> **OMB Approval No. 0985-0018**

**Pension Counseling & Information Projects**

**Program Announcement and**

**Grant Application Instructions**

**U.S. Administration on Aging**

**2007**

**Department of Health and Human Services (HHS)**

**Administration on Aging (AoA)**

**AoA Center:** Center for Wellness and Community-Based Services

######## Funding Opportunity Title: Pension Counseling & Information Projects  {#funding-opportunity-title-pension-counseling-information-projects .unnumbered}

**Announcement Type:** Initial

**Funding Opportunity Number:** HHS-2007-AoA-PC-0711

**Catalog of Federal Domestic Assistance (CFDA) Number:** 93.048

**Key Dates:** The deadline for receipt of applications is July 20, 2007

**Executive Summary:**

Since 1993, the Administration on Aging (AoA) has funded the Pension
Counseling and Information Program (the Program) to help individuals
understand and exercise their pension rights. Originally a
demonstration, pension counseling became a permanent program under Title
II of the Older Americans Act (OAA) in 2000 and consists of multiple
counseling projects and a single national technical assistance project.
In FY 2001 and 2002, AoA shifted its funding focus from local and
statewide projects to multi-state, regional projects in order to move
the Program toward nationwide coverage. AoA-funded regional counseling
projects currently serve 25 states.

The counseling projects provide individuals who reside, have worked in,
or have some other connection to the regional service area with the
following services: drafting administrative pension claims and appeals,
and support through administrative proceedings; identifying and pursuing
pension benefits from sponsors that have discontinued their plan,
changed names, merged with another company or gone out of business;
answering basic questions about rights and remedies under all public and
private pension systems throughout the service region; and operating a
region-wide outreach program to ensure public awareness of project
services, emphasizing outreach to those who need pension counseling
services the most. Projects receive legal training, case consultation
and operational coordination and support from the national technical
project.

######## Through this program announcement, AoA plans to award five (5) regional pension counseling grants at a federal share of approximately \$157,500 per year for a project period of up to three years, contingent upon the availability of federal funds. Eligible applicants include domestic public or private and non-profit entities including state, local and Indian tribal governments, faith-based organizations, community-based organizations, hospitals, and institutions of higher education, with a proven record of advising and representing individuals who have been denied employer or union-sponsored pensions or other retirement savings plan benefits, and which have the capacity to deliver services on a regional basis. {#through-this-program-announcement-aoa-plans-to-award-five-5-regional-pension-counseling-grants-at-a-federal-share-of-approximately-157500-per-year-for-a-project-period-of-up-to-three-years-contingent-upon-the-availability-of-federal-funds.-eligible-applicants-include-domestic-public-or-private-and-non-profit-entities-including-state-local-and-indian-tribal-governments-faith-based-organizations-community-based-organizations-hospitals-and-institutions-of-higher-education-with-a-proven-record-of-advising-and-representing-individuals-who-have-been-denied-employer-or-union-sponsored-pensions-or-other-retirement-savings-plan-benefits-and-which-have-the-capacity-to-deliver-services-on-a-regional-basis. .unnumbered}

# FUNDING OPPORTUNITY DESCRIPTION 

**[Program Environment]{.underline}**

Income from employer-sponsored pensions and retirement savings plans is
increasingly crucial to the well-being of a majority of older Americans.
At the same time, threats to our nation's retirement security are also
on the rise. Changes in benefit formulas, pension plan underfunding,
terminations and freezes all affect millions of workers and retirees
each year. In addition to these systemic issues, an array of
fact-specific difficulties also adds to our nation's growing sense of
"retirement insecurity." Each year thousands are reaching retirement age
only to realize that their pensions have been miscalculated, or denied
altogether. Difficult questions concerning the impact of death and
divorce on retirement benefits add a further level of obfuscation. In
addition, thousands more \-- due to their previous employer having
changed its name, relocated, merged with another company or gone out of
business altogether \-- have completely lost track of the retirement
benefits they have earned. Vulnerable older adults urgently need to have
a place to turn for direct hands-on help in obtaining the retirement
benefits they have earned.

Obstacles inherent in the system make it difficult for individuals to
find reliable assistance. Private employers sponsor more than 700,000
retirement plans in the United States, and government employers bring
thousands more plans into the mix, each interacting with state and
federal tax laws to add further inaccessibility. No single government
agency is charged with assisting individuals who have difficulty
navigating these pension systems to locate or claim their benefits.
Where government assistance is available, it will generally not
calculate or verify benefit amounts, interpret complex plan language, or
conduct extensive investigations into individual facts and circumstances
such as rebuilding work histories to prove eligibility. And finding a
lawyer to help is also a daunting challenge; not only due to the highly
specialized and complex nature of this area of practice, but also
because those who are most dependent on the income from these plans --
low and moderate wage earners -- often have cases of only modest value
that may not attract the interest of the private bar. The need for
accessible, affordable and trustworthy pension assistance has never been
greater.

**[Program History]{.underline}**

Recognizing this tremendous need, Congress directed the AoA to develop
demonstration projects specifically designed to help individuals
understand and exercise their pension rights. Beginning in 1993, the AoA
has funded the Pension Counseling and Information Program, founded upon
two service hallmarks: trustworthy and personalized assistance
regardless of age, income or value of the pension claim; and,
broad-based expertise covering all employer-sponsored pension and
retirement plans, regardless of sponsor type (public, private) or plan
type (defined benefit, defined contribution).

AoA has expanded the Program to its current level, covering 25 states
through a network of regional pension counseling projects and a single
national technical assistance project. The Program has been
overwhelmingly successful across a variety of measures, the most
impressive of which is that it has recovered over \$70 million in
benefits for the tens of thousands of clients it has served. This
represents a direct return to clients served of more than \$5.50 for
every federal funding dollar invested. Even when benefits are not
warranted, the information and assistance that the projects provide
offer vulnerable elderly individuals the satisfaction of finally
achieving "peace of mind" after months or even years of frustration in
searching for answers. The projects also have an extensive outreach
network that helps to keep individuals aware of their pension rights and
of the fact that the counseling projects exist, should they encounter a
problem. Based on this success, the Counseling Program was made a
permanent program under Title II of the Older Americans Act, as amended
in 2000.

**[AoA Program Purpose]{.underline}**

The Pension Counseling and Information Program's effort to protect
financial security in retirement directly supports the Administration on
Aging's interests in promoting increased choice and greater independence
among older adults. The activities of the Program serve to enhance the
financial, emotional, physical, and mental well-being of older adults,
and thereby increase their capacity for independent choice with regard
to health care and medication, nutrition, and living conditions, as well
as planning for long-term care. These decisions, in turn, support older
individuals' efforts to maintain security and independence in
retirement, to make better financial and other choices in their later
years, and to remain in their own homes with high quality of life for as
along as possible. Advocacy programs such as the Pension Counseling and
Information Program also help to ensure that older adults are able to
exercise increased choice and independence in an environment that is
free from abuse, neglect and exploitation. Moreover, the Program
directly contributes to the accomplishment of AoA's Strategic Goals and
Objectives goals for 2007--2012[^1] in the following ways:

-   Monetary recoveries help individuals achieve and maintain financial
    security, which in turn allows them to remain in their homes and
    increases their independence and decision making;

-   Outreach information directly increases access to consumers on
    issues related to elder rights, consumer protection and economic
    security in retirement; thereby empowering seniors to make informed
    decisions with respect to pensions and other employer-sponsored
    retirement savings plans;

-   Direct information and advocacy services efficiently fill an
    important gap across a broad spectrum of need, since no single
    government agency has the formal responsibility to look out for and
    assist retirement plan participants;

-   Program capacity is maximized through partnerships with
    community-based organizations and the aging network, and through
    linkages with AoA's Eldercare Locator, Aging and Disability Resource
    Centers, and legal services programs;

-   Measurable outcomes are defined and encouraged by employing
    sophisticated data collection and evaluation measures in
    consultation with the AoA Office of Evaluation.

**[Project Goal, Objectives and Activities]{.underline}**

Applicants must submit a project plan, the primary goal of which is to
establish or continue a regional pension counseling and information
project. Applications must demonstrate the sponsoring organization's
ability to accomplish the following goals and activities:

A.  [Regional Pension Counseling and Information Services]{.underline}.
    A major goal of a regional pension counseling and information
    project is to provide appropriate services throughout a proposed
    region. Key objectives and activities must include:

    1.  [Counseling and Information Services]{.underline}.

a\. [Quick-Call Services]{.underline}: Many individuals come to the
counseling projects with basic questions about their pension plans. Many
of these inquiries (often referred to as "quick calls") can be answered
in a single, brief telephone conversation or email communication.

b\. [Case Services]{.underline}: Beyond providing answers to basic
inquiries about pension-related rights and remedies, counseling projects
must provide direct and often detailed legal, investigative and other
advocacy services (short of formal litigation) to clients who require
them.  These services range from researching the answers to complex
legal questions; to brief services like letter writing, email and
telephone communications on behalf of clients; to more extensive case
work including:

i.  Legal assistance to clients through administrative proceedings,
    including the drafting of benefit claims and appeals, and
    negotiating benefit settlement agreements;

ii. Obtaining and evaluating governing plan documents and other
    information necessary to calculate or claim benefits or to evaluate,
    establish, or otherwise exercise other pension rights;

iii. Researching and investigating legal issues and other matters
     relevant to participant and beneficiary rights and remedies under
     the various pension laws; and,

iv. Locating "lost" pension benefits for individuals (or their
    beneficiaries) who worked long enough with an employer to earn a
    benefit, but whose employer has changed name, relocated, terminated
    its plan, gone out off business, or cannot otherwise be immediately
    located.

> c\. [Referral Services]{.underline}: The purpose of a project's
> referral efforts is to build and utilize a cohesive region-wide
> network of private and public service providers to serve clients whose
> needs, such as detailed actuarial assessments or formal litigation,
> are outside the scope of counseling and information services, . To
> meet this need, projects must establish and maintain a region-wide
> network of trustworthy referral resources in the following service
> areas: individual or class litigation; actuarial or accounting
> services; domestic relations orders; financial education, retirement
> and estate planning; and elder rights and consumer protection.

1.  [Regional Service Delivery]{.underline}: All projects must be
    regional, generally requiring that a proposed project must serve a
    minimum of two (2) or more states (see exception, 2.b. below).
    Equivalent services and equivalent access to those services must be
    provided throughout the proposed service region. Preference in
    awarding funds will be given to applicants with an evidenced
    capacity to deliver regional services.

    a.  [Multi-state Regions]{.underline}: Applications for multi-state
        regions should evidence that substantial thought and logic has
        gone into the definition of the proposed region. Criteria for
        forming a multi-state region might include the fact that all
        states lie within a single federal circuit; that the collection
        of states is already recognized as a region (Pacific Northwest,
        or Southeastern US); that other service providers are already
        networked throughout the region; or that multi-state outreach
        efforts are more efficient due to geographic layout of the
        proposed region. Special thought should be given to address
        issues related to the practice of law in multiple jurisdictions.

    b.  [Single-state Regions]{.underline}: Applicants proposing a
        single-state "region" must provide additional justification to
        show that the single state has a need for pension counseling
        services sufficient to support a dedicated counseling project.
        Such justification might include data on the population within
        the state that is covered by or receiving income from a private
        or public pension or retirement income plan, and the number of
        pension inquiries received by government agencies, public plan
        offices or other sources of basic pension information within the
        state. The AoA will not fund a proposal to serve less than an
        entire single state.

2.  [Exclusive Subject Matter]{.underline}: For purposes of this grant
    program, "pensions" or "pensions and retirement savings plans"
    include defined benefit pensions and defined contribution pension
    and profit sharing plans that provide retirement income, and that
    are sponsored by government (federal -- civil service, military, and
    railroad -- and state, county and local) and private (including
    religious) employers. Public or private health, welfare and
    disability benefits, benefits provided through the Social Security
    Administration, Veterans Administration or other public benefits and
    entitlement programs are not the focus of this grant program.

3.  [Individuals Served]{.underline}: Projects must provide equivalent
    services and equivalent access to those services to individuals,
    regardless of age or income who:

    a.  Reside or work in the project's service region; or who

    b.  Worked or resided in the project's service region while earning
        a pension, or when married to an individual earning a pension;
        or who

    c.  Seek pension benefits that are sponsored, administered,
        trusteed, or are otherwise held or distributed by an entity that
        is or was headquartered or operated within the service region.

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B.  [Regional Outreach Activities]{.underline}: Another major goal of a
    regional pension counseling and information project is to conduct
    region-wide outreach in order to maximize the intake of appropriate
    clients and to build and maintain successful client-referral
    relationships with trustworthy information and service providers. A
    portion of the project's outreach activities must be targeted to
    reach underserved and hard-to-reach seniors, including those with
    limited-English proficiency. Regional projects are responsible for
    all outreach activities within their service region. The national
    technical assistance project will coordinate directly with regional
    projects on intake and outreach activities at the national level.
    Project outreach must include the following objectives and
    activities:

    1.  [Regional Intake and Referral Network]{.underline}: Projects
        should develop and maintain a coordinated intake and referral
        network that takes maximum advantage of existing legal and aging
        service and information providers throughout the region,
        including: federal, state and local government pension agencies
        and plan offices; offices of elected representatives and their
        respective constituent services functions; law firms and solo
        practitioners with experience in pension law; state and local
        bar associations' lawyer referral services; legal services
        providers; state and area agencies on aging; and community
        organizations focusing on elder rights and consumer protection.
        Special emphasis should be placed on coordinating client
        referrals between the project and the Aging and Disability
        Resource Centers (ADRCs) within the project's service region. At
        a minimum, this requires that project websites contain readily
        apparent links to ADRCs and intake and referral networks as
        appropriate.

    2.  [Specialized Outreach Activities and Materials]{.underline}:
        Outreach for pension counseling services has proven most
        effective when it is undertaken as a specialized component,
        separate from outreach for other services offered by the
        sponsoring agency. Project websites, brochures, fliers, fact
        sheets and other materials should clearly establish the
        specialty focus on pension assistance and information, and on
        helping potential clients understand and exercise their pension
        rights. Regional projects are responsible for developing
        materials covering state and local pension systems throughout
        the region based on client need. The national technical
        assistance project is responsible for developing materials
        covering plans governed by federal law, also based on project
        and/or client need.

    3.  [Media Relations]{.underline}: Proposals must demonstrate
        organizational experience and capacity to deal quickly and
        effectively with inquiries from members of the press and other
        media.

    4.  [Low and no-cost access]{.underline}: Projects must be easily
        accessible to low-income, rural and other hard-to-reach senior
        populations throughout the region through technologies such as a
        toll-free phone line and an easy-to-navigate website.

    5.  [Outreach events]{.underline}: Projects are encouraged to be
        creative with their outreach efforts. Proposals that include
        presentations, workshops, classes, seminars or other educational
        efforts must demonstrate that such efforts:

-   Will use the project's expertise in pension law, rights and remedies
    (as opposed to retirement or estate planning, or other financial
    education); and

-   Will be primarily targeted at attracting pension clients for the
    project or at expanding the project's regional intake and referral
    network; and

-   Will not significantly reduce project resources that could otherwise
    be dedicated to pension counseling or more direct outreach
    activities.

C.  [Programmatic Consistency]{.underline}: Now that the AoA Pension
    Counseling Program is significantly beyond the "demonstration phase"
    and is a permanent program under the Older Americans Act, AoA has
    identified certain practices that contribute significantly to a
    project's overall success. AoA bases the following recommendations
    on the experience of the Program to date. AoA now looks for
    increased consistency across projects in certain key operational
    areas proven over time to increase project efficiency and
    effectiveness in line with Program goals. Where it is not feasible
    to implement these practices immediately, projects should propose
    them as goals.

    1.  [Staffing]{.underline}: Certain practices in the area of
        staffing maximize both the project's ability to provide the
        highest levels of counseling services, as well as the project's
        breadth and depth of institutional experience over time.

> a\. [Specialized Intake and Counseling Staff]{.underline}: Due to the
> significant learning curve involved in pension work, project
> effectiveness and efficiencies are maximized when pension client
> intake and casework skills are developed in specialist staff --
> positions dedicated in whole or in significant part to the work of the
> pension project. Specialists can develop expertise more rapidly,
> conduct more detailed and complete client intake, and deliver higher
> levels of counseling service more efficiently and effectively than
> generalists. Projects are encouraged to establish specialized staff
> positions for pension intake and casework as part of a larger strategy
> to build institutional skill and experience over time.
>
> b\. [Lawyers in Key Positions]{.underline}: Project staff responsible
> for the project's delivery of legal services must be licensed to
> practice law. Attorney staff must supervise paralegal, lay and
> volunteer personnel to ensure that obscure loopholes of the various
> pension laws and plans are not overlooked.
>
> c\. [Maximize Direct Access to "Live" Specialist Staff]{.underline}:
> Projects should maximize the number of non-overlapping business hours
> that specialist staff are available for client intake and casework
> activity. Projects should also build systems that connect potential
> clients to those resources as directly as possible, reducing client
> exposure to answering machines or non-specialist staff.
>
> d\. [Maximize Time Commitment of Volunteers, Law Students,
> etc.]{.underline}: Projects can increase their service capacity by
> using volunteers, law students, and/or other low or no-cost staffing
> alternatives to assist with investigative and other pension counseling
> activities that do not require the attention of a licensed attorney.
> However, because of the significant investment that projects make in
> the training and supervision of this population, and because of the
> guaranteed loss of project expertise upon turnover of these positions,
> projects should seek to maximize the duration that such staff are
> likely to stay with the project. Law students hired through work-study
> programs have stayed at pension projects for up to two years, and
> retired professionals who are paid a modest stipend to offset any
> costs they incur in volunteering have also proven a reliable resource
> over time.
>
> e\. [Staff Development]{.underline}: Ensuring that pension counseling
> staff receive sufficient and targeted continuing legal education is
> essential to the success of a counseling project. Proposals must
> outline a training and development plan for all project staff,
> including law students, volunteers and others. Substantive legal
> training, technical assistance and programmatic guidance are offered
> through the national technical assistance project. Supplemental
> training for specialized project staff is available and encouraged and
> should be coordinated with the national technical assistance project.
> Specifically, proposals must allocate adequate time and travel
> resources each project year to ensure that:
>
> i\. Specialized staff in each project location attend the annual
> Pension Counseling Project Training Conference in Washington, D.C.;
>
> ii\. At least two days of on on-site, customized legal training and /
> or operational consultation and review are coordinated with the
> national technical assistance project; and
>
> iii\. At least one supplemental legal training event is attended by
> project staff.
>
> 2\. [Data Collection and Reporting]{.underline}: Data will be
> collected and reported in a manner consistent across all AoA-funded
> counseling projects. AoA will identify the baseline data set to be
> collected, and provide a low or no-cost tool to collect and report on
> that data. At a minimum the data set will include client demographics,
> types and levels of services provided, client outcomes, pension plan
> and sponsor types and locations, as well as the legal issues involved.
> Projects will collect and report data from each of their multiple
> locations (if applicable) and on the regional project's activities as
> a whole. All projects funded under this program will submit reports to
> the AoA and to the national technical assistance project for
> consolidation and analysis. Projects will be expected to collect and
> retain documents and contact information for the pension plans they
> identify in their casework and share this information with other
> pension counseling projects and the national technical assistance
> project.
>
> 3\. [Shared Learning]{.underline}: Projects are expected to build on
> the experience of existing pension counseling projects and to share
> their insights regarding client casework, outreach and project
> operations with other pension counseling projects and the national
> technical assistance project. No-cost tools such as the AoA Pension
> Counseling Listserv are available for this purpose.

### Statutory Authority  {#statutory-authority .unnumbered}

The statutory authority for grants under this program announcement is
contained in Title II, Section 215 of the Older Americans Act (OAA)
(42U.S.C. 3032), as amended in 2006 (P.L. 109-365).

# AWARD INFORMATION 

Award Type: Grant

Estimated Federal Funds Available: \$787,500 per year

Estimated Number of Awards: Up to 5 (five)

Average Projected Award Amount: Up to \$157,500 per year

Project Start Date: September 30, 2007

Estimated Length of Project: Up to three (3) years

## III. ELIGIBILITY INFORMATION {#iii.-eligibility-information .unnumbered}

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

######## Eligible applicants include domestic public or private and non-profit entities including state, local and Indian tribal governments, faith-based organizations, community-based organizations, hospitals, and institutions of higher education, with a proven record of advising and representing individuals who have been denied employer or union-sponsored pensions or other retirement savings plan benefits, and which have the capacity to deliver services on a regional basis. {#eligible-applicants-include-domestic-public-or-private-and-non-profit-entities-including-state-local-and-indian-tribal-governments-faith-based-organizations-community-based-organizations-hospitals-and-institutions-of-higher-education-with-a-proven-record-of-advising-and-representing-individuals-who-have-been-denied-employer-or-union-sponsored-pensions-or-other-retirement-savings-plan-benefits-and-which-have-the-capacity-to-deliver-services-on-a-regional-basis. .unnumbered}

######## 2. Cost Sharing or Matching {#cost-sharing-or-matching .unnumbered}

Under this Older Americans Act program, AoA will fund no more than 75%
of the project's total cost, which means the applicant must cover at
least 25% of the project's total cost with non-federal resources. In
other words, for every three (3) dollars received in federal funding,
the applicant must contribute at least one (1) dollar in non-federal
resources toward the project's total cost, as reflected in the formula
included under Item 18 in Attachment A. You can use this formula to
calculate your minimum required match. A common error applicants make is
to match 25% of the federal share, rather than 25% of the project's
total cost. In addition, successful applicants will be accountable for
all proposed match, including that above the minimum requirement.

######## 3. Application Screening Criteria {#application-screening-criteria .unnumbered}

All applications will be screened to assure a level playing field for
all applicants. Applications that fail to meet the screening criteria
described below will **[not]{.underline}** be reviewed and will receive
**[no]{.underline}** further consideration.

In order for an application to be reviewed, it must meet the following
screening requirements:

1.  Applications must be submitted electronically via
    [www.grants.gov](http://www.grants.gov/) by midnight July 20, 2007.

2.  The Project Narrative section of the Application must be
    double-spaced, on 8 ½" x 11" plain white paper with 1" margins on
    both sides, and a font size of not less than 11.

3.  The Project Narrative must [not]{.underline} exceed 20 pages. NOTE:
    The Project Work Plan, Letters of Commitment, and Vitae of Key
    Project Personnel **[are not counted]{.underline}** as part of the
    Project Narrative for purposes of the 20-page limit.

## IV. APPLICATION AND SUBMISSION INFORMATION {#iv.-application-and-submission-information .unnumbered}

All applicants are required to submit electronically through
[http://www.grants.gov](http://www.grants.gov/) by midnight July 20,
2007.

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

Application materials can be obtained from
[http://www.grants.gov](http://www.grants.gov/) or
<http://www.aoa.gov/doingbus/fundopp/fundopp.asp>.

Application materials are also available by writing to:

> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Valerie Soroka
>
> Center for Wellness and Community Based Services
>
> Washington, D.C. 20201
>
> Or by calling: 202-357-3531
>
> Or e-mailing: valerie.soroka@aoa.hhs.gov

Please note: AoA is requiring applications for this announcement to be
submitted electronically through
[www.grants.gov](http://www.grants.gov/). The Grants.gov registration
process can take several days. If your organization is not currently
registered with [www.grants.gov](http://www.grants.gov/), please begin
this process immediately. **For assistance with
[www.grants.gov](http://www.grants.gov/), please contact them at**
[support@grants.gov](mailto:support@grants.gov?subject=Support) **or
1-800-518-4726 between 7 a.m. and 9 p.m. Eastern Time.** At
[www.grants.gov](http://www.grants.gov/), you will be able to download a
copy of the application packet, complete it off-line, and then upload
and submit the application via the Grants.gov website.

Basic information and instructions for applications submitted via
[www.grants.gov](http://www.grants.gov/) include the following:

-   You may access the electronic application for this program on
    [www.Grants.gov](http://www.Grants.gov/). You must search the
    downloadable application page by the CFDA number (93.048).

-   At the www.grants.gov website, you will find information about
    submitting an application electronically through the site, including
    the hours of operation. AoA strongly recommends that you do not wait
    until the application due date to begin the application process
    through [www.grants.gov](http://www.grants.gov/) because of the time
    delay.

-   All applicants must have a Dun and Bradstreet (D&B) Data Universal
    Numbering System number (DUNS) and register in the Central
    Contractor Registry (CCR). You should allow a minimum of **five
    days** to complete the CCR registration.

-   You may submit all documents electronically, including all
    information included on the SF 424 and all necessary assurances and
    certifications.

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

-   After you electronically submit your application, you will receive
    an automatic acknowledgement from www.grants.gov that contains a
    Grants.gov tracking number. The Administration on Aging will
    retrieve your application form from Grants.gov.

-   We may request that you provide original signatures on forms at a
    later date.

-   Each year organizations registered to apply for federal grants
    through [www.grants.gov](http://www.grants.gov/) will need to renew
    their registration with the Central Contractor Registry (CCR). You
    can register with the CCR online and it will take about 30 minutes
    ([www.grants.gov/CCRRegister](http://www.grants.gov/CCRRegister)).
    You should receive your CCR registration within 7 -- 10 business
    days.  

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

######## a. DUNS Number  {#a.-duns-number .unnumbered}

The Office of Management and Budget requires applicants to provide a Dun
and Bradstreet (D&B) Data Universal Numbering System (DUNS) number when
applying for Federal grants or cooperative agreements on or after
October 1, 2003. It is entered on the SF 424. It is a unique,
**nine-digit identification number**, which provides unique identifiers
of single business entities. The DUNS number is *free and easy* to
obtain.

Organizations can receive a DUNS number at no cost by calling the
dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
using this link:
<https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf>.

######## b. Project Narrative {#b.-project-narrative .unnumbered}

The Project Narrative must be double-spaced, on 8 ½" x 11" paper with 1"
margins on both sides, and a font size of not less than 11. You can use
smaller font sizes to fill in the Standard Forms and Sample Formats. The
suggested length for the Project Narrative is ten to twenty pages;
twenty pages is the maximum length allowed. AoA will not accept
applications with a Project Narrative that exceeds 20 pages. The Project
Work Plan, Letters of Cooperation, and Vitae of Key Personnel are not
counted as part of the Project Narrative for purposes of the 20-page
limit, but all of the other sections noted below are included in the
limit.

The components counted as part of the 20 page limit include:

-   Summary/Abstract

-   Problem Statement

-   Goal(s) and Objective(s)

-   Proposed Intervention

-   Special Target Populations and Organizations

-   Outcomes

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

The Project Narrative is the most important part of the application,
since it will be used as the primary basis to determine whether or not
your project meets the minimum requirements for grants under Title IV of
the Older Americans Act. The Project Narrative should provide a **clear
and concise** description of your project. AoA recommend that your
project narrative include the following components:

**[Summary/Abstract]{.underline}.** This section should include a one
page - 300 words maximum - description of the proposed project,
including: the goal, priority area(s), target population, activities,
products and measurable outcomes. Detailed instructions for completing
the summary/abstract are included in Attachment E of this document.

**[Problem Statement]{.underline}.** This section should describe, in
both quantitative and qualitative terms, the nature and scope of the
particular problem or issue the proposed intervention is designed to
address. Specifically, it should identify the types, severity and
prevalence of issues within the proposed region that can be addressed by
the proposed counseling project. Applicants are expected to demonstrate
an understanding of what populations are most affected by these pension
issues, noting any proposed target populations and the unique nature of
pension problems they encounter, as appropriate (Suggested length: one
to two pages).

**[Goal(s) and Objectives]{.underline}.** This section should consist of
a description of the project's goal(s) and major objectives in terms of
the priority area(s). In responding to this program announcement, we
recommend you have only one overall goal: to provide pension counseling
and information services to \[region\]. Activities should be organized
under the following project objectives: service delivery, outreach and
programmatic consistency.

**[Proposed Intervention]{.underline}.** This section should provide a
clear and concise description of the intervention you are proposing to
use to address the problem described in the "Problem Statement." You
should also describe the rationale for using the particular
intervention, including factors such as: "lessons learned" for similar
projects previously tested in your community, or in other areas of the
country; factors in the larger environment that have created the "right
conditions" for the intervention (e.g., existing social, economic or
political factors that you'll be able to take advantage of, etc.). Also
note any major barriers you anticipate encountering, and how your
project will be able to overcome those barriers. Be sure to describe the
role and makeup of strategic partnerships you plan to involve in
implementing the intervention, including other organizations, funders,
and/or consumer groups. (Suggested length: 3 to five pages.)

**[Special Target Populations and Organizations]{.underline}.** This
section should describe how the proposed intervention will target
vulnerable populations, specifically relating to identifying and
responding to the need for pension counseling services among
disadvantaged, hard-to-reach, and limited-English speaking populations.
It should also describe how you plan to involve community-based
organizations in a meaningful way in the planning and implementation of
the proposed regional project. (Suggested length: one to two pages.)

**[Outcomes]{.underline}**. This section of the project narrative must
clearly identify the [measurable]{.underline} outcome(s) that will
result from the project. (NOTE: AoA will not fund any project that does
not include measurable outcomes). This section should also describe how
the project's findings might benefit the field at large, (e.g., how the
findings could help other organizations throughout the nation to address
the same or similar problems). List measurable outcomes in the attached
Work Plan Grid (Attachment D) under "Measurable Outcomes" in addition to
any discussion included in the narrative along with a description of how
the project might benefit the field at large. (Suggested Length: one to
two pages.)

A "measurable outcome" is an observable end-result that describes how a
particular intervention benefits consumers. It can describe a change in
the degree of customer satisfaction; a change in the responsiveness or
cost-effectiveness of a service delivery system; an increase in access
to service for previously underserved target groups; a measurable
increase in awareness, skills, and behaviors that result in protection
of the financial security and consumer rights of elders; a measurable
improvement in seniors' financial, emotional, physical, and mental
well-being; or an increase in the number of cases closed with a
favorable result for the client.

A measurable outcome is not a measurable "output" such as: the number of
clients served; the number of training sessions held; the number of
informational materials disseminated; or the number of service units
provided.

You should keep the focus of this section on describing
[what]{.underline} outcome(s) will be produced by the project. You
should use the Evaluation section noted below to describe
[how]{.underline} the outcome(s) will be measured and reported. Your
application will be scored on the clarity and nature of your proposed
outcomes, not on the number of outcomes cited.

**[Project Management]{.underline}**. This section should include a
clear delineation of the roles and responsibilities of project staff,
sub-grantees, consultants and partner organizations, and how they will
contribute to achieving the project's objectives and outcomes. It should
specify who would have day-to-day responsibility for key tasks such as:
leadership of project; monitoring the project's on-going progress,
preparation of reports; communications with other partners and AoA. It
should also describe the approach that will be used to monitor and track
progress of the project's tasks and objectives. (Suggested Length: one
to two pages.)

**[Evaluation]{.underline}**. This section should describe the
method(s), techniques and tools that will be used to: 1) determine
whether or not the proposed intervention achieved its anticipated
outcome(s), and 2) document the project "lessons learned" (both positive
and negative) that will be useful to others interested in replicating
the intervention, or using the results to inform policy or program
decision-making on the federal, state and/or local level. (Suggested
Length: three to five pages.)

**[Dissemination]{.underline}.** This section should describe the method
that will be used to disseminate the project's successful products and
practices in a timely manner and in easily understandable formats, to
parties who might be interested in using the results of the project to
improve practice, service delivery, program development, and/or
policy-making, including and especially those parties who would be
interested in replicating the project. (Suggested Length: one to two
pages.)

**[Organizational Capability Statement]{.underline}.** Each application
should include an organizational capability statement and vitae for key
project personnel. The organizational capability statement should
describe how the applicant entity (or the particular division of a
larger organization which will have responsibility for this project) is
organized, the nature and scope of its mission and work, and/or the
capabilities it possesses. This description should cover capabilities of
the applicant entity not included in the program narrative, such as any
current or previous relevant experience and/or the record of the project
team in preparing cogent and useful reports, publications, and other
products. If appropriate, include an organization chart showing the
relationship of the project to the current organization. Please attach
short vitae for key project staff only. Neither vitas nor an
organizational chart will count towards the narrative page limit. Also
include information about any contractual organization(s) that will have
a significant role(s) in implementing the project and achieving project
goals.

######## Attachments {#attachments .unnumbered}

**[Work Plan]{.underline}**. The Project Work Plan should reflect, and
be consistent with, the Project Narrative and Line-Item Budget. For each
major task and action step, the work plan should identify the timeframes
to achieve the proposed objectives and the lead person responsible for
completing the task. It is recommended that the Work Plan include the
following information as outlined in Attachment D: Work Plan Template:

-   Overall goal;

-   Measurable outcome(s);

-   Key objectives;

-   Major tasks and action steps;

-   Lead person; and

-   Timeframe with start and end dates.

There are no page limits for completing a Work Plan.

**[Letters of Commitment from Key Participating Organizations and
Agencies]{.underline}.**

Include confirmation of the commitments to the project (should it be
funded) made by [key]{.underline} collaborating organizations and
agencies in this part of the application. Any organization that is
specifically named to have a significant role in carrying out the
project should be considered an essential collaborator. The signed
letters of collaboration must specify the commitment, role, and
resources/activities that will be provided in support of the applicant.
Strategies to reach targeted populations must be documented with letters
of commitment that detail the specific role/function in support of the
project's effort that will be played by the collaborating organization.
The organization's expertise, experience, and access to the targeted
population(s) should also be described in the letter of commitment.

For applications submitted electronically via Grants.gov, signed letters
of commitment should be scanned and included as attachments. Applicants
unable to scan the signed letters of commitment may fax them to the AoA
Grants Management Office at 202-357-3466 by the application submission
deadline. The Program Announcement number should appear at the top of
each page faxed.

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

The deadline for the submission of applications under this program
announcement is July 20, 2007. Applications must be submitted
electronically by midnight Eastern time, July 20, 2007.

Applications that fail to meet the application due date will
**[not]{.underline}** be reviewed and will receive **[no]{.underline}**
further consideration.

Grants.gov will automatically send applicants a tracking number and date
of receipt verification electronically once the application has been
successfully received and validated in Grants.gov.

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

This funding opportunity announcement is not subject to the requirements
of Executive Order 12372, "Intergovernmental Review of Federal
Programs."

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

The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

-   Basic research (e.g. scientific or medical experiments)

-   Continuation of existing projects without expansion or new and
    innovative

> approaches

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

Electronic submissions must be sent to:
[http://www.grants.gov](http://www.grants.gov/).

Applicants submitting their application through
[www.grants.gov](http://www.grants.gov/) must register in the Central
Contractor Registry (CCR) database in order to be able to submit the
application. One element of the CCR is the DUNS number (see section
IV.2), which must be obtained separately from CCR registration.
Information about CCR is available at
<http://www.grants.gov/CCRRegister>. You must also register with a
Credential Provider to receive a username and password to securely
submit your grant application. Information is available at
<http://www.grants.gov/CredentialProvider> .

######## V. APPLICATION REVIEW INFORMATION  {#v.-application-review-information .unnumbered}

######## 1. Criteria  {#criteria .unnumbered}

Applications are scored by assigning a maximum of 100 points across four
criteria:

-   Purpose and Need for Assistance - (15 points);

-   Approach, Workplan and Activities - (35 points);

-   Outcomes/Evaluation/Dissemination - (20 points); and

-   Level of Effort - (30 points).

  ------------------------------------------------------ ---------------------
  a\. [Purpose and Need for Assistance]{.underline}      [Weight: 15
                                                         points]{.underline}

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

i.  [Purpose and Need]{.underline}: Is the problem as identified for the
    region and general populations consistent with the AoA Program
    purpose, as described in Section I of this Program Announcement?
    Does the applicant understand the specific nature, varieties and
    prevalence of pension problems facing potential clients throughout
    the region, and across all pension systems in general? Are the
    "purpose and need" themes, as identified, appropriately and
    thoughtfully addressed throughout the proposal? (10) points)

ii. [Targeting]{.underline}: Does the applicant identify and prioritize
    any target populations within their region? Does the applicant
    clearly identify and substantiate the target population's need for
    pension counseling services? Is the problem as identified for target
    populations consistent with the AoA Program purpose? (5 points)

  ------------------------------------------------------ ---------------------
  b\. [Approach, Work Plan and Activities]{.underline}   [Weight: 35
                                                         points]{.underline}

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

i.  [Overall Approach]{.underline}: Does the applicant present a well
    thought out approach for each of the following:

-   [Regional Pension Counseling and Information Services]{.underline}:
    Does the applicant present a well-thought-out approach for
    delivering the full range of pension counseling and information
    services to clients throughout the region? Does this approach
    include referral resources for services related to but outside the
    scope of pension counseling, including specific considerations for
    the region's aging-related services? Does the proposal present a
    sound rationale and client-focused justification in defining the
    service region? Does the proposal adequately address issues related
    to single- or multi-state service regions? (10 points)

-   [Regional Outreach]{.underline}: Does the applicant present a well
    thought out approach for outreach activities covering the entire
    region? Has the applicant targeted a portion of its outreach to meet
    an identified need among disadvantaged and limited-English speaking
    populations? Has the applicant identified appropriate aging and
    other community-based groups to aid the project in planning and
    executing these efforts? (5 points)

-   [Programmatic Consistency]{.underline}: Does the applicant propose
    an operational model that is consistent with or works toward the
    identified staffing practices? Does the proposal reflect strong
    commitment to the collection and reporting of project data? Does the
    proposal incorporate the lessons learned from prior efforts of the
    Pension Counseling and Information Program and commit to shared
    learning, moving forward? (5 points)

ii. [Work Plan and Activities]{.underline}: Is the project work plan
    clear and comprehensive? Does it include sensible and feasible
    timeframes for the accomplishment of tasks presented? Does the work
    plan include specific objectives and tasks that are linked to
    measurable outcomes? Are the roles and responsibilities of project
    staff, consultants, and partners clearly defined and linked to
    specific objectives and tasks? Has the applicant adequately planned
    for the appropriate training and technical support necessary for
    project staff, regional affiliates, and identified intake and
    support networks? Has the applicant planned for the involvement of
    the national technical assistance project in facilitating the
    execution of its work plan? (15 points)

c\. [Project Outcomes, Evaluation, and Dissemination]{.underline}
[Weight: 20 points]{.underline}

i.  [Outcomes]{.underline}: Are the expected project benefits and
    results clear, realistic, and consistent with the objectives and
    purpose of the project? Are the anticipated outcomes of the proposed
    project likely to be achieved, and will they significantly assist
    individuals in understanding and enforcing their pension rights? Are
    the proposed outcomes quantifiable and measurable, consistent with
    the definition of a project outcome contained in Section IV.2.b. of
    the Program Announcement? (10 points)

ii. [Evaluation]{.underline}: Does the approach adequately measure
    whether or not the project has achieved its proposed outcome(s)? Is
    the evaluation designed to capture and communicate "lessons learned"
    that might be of use to others in the pension counseling community,
    or those interested in replicating the project? (5 points)

iii. [Dissemination]{.underline}: Will the dissemination plan get
     relevant and easy-to-use information in a timely manner to parties
     that might be interested in making use of its findings,
     particularly to those who might want to replicate the project? Does
     the proposal detail a plan for sharing its findings with all
     appropriate audiences? (5 points)

d\. [Level of Effort]{.underline} [Weight: 30 points]{.underline}

i.  [Capacity]{.underline}: Is the applicant organization, its staff and
    affiliates, sufficiently knowledgeable of pension law, regional
    service delivery, and the range of required counseling, outreach and
    support services to efficiently and effectively undertake the
    proposed intervention? Has the applicant demonstrated capacity and
    experience in using quantitative and/or qualitative performance
    outcome information to support its activity and management
    decisions? (10 points)

ii. [Collaborations]{.underline}: Are letters included, as appropriate,
    from stakeholders and organizations identified as collaborators, and
    do they specify the commitment, role, and resources/activities that
    will be provided in support of the applicant, consistent with the
    work plan description of their intended roles and contributions? (5
    points)

iii. [Staffing]{.underline}: Is the time commitment of project staff,
     consultants, and/or partners appropriate and adequate to carry out
     the project? Is the time commitment of the proposed director and
     other key project personnel sufficient to assure proper direction,
     management, and timely completion of the project? (10 points)

iv. [Budget]{.underline}: Is the project cost-effective and
    programmatically efficient, maximizing Federal and all other
    resources? Is the budget justified with respect to the adequacy and
    reasonableness of resources requested? Are budget line items clearly
    delineated and consistent with work plan objectives and the AoA
    Program purpose? (5 points)

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

########   {#section .unnumbered}

An independent review panel of at least three individuals will evaluate
applications that pass the screening. These reviewers are experts in
their field, and are drawn from academic institutions, non-profit
organizations, state and local government, and federal government
agencies other than AoA. Based on the specific programmatic
considerations as outlined under section I, Funding Opportunity
Description, the reviewers will comment on and score the applications,
focusing their comments and scoring decisions on the criteria identified
above.

Final award decisions will be made by the Assistant Secretary for Aging
(ASA). In making these decisions, the ASA will take into consideration:
recommendations of the review panel; reviews for programmatic and grants
management compliance; the reasonableness of the estimated cost to the
government considering the available funding and anticipated results;
and the likelihood that the proposed project will result in the benefits
expected.

Applicants have the option of omitting from the application copies (not
the original) specific salary rates or amounts for individuals specified
in the application budget and Social Security Numbers. The copies may
include summary salary information.

## VI. AWARD ADMINISTRATION INFORMATION {#vi.-award-administration-information .unnumbered}

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

Successful applicants will receive an Approval Letter, and a Notice of
Award. The Notice of Award is the authorizing document, and will be
signed by the AoA grants management officer, the AoA authorizing
official, and the AoA budget office. Unsuccessful applicants are
notified within 30 days of the final funding decision and will receive a
disapproval letter via U.S. mail.

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

The award is subject to DHHS Administrative Requirements, which can be
found in 45CFR Part 74 and 92 and the Standard Terms and Conditions
implemented through the HHS Grants Policy Statement, October 1, 2006
located at http://www.hhs.gov/grantsnet/adminis/gpd/index.htm.

######## 3. Reporting  {#reporting .unnumbered}

The SF-269 (Financial Status Report) is due annually and the AoA program
progress report is due semi-annually. Final performance and SF-269
reports are due 90 days after the end of the project period. The final
performance report will replace the final semi-annual report. However,
the final performance report should include a discussion of the
activities, progress, and achievements from the last 6 months of the
project along with a summary of the overall project.

## VII. AGENCY CONTACTS  {#vii.-agency-contacts .unnumbered}

Project Officer:

U.S. Department of Health and Human Services

Administration on Aging

Washington, DC 20201

Attn: Valerie Soroka

Telephone: (202) 357-3531, e-mail: <valerie.soroka@aoa.hhs.gov>

Director, Office of Grants Management:

U.S. Department of Health and Human Services

Administration on Aging

Washington, DC 20201

Attn: Stephen Daniels

Telephone: (202) 357-3464, e-mail: <Stephen.Daniels@aoa.hhs.gov>

## VIII. OTHER INFORMATION {#viii.-other-information .unnumbered}

###### A. Application Elements {#a.-application-elements .unnumbered}

To expedite the processing of applications, we request that you arrange
the components of your application in the following order:

1.  SF 424 -- Application for Federal Assistance.

2.  SF 424A -- Budget Information.

3.  Separate Budget Narrative/Justification (See Attachments for Sample
    Format).

4.  SF 424B -- Assurances. Note: Be sure to complete this form according
    to instructions and have it signed and dated by the authorized
    representative (see item 18d on the SF 424).

5.  Certification

6.  Proof of non-profit status

7.  Copy of the applicant\'s most recent indirect cost agreement, as
    necessary.

8.  Project Narrative with Work Plan (See Attachment for Sample Work
    Plan Format).

9.  Organizational Capability Statement and Vitae for Key Project
    Personnel.

10. Letters of Commitment from Key Partners.

11. "Survey on Ensuring Equal Opportunity for Applicants" (Optional
    non-profit applicants)

###### B. The Paperwork Reduction Act of 1995 (P.L. 104-13) {#b.-the-paperwork-reduction-act-of-1995-p.l.-104-13 .unnumbered}

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 project description and budget justification is approved under OMB
control number 0985-0018.

######## Public reporting burden for this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed and reviewing the collection information. {#public-reporting-burden-for-this-collection-of-information-is-estimated-to-average-10-hours-per-response-including-the-time-for-reviewing-instructions-gathering-and-maintaining-the-data-needed-and-reviewing-the-collection-information. .unnumbered}

**ATTACHMENTS**

**Attachment A:**

**Instructions for completing the SF 424, Budget (SF 424A), Budget
Narrative and Other Required Forms**

**Attachment B:**

**Budget Justification Format -- Sample Format with Examples**

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

**Attachment F:**

**"Survey on Ensuring Equal Opportunity for Applicants"**

#  Attachment A

# Instructions for completing the SF 424, Budget (SF 424A), Budget Narrative, and Other Required Forms

  -----------------------------------------------------------------------
  This section provides step-by-step instructions for completing the four
  (4) standard federal forms required as part of your grant application,
  including special instructions for completing Standard Budget Forms 424
  and 424A. Standard Forms 424 and 424A are used for a wide variety of
  federal grant programs, and federal agencies have the discretion to
  require some or all of the information on these forms. AoA does not
  require all the information on these Standard Forms. Accordingly,
  please use the instructions below in lieu of the standard instructions
  attached to SF 424 and 424A to complete these forms. Please note that
  in FY 2006, a new version of the SF 424 is being used for new grants.

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

###### a. Standard Form 424 {#a.-standard-form-424 .unnumbered}

1\. **Type of Submission:** (Required): Select one type of submission in
accordance with agency instructions.

• Preapplication • Application • Changed/Corrected Application -- If AoA
requests, check if this submission is to change or correct a previously
submitted application.

2\. **Type of Application**: (Required) Select one type of application
in accordance with agency instructions.

• New . • Continuation • Revision

3\. **Date Received:** Leave this field blank.

4\. **Applicant Identifier**: Leave this field blank

5a **Federal Entity Identifier**: Leave this field blank

5b. **Federal Award Identifier**: For new applications leave blank. For
a continuation or revision to an existing award, enter the previously
assigned Federal award (grant) number.

6\. **Date Received by State:** Leave this field blank.

7\. **State Application Identifier:** Leave this field blank.

8\. **Applicant Information**: Enter the following in accordance with
agency instructions:

**a. Legal Name**: (Required): Enter the name that the organization has
registered with the Central Contractor Registry. Information on
registering with CCR may be obtained by visiting the Grants.gov website.

**b. Employer/Taxpayer Number (EIN/TIN):** (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by
the Internal Revenue Service.

**c. Organizational DUNS**: (Required) Enter the organization's DUNS or
DUNS+4 number received from Dun and Bradstreet. Information on obtaining
a DUNS number may be obtained by visiting the Grants.gov website.

**d. Address**: (Required) Enter the complete address including the
county.

**e. Organizational Unit:** Enter the name of the primary organizational
unit (and department or division, if applicable**)** that will undertake
the project.

**f. Name and contact information of person to be contacted on matters
involving this application**: Enter the name (First and last name
required), organizational affiliation (if affiliated with an
organization other than the applicant organization), telephone number
(Required), fax number, and email address (Required) of the person to
contact on

matters related to this application.

9\. **Type of Applicant:** (Required) Select the applicant organization
"type" from the following drop down list.

A. State Government B. County Government C. City or Township Government
D. Special District Government E. Regional Organization F. U.S.
Territory or Possession G. Independent School District H. Public/State
Controlled Institution of Higher Education I. Indian/Native American
Tribal Government (Federally Recognized) J. Indian/Native American
Tribal Government (Other than Federally Recognized) K. Indian/Native
American Tribally Designated Organization L. Public/Indian Housing
Authority M. Nonprofit with 501C3 IRS Status (Other than Institution of
Higher Education) N. Nonprofit without 501C3 IRS Status (Other than
Institution of Higher Education) O. Private Institution of Higher
Education P. Individual Q. For-Profit Organization (Other than Small
Business) R. Small Business S. Hispanic-serving Institution T.
Historically Black Colleges and Universities (HBCUs) U. Tribally
Controlled Colleges and Universities (TCCUs) V. Alaska Native and Native
Hawaiian Serving Institutions W. Non-domestic (non-US) Entity X. Other
(specify)

10\. **Name Of Federal Agency**: (Required) Enter U.S. Administration on
Aging

11\. **Catalog Of Federal Domestic Assistance Number/Title:** The CFDA
number can be found on page one of the Program Announcement.

12\. **Funding Opportunity Number/Title:** (Required) The Funding
Opportunity Number and title of the opportunity can be found on page one
of the program announcement.

13\. **Competition Identification Number/Title:** Leave this field
blank.

14\. **Areas Affected By Project:** List the largest political entity
affected (cities, counties, state etc).

15\. **Descriptive Title of Applicant's Project:** (Required) Enter a
brief descriptive title of the project.

16\. **Congressional Districts Of**: (Required) 16a. Enter the
applicant's Congressional District, and 16b. Enter all district(s)
affected by the program or project. Enter in the format: 2 characters
State Abbreviation -- 3 characters District Number, e.g., CA-005 for
California 5th district, CA-012 for California 12^th^ district, NC-103
for North Carolina's 103rd district. • If all congressional districts in
a state are affected, enter "all" for the district number, e.g., MD-all
for all congressional districts in Maryland. • If nationwide, i.e. all
districts within all states are affected, enter US-all.

17\. **Proposed Project Start and End Dates**: (Required) Enter the
proposed start date and end date of the project.

18\. **Estimated Funding:** (Required) Enter the amount requested or to
be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included on
appropriate lines, as applicable. If the action will result in a dollar
change to an existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses.

**NOTE:** Applicants should review cost sharing or matching principles
contained in Subpart C of 45 CFR Part 74 or 45 CFR Part 92 before
completing Item 18 and the Budget Information Sections A, B and C noted
below.

All budget information entered under item 18 should cover the upcoming
budget period. For sub-item 18a, enter the federal funds being
requested. Sub-items 18b-18e is considered matching funds. The dollar
amounts entered in sub-items 18b-18f must total at least 1/3^rd^ of the
amount of federal funds being requested (the amount in 18a). For a full
explanation of AoA's match requirements, see the information in the box
below. For sub-item 18f, enter only the amount, if any, that is going to
be used as part of the required match.

There are three types of match: 1.) non-federal cash; 2.) non-federal
non-cash (i.e., in-kind); and 3.) program income. In general, costs
borne by the applicant and cash contributions of any and all third
parties involved in the project, including sub-grantees, contractors and
consultants, are considered [cash matching funds]{.underline}.
Generally, most contributions from third parties will be non-cash (i.e.,
in-kind) matching funds. Examples of [non-cash (in-kind)
match]{.underline} include: volunteered time and use of facilities to
hold meetings or conduct project activities. A third form of non-federal
match is projected [program income]{.underline} derived from activities
of the project such as participant fees and sale of publications. [Only
program income that is to be used as part of the required match should
be shown on Line 15.]{.underline}

NOTE: **Indirect charges** may only be requested if: (1) the applicant
has a current indirect cost rate agreement approved by the Department of
Health and Human Services or another federal agency; or (2) the
applicant is a state or local government agency. State governments
should enter the amount of indirect costs determined in accordance with
DHHS requirements. **If indirect costs are to be included in the
application, a copy of the approved indirect cost agreement must be
included with the application.**

19\. **Is Application Subject to Review by State Under Executive Order
12372 Process?** Check c. Program is not covered by E.O. 12372

20\. **Is the Applicant Delinquent on any Federal Debt?** (Required)
This question applies to the applicant organization, not the person who
signs as the authorized representative. If yes, include an explanation
on the continuation sheet.

21\. **Authorized Representative**: (Required) To be signed and dated by
the authorized representative of the applicant organization. Enter the
name (First and last name required) title (Required), telephone number
(Required), fax number, and email address (Required) of the person
authorized to sign for the applicant. A copy of the governing body's
authorization for you to sign this application as the official
representative must be on file in the applicant's office. (Certain
Federal agencies may require that this authorization be submitted as
part of the application.)

**b. Standard Form 424A**

+-----------------------------------------------------------------------+
| > NOTE: Standard Form 424A is designed to accommodate applications    |
| > for multiple grant programs; thus, for purposes of this AoA         |
| > program, many of the budget item columns and rows are not           |
| > applicable. You should only consider and respond to the budget      |
| > items for which guidance is provided below. Unless otherwise        |
| > indicated, the SF 424A should reflect a one year budget.            |
+-----------------------------------------------------------------------+

##### Section A ‑ Budget Summary {#section-a-budget-summary .unnumbered}

> [Line 5]{.underline}: Leave columns ( c) and (d) blank. Enter TOTAL
> federal costs in column (e) and total non‑federal costs (including
> third party in‑kind contributions and any program income to be used as
> part of the grantee match) in column (f). Enter the sum of columns (e)
> and (f) in column (g).

##### Section B ‑ Budget Categories {#section-b-budget-categories .unnumbered}

> Column 3: Enter the breakdown of how you plan to use the federal funds
> being
>
> requested by object class category (see instructions for each object
> class category below).
>
> Column 4: Enter the breakdown of how you plan to use the non-federal
> share by object class category.
>
> Column 5: Enter the total funds required for the project (the sum of
> Columns 3 and 4) by object class category.

+-----------------------------------------------------------------------+
| ###### Separate Budget Narrative/Justification Requirem               |
| ent {#separate-budget-narrativejustification-requirement .unnumbered} |
|                                                                       |
| > You must submit a separate budget narrative as part of your         |
| > application. **A blank sample format (and one with examples) has    |
| > been included in the attachments for your use in developing and     |
| > presenting your Budget Narrative.** In your budget justification,   |
| > you should include a breakdown of the budget which shows the costs  |
| > for all of the object class categories noted in Section B, across   |
| > three columns: federal; non-federal cash; and non-federal in-kind.  |
| > The justification should fully explain and justify the costs in     |
| > each of the major budget items for each of the object class         |
| > categories, as described below. Third party in-kind contributions   |
| > and program income designated as non-federal match contributions    |
| > should be clearly identified and justified separately from the      |
| > justification for the budget line items. The full budget            |
| > justification should be included in the application immediately     |
| > following the SF 424 forms. **The budget justification should       |
| > provide a detailed breakdown of large dollar values.**              |
+-----------------------------------------------------------------------+

> [Line 6a]{.underline}: [Personnel]{.underline}: Enter total costs of
> salaries and wages of applicant/grantee staff. Do not include the
> costs of consultants; consultant costs should be included under 6h ‑
> Other. [In the Justification]{.underline}: Identify the project
> director, if known. Specify the key staff, their titles, brief summary
> of project related duties, and the percent of their time commitments
> to the project in the budget justification.
>
> [Line 6b]{.underline}: [Fringe Benefits]{.underline}: Enter the total
> costs of fringe benefits unless treated as part of an approved
> indirect cost rate. [In the Justification]{.underline}: Provide a
> break‑down of amounts and percentages that comprise fringe benefit
> costs, such as health insurance, FICA, retirement insurance, etc.
>
> [Line 6c]{.underline}: [Travel]{.underline}: Enter total costs of
> [out‑of‑town travel]{.underline} (travel requiring per diem) for staff
> of the project. Do not enter costs for consultant\'s travel - this
> should be included in line 6h. [In the Justification]{.underline}:
> Include the total number of trips, destinations, purpose, length of
> stay, subsistence allowances and transportation costs (including
> mileage rates).
>
> [Line 6d]{.underline}: [Equipment]{.underline}: Enter the total costs
> of all equipment to be acquired by the project. For all grantees,
> \"equipment\" is non‑expendable tangible personal property having a
> useful life of more than one year and an acquisition cost of \$5,000
> or more per unit. If the item does not meet the \$5,000 threshold,
> include it in your budget under Supplies, line 6e. [In the
> Justification]{.underline}: Equipment to be purchased with federal
> funds must be justified as necessary for the conduct of the project.
> The equipment must be used for project-related functions; the
> equipment, or a reasonable facsimile, must not be otherwise available
> to the applicant or its sub‑grantees. The justification also must
> contain plans for the use or disposal of the equipment after the
> project ends.
>
> [Line 6e]{.underline}: [Supplies:]{.underline} Enter the total costs
> of all tangible expendable personal property
>
> (supplies) other than those included on line 6d. [In the
> Justification:]{.underline} Provide general description of types of
> items included.
>
> [Line 6f]{.underline}: [Contractual]{.underline}: Enter the total
> costs of all contracts, including (1) procurement
>
> contracts (except those, which belong on other lines such as
> equipment, supplies, etc.). Also include any contracts with
> organizations for the provision of technical assistance. Do not
> include payments to individuals on this line. [In the
> Justification]{.underline}: Attach a list of contractors indicating
> the name of the organization, the purpose of the contract, and the
> estimated dollar amount. If the name of the contractor, scope of work,
> and estimated costs are not available or have not been negotiated,
> indicate when this information will be available. Whenever the
> applicant/grantee intends to delegate a substantial part (one-third,
> or more) of the project work to another agency, the applicant/grantee
> must provide a completed copy of Section B, Budget Categories for each
> contractor, along with supporting information and justifications.
>
> [Line 6g]{.underline}: [Construction]{.underline}: Leave blank since
> construction is not an allowable cost under this AoA program.
>
> [Line 6h]{.underline}: [Other]{.underline}: Enter the total of all
> other costs. Such costs, where applicable, may
>
> include, but are not limited to: insurance, medical and dental costs
> (i.e. for project volunteers this is different from personnel fringe
> benefits); non-contractual fees and travel paid directly to
> *individual* consultants; [local]{.underline} transportation (all
> travel which does not require per diem is considered local travel);
> postage; space and equipment rentals/lease; printing and publication;
> computer use; training and staff development costs (i.e. registration
> fees). If a cost does not clearly fit under another category, and it
> qualifies as an allowable cost, then rest assured this is where it
> belongs. [In the Justification:]{.underline} Provide a reasonable
> explanation for items in this category. For individual consultants,
> explain the nature of services provided and the relation to activities
> in the work plan. Describe the types of activities for staff
> development costs.
>
> [Line 6i]{.underline}: [Total Direct Charges]{.underline}: Show the
> totals of Lines 6a through 6h.
>
> [Line 6j]{.underline}: [Indirect Charges]{.underline}: Enter the total
> amount of indirect charges (costs), if any. If
>
> no indirect costs are requested, enter \"none.\" Indirect charges may
> be requested if: (1) the applicant has a current indirect cost rate
> agreement approved by the Department of Health and Human Services or
> another federal agency; or (2) the applicant is a state or local
> government agency.
>
> Justification: [State governments should enter the amount of indirect
> costs determined in accordance with DHHS requirements]{.underline}. An
> applicant that will charge indirect costs to the grant must enclose a
> copy of the current rate agreement. If the applicant organization is
> in the process of initially developing or renegotiating a rate, it
> should immediately upon notification that an award will be made,
> develop a tentative indirect cost rate proposal based on its most
> recently completed fiscal year in accordance with the principles set
> forth in the cognizant agency\'s guidelines for establishing indirect
> cost rates, and submit it to the cognizant agency. Applicants awaiting
> approval of their indirect cost proposals may also request indirect
> costs. It should be noted that when an indirect cost rate is
> requested, those costs included in the indirect cost pool should not
> also be charged as direct costs to the grant. Also, if the applicant
> is requesting a rate which is less than what is allowed under the
> program, the authorized representative of the applicant organization
> must submit a signed acknowledgement that the applicant is accepting a
> lower rate than allowed.
>
> [Line 6k]{.underline}: [Total]{.underline}: Enter the total amounts of
> Lines 6i and 6j.
>
> [Line 7]{.underline}: [Program Income]{.underline}: As appropriate,
> include the estimated amount of income, if any, you expect to be
> generated from this project that you wish to designate as match (equal
> to the amount shown for Item 15(f) on Form 424). [Note]{.underline}:
> Any program income indicated at the bottom of Section B and for item
> 15(f) on the face sheet of Form 424 will be included as part of
> non-Federal match and will be subject to the rules for documenting
> completion of this pledge. If program income is expected, but is not
> needed to achieve matching funds, do not include that portion here or
> on Item 15(f) of the Form 424 face sheet. Any anticipated program
> income that will not be applied as grantee match should be described
> in the Level of Effort section of the Program Narrative.

##### Section C ‑ Non‑Federal Resources {#section-c-nonfederal-resources .unnumbered}

> [Line 12]{.underline}: Enter the amounts of non‑Federal resources that
> will be used in carrying out the proposed project, by source
> (Applicant; State; Other) and enter the total amount in Column (e). Do
> not include program income unless it is used to meet the match
> requirement. Keep in mind that if program income used to meet the
> match requirement and the projected level of program income is not
> met, thereby decreasing the level of match, the amount of federal
> funds available to the grantee may be reduced if the match falls below
> required levels.
>
> [Section D ‑ Forecasted Cash Needs]{.underline} - Not applicable.
>
> [Section E ‑ Budget Estimate of Federal Funds Needed for Balance of
> the Project]{.underline}
>
> [Line 20]{.underline}: NOTE: Leave this line blank. Section E is
> relevant only for multi-year grant applications, where the project
> period is 24 months or longer. This section does not apply to grant
> awards where the project period is less than 17 months.

###### Section F ‑ Other Budget Information {#section-f-other-budget-information .unnumbered}

> [Line 22]{.underline}: [Indirect Charges]{.underline}: Enter the type
> of indirect rate (provisional, predetermined,
>
> final or fixed) to be in effect during the funding period, the base to
> which the rate is applied, and the total indirect costs. Include a
> copy of your current Indirect Cost Rate Agreement.
>
> [Line 23]{.underline}: [Remarks]{.underline}: Provide any other
> comments deemed necessary.

###### c. Standard Form 424B - Assurances {#c.-standard-form-424b---assurances .unnumbered}

> This form contains assurances required of applicants under the
> discretionary funds programs administered by the Administration on
> Aging. Please note that a duly authorized representative of the
> applicant organization must certify that the organization is in
> compliance with these assurances.

###### d. Certification Regarding Lobbying {#d.-certification-regarding-lobbying .unnumbered}

> This form contains certifications that are required of the applicant
> organization regarding (a) lobbying; (b) debarment, suspension, and
> other responsibility matters; and (c) drug-free workplace
> requirements. Please note that a duly authorized representative of the
> applicant organization must attest to the applicant's compliance with
> these certifications.

###### e. Other Application Components {#e.-other-application-components .unnumbered}

**Survey on Ensuring Equal Opportunity for Applicants**

> The Office of Management and Budget (OMB) has approved an HHS form to
> collect information on the number of faith-based groups applying for a
> HHS grant. Non-profit organizations, excluding private universities,
> are asked to include a completed survey with their grant application
> packet. Attached you will find the OMB approved HHS "Survey on
> Ensuring Equal Opportunity for Applicants" form (Attachment G). Your
> help in this data collection process is greatly appreciated.

**Proof of Non-Profit Status**

> Non-profit applicants must submit proof of non-profit status. Any of
> the following constitutes acceptable proof of such status:
>
> A copy of a currently valid IRS tax exemption certificate.
>
> A statement from a State taxing body, State attorney general, or other
> appropriate State official certifying that the applicant organization
> has a non-profit status and that none of the net earnings accrue to
> any private shareholders or individuals.
>
> A certified copy of the organization's certificate of incorporation or
> similar document that clearly establishes non-profit status.

## Indirect Cost Agreement {#indirect-cost-agreement .unnumbered}

> Applicants that have included indirect costs in their budgets must
> include a copy of the current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency.
> This is optional for applicants that have not included indirect costs
> in their budgets.

**Attachment B: Budget Narrative, Page 1 -- Sample Format with
EXAMPLES**

+---------+-------+------+------+--------+----------------------------+
| > *     | **Fe  | **N  | **N  | #      | ### Justification {#       |
| *Object | deral | on-F | on-F |  TOTAL | justification .unnumbered} |
| > Class | Fu    | eder | eder |        |                            |
| > Cat   | nds** | al** | al** |        |                            |
| egory** |       |      |      |        |                            |
|         |       | **Ca | **I  |        |                            |
|         |       | sh** | n-Ki |        |                            |
|         |       |      | nd** |        |                            |
+---------+-------+------+------+--------+----------------------------+
| **Pers  | \$4   |      | \$5  | \$     | Project Supervisor (name)  |
| onnel** | 0,000 |      | ,000 | 45,000 | = .3FTE @ \$50,000/yr =    |
|         |       |      |      |        | \$15,000                   |
|         |       |      |      |        |                            |
|         |       |      |      |        | Project Director (name) =  |
|         |       |      |      |        | 1FTE @ \$30,000 = \$30,000 |
+---------+-------+------+------+--------+----------------------------+
| *       | \$1   | 0    | 0    | \$     | Fringes on Supervisor and  |
| *Fringe | 2,600 |      |      | 12,600 | Director @ 28% of salary.  |
| Ben     |       |      |      |        |                            |
| efits** |       |      |      |        | FICA (7.65%) = \$3,442     |
|         |       |      |      |        |                            |
|         |       |      |      |        | Health (12%) = \$5,400     |
|         |       |      |      |        |                            |
|         |       |      |      |        | Dental (5%) = \$2,250      |
|         |       |      |      |        |                            |
|         |       |      |      |        | Life (2%) = \$ 900         |
|         |       |      |      |        |                            |
|         |       |      |      |        | Workers Comp Insurance     |
|         |       |      |      |        | (.75%) = \$ 338            |
|         |       |      |      |        |                            |
|         |       |      |      |        | Unemployment Insurance     |
|         |       |      |      |        | (.6%) = \$ 270             |
+---------+-------+------+------+--------+----------------------------+
| **T     | \$    | 0    | \$   | \      | Travel to Annual Grantee   |
| ravel** | 3,000 |      | 967  | $3,967 | Meeting:                   |
|         |       |      |      |        |                            |
|         |       |      |      |        | Airfare: 1 RT x 2 people x |
|         |       |      |      |        | \$750/RT = \$1,500         |
|         |       |      |      |        |                            |
|         |       |      |      |        | Lodging: 3 nights x 2      |
|         |       |      |      |        | people x \$100/night = \$  |
|         |       |      |      |        | 600                        |
|         |       |      |      |        |                            |
|         |       |      |      |        | Per Diem: 4 days x 2       |
|         |       |      |      |        | people x \$40/day = \$ 320 |
|         |       |      |      |        |                            |
|         |       |      |      |        | Out-of-Town Project Site   |
|         |       |      |      |        | Visits                     |
|         |       |      |      |        |                            |
|         |       |      |      |        | Car mileage: 3 trips x 2   |
|         |       |      |      |        | people x 350 miles/trip    |
|         |       |      |      |        |                            |
|         |       |      |      |        | x \$ .365/mile = \$ 767    |
|         |       |      |      |        |                            |
|         |       |      |      |        | Lodging: 3 trips x 2       |
|         |       |      |      |        | people x 1 night/ trip     |
|         |       |      |      |        |                            |
|         |       |      |      |        | x \$50/night = \$300       |
|         |       |      |      |        |                            |
|         |       |      |      |        | Per Diem: 3 trips x 2      |
|         |       |      |      |        | people x 2days/trip        |
|         |       |      |      |        |                            |
|         |       |      |      |        | x \$40/day = \$480         |
+---------+-------+------+------+--------+----------------------------+

Attachment B: Budget Narrative, Page 2 - Sample Format with EXAMPLES

+-----+-------+------+------+------+----------------------------------+
| **  | *     | #### | *    | #    | ### Justificatio                 |
| Obj | *Fede | # No | *Non | ###  | n {#justification-1 .unnumbered} |
| ect | ral** | n-Fe | -Fed | *[TO |                                  |
| C   |       | dera | eral | TAL] |                                  |
| las | #     | l {# | I    | {.un |                                  |
| s** | Funds | non- | n-Ki | derl |                                  |
|     |       | fede | nd** | ine} |                                  |
| **C |       | ral  |      | * {# |                                  |
| ate |       | .unn |      | tota |                                  |
| gor |       | umbe |      | l-1  |                                  |
| y** |       | red} |      | .unn |                                  |
|     |       |      |      | umbe |                                  |
|     |       | ##   |      | red} |                                  |
|     |       | ###  |      |      |                                  |
|     |       | Cash |      |      |                                  |
|     |       |  {#c |      |      |                                  |
|     |       | ash  |      |      |                                  |
|     |       | .unn |      |      |                                  |
|     |       | umbe |      |      |                                  |
|     |       | red} |      |      |                                  |
+-----+-------+------+------+------+----------------------------------+
| *   | 0     | 0    | 0    | 0    | No equipment requested           |
| *Eq |       |      |      |      |                                  |
| uip |       |      |      |      |                                  |
| men |       |      |      |      |                                  |
| t** |       |      |      |      |                                  |
+-----+-------+------+------+------+----------------------------------+
| **S | \$    |      | \$2  | \$3  | Laptop computer for use in       |
| upp | 1,500 |      | ,000 | ,500 | client intakes = \$1,340         |
| lie |       |      |      |      |                                  |
| s** |       |      |      |      | Consumable supplies (paper,      |
|     |       |      |      |      | pens, etc.)                      |
|     |       |      |      |      |                                  |
|     |       |      |      |      | \$100/mo x 12 months = \$1,200   |
|     |       |      |      |      |                                  |
|     |       |      |      |      | Copying \$80/mo x 12 months = \$ |
|     |       |      |      |      | 960                              |
+-----+-------+------+------+------+----------------------------------+
| **C | \$20  | \$50 | 0    | \    | Contracts to A,B,C direct        |
| ont | 0,000 | ,000 |      | $250 | service providers (name          |
| rac |       |      |      | ,000 | providers)                       |
| tua |       |      |      |      |                                  |
| l** |       |      |      |      | adult day care contractor =      |
|     |       |      |      |      | \$75,000                         |
|     |       |      |      |      |                                  |
|     |       |      |      |      | respite care contractor in home= |
|     |       |      |      |      | \$75,000                         |
|     |       |      |      |      |                                  |
|     |       |      |      |      | respite care contractor-NF =     |
|     |       |      |      |      | \$50,000                         |
|     |       |      |      |      |                                  |
|     |       |      |      |      | personal care/companion provider |
|     |       |      |      |      | = \$50,000                       |
|     |       |      |      |      |                                  |
|     |       |      |      |      | See detailed budget              |
|     |       |      |      |      | justification for each provider  |
|     |       |      |      |      | (and then provide it!)           |
+-----+-------+------+------+------+----------------------------------+

+-----+-----+------+------+------+-----------------------------------+
| A   |     |      |      |      |                                   |
| tta |     |      |      |      |                                   |
| chm |     |      |      |      |                                   |
| ent |     |      |      |      |                                   |
| B:  |     |      |      |      |                                   |
| Bud |     |      |      |      |                                   |
| get |     |      |      |      |                                   |
| N   |     |      |      |      |                                   |
| arr |     |      |      |      |                                   |
| ati |     |      |      |      |                                   |
| ve, |     |      |      |      |                                   |
| P   |     |      |      |      |                                   |
| age |     |      |      |      |                                   |
| 3   |     |      |      |      |                                   |
| --  |     |      |      |      |                                   |
| Sam |     |      |      |      |                                   |
| ple |     |      |      |      |                                   |
| For |     |      |      |      |                                   |
| mat |     |      |      |      |                                   |
| w   |     |      |      |      |                                   |
| ith |     |      |      |      |                                   |
| EX  |     |      |      |      |                                   |
| AMP |     |      |      |      |                                   |
| LES |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **O | \$  | \$8  | \$19 | \$37 | Local conference registration fee |
| the | 10, | ,000 | ,800 | ,800 | (name conference) = \$ 200        |
| r** | 000 |      |      |      |                                   |
|     |     |      |      |      | Printing brochures (50,000 @ \$   |
|     |     |      |      |      | .05 ea) = \$ 2,500                |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video production = \$19,800       |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video Reproduction = \$ 3,500     |
|     |     |      |      |      |                                   |
|     |     |      |      |      | NF Respite Training Manual        |
|     |     |      |      |      | reproduction                      |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$3/manual x \$2000 manuals = \$  |
|     |     |      |      |      | 6,000                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Postage \$150/mo x 12 months = \$ |
|     |     |      |      |      | 1,800                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Caregiver Forum meeting room      |
|     |     |      |      |      | rentals                           |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$200/day x 12 forums = \$ 2,400  |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Respite Training Scholarships =   |
|     |     |      |      |      | \$1,600                           |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | None                              |
| *In |     |      |      |      |                                   |
| dir |     |      |      |      |                                   |
| ect |     |      |      |      |                                   |
| Cha |     |      |      |      |                                   |
| rge |     |      |      |      |                                   |
| s** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| #   | \$2 | \$58 | \$27 | \    |                                   |
| ### | 67, | ,000 | ,767 | $352 |                                   |
| # T | 100 |      |      | ,267 |                                   |
| OTA |     |      |      |      |                                   |
| L { |     |      |      |      |                                   |
| #to |     |      |      |      |                                   |
| tal |     |      |      |      |                                   |
| -2  |     |      |      |      |                                   |
| .un |     |      |      |      |                                   |
| num |     |      |      |      |                                   |
| ber |     |      |      |      |                                   |
| ed} |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+

Attachment C: Budget Narrative -- Page 1 -- Sample Format

+-----+-----+-----+-----+--------+-----------------------------------+
| >   | **F | **N | **N | #      | ### Justificati                   |
|  ** | ede | on- | on- |  TOTAL | on {#justification-2 .unnumbered} |
| Obj | ral | Fed | Fed |        |                                   |
| ect | F   | era | era |        |                                   |
| >   | und | l** | l** |        |                                   |
|  Cl | s** |     |     |        |                                   |
| ass |     | **  | **  |        |                                   |
| > C |     | Cas | In- |        |                                   |
| ate |     | h** | Kin |        |                                   |
| gor |     |     | d** |        |                                   |
| y** |     |     |     |        |                                   |
+-----+-----+-----+-----+--------+-----------------------------------+
| *   |     |     |     |        |                                   |
| *Pe |     |     |     |        |                                   |
| rso |     |     |     |        |                                   |
| nne |     |     |     |        |                                   |
| l** |     |     |     |        |                                   |
+-----+-----+-----+-----+--------+-----------------------------------+
| **  |     |     |     |        |                                   |
| Fri |     |     |     |        |                                   |
| nge |     |     |     |        |                                   |
| B   |     |     |     |        |                                   |
| ene |     |     |     |        |                                   |
| fit |     |     |     |        |                                   |
| s** |     |     |     |        |                                   |
+-----+-----+-----+-----+--------+-----------------------------------+
| *   |     |     |     |        |                                   |
| *Tr |     |     |     |        |                                   |
| ave |     |     |     |        |                                   |
| l** |     |     |     |        |                                   |
+-----+-----+-----+-----+--------+-----------------------------------+
| *   |     |     |     |        |                                   |
| *Eq |     |     |     |        |                                   |
| uip |     |     |     |        |                                   |
| men |     |     |     |        |                                   |
| t** |     |     |     |        |                                   |
+-----+-----+-----+-----+--------+-----------------------------------+

**Attachment C: Budget Narrative -- Page 2 -- Sample Format**

+-----+------+------+----+--------+-----------------------------------+
| >   | *    | **N  | *  | #      | ### Justificati                   |
|  ** | *Fed | on-F | *N |  TOTAL | on {#justification-3 .unnumbered} |
| Obj | eral | eder | on |        |                                   |
| ect | Fun  | al** | -F |        |                                   |
| >   | ds** |      | ed |        |                                   |
|  Cl |      | **Ca | er |        |                                   |
| ass |      | sh** | al |        |                                   |
| > C |      |      | ** |        |                                   |
| ate |      |      |    |        |                                   |
| gor |      |      | *  |        |                                   |
| y** |      |      | *I |        |                                   |
|     |      |      | n- |        |                                   |
|     |      |      | Ki |        |                                   |
|     |      |      | nd |        |                                   |
|     |      |      | ** |        |                                   |
+-----+------+------+----+--------+-----------------------------------+
| **S |      |      |    |        |                                   |
| upp |      |      |    |        |                                   |
| lie |      |      |    |        |                                   |
| s** |      |      |    |        |                                   |
+-----+------+------+----+--------+-----------------------------------+
| **C |      |      |    |        |                                   |
| ont |      |      |    |        |                                   |
| rac |      |      |    |        |                                   |
| tua |      |      |    |        |                                   |
| l** |      |      |    |        |                                   |
+-----+------+------+----+--------+-----------------------------------+
| **O |      |      |    |        |                                   |
| the |      |      |    |        |                                   |
| r** |      |      |    |        |                                   |
+-----+------+------+----+--------+-----------------------------------+
| *   |      |      |    |        |                                   |
| *In |      |      |    |        |                                   |
| dir |      |      |    |        |                                   |
| ect |      |      |    |        |                                   |
| Cha |      |      |    |        |                                   |
| rge |      |      |    |        |                                   |
| s** |      |      |    |        |                                   |
+-----+------+------+----+--------+-----------------------------------+
| #   |      |      |    |        |                                   |
| ### |      |      |    |        |                                   |
| # T |      |      |    |        |                                   |
| OTA |      |      |    |        |                                   |
| L { |      |      |    |        |                                   |
| #to |      |      |    |        |                                   |
| tal |      |      |    |        |                                   |
| -5  |      |      |    |        |                                   |
| .un |      |      |    |        |                                   |
| num |      |      |    |        |                                   |
| ber |      |      |    |        |                                   |
| ed} |      |      |    |        |                                   |
+-----+------+------+----+--------+-----------------------------------+

Attachment D: Project Work Plan, Page 1 -- Sample Format

  --------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Goal:**                                                                                                                                                  

  **Measurable                                                                                                                                               
  Outcome(s):**                                                                                                                                              

  **Major         **Key Tasks**                   **Lead     **Timeframe                                                                                     
  Objectives**                                    Person**   (Start and                                                                                      
                                                             End Date by                                                                                     
                                                             Month)**                                                                                        

                                                             **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  1\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

                                                                                                                                                             

  2\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

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

Attachment D: Project Work Plan, Page 2 -- Sample Format

  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                   **Lead     **Timeframe                                                                                     
  Objectives**                                   Person**   (Start and                                                                                      
                                                            End Date by                                                                                     
                                                            Month)**                                                                                        

                                                            **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  3\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  4\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

Attachment D: Project Work Plan, Page 3 -- Sample Format

  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                   **Lead     **Timeframe                                                                                     
  Objectives**                                   Person**   (Start and                                                                                      
                                                            End Date by                                                                                     
                                                            Month)**                                                                                        

                                                            **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  5\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  6\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

NOTE: Please do note infer from this sample format that your work plan
must have 6 major objectives. If you need more pages, simply repeat this
format on additional pages.

**Attachment E**

Instructions for Completing the Project Summary/Abstract

-   All applications for grant funding must include a Summary/Abstract
    that concisely describes the proposed project. It should be written
    for the general public.

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-   To ensure uniformity, please limit the length to no more than 265
    words on a single page with a font size of not less than 11,
    doubled-spaced.

-   The abstract must include the project's goal(s), objectives, overall
    approach (including target population and significant partnerships),
    anticipated outcomes, products, and duration. The following are very
    simple descriptions of these terms, and a sample Compendium
    abstract.

> **Goal(s)** -- broad, overall purpose, usually in a mission statement,
> i.e. what you want to do, where you want to be
>
> **Objective(s)** -- narrow, more specific, identifiable or measurable
> steps toward a goal. Part of the planning process or sequence (the
> "how"). Specific performances which will result in the attainment of a
> goal.
>
> **Outcomes -** measurable results of a project. Positive benefits or
> negative changes, or measurable characteristics that occur as a result
> of an organization's or program's activities. (outcomes are the
> end-point)

**Products --** materials, deliverables.

-   A model abstract/summary is provided below:

The grantee, Okoboji University, supports this three year Dementia
Disease demonstration (DD) project in collaboration with the local
Alzheimer's Association and related Dementias groups. The
[goal]{.underline} of the project is to provide comprehensive,
coordinated care to individuals with memory concerns and to their
caregivers. The approach is to expand the services and to integrate the
bio-psycho-social aspects of care. The [objectives]{.underline} are: 1)
to provide dementia specific care, i.e., care management fully
integrated into the services provided; 2) to train staff, students and
volunteers; 3) to establish a system infrastructure to support services
to individuals with early stage dementia and to their caregivers; 4) to
develop linkages with community agencies; 5) to expand the assessment
and intervention services; 6) to evaluate the impact of the added
services; 7) to disseminate project information. The expected
[outcomes]{.underline} of this DD project are: patients will maintain as
high a level of mental function and physical functions (thru Yoga) as
possible; caregivers will increase ability to cope with changes; and pre
and post -- project patient evaluation will reflect positive results
from expanded and integrated services. The [products]{.underline} from
this project are: a final report, including evaluation results; a
website; articles for publication; data on driver assessment and in-home
cognitive retraining; abstracts for national conferences.

**Applicant's (Organization) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Grant Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_\_\_**

1\. Does the applicant have 501(c)(3) status?

Yes No

2\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

3\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

4\. Is the applicant a faith-based/religious\
organization?

Yes No

5\. Is the applicant a non-religious community-based organization?

Yes No

6\. Is the applicant an intermediary that will manage the grant on
behalf of other organizations?

> Yes No

7\. Has the applicant ever received a government grant or contract
(Federal, State, or local )?

Yes No

8\. Is the applicant a local affiliate of a national\
organization?

Yes No

# Survey Instructions on Ensuring Equal Opportunity for Applicants

**Provide the applicant's (organization) name and DUNS number and the
grant name and CFDA number.**

1\. 501(c)(3) status is a legal designation provided on application to
the Internal Revenue Service by eligible organizations. Some grant
programs may require nonprofit applicants to have 501(c)(3) status.
Other grant programs do not.

2\. For example, two part-time employees who each work half-time equal
one full-time equivalent employee. If the applicant is a local affiliate
of a national organization, the responses to survey questions 2 and 3
should reflect the staff and budget size of the local affiliate.

3\. Annual budget means the amount of money your organization spends
each year on all of its activities.

4\. Self-identify.

5\. An organization is considered a community-based organization if its
headquarters/service location shares the same zip code as the clients
you serve.

6\. An "intermediary" is an organization that enables a group of small
organizations to receive and manage government funds by administering
the grant on their behalf.

7.  Self-explanatory.

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7.  Self-explanatory.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
2202-4651.

**If you have comments or concerns regarding the status of your
individual submission of this form, write directly to:** Joyce I. Mays,
Application Control Center, U.S. Department of Education, 7^th^ and D
Streets, SW, ROB-3, Room 3671, Washington, D.C. 20202-4725

> OMB No. 1890-0014 Exp. 1/31/20

[^1]: see
    [http://www.aoa.gov/about/strategic/AoA%20Strategic%20Action%20Plan%202007-2012.pdf](http://www.aoa.gov/about/strategic/AoA Strategic Action Plan 2007-2012.pdf)