by the application due date and time,
    as detailed in Section IV-3 of this grant announcement.

-   Information provided must be sufficient for review.

-   Text must be legible. Pages must be typed in black ink,
    single-spaced, using a font of Times New Roman 12, with all margins
    (left, right, top, bottom) at least one inch each. (For Project
    Narratives submitted electronically, see separate requirements in
    Section IV-6 of this announcement under "Submission of Electronic
    Applications.")

-   To ensure equity among applications, page limits for the Project
    Narrative cannot be exceeded.

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

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

-   The 10 application components required for SAMHSA applications
    should be included and submitted in the following order:

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-   Face Page (Standard Form 424 v2, which is in PHS 5161-1)

-   Abstract

-   Table of Contents

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

-   Project Narrative and Supporting Documentation

-   Appendices

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

-   Certifications

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

-   Checklist (a form in PHS 5161-1)

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-   Applications should comply with the following requirements:

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-   Provisions relating to confidentiality and participant protection
    specified in Section V-1 of this announcement.

-   Budgetary limitations as specified in Sections I, II, and IV-5 of
    this announcement.

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

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-   Pages should be typed single-spaced in black ink with one column per
    page. Pages should not have printing on both sides.

-   Pages should be numbered consecutively from beginning to end so that
    information can be located easily during review of the application.
    The abstract page should be page 1, the table of contents should be
    page 2, etc. The four pages of Standard form 424 v2 are not to be
    numbered. Appendices should be labeled and separated from the
    Project Narrative and budget section, and the pages should be
    numbered to continue the sequence.

-   The page limits for Appendices stated in Section IV-2.2 of this
    announcement should not be exceeded.

-   Send the original application and two copies to the mailing address
    in Section IV-6 of this document. Please do not use staples, paper
    clips, and fasteners. Nothing should be attached, stapled, folded,
    or pasted. Do not use heavy or lightweight paper or any material
    that cannot be copied using automatic copying machines. Odd-sized
    and oversized attachments such as posters will not be copied or sent
    to reviewers. Do not include videotapes, audiotapes, or CD-ROMs.

###  

### Appendix B -- Guidance for Electronic Submission of Applications

If you would like to submit your application electronically, you may
search [www.Grants.gov](http://www.Grants.gov/) for the downloadable
application package by the funding announcement number (called the
opportunity number) or by the Catalogue of Federal Domestic Assistance
(CFDA) number. You can find the CFDA number on the first page of the
funding announcement.

You must follow the instructions in the User Guide available at the
[www.Grants.gov](http://www.Grants.gov/) apply site, on the Help page.
In addition to the User Guide, you may wish to use the following sources
for help:

-   By e-mail: <support@Grants.gov>

-   By phone: 1-800-518-4726 (1-800-518-GRANTS). The Customer Support
    Center is open from 7:00 a.m. to 9:00 p.m. Eastern Time, Monday
    through Friday, excluding Federal holidays.

**If this is the first time you have submitted an application through
Grants.gov, you must complete four separate registration processes
before you can submit your application. Allow at least two weeks (10
business days) for these registration processes, prior to submitting
your application.** The processes are: 1) DUNS Number registration; 2)
Central Contractor Registry (CCR) registration; 3) Credential Provider
registration; and 4) Grants.gov registration.

**It is strongly recommended that you submit your grant application
using Microsoft Office 2003 products (e.g., Microsoft Word 2003,
Microsoft Excel, etc.).** The new Microsoft Vista operating system and
Microsoft Office 2007 products are not currently accepted by Grants.gov.
If you do not have access to Microsoft Office products, you may submit
PDF files. Directions for creating PDF files can be found on the
Grants.gov Web site. Use of file formats other than Microsoft Office or
PDF may result in your file being unreadable by our staff.

The Project Narrative must be a separate document in the electronic
submission. Formatting requirements for SAMHSA grant applications are
described in Appendix A of this announcement. These requirements also
apply to applications submitted electronically, with the following
exceptions only for Project Narratives submitted electronically in
Microsoft Word. These requirements help ensure the accurate transmission
and equitable treatment of applications.

-   *Text legibility*: Use a font of Times New Roman 12, line spacing of
    single space, and all margins (left, right, top, bottom) of at least
    one inch each. Adhering to these standards will help to ensure the
    accurate transmission of your document.

-   *Amount of space allowed for Project Narrative*: The Project
    Narrative for an electronic submission may not exceed **15,450**
    words. **If the Project Narrative for an electronic submission
    exceeds the word limit, the application will be screened out and
    will not be reviewed**. To determine the number of words in your
    Project Narrative document in Microsoft Word, select
    file/properties/statistics.

**Keep the Project Narrative as a separate document. Please consolidate
all other materials in your application to ensure the fewest possible
number of attachments. Be sure to label each file according to its
contents, e.g., "Appendices 1-3", "Appendices 4-5." **

Ensure all pages in your application are numbered consecutively, with
the exception of the standard forms in the PHS-5161 application package.
**Documents containing scanned images must also contain page numbers to
continue the sequence.** Failure to comply with these requirements may
affect the successful transmission and consideration of your
application.

Applicants are strongly encouraged to submit their applications to
Grants.gov early enough to resolve any unanticipated difficulties prior
to the deadline. You may also submit a back-up paper submission of your
application. Any such paper submission must be received in accordance
with the requirements for timely submission detailed in Section IV-3 of
this announcement. The paper submission must be clearly marked:
**"Back-up for electronic submission."** The paper submission must
conform with all requirements for non-electronic submissions. If both
electronic and back-up paper submissions are received by the deadline,
the electronic version will be considered the official submission.

After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. It is important that you retain this number. **Include
the Grants.gov tracking number in the top right corner of the face page
(SF 424 v2) for any paper submission. Receipt of the tracking number is
the only indication that Grants.gov has successfully received and
validated your application. If you do not receive a Grants.gov tracking
number, you may want to contact the Grants.gov help desk for
assistance.**

The Grants.gov Web site does not accept electronic signatures at this
time. Therefore, you must submit a signed paper original of the face
page (SF 424 v2), the assurances (SF 424B), and hard copy of any other
required documentation that cannot be submitted electronically. **You
must include the Grants.gov tracking number for your application on
these documents with original signatures, on the top right corner of the
face page, and send the documents to the following address. The
documents must be received at the following address within 5 business
days after your electronic submission.** Delays in receipt of these
documents may impact the score your application receives or the ability
of your application to be funded.

**For United States Postal Service:**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20857**

ATTN: Electronic Applications

**For other delivery services, change the zip code to 20850.**

If you require a phone number for delivery, you may use (240) 276-1199.

### Appendix C - Statement of Assurance

As the authorized representative of \[*insert name of applicant
organization*\]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
I assure SAMHSA that all participating service provider organizations
listed in this application meet the two-year experience requirement and
applicable licensing, accreditation, and certification requirements. If
this application is within the funding range for a grant award, we will
provide the SAMHSA Government Project Officer (GPO) with the following
documents. I understand that if this documentation is not received by
the GPO within the specified timeframe, the application will be removed
from consideration for an award and the funds will be provided to
another applicant meeting these requirements.

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

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

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

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

Signature of Authorized Representative Date

### Appendix D -- Sample Logic Model 

A Logic Model is a tool to show how your proposed project links the
purpose, goals, objectives, and tasks stated with the activities and
expected outcomes or "change" and can help to plan, implement, and
assess your project. The model also links the purpose, goals,
objectives, and activities back into planning and evaluation. A Logic
Model is a *picture* of your project. It graphically shows the
activities and progression of the project. It should also describe the
relationships among what resources you put in (inputs), what you do
(outputs), and what happens or results (outcomes). Based on both your
planning and evaluating activities, you can then make a "logical" chain
of "if-then" relationships.

Look at the graphic on the following page to see the chain of events
that links the inputs to program components, the program components to
outputs, and the outputs to outcomes (goals).

The framework you set up to build your model is based on a review of
your Statement of Need, in which you state the conditions that gave rise
to the project with your target group. Then you look at the **Inputs,**
which are the resources, contributions, time, staff, materials**,** and
equipment you will invest to change these conditions. These inputs then
are organized into the **Program Components**, which are the activities,
services, interventions and tasks that will reach the target population.
These outputs then are intended to create **Outputs** such as changes or
benefits for the consumer, families, groups, communities, organizations
and SAMHSA. The understanding and further evidence of what works and
what does not work will be shown in the **Outcomes**, which include
achievements that occur along the path of project operation.

### 

### 

\*The logic model presented is not a required format and SAMHSA does not
expect strict adherence to this format. It is presented only as a sample
of how you can present a logic model in your application.

### 

### 

### 

Sample Logic Model\*

+--------------+---+--------------+---+---------------+---+---------------+
| *            |   | **Program    |   | **Outputs**   |   | **Outcomes**  |
| *Resources** |   | Components** |   |               |   |               |
|              |   |              |   | **(           |   | **(Goals)**   |
| **(Inputs)** |   | **(A         |   | Objectives)** |   |               |
|              |   | ctivities)** |   |               |   |               |
+--------------+---+--------------+---+---------------+---+---------------+
| **Examples** |   | **Examples** |   | **Examples**  |   | **Examples**  |
+--------------+---+--------------+---+---------------+---+---------------+
| People       |   | Outreach     |   | Waiting list  |   | Inprogram:    |
|              |   |              |   | length        |   |               |
| Staff --     |   | Intak        |   |               |   | Client        |
| hours        |   | e/Assessment |   | Waiting list  |   | satisfaction  |
|              |   |              |   | change        |   |               |
| Volunteer -- |   | Client       |   |               |   | Client        |
| hours        |   | Interview    |   | Client        |   | retention     |
|              |   |              |   | attendance    |   |               |
| Funds        |   | Treatment    |   |               |   | In or         |
|              |   | Planning     |   | Client        |   | postprogram:  |
| Other        |   |              |   | participation |   |               |
| resources    |   | Treatment by |   |               |   | > Reduced     |
|              |   | type:        |   | Number of     |   | > drug use -- |
| Facilities   |   |              |   | Clients:      |   | > self        |
|              |   | Methadone    |   |               |   | > reports,    |
| Equipment    |   | maintenance  |   | Admitted      |   | > urine, hair |
|              |   |              |   |               |   | >             |
| Community    |   | Weekly       |   | Terminated    |   | > Empl        |
| services     |   | 12-step      |   |               |   | oyment/school |
|              |   | meetings     |   | Inprogram     |   | > progress    |
|              |   |              |   |               |   | >             |
|              |   | De           |   | Graduated     |   | >             |
|              |   | toxification |   |               |   | Psychological |
|              |   |              |   | Placed        |   | > status      |
|              |   | Counseling   |   |               |   | >             |
|              |   | sessions     |   | Number of     |   | > Vocational  |
|              |   |              |   | Sessions:     |   | > skills      |
|              |   | Relapse      |   |               |   | >             |
|              |   | prevention   |   | Per month     |   | > Social      |
|              |   |              |   |               |   | > skills      |
|              |   | Crisis       |   | Per           |   | >             |
|              |   | intervention |   | client/month  |   | > Safer       |
|              |   |              |   |               |   | > sexual      |
|              |   | Special      |   | Funds raised  |   | > practices   |
|              |   | Training     |   |               |   | >             |
|              |   |              |   | Number of     |   | > Nutritional |
|              |   | Vocational   |   | volunteer     |   | > practices   |
|              |   | skills       |   | hours/month   |   | >             |
|              |   |              |   |               |   | > Child care  |
|              |   | Social       |   | Other         |   | > practices   |
|              |   | skills       |   | resources     |   | >             |
|              |   |              |   | required      |   | > Reduced     |
|              |   | Nutrition    |   |               |   | > deli        |
|              |   |              |   |               |   | nquency/crime |
|              |   | Child care   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Literacy     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Tutoring     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Safer sex    |   |               |   |               |
|              |   | practices    |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Other        |   |               |   |               |
|              |   | Services     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Placement in |   |               |   |               |
|              |   | employment   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Prenatal     |   |               |   |               |
|              |   | care         |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Child care   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Aftercare    |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Program      |   |               |   |               |
|              |   | Support      |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Fundraising  |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Long-range   |   |               |   |               |
|              |   | planning     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Ad           |   |               |   |               |
|              |   | ministration |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Public       |   |               |   |               |
|              |   | Relations    |   |               |   |               |
+--------------+---+--------------+---+---------------+---+---------------+

### Appendix E -- Logic Model Resources

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

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

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

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

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

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

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

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

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

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

241\. Thousand Oaks, CA: Sage.

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

### Appendix F -- Confidentiality and Participant Protection 

### 

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

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

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

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

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

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

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

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

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

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

3.  [Absence of Coercion]{.underline}

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

-   If you plan to compensate participants, state how participants will
    be awarded incentives (e.g., money, gifts, etc.). Provide
    justification that the use of incentives is appropriate, judicious,
    and conservative and that incentives do not provide an "undue
    inducement" which removes the voluntary nature of participation.
    Incentives should be the minimum amount necessary to meet the
    programmatic and performance assessment goals of the grant.
    Applicants should determine the minimum amount that is proven
    effective by consulting with existing local programs and reviewing
    the relevant literature. In no case may the value if an incentive
    paid for with SAMHSA discretionary grant funds exceed \$20.

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

4.  [Data Collection]{.underline}

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

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

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-   Provide in **Appendix 9, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

5.  [Privacy and Confidentiality]{.underline}

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

-   Describe:

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```
-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

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

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

6.  [Adequate Consent Procedures]{.underline}

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

-   State:

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-   Whether or not their participation is voluntary.

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

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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

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

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

-   Include, as appropriate, sample consent forms that provide for: (1)
    informed consent for participation in service intervention; (2)
    informed consent for participation in the data collection component
    of the project; and (3) informed consent for the exchange (releasing
    or requesting) of confidential information. The sample forms must be
    included in **Appendix 10, "Sample Consent Forms"**, of your
    application. If needed, give English translations.

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

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

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

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

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

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

Applicants may also have to comply with the Protection of Human Subjects
Regulations (45 CFR 46), depending on the evaluation and data collection
procedures proposed and the population to be served.

Applicants must be aware that even if the Protection of Human Subjects
Regulations do not apply to all projects funded, the specific
performance assessment design proposed by the applicant may require
compliance with these regulations. For assistance in determining if your
proposed performance assessment meets the criteria in 45 CFR 46,
Protection of Human Subjects Regulations, refer to the SAMHSA decision
tree on the SAMHSA Web site, under "Applying for a New SAMHSA Grant,"
<http://www.samhsa.gov/grants/apply.aspx>.

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

General information about Protection of Human Subjects Regulations can
be obtained on the Web at <http://www.hhs.gov/ohrp>. You may also
contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline} or by
phone (240/453-6900). SAMHSA-specific questions related to Protection of
Human Subjects Regulations should be directed to the program contact
listed in Section VII of this RFA.

### 

###  

### Appendix G -- Funding Restrictions

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

-   Pay for any lease beyond the project period.

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

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

-   Provide residential or outpatient treatment services when the
    facility has not yet been acquired, sited, approved, and met all
    requirements for human habitation and services provision. (Expansion
    or enhancement of existing residential services is permissible.)

-   Pay for housing other than residential mental health and/or
    substance abuse treatment.

-   Provide inpatient treatment or hospital-based detoxification
    services. Residential services are not considered to be inpatient or
    hospital-based services.

-   Make direct payments to individuals to induce them to enter
    prevention or treatment services. However, SAMHSA discretionary
    grant funds may be used for non-clinical support services (e.g., bus
    tokens, child care) designed to improve access to and retention in
    prevention and treatment programs.

-   Make direct payments to individuals to encourage attendance and/or
    attainment of prevention or treatment goals. However, SAMHSA
    discretionary grant funds may be used for non-cash incentives of up
    to \$20 to encourage attendance and/or attainment of prevention or
    treatment goals when the incentives are built into the program
    design and when the incentives are the minimum amount that is deemed
    necessary to meet program goals. SAMHSA policy allows an individual
    participant to receive more than one incentive over the course of
    the program. However, non-cash incentives should be limited to the
    minimum number of times deemed necessary to achieve program
    outcomes. A grantee or treatment or prevention provider may also
    provide up to \$20 cash or equivalent (coupons, bus tokens, gifts,
    child care, and vouchers) to individuals as incentives to
    participate in required data collection follow up. This amount may
    be paid for participation in each required interview.

-   Food is generally unallowable unless it's an integral part of a
    conference grant or program specific, e.g., children's program,
    residential.

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

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

SAMHSA will not accept a "research" indirect cost rate. The grantee must
use the "other sponsored program rate" or the lowest rate available.

### Appendix H -- Sample Budget and Justification

**ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND**

**NARRATIVE JUSTIFICATION TO ACCOMPANY**

**SF 424A: SECTION B FOR 01 BUDGET PERIOD**

**[OBJECT CLASS CATEGORIES]{.underline}**

**[Personnel]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Project

> Director J. Doe \$30,000 1.0 \$30,000 \$-0-
>
> Clinical
>
> Director J. Doe \$-0- In-Kind

Secretary Unnamed \$18,000 0.5 \$-0- \$ 9,000

Counselor R. Down \$25,000 1.0 \$25,000 \$-0-

**SUBTOTAL \$55,000 \$9,000**

**Enter Personnel subtotal on 424A, Section B, 6.a. \$64,000**

**[Fringe Benefits]{.underline}** (24%) \$15,360 \$-0-

**SUBTOTAL \$15,360 \$-0-**

**Enter Fringe Benefits subtotal on 424A, Section B, 6.b. \$15,360**

**[Travel]{.underline}**

2 trips for SAMHSA Meetings for 2 Attendees

(Airfare @ \$600 x 4 = \$2,400) + (per diem

@ \$120 x 4 x 6 days = \$2,880) \$5,280 \$-0-

Local Travel (500 miles x .24 per mile) \$-0- \$120

\[Note: Current Federal Government per diem rates are available at
[www.gsa.gov](http://www.gsa.gov/).\]

**SUBTOTAL \$5,280 \$120**

**Enter Travel subtotal on 424A, Section B, 6.c. \$ 5,400**

**[Equipment]{.underline}** (List Individually)

\"Equipment\" means an article of nonexpendable, tangible personal
property having a useful life of more than one year and an acquisition
cost which equals the lesser of (a) the capitalization level established
by the governmental unit or nongovernmental applicant for financial
statement purposes, or (b) \$5000.

**SUBTOTAL \$-0- \$-0-**

**Enter Equipment subtotal on 424A, Section B, 6.d. \$-0-**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**[Supplies]{.underline}**

Office Supplies \$500 \$-0-

Computer Software -- Microsoft Word \$-0- 500

**Enter Supplies subtotal on 424A, Section B, 6.e. \$1,000**

**[CONTRACTUAL COSTS]{.underline}**

**[Evaluation]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Evaluator J. Wilson \$48,000 .05 \$24,000 \$-0-

Other Staff \$18,000 1.0 \$18,000 \$-0-

Fringe Benefits (25%) \$10,500 \$-0-

**Travel**

2 trips x 1 Evaluator

(\$600 x 2) \$ 1,200 \$-0-

Per Diem @ \$120 x 6 720 \$-0-

Supplies (General Office) 500 \$-0-

Evaluation Contractual Direct Costs \$54,920 \$-0-

Evaluation Contractual Indirect Costs (19%) \$10,435 \$-0-

Evaluation Contract Subtotal **\$65,355**

**SUBTOTAL \$65,355** **\$-0- \$65,355**

**[Training]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Coordinator M. Smith \$ 12,000 0.5 \$12,000 \$-0-

Admin. Asst. N. Jones 9,000 0.5 9,000 \$-0-

Fringe Benefits (25%) 5,250 \$-0-

**Travel**

2 Trips for Training

Airfare @ \$600 x 2 \$1,200 \$-0-

Per Diem \$120 x 2 x 2 days 480 \$-0-

Local (500 miles x .24/mile) 120 \$-0-

**Supplies**

Office Supplies \$500 \$-0-

Software (Microsoft Word) \$500 \$-0-

Training Contractual Direct Costs Subtotal \$40,025 \$-0- **\$40,025**

Training Contractual Indirect Costs Subtotal \$-0- \$-0- **\$-0-**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**SUBTOTAL \$105,380 \$-0-** **\$105,380**

**Enter Contractual subtotal on 424A, Section B, 6.f. \$105,380**

**SAMHSA Non-Federal TOTAL**

**Funded Sources**

**[OTHER]{.underline}**

Rent (500 Sq. Ft. x \$9.95) \$ 4,975 \$-0-

Telephone \$ 500 \$-0-

Maintenance (e.g., van) \$-0- \$ 2,500

Audit \$-0- \$ 3,000

Consultants = Expert @ \$250/day X 6 day \$ 1,500 \$-0-

(If expert is known, should list by name)

**SUBTOTAL \$6,957 \$5,500**

**Enter Other subtotal on 424A, Section B, 6.h. \$12,475**

**[TOTAL DIRECT CHARGES]{.underline} (sum of 6.a-6.h)**

> **Enter Total Direct on 424A, Section B, 6.i. \$192,640**

**[INDIRECT CHARGES]{.underline}**

15% of Salary and Wages (copy of negotiated

Indirect Cost Rate Agreement attached) \[\$64,000 X 15% = \$9,600\]

> **Enter Indirect Costs subtotal of 424A, Section B, 6.j. \$9,600**
>
> **Enter TOTALS on 424A, Section B, 6.k. (sum of 6i and 6j) \$202,240**

**[JUSTIFICATION]{.underline}**

PERSONNEL - Describe the role and responsibilities of each position.

FRINGE BENEFITS - List all components of the fringe benefit rate.

EQUIPMENT - List equipment and describe the need and the purpose of the
equipment in relation to the proposed project.

SUPPLIES - Generally self-explanatory; however, if not, describe need.
Include explanation of how the cost has been estimated.

TRAVEL - Explain need for all travel other than that required by SAMHSA.

CONTRACTUAL COSTS - Explain the need for each contractual arrangement
and how these components relate to the overall project.

OTHER - Generally self-explanatory. If consultants are included in this
category, explain the need and how the consultant's rate has been
determined. If rent is requested, provide the name of the owner of the
building/facility. If anyone related to the project owns the building
which is a less than arms length arrangement, provide cost of
ownership/use allowance.

INDIRECT COST RATE - If your organization has no indirect cost rate,
please indicate whether your organization plans to: a) waive indirect
costs if an award is issued; or b) negotiate and establish an indirect
cost rate with DHHS within 90 days of award issuance.

OTHER SOURCES -- If other non-Federal sources of funding, including
match or cost sharing as a total operating budget is included, provide
the name of the source, e.g., in-kind, foundation, program income,
Medicaid, State funds, applicant organization, etc., and explain its
use.

[CALCULATION OF FUTURE BUDGET PERIODS]{.underline}

[(based on first 12-month budget period)]{.underline}

Review and verify the accuracy of future year budget estimates.
Increases or decreases in the future years must be explained and
justified. (NOTE: salary cap of \$186,600 is effective for all FY 2008
awards.)

First Second Third

12-month 12-month 12-month

Period Period Period

Personnel

Project Director 30,000 30,000 30,000

Secretary\* 9,000 18,000 18,000

Counselor 25,000 25,000 25,000

TOTAL PERSONNEL 64,000 73,000 73,000

\*Increased from 50% to 100% effort in 02 through 03 budget periods.

Fringe Benefits (24%) 15,360 17,520 17,520

Travel 5,400 5,400 5,400

Equipment -0- -0- -0-

Supplies\*\* 1,000 520 520

\*\*Increased amount in 01 year represents costs for software.

Contractual

Evaluation\*\*\* 65,355 67,969 70,688

Training 40,025 40,025 40,025

\*\*\*Increased amounts in 02 and 03 years reflect the increase in
client data collection.

Other 1,500 1,500 1,500

Total Direct Costs 192,640 205,934 208,653

Indirect Costs 9,600 9,600 9,600

(15% S&W)

TOTAL COSTS 202,240 216,884 219,603

The Federal dollars requested for all object class categories for the
first 12-month budget period are entered on Form 424A, Section B, Column
(1), lines 6a-6i. The [total]{.underline} Federal dollars requested for
the second through the fifth 12-month budget periods are entered on Form
424A, Section E, Columns (b) -- (e), line 20. The RFA will specify the
maximum number of years of support that may be requested.

[^1]: Approved by OMB under control no. 0920-0428; Public reporting
    burden for the Public Health System Reporting Requirement is
    estimated to average 10 minutes per response, including the time for
    copying the face page of SF 424 v2 and the abstract and preparing
    the letter for mailing. An agency may not conduct or sponsor, and a
    person is not required to respond to, a collection of information
    unless it displays a currently valid OMB control number. The OMB
    control number for this project is 0920-0428. Send comments
    regarding this burden to CDC Clearance Officer, 1600 Clifton Road,
    MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428).