Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Projects to Deliver**

**Peer-to-Peer Recovery Support Services**

**Short Title: Recovery Community Services Program -- RCSP**

**(Initial Announcement)**

**Request for Applications (RFA) No. TI-07-002**

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **February 28, 2007**                         |
| Deadline**           |                                               |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Letters from State Single Point of Contact  |
| Review**             | (SPOC) are due no later than 60 days after    |
|                      | application deadline.**                       |
| **(E.O. 12372)**     |                                               |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by application deadline. Comments from Single |
| (PHSIS)/Single State | State Agency are due no later than 60 days    |
| Agency               | after application deadline.**                 |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

Number range CHAPTER

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

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Eric B. Broderick,
D.D.S., M.P.H.

Director Acting Deputy Administrator

Center for Substance Abuse Treatment Assistant Surgeon General

Substance Abuse and Mental Health Substance Abuse and Mental Health
Services Administration Services Administration

> **Table of Contents**

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

[1. INTRODUCTION 5](#introduction)

[2. EXPECTATIONS 5](#expectations)

[**II.** **AWARD INFORMATION** 11](#award-information)

[**III.** **ELIGIBILITY INFORMATION** 11](#eligibility-information)

[1. ELIGIBLE APPLICANTS 11](#eligible-applicants)

[2. COST-SHARING 12](#cost-sharing)

[3. OTHER 12](#other)

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

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

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

[3. SUBMISSION DATES AND TIMES 16](#submission-dates-and-times)

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

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

[6. OTHER SUBMISSION REQUIREMENTS 20](#other-submission-requirements)

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

[1. EVALUATION CRITERIA 21](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 28](#review-and-selection-process)

[**VI.** **AWARD ADMINISTRATION INFORMATION**
28](#award-administration-information)

[1. AWARD NOTICES 28](#award-notices)

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

[3. REPORTING REQUIREMENTS 29](#reporting-requirements)

[**VII.** **AGENCY CONTACTS** 30](#agency-contacts)

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

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

[**Appendix C: References Cited** 37](#appendix-c-references-cited)

[**Appendix D: Four Types of Peer Social Support including service
categories and examples**
38](#appendix-d-four-types-of-peer-social-support-including-service-categories-and-examples)

[**Appendix E: Core Values for RCSP Peer-to-Peer Recovery Support
Services**
39](#appendix-e-core-values-for-rcsp-peer-to-peer-recovery-support-services)

[**Appendix F: Sample Consent Form for Participation in Peer-to-Peer
Recovery Support Services**
40](#appendix-f-sample-consent-form-for-participation-in-peer-to-peer-recovery-support-services)

[**Appendix G: Analysis of Examples of Risks and Protections for Peer
Recovery Support Services**
42](#appendix-g-analysis-of-examples-of-risks-and-protections-for-peer-recovery-support-services)

[**Appendix H: Additional Consideration: Peer vs. Professional Support
Services**
45](#appendix-h-additional-consideration-peer-vs.-professional-support-services)

[**Appendix I: Glossary** 46](#appendix-i-glossary)

[**Appendix J: RCO/FO Designation and Statement of Assurance**
47](#appendix-j-rcofo-designation-and-statement-of-assurance)

[**Appendix K: Confidentiality and Participant Protection**
48](#appendix-k-confidentiality-and-participant-protection)

[Appendix L: Sample RCSP Budget 52](#appendix-l-sample-rcsp-budget)

**Executive Summary:**

The Substance Abuse and Mental Health Services Administration, Center
for Substance Abuse Treatment is accepting applications for fiscal year
(FY) 2007 for Recovery Community Services Program grants. The purpose of
this program is to deliver **peer-to-peer recovery support services**
that help prevent relapse and promote sustained recovery from alcohol
and drug use disorders. Successful applicants will provide peer-to-peer
recovery support services that are responsive to community needs and
strengths, and will carry out a performance assessment of these
services.

#  {#section .unnumbered}

**Funding Opportunity Title:** Recovery Community Services Program

**Funding Opportunity Number:** TI-07-002

**Due Date for Applications:** February 28, 2007

**Anticipated Total Available Funding:** \$2.9 million

**Estimated Number of Awards:** 8

**Estimated Award Amount:** Up to \$350,000

**Length of Project Period:** Up to 4 years

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

#   {#section-1 .unnumbered}

# FUNDING OPPORTUNITY DESCRIPTION

## INTRODUCTION

TNumber range CHAPTERhe Substance Abuse and Mental Health Services
Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT)
announces the availability of FY 2007 funds for grants to deliver
**peer-to-peer recovery support services** that help prevent relapse and
promote sustained recovery from alcohol and drug use disorders.
Successful applicants will provide peer-to-peer recovery support
services that are responsive to community needs and strengths, and will
carry out a performance assessment of these services.

Recovery Community Services Program (RCSP) grants are authorized under
section 509 of the Public Health Service Act, as amended. This
announcement addresses Healthy People 2010 focus area 26 (Substance
Abuse).

## EXPECTATIONS

**2.1 Target/Involved Population**

The primary target for this program is people with a history of alcohol
and/or drug problems who are in or seeking recovery, along with their
family members and significant others, who will be both the providers
and recipients of recovery support services. For purposes of this
document, the term *peer* means people who share the experience of
addiction and recovery, either directly or as family members/significant
others.

#  {#section-2 .unnumbered}

**2.2 Eligible Services**

Peer-to-peer recovery support services are designed and delivered by
peers in recovery. Successful peer recovery support services initiatives
will network and build strong and mutually supportive relationships with
formal systems in their communities (i.e., treatment programs, housing,
transportation, justice, education). However, peer services will be
designed and delivered primarily by individuals in recovery to meet the
targeted community's recovery support needs, as the community defines
them. Therefore, although supportive of formal treatment, peer recovery
support services are not treatment in the commonly understood clinical
sense of the term.

At the same time, peer recovery support services are expected to extend
and enhance the treatment continuum in at least two ways. These services
will help prevent relapse and promote long-term recovery, thereby
reducing the strain on the over-burdened treatment system. Moreover,
when individuals do experience relapse, recovery support services can
help minimize the negative effects through early intervention and, where
appropriate, timely referral to treatment.

Continued sobriety or abstinence (which includes abstinence attained
with medication, such as methadone or buprenorphine) is an important
part of sustained recovery from addiction. However, recovery is a larger
construct than sobriety or abstinence that embraces a reengagement with
the community based on resilience, health, and hope. Therefore, peer
recovery support services are expected to focus less on the pathology of
substance use disorders and more on maximizing the opportunities to
create a lifetime of recovery and wellness for self, family, and
community. Appendix D provides a listing of examples of peer-to-peer
recovery support services.

**This grant program is not designed to support the provision of
professional treatment services of any kind, including aftercare, by any
type of provider.** Peer support services cannot replace acute
treatment, and it would be unethical to utilize peer leaders from the
recovery community to provide services, such as treatment, counseling,
or psychotherapy, that should be provided by a professional. Peer
leaders providing recovery support services under this program will
offer supportive services that differ from and complement those provided
by alcohol and drug counselors, psychotherapists, or other
professionals.

**In addition, the program is not designed to support counselors,
psychotherapists, other treatment providers, or other professionals of
any kind in the provision of recovery support services.** Individuals
who self-identify as both a professional and a person in recovery may
provide recovery support services in their capacity as a peer, but may
not provide professional services under this grant.

RCSP is intended to support peer leaders from the recovery community in
providing recovery support services to people in recovery and their
family members.

3.  **Mix of Services**

You must demonstrate that the array of services offered is responsive to
community need and complements existing community resources.
Applications proposing culturally-specific peer recovery support models
are encouraged, as are applications proposing to serve specific
populations needing or in recovery, such as veterans, people with
disabilities, and other segments of the recovery community. The goal is
to add to the existing resources in the community with peer-to-peer
recovery support services that can meet the stage-appropriate needs of
people who are seeking to initiate recovery or working to sustain it.
Successful peer-to-peer recovery support services will include ongoing
assessment of participants' support needs and a menu of supportive
services to meet the needs at various stages in recovery.

Because peer recovery support services operationalize the construct of
social support, it may be helpful for you to consider four types of
social support cited in the literature (Cobb, 1976; Salser, 2002), and
to design a mix of services that includes activities in the following
categories:

-   Number range CHAPTER[Emotional support]{.underline} refers to
    demonstrations of empathy, caring, and concern that bolster one's
    self-esteem and confidence. Peer mentoring, peer coaching, and
    peer-led support groups are examples of peer-to-peer recovery
    support services that provide emotional support.

```{=html}
<!-- -->
```
-   [Informational support]{.underline} involves assistance with
    knowledge, information, and skills. This type of support can include
    providing information on where to go for resources or might involve
    teaching a specific skill. Examples of peer recovery support
    services that provide informational support include peer-led life
    skills training (e.g., parenting, stress management, conflict
    resolution), job skills training, citizenship restoration,
    educational assistance, and health and wellness information (e.g.,
    smoking cessation, nutrition, relaxation training).

```{=html}
<!-- -->
```
-   [Instrumental support]{.underline} refers to concrete assistance in
    helping others do things or get things done, especially stressful or
    unpleasant tasks. Examples in this category might include providing
    transportation to get to support groups, child-care, clothing
    closets, and concrete assistance with tasks such as filling out
    applications or helping people obtain entitlements.

```{=html}
<!-- -->
```
-   [Affiliational support]{.underline} offers the opportunity to
    establish positive social connections with other recovering people.
    It is important for people in recovery to learn social and
    recreational skills in an alcohol- and drug-free environment.
    Especially in early recovery -- when there may be little that is
    reinforcing about abstaining from alcohol or drugs -- alcohol- and
    drug-free socialization may help prevent relapse \[Meyers & Squires,
    2001; Miller, Meyers & Hiller-Sturmhofel, 1999). In addition,
    community and cultural connections can be important in helping the
    recovering person establish a new identity around health and
    wellness as opposed to an identity formed in relation to the
    cultures of alcohol and drugs (Coyhis and White, 2002).

Based on your assessment of the targeted recovery community, you should
determine which services, and in which proportion, are expected to be
optimally responsive to community needs.

Note: Although alcohol- and drug-free socialization is an acceptable
service under this grant, you may not limit your services to
socialization activities but, rather, must include a broad range of
services from the various social support categories.

3.  **Core Values**

You must identify the core values that will guide your approach, and
explain how these values will be operationalized in the design and
delivery of peer-to-peer recovery support services. Your application
must discuss each of the following values, which are further explained
in **Appendix E:** (a) keeping recovery first; (b) participatory
process; (c) authenticity of peers helping peers; (d) leadership
development; and (e) cultural diversity and inclusion. You may identify
and discuss other values important to the targeted recovery community,
but you must discuss these five.

**2.5 Types of Peer Service Organizations**

Number range CHAPTERApplications must be submitted by either independent
*recovery community organizations (RCOs)* or *facilitating organizations
(FOs)*.

***RCOs*** are organizations comprised of and led primarily by people in
recovery and their family members. These organizations directly provide
recovery support services. RCOs are independent organizations with
nonprofit status.

***FOs*** are not necessarily comprised of and led by people in
recovery. However, the FO will host peer-run recovery support service
programs and will ensure that people in recovery are involved in all
aspects of application development, program design, and implementation.
These organizations provide a structure and support for RCOs. Examples
of facilitating organizations include: treatment and mental health
agencies, community service centers, consortia of community-based
organizations, universities, units of government, faith-based
organizations, and federally recognized tribes.

Treatment providers, units of government, universities, and all other
professionally-based organizations may apply **[only]{.underline}** as
*FOs*.

Members of the recovery community must have a meaningful leadership role
in any project, whether carried out by an *RCO* or *FO*.

Grantees must begin delivering peer-to-peer recovery support services
within 6 months of award. In order to comply, it is necessary for an
applicant to be an established entity (with a viable organizational
infrastructure, including appropriate governance, management, and fiscal
management capabilities) and to have experience providing peer recovery
support services or other relevant services engaging the recovery
community in the design and delivery of recovery support services. You
must clearly describe your operating experience in your Project
Narrative in Section V-1.

**2.6 Infrastructure Development (maximum 15% of total grant award)**

Organizations funded under RCSP must be sufficiently established and
experienced to [begin implementing peer recovery support services within
6 months of award]{.underline}. However, SAMHSA recognizes that
infrastructure development may be needed to support organization
development, in relation to project start-up, as well as service design,
in some instances. Although the majority of grant funds should be used
for direct services, you may use up to 15% of the total RCSP grant award
for the following types of infrastructure development, if necessary, to
support the design, development, and initiation of the peer services you
will offer:

-   Activities related to organizational and project start-up; for
    example, staff and board development, and enhancements to existing
    organizational functions, such as risk management, record-keeping,
    and accounting services.

-   Community assessment and development. (Although you must demonstrate
    knowledge of community needs and resources in your application, if
    you are funded, you may use a limited amount of grant funds to
    conduct additional assessments and refine your service plan, and to
    further mobilize the targeted recovery community to participate in
    the program.)

-   Building partnerships and entering into service delivery or other
    agreements to ensure the success of the project.

It is expected that peer leadership development (e.g., recruiting,
orienting, training, and supervising peers to provide services) will be
an ongoing activity. Peer leadership development is not considered
infrastructure development.

**2.7 Data Collection and Performance Measurement**

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

The purpose of the RCSP GPRA data is to provide information that helps
to establish the effectiveness of the peer-to-peer recovery support
services you deliver in preventing relapse and promoting sustained
recovery. To accomplish this, you will be required to provide data on a
set of required performance indicators.

**For adults and adolescents/youth receiving services**, GPRA indicators
include changes in a positive direction or stability over time where
appropriate on each of the following measures, showing that participants
receiving your services:

■ Have not used illegal drugs or misused alcohol or prescription drugs
during the past month.

■ Are currently employed or engaged in productive activities.

■ Have reduced their involvement with the criminal justice system.

■ Have a permanent place to live in the community.

■ Have increased or maintained positive social connections.

■ Have experienced increased access to recovery support and other
services.

■ Are being retained in your program.

Please note: Although SAMHSA recognizes the important role that family
members and significant others can play in supporting an individual's
recovery, the GPRA tool is not appropriate for family members or others
who are not themselves in recovery. Therefore, although you may propose
activities and services for family members, you should not plan to
conduct GPRA performance data collection and reporting for individuals
who are not personally in recovery from substance use disorders.

You must document your ability to collect and report the required data
in \"Section V-D: Performance Assessment and Data\" of your application.
You should not, however, include GPRA data collection forms. If you do
not have the capability to collect and report on the GPRA measures, you
will need to partner with an individual or organization that does.

Grantees must collect and report data using the Discretionary Services
Client Level GPRA tool, which can be found at
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/) (click
on CSAT-GPRA, then click on \"Data Collection Tools/Instructions\"),
along with instructions for completing it. Hard copies are available in
the application kits distributed by SAMHSA\'s National Clearinghouse for
Alcohol and Drug Information.

GPRA data must be collected via face-to-face interview at baseline
(i.e., the client\'s entry into the project), discharge, and 6 months
after the baseline. After GPRA data are collected, data must then be
entered into CSAT\'s GPRA Data Entry and Reporting System
([www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/))
within 7 business days of the forms being completed. In addition, 80% of
the participants must be followed up.

CSAT will provide training and technical assistance on data collecting,
tracking, and follow-up, as well as data entry.

The terms and conditions of the grant award also will specify the data
to be submitted and the schedule for submission. Grantees will be
required to adhere to these terms and conditions of award.

**2.8 Performance Assessment**

Grantees must assess their projects, addressing the performance measures
described in Section I-2.7. The assessment should be designed to help
you determine whether you are achieving the goals, objectives and
outcomes you intend to achieve and whether adjustments need to be made
to your project. You will be required to report on your progress
achieved, barriers encountered, and efforts to overcome these barriers
in a performance assessment report to be submitted at least annually.

Your performance assessment must include at a minimum the required GPRA
performance measures (outcomes) described in Section I-2.7. Other
measures that measure project impacts or outcomes must be explained and
justified in your application. The final performance assessment must
also include process components (see below) which measure change
relating to project goals and objectives over time compared to baseline
information.

**Process components** should address issues such as:

-   How closely did implementation match the plan?

-   What types of deviation from the plan occurred?

-   What led to the deviations?

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

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

**No more than 20% of the total grant award may be used for data
collection, performance measurement, and performance assessment, e.g.,
activities required in Sections I-2.7 and I-2.8.**

**2.9 Grantee Meetings**

There are 2 meetings per year. You must plan to send at least two to
three key staff members (including the Project Director) to a yearly
technical assistance meeting, and you must plan to send approximately
5-8 representatives of your project, including key staff and peer
leaders from your targeted recovery community, to a yearly RCSP
conference. You must include funding for this travel in your budget. At
these meetings, grantees will present the results of their projects and
Federal staff will provide technical assistance. Each meeting will be 3
days. These meetings will usually be held in the Washington, D.C., area,
and attendance is mandatory.

# AWARD INFORMATION

**Funding Mechanism:** Grant

**Anticipated Total Available Funding:** \$2.9 million

**Estimated Number of Awards:** 8

**Estimated Award Amount:** Up to \$350,000

**Length of Project Period:** Up to 4 years

Out of the \$2.9 million available, SAMHSA/CSAT plans to set aside
approximately \$1.45 million to fund up to 4 RCOs (as defined in Section
I-2.5, entitled "Types of Peer Service Organizations").

**Proposed budgets cannot exceed \$350,000 in total costs (direct and
indirect) in any year of the proposed project.** Annual continuation
awards will depend on the availability of funds, grantee progress in
meeting project goals and objectives, and timely submission of required
data and reports.

**This program is being announced prior to the appropriation for FY 2007
for SAMHSA's programs, with funding estimates based on the President's
budget request for FY 2007. Applications are invited based on the
assumption that sufficient funds will be appropriated for FY 2007 to
permit funding of a reasonable number of applications solicited. All
applicants are reminded, however, that we cannot guarantee that
sufficient funds will be appropriated to permit SAMHSA to fund any
applications.**

# ELIGIBILITY INFORMATION

## ELIGIBLE APPLICANTS 

Eligible applicants are domestic public and private nonprofit entities.
For example, State and local governments, federally recognized American
Indian/Alaska Native tribes and tribal organizations, urban Indian
organizations, public or private universities and colleges; and
community- and faith-based organizations may apply. The statutory
authority for this program prohibits grants to for-profit agencies.

Consortia comprised of various types of eligible organizations are
permitted; however, a single organization representing the consortium
must be the applicant, the recipient of any award, and the entity
responsible for satisfying the grant requirements.

**All applicants, including single organizations and consortia, must
clearly indicate in their project narrative (in Section A, Statement of
Need) as well as in the RCO/FO Designation and Statement of Assurance in
Appendix J whether they are applying for a grant as a Recovery Community
Organization (RCO) or Facilitating Organization (FO).** All applicants
must make this designation in order for the application to be reviewed
and considered for an award.

RCSP grantees in the 1998 and 2001 cohorts and those in the 2003 cohort
(whose current awards are ending September 29, 2007) may apply for this
program. RCSP grantees in the 2004 and 2006 cohorts are ineligible for
this program.

## COST-SHARING 

Cost-sharing is not required in this program.

## OTHER

**3.1 Additional Eligibility Requirements**

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

2.  **Evidence of Experience**

SAMHSA believes that only existing experienced organizations with
demonstrated infrastructure and expertise will be able to provide
required services quickly and effectively. Therefore, in addition to the
basic eligibility requirements specified in this announcement,
applicants must meet the following additional requirement related to the
provision of services:

-   Each applicant organization must have at least 2 years experience
    (as of the due date of the application) providing peer recovery
    support services or other relevant services engaging the recovery
    community in the design and delivery of recovery support services in
    the geographic area(s) covered by the application.

In **Appendix 1** of your application, you must include the completed
**RCO/FO** **Designation and** **Statement of Assurance** (provided in
Appendix J of this announcement), signed by the authorized
representative of the applicant organization identified on the face page
of the application, stating that the applicant is applying for a grant
as either a RCO or FO and that the applicant organization meets the
2-year experience requirement.

In addition, if, following application review, an application's score is
within the fundable range for a grant award, the Government Project
Officer (GPO) will call the applicant and request that the following
documentation be sent by overnight mail:

-   Official documentation that the applicant organization has been
    providing peer recovery support services or other relevant services
    engaging the recovery community in the design and delivery of
    recovery support services for a minimum of 2 years before the date
    of the application in the area(s) in which the services are to be
    provided. Official documentation can be a copy of the organization's
    charter, its 501(c)(3) status, or other documents that definitively
    establish that the organization has provided relevant services for
    the last 2 years.

**If the GPO does not receive this documentation within the time
specified, the application will be removed from consideration for an
award.**

# APPLICATION AND SUBMISSION INFORMATION 

## ADDRESS TO REQUEST APPLICATION PACKAGE 

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

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

Additional materials available on this web site include:

-   a technical assistance manual for potential applicants;

-   standard terms and conditions for SAMHSA grants;

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

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

## CONTENT AND FORM OF APPLICATION SUBMISSION

**2.1 Application Kit**

SAMHSA application kits include the following documents:

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

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

You must use the above documents in completing your application.

**2.2 Required Application Components**

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

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

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

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

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

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

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

-   **Appendices 1 through 4**-- Use only the appendices listed below.
    If your application includes any appendices not required in this
    document, they will be disregarded. Do not use more than 30 pages
    for Appendices 1, 3, and 4 combined. There is no page limitation for
    Appendix 2. Do not use appendices to extend or replace any of the
    sections of the Project Narrative. Reviewers will not consider them
    if you do.

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-   *Appendix 1*: The RCO/FO Designation and Statement of Assurance
    (signed by the authorized representative of the applicant
    organization identified on the face page of the application) and
    letters of commitment/support from all organizations that have
    agreed to participate in the proposed project.

-   *Appendix 2*: Data Collection Instruments/Interview Protocols (no
    page limitation)

-   *Appendix 3*: Sample Consent Forms

-   *Appendix 4*: Letter to the SSA (if applicable; see Section IV-4 of
    this document)

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-   **Assurances** -- Non-Construction Programs. Use Standard Form 424B
    found in the PHS 5161-1. You are also required to complete the
    Assurance of Compliance with SAMHSA Charitable Choice Statutes and
    Regulations, Form SMA 170. This form will be posted on SAMHSA's Web
    site with the RFA and provided in the application kits available at
    SAMHSA's clearinghouse (NCADI).

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

-   **Disclosure of Lobbying Activities** -- Use Standard Form LLL found
    in the PHS 5161-1. Federal law prohibits the use of appropriated
    funds for publicity or propaganda purposes, or for the preparation,
    distribution, or use of the information designed to support or
    defeat legislation pending before the Congress or State
    legislatures. This includes "grass roots" lobbying, which consists
    of appeals to members of the public suggesting that they contact
    their elected representatives to indicate their support for or
    opposition to pending legislation or to urge those representatives
    to vote in a particular way.

-   **Checklist** -- Use the Checklist found in the PHS 5161-1. The
    Checklist ensures that you have obtained the proper signatures,
    assurances and certifications and is the last page of your
    application.

2.3 Application Formatting Requirements

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

## SUBMISSION DATES AND TIMES 

Applications are due by close of business on **February 28, 2007**.
**Hand carried applications will not be accepted. Applications may be
shipped using only DHL, Federal Express (FedEx), United Parcel Service
(UPS), or the United States Postal Service (USPS).**

Your application must be received by the application deadline, or you
must have proof of its timely submission as specified below.

-   **For packages submitted via DHL, Federal Express (FedEx), or United
    Parcel Service (UPS), proof of timely submission shall be the date
    on the tracking label affixed to the package by the carrier upon
    receipt by the carrier. That date must be at least 24 hours prior to
    the application deadline. The date affixed to the package by the
    applicant will not be sufficient evidence of timely submission.**

-   For packages submitted via the United States Postal Service (USPS),
    proof of timely submission shall be a postmark not later than 1 week
    prior to the application deadline, and the following upon request by
    SAMHSA:

    -   proof of mailing using USPS Form 3817 (Certificate of Mailing),
        or

    -   a receipt from the Post Office containing the post office name,
        location, and date and time of mailing.

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

**Applications not meeting the timely submission requirements above will
not be considered for review.** Please remember that mail sent to
Federal facilities undergoes a security screening prior to delivery.
Allow sufficient time for your package to be delivered.

If an application is mailed to a location or office (including room
number) that is not designated for receipt of the application, and that
results in the designated office not receiving your application in
accordance with the requirements for timely submission, it will cause
the application to be considered late and ineligible for review.

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

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

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

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

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

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

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

    -   The SPOC should send any State review process recommendations to
        the following address within 60 days of the application
        deadline. **For United States Postal Service:** Crystal
        Saunders, Director of Grant Review, Office of Program Services,
        Substance Abuse and Mental Health Services Administration, Room
        3-1044, 1 Choke Cherry Road, Rockville MD **20857**. ATTN: SPOC
        -- Funding Announcement No. TI-07-002. Change the zip code to
        **20850** if you are using another delivery service.

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

The PHSIS consists of the following information:

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

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

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

If applicable, you [must]{.underline} include a copy of a letter
transmitting the PHSIS to the SSA in **Appendix 4, "Letter to the
SSA**." The letter must notify the State that, if it wishes to comment
on the proposal, its comments should be sent not later than 60 days
after the application deadline to the following address. **For United
States Postal Service:** Crystal Saunders, Director of Grant Review,
Office of Program Services, Substance Abuse and Mental Health Services
Administration, Room 3-1044, 1 Choke Cherry Road, Rockville MD
**20857**. ATTN: SSA -- Funding Announcement No. TI-07-002. Change the
zip code to **20850** if you are using another delivery service.

In addition:

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

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

## FUNDING LIMITATIONS/RESTRICTIONS

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents, which are available at
<http://www.hhs.gov/grantsnet/roadmap/index.html>:

-   Institutions of Higher Education: OMB Circular A-21

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

-   Nonprofit Organizations: OMB Circular A-122

-   Hospitals: 45 CFR Part 74, Appendix E

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

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

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

RCSP grant funds must be used for purposes supported by the program
(peer-to-peer recovery support services) and may not be used to:

-   Pay for any lease beyond the project period.

-   Pay for professional alcohol and/or drug treatment services. (Note:
    This program supports peer-to-peer recovery support services that
    prevent relapse and promote long-term recovery.)

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-   Provide services to incarcerated populations (defined as those
    persons in jail, prison, detention facilities, or in custody where
    they are not free to move about in the community), [except, for a
    period of no longer than 6 months, to assist in the transition from
    the incarcerated setting to the community.]{.underline} For example,
    funds under this program could be used to support peer recovery
    mentoring offered to individuals awaiting discharge from prison.
    Such mentoring would be designed to help the incarcerated person
    develop a relationship with a mentor who would continue the
    relationship with the ex-offender in the community upon his/her
    release. Similarly, pre-release recovery support groups facilitated
    by peer leaders from the community might be offered in a
    correctional facility to assist incarcerated persons awaiting
    release as they develop plans for maintaining sobriety/abstinence in
    the community.

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

-   Pay for programs, services, or materials that are routinely provided
    free of charge to the recovery community.

-   Pay to induce individuals to participate in recovery support
    services. However, grantees may allocate funds for various types of
    instrumental support for participants, such as bus tokens, coupons
    for food, access to clothing closet, etc., and for motivational
    incentives (e.g., prizes of nominal value of up to \$20 or
    equivalent). Grantees may allocate funds to compensate peer leaders
    who will provide recovery support services; however, some program
    models will not involve compensation for peer leaders, but will
    utilize peer leaders who volunteer their services. In addition, a
    grantee may provide up to \$20 or equivalent (coupons, bus tokens,
    gifts, child care, and vouchers) to individuals as incentives to
    participate in required data collection follow-up. This amount may
    be paid for participation in each required interview. Any funds
    proposed for instrumental supports for participants, peer
    compensation, or incentives for data collection must be clearly
    described in the project narrative and included in the budget and
    budget narrative.

-   Pay for entertainment. However, alcohol- and drug-free socialization
    activities may be included as part of a mix of peer recovery support
    services. Such activities should be clearly explained and justified
    in the project narrative and budget narrative.

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

-   Pay for advocacy or lobbying.

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

## OTHER SUBMISSION REQUIREMENTS

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

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

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

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

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

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

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

Send applications to the address below:

**For United States Postal Service:**

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

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

Do not send applications to other agency contacts, as this could delay
receipt. Be sure to include "**RCSP -- TI-07-002**" in item number 12 on
the face page of any paper applications. If you require a phone number
for delivery, you may use (240) 276-1199.

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

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

# APPLICATION REVIEW INFORMATION

## EVALUATION CRITERIA

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

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

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

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

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

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-   The Supporting Documentation you provide in Sections F-I and
    Appendices 1-4 will be considered by reviewers in assessing your
    response, along with the material in the Project Narrative.

-   The relative value of each section is indicated by the percent
    listed after each section heading. Although scoring weights are not
    assigned to individual bullets, applicants are encouraged to respond
    to each bulleted statement.

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

-   Clearly state whether your organization is applying for a grant as a
    Facilitating Organization (FO) or a Recovery Community Organization
    (RCO).

    -   Define the target populations that will receive and provide peer
        recovery support services and provide a rationale for selecting
        those target populations, as well as the geographic area to be
        served. (Note: Extensive demographic information is not
        required.) If you plan to focus on a specific segment of the
        recovery community, explain why this is necessary or desirable.

    -   Discuss your understanding of the recovery support needs of the
        targeted recovery community, and identify the sources of
        documentation for these needs. Documentation may come from
        quantitative and/or qualitative sources. The quantitative data
        could come from community assessments you or others have
        conducted, or from local data or trend analyses, State data
        (e.g., from State Needs Assessments), and/or national data
        (e.g., from SAMHSA's National Survey on Drug Abuse and Health).
        Qualitative sources could include focus groups and key informant
        interviews you or others have conducted with the targeted
        community, as well as anecdotal reports.

    -   Describe how the proposed peer recovery support services will
        complement existing professional and peer services in your
        community (e.g., formal treatment and self-help programs).

**Section B: Project Approach (35%)**

-   Clearly state the purpose, goals, and objectives of your proposed
    project. Describe how achievement of goals will produce meaningful
    and relevant results (e.g., increase number, range, and availability
    of services; help prevent relapse; strengthen linkage between
    treatment and recovery; increase support for sustained recovery in
    your community).

-   Explain how the proposed services will meet your goals and
    objectives.

-   Discuss and explain the core values that will guide the project
    design and implementation, and explain how each of these values will
    be operationalized. At a minimum, discuss each of the following
    values as it relates to the proposed project: (a) keeping recovery
    first; (b) participatory process; (c) authenticity of peers helping
    peers; (d) leadership development; and (e) cultural
    diversity/inclusion, including the various "cultures of recovery"
    and/or routes to recovery, e.g., medication-assisted recovery,
    faith-based recovery, 12-step treatment, etc.). (See Appendix E for
    an explanation of these values.) You may identify and discuss other
    values important to your targeted recovery community, but you must
    discuss these five.

-   Describe how the services will be implemented.

    -   Clearly explain each recovery support service you plan to
        provide. (Note: Be sure to include a mix of services that builds
        on the strengths and needs in the targeted recovery community.)
        Explain who will provide each service, to whom, and in what
        format and setting.

    -   Explain your plans for building recovery community members'
        skills to serve as peer leaders and service providers in the
        delivery of peer-to-peer recovery support services. Include a
        discussion of your plans for recruiting, screening, orienting,
        training, and supervising the peers providing recovery support
        services.

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-   Clearly state the unduplicated number of individuals you propose to
    serve (annually and over the entire project period) with grant
    funds, including the types and numbers of services to be provided
    and anticipated outcomes.

-   Describe how the target population ─ both peer leaders/providers and
    service recipients ─ will be identified, recruited, and retained.

-   Describe how the proposed project will address issues of age, race,
    ethnicity, culture, language, sexual orientation, disability,
    literacy, gender, and path to recovery in the target population.

-   Describe the role of members of the recovery community in helping to
    prepare the application, and how they will help plan and implement
    the project.

-   Describe how the project components will be embedded within and/or
    complement the existing service delivery system, including other
    SAMHSA-funded projects, if applicable. Discuss how you plan to
    develop effective partnerships with professional treatment
    organizations and self-help groups, so as to minimize duplication of
    services and perceived threats of encroachment on established
    "territory." Identify any other organizations that will participate
    in the proposed project. Describe their roles and responsibilities
    and demonstrate their commitment to the project. Include letters of
    commitment from community organizations supporting the project in
    **Appendix 1** of your application.

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

    **Section C: Management and Organizational Capacity (30%)**

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-   Discuss your organization's readiness to implement a program of
    peer-to-peer recovery support services. Describe previous efforts
    organizing and mobilizing the targeted recovery community (by your
    organization or others), and explain why you think the targeted
    community is ready to participate in providing and receiving
    peer-to-peer recovery support services.

-   Describe your organization's experience providing peer recovery
    support services or other relevant services that engage the recovery
    community in the design and delivery of recovery support services in
    the proposed geographic area(s).

-   Provide a timeline for Year 1 of the project (chart or graph)
    showing key activities, milestones, and responsible staff. Your
    time-line must show peer services up and running no later than 6
    months after grant award. \[Note: The timeline should be part of the
    Project Narrative. It should not be placed in an appendix.\]

-   Provide a list of staff who will participate in the project, showing
    the role of each and their level of effort and qualifications.
    Include the Project Director and other key personnel, such as the
    Volunteer/Peer Coordinator and the individual who will conduct the
    performance assessment.

-   Show that the necessary groundwork (e.g., planning, stakeholder
    mobilization and development, memoranda of agreement, identification
    of potential facilities) has been completed or is near completion so
    that the project can be implemented and service delivery can begin
    as soon as possible, and no later than 6 months after grant award.

-   Describe your organization's capability to manage a Federal grant.
    Explain in detail your organization's governance structure and your
    previous management experience, as well as your record-keeping and
    fiscal management capacities.

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

    **Section D: Performance Assessment and Data (15%)**

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-   Document your ability to collect, manage, and report on the required
    performance measures as explained in Section I-2.7 of this RFA.
    (Note: It is not necessary to include any performance measures other
    than those listed in Section I-2.7 in your performance assessment
    design. SAMHSA/CSAT will provide the necessary protocols and forms
    for collection and reporting of data on these measures, so you do
    not need to include data collection forms for these measures in your
    application.)

-   If you choose to collect data on any performance measures in
    addition to those identified in Section I-2.7, you must specify and
    justify the additional measures. If you choose to include additional
    performance measures in your performance assessment, you must also
    describe your plans for data collection, management, analysis,
    interpretation, and reporting. You must also include your valid and
    reliable data collection instruments in **Appendix 2** of your
    application.

-   Describe your assessment of **process components** and explain how
    it will reflect the experience and lessons learned from your
    project. Include in **Appendix 2** any forms or protocols you plan
    to use for your process assessment.

**Section E: Program Costs and Sustainability (10%)**

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

 Program costs. The following are considered reasonable ranges by
modality:

-   Peer recovery support services (e.g., peer mentoring/coaching,
    recovery resource/drop-in centers, peer-led recovery support
    groups): \$1,000 to \$2,500

-   Peer outreach/pre-treatment/brief intervention: \$200 to \$1,200

> The peer outreach/pre-treatment/brief intervention services cost band
> applies only to peer outreach-pre-treatment/brief intervention
> programs that do not also offer more intensive services, but operate
> within a network of providers who do offer such services. Peer
> recovery support programs that add peer outreach/pre-treatment/brief
> intervention to a more intensive peer recovery support modality or
> modalities are expected to fall within the cost band for the more
> intensive modality.

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

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

**SUPPORTING DOCUMENTATION**

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

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

**Section H** - Biographical Sketches and Job Descriptions.

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

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

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

    **Section I:** Confidentiality and SAMHSA Participant
    Protection/Human Subjects: Applicants must describe procedures
    relating to Confidentiality, Participant Protection and the
    Protection of Human Subjects Regulations in Section I of the
    application, using the guidelines provided below. Number range
    CHAPTERMore detailed guidance for completing this section can be
    found in Appendix K of this RFA.

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

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

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

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

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

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

-   Describe data collection procedures, including sources (e.g.,
    participants, school records) and the data collecting setting (e.g.,
    clinic, school). Provide copies of proposed data collection
    instruments and interview protocols in **Appendix 2** of your
    application, "Data Collection Instruments/Interview Protocols."
    State whether specimens such as urine and/or blood will be obtained
    and the purpose for collecting the specimens. If applicable,
    describe how the specimens and process will be monitored to ensure
    the safety of participants.

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

-   Describe the process for obtaining and documenting consent from
    adult participants and assent from minors along with consent from
    their parents or legal guardians. Provide copies of all consent
    forms in **Appendix 3** of your application, "Sample Consent Forms."
    If needed, give English translations.

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

**Note:** Sample Consent Form for Participation in Peer Recovery Support
Services is included in **Appendix F** of this RFA. In addition,
examples of risks and protections for peer recovery support services are
included in **Appendix G**. Additional participant protection challenges
for peer services are included in **Appendix H**, along with examples of
strategies to address the challenges. These appendices are provided to
help you consider some of the participant protection issues that may
affect your proposed project. They are not to be considered exhaustive;
you must consider the specific risks and protections that will be
important for your particular project.

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

SAMHSA expects that most grantees funded under this announcement will
not have to comply with the Protection of Human Subjects Regulations (45
CFR 46), which requires Institutional Review Board (IRB) approval.
However, in some instances, the applicant's proposed performance
assessment design may meet the regulation's criteria of research
involving human subjects. Applicants whose projects must comply with the
Human Subjects Regulations must, in addition to the bullets above, fully
describe the process for obtaining IRB approval. While IRB approval is
not required at the time of grant award, these grantees will be
required, as a condition of award, to provide documentation that an
Assurance of Compliance is on file with the Office for Human Research
Protections (OHRP). IRB approval must be received in these cases prior
to enrolling clients in the project. General information about Human
Subjects Regulations can be obtained through OHRP at
http://www.hhs.gov/ohrp, or ohrp@osophs.dhhs.gov, or (240) 453-6900.
SAMHSA--specific questions should be directed to the program contact
listed in Section VII of this announcement.

## REVIEW AND SELECTION PROCESS

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

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by the
    peer review committee and, when applicable, approved by the CSAT
    National Advisory Council;

-   availability of funds; and

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

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

# AWARD ADMINISTRATION INFORMATION

## AWARD NOTICES 

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

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

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

## 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS  {#administrative-and-national-policy-requirements .unnumbered}

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

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

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

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

    -   requirements relating to additional data collection and
        reporting;

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

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

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

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

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

## REPORTING REQUIREMENTS

In addition to the data reporting requirements listed in Section I-2.7,
you must comply with the following reporting requirements:

**3.1 Progress and Financial Reports**

-   Grantees must provide quarterly and final progress reports. The
    final report must summarize information from the quarterly reports,
    describe the accomplishments of the project, and describe next steps
    for implementing plans developed during the grant period. Because
    SAMHSA is extremely interested in ensuring that peer recovery
    services can be sustained, your progress reports should explain
    plans to ensure the sustainability of efforts initiated under this
    grant. Initial plans for sustainability should be described in
    year 01. In each subsequent year, you should describe the status of
    your project, as well as the successes achieved and obstacles
    encountered in that year.

-   Grantees must provide annual and final financial status reports.

-   SAMHSA will provide guidelines and requirements for these reports to
    grantees at the time of award and at the initial grantee orientation
    meeting after award. SAMHSA staff will use the information contained
    in the reports to determine the grantee's progress toward meeting
    its goals.

3.2 Government Performance and Results Act (GPRA)

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

**3.3 Publications**

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

In addition, SAMHSA requests that grantees:

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

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

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

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

# AGENCY CONTACTS

For questions about program issues, contact:

> Marsha Baker
>
> Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

> 1 Choke Cherry Road, Room 5-1124
>
> Rockville, MD 20857
>
> \(240\) 276-1566
>
> <marsha.baker@samhsa.hhs.gov>

For questions on grants management issues, contact:

Kimberly Pendleton

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 7-1097

Rockville, Maryland 20857

\(240\) 276-1421

<kimberly.pendleton@samhsa.hhs.gov>

# Appendix A -- Checklist for Formatting Requirements and Screenout Criteria for SAMHSA Grant Applications {#appendix-a-checklist-for-formatting-requirements-and-screenout-criteria-for-samhsa-grant-applications .unnumbered}

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

-   Use the PHS 5161-1 application.

-   Applications must be received by the application deadline or have
    proof of timely submission, as detailed in Section IV-3 of the grant
    announcement.

-   Information provided must be sufficient for review.

-   Text must be legible. (For Project Narratives submitted
    electronically in Microsoft Word, see separate requirements in
    Section IV-6 of this announcement under "Submission of Electronic
    Applications.")

• Type size in the Project Narrative cannot exceed an average of 15
characters per

inch, as measured on the physical page. (Type size in charts, tables,
graphs, and

footnotes will not be considered in determining compliance.)

• Text in the Project Narrative cannot exceed 6 lines per vertical inch.

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

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded. (For Project Narratives
    submitted electronically in Microsoft Word, see separate
    requirements in Section IV-6 of this announcement under "Submission
    of Electronic Applications.")

• Applications would meet this requirement by using all margins (left,
right, top, bottom) of at least one inch each, and adhering to the page
limit for the Project Narrative stated in the specific funding
announcement.

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by the page limit. This number represents the full page less
margins, multiplied by the total number of allowed pages.

• Space will be measured on the physical page. Space left blank within
the Project Narrative (excluding margins) is considered part of the
Project Narrative, in determining compliance.

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

-   The 10 application components required for SAMHSA applications
    should be included. These are:

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

-   Abstract

-   Table of Contents

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

-   Project Narrative and Supporting Documentation

-   Appendices

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

-   Certifications

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

-   Checklist (a form in PHS 5161-1)

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```
-   Applications should comply with the following requirements:

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

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

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

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

-   Please number pages consecutively from beginning to end so that
    information can be located easily during review of the application.
    The cover page should be page 1, the abstract page should be page 2,
    and the table of contents page should be page 3. Appendices should
    be labeled and separated from the Project Narrative and budget
    section, and the pages should be numbered to continue the sequence.

-   The page limits for Appendices stated in the specific funding
    announcement should not be exceeded.

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

# Appendix B -- Guidance for Electronic Submission of Applications {#appendix-b-guidance-for-electronic-submission-of-applications .unnumbered}

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

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

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

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

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

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

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

-   *Text legibility*: Use a font of Times New Roman 12, line spacing of
    single space, and all margins (left, right, top, bottom) of one inch
    each. Adhering to these standards will help to ensure the accurate
    transmission of your document. If the type size in the Project
    Narrative of an electronic submission exceeds 15 characters per
    inch, or the text exceeds 6 lines per vertical inch, SAMHSA will
    reformat the document to Times New Roman 12, with line spacing of
    single space. Please note that this may alter the formatting of your
    document, especially for charts, tables, graphs, and footnotes.

-   *Amount of space allowed for Project Narrative*: The Project
    Narrative for an electronic submission may not exceed 15,450 words.
    If the Project Narrative for an electronic submission exceeds the
    word limit and exceeds the allowed space as defined in Appendix A,
    then **any part of the Project Narrative in excess of these limits
    will not be submitted to review**. To determine the number of words
    in your Project Narrative document in Microsoft Word, select
    file/properties/statistics.

While keeping the Project Narrative as a separate document, please
consolidate all other materials in your application to ensure the fewest
possible number of attachments. Ensure all pages in your application are
numbered consecutively, with the exception of the standard forms in the
PHS-5161 application package. Please name and number your attachments,
indicating the order in which they should be assembled. Failure to
comply with these requirements may affect the successful transmission
and consideration of your application.

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

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

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

**For United States Postal Service:**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20857**

ATTN: Electronic Applications

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

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

# Appendix C: References Cited {#appendix-c-references-cited .unnumbered}

Cobb, S. (1976). Social support as a moderator of life stress.
*Psychosomatic Medicine*, 38, 5: 300-314.

Coyhis, D. & White, W. (2002). Addiction and recovery in Native America,
lost history, enduring lessons. *Counselor*, September/October, 35-44.

Meyers, R. & Squires, D. (2001). *The community reinforcement approach.*
Retrieved May 3, 2005, from Behavioral Health Recovery Management Web
site: <http://www.bhrm.org/guidelines/CRAmanual.pdf>

Miller, W., Meyers, R. & Hiller-Sturmhofel, S. (1999). The
community-reinforcement approach. *Alcohol Research & Health*, 23(2),
116-121.

Number range CHAPTER

Salser, M. (2002). Consumer-Delivered Services as a Best Practice in
Mental Health Care Delivery and The Development of Practice Guidelines.
Psychiatric Rehabilitation Skills, 6(3): 355-383.

# Appendix D: Four Types of Peer Social Support (including service categories and examples\*) {#appendix-d-four-types-of-peer-social-support-including-service-categories-and-examples .unnumbered}

+-------------+--------------------------------------------------------+
| **Type of   | **Service Categories and Examples**                    |
| Support**   |                                                        |
+-------------+--------------------------------------------------------+
| **Emotional | **Peer-led Support Groups**                            |
| Support**   |                                                        |
|             | Examples: Non-12-Step recovery; recovery support with  |
|             | HIV, Hepatitis C, PTSD, mental illness; culture-and    |
|             | gender-specific; (family members; parents, women)      |
+-------------+--------------------------------------------------------+
|             | **Peer-led Recovery Mentoring (coaching) projects**:   |
|             | One-on-one                                             |
+-------------+--------------------------------------------------------+
| **In        | **Peer-led Resource Connector programs**               |
| formational |                                                        |
| Support**   | Examples: assistance with: housing, employment, public |
|             | assistance, emergency relief, benefits and             |
|             | entitlements, legal services, citizen restoration,     |
|             | educational applications and financial aid, vocational |
|             | rehabilitation and training                            |
+-------------+--------------------------------------------------------+
|             | **Life** **Skills classes and workshops**              |
|             |                                                        |
|             | Examples: financial management, nutrition and meal     |
|             | planning, parenting, relationship skills, home         |
|             | management, time management, citizen restoration       |
+-------------+--------------------------------------------------------+
|             | **Health and Wellness classes and workshops**          |
|             |                                                        |
|             | Examples: relapse prevention, stress management,       |
|             | personal growth, anger management, reproductive        |
|             | health, HIV and Hepatitis C prevention and management, |
|             | smoking cessation, dance, yoga, and other exercise,    |
|             | mental health strategies, self care                    |
+-------------+--------------------------------------------------------+
|             | **Education and Career Planning classes and            |
|             | workshops**                                            |
|             |                                                        |
|             | Examples: ESL; GED; reading and study skills, career   |
|             | aptitude, workforce preparation and readiness,         |
|             | computer skills and resume writing.                    |
+-------------+--------------------------------------------------------+
|             | **Leadership Development classes and workshops**       |
|             |                                                        |
|             | Examples: workforce skills, personal development,      |
|             | communication and conflict resolution, peer ethics,    |
|             | cultural competency, facilitation and group process,   |
|             | burnout prevention, supervision                        |
+-------------+--------------------------------------------------------+
| **I         | **Direct Instrumental**                                |
| nstrumental |                                                        |
| Support**   | Examples: child care, transportation, clothing         |
|             | services, food banks, emergency services               |
+-------------+--------------------------------------------------------+
| **Af        | **AOD-Free Social/Recreational activities**            |
| filiational | Substitution of addiction-oriented social networks     |
| Support**   | with pro-recovery networks and communities of          |
|             | affiliation.                                           |
|             |                                                        |
|             | Examples: family-centered events, leisure interest     |
|             | development, conferences, speaker events, educational  |
|             | forums, community and cultural events, sport team      |
|             | events, health and information fairs, Recovery Month   |
|             | events                                                 |
+-------------+--------------------------------------------------------+
|             | **Recovery Centers** Includes Drop-in Centers          |
+-------------+--------------------------------------------------------+

\*Note that service categories do not always fall neatly into the four
types of support and there can be considerable overlapping. Many service
categories are a blend of support types. For example: 1) Resource
Connector programs often include Emotional, Informational and
Instrumental components; 2) Recovery Centers are categorized as
Affiliational support, but encompass all of the four support areas; and
3) Leadership Development, key to the success of peer support services,
is classified as Informational support but is not an easy fit into this,
or any, area.

# Appendix E: Core Values for RCSP Peer-to-Peer Recovery Support Services {#appendix-e-core-values-for-rcsp-peer-to-peer-recovery-support-services .unnumbered}

The current RCSP Number range CHAPTERbuilds on the work of earlier
SAMHSA/CSAT initiatives with the recovery community, as well as efforts
in the mental health and HIV/AIDS consumer communities, that have
focused on the importance and value of peer-to-peer service. The program
is built on the recognition that individuals in recovery, their
families, and their community allies are critical resources that can
effectively extend, enhance, and improve formal treatment. RCSP is
designed to achieve its goals by focusing on recovery community
resources and motivation that already exist within most communities;
employing a peer-driven, strength-based, and wellness-oriented approach
that is grounded in the "culture(s) of recovery"; and utilizing existing
community resources.

Because peer services emphasize strength, wellness, community-based
delivery, and provision by peers rather than experts, these services can
be viewed as promoting self-efficacy, community connectedness, and
quality of life, all important factors in sustained recovery.

Previous efforts among CSAT's RCSP grantees have pointed to the
importance of five core values in recovery community organizing,
including organizing to provide peer services. These values are:

-   **Keeping recovery first** -- placing recovery at the center of the
    effort, grounding peer-to-peer services in the strengths and innate
    resiliency that recovery represents;

-   **Participatory process** -- involving the targeted recovery
    community in project design and implementation, so that recovery
    community members identify their own strengths and needs, and design
    and deliver peer services that address them;

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```
-   **Authenticity of peers helping peers** -- drawing on the power of
    example, as well as the hope and motivation that one person in
    recovery can offer to another, providing opportunities to give back
    to the community, and embracing the notion that both people in a
    relationship based on mutuality can be helped and empowered in the
    process;

-   **Leadership development** -- building leadership among members of
    the recovery community so that they are able to guide and direct the
    service program and deliver support services to their peers; and

-   **Cultural diversity and inclusion --** developing a recovery
    community peer support services program that is inclusive of various
    groups and that honors differing routes to recovery, including
    medication-assisted recovery.

# Appendix F: Sample Consent Form for Participation in Peer-to-Peer Recovery Support Services {#appendix-f-sample-consent-form-for-participation-in-peer-to-peer-recovery-support-services .unnumbered}

Number range CHAPTER

I, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
consent to participate in peer recovery support

(participant's name - printed)

services offered by
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

\[grantee: insert name of grantee organization\] (hereafter referred to
as "the organization.")

I understand that these are peer-to-peer services, offered to support my
recovery, help me avoid relapse, and promote my overall functioning and
well-being. I understand that these are not professional services by a
treatment provider, mental health counselor, or other professional, and
that I may seek professional services elsewhere should I choose to do
so.

The specific service I will be receiving is:

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

\[grantee: insert name of recovery support service\]

I expect to be receiving this service from
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

I understand that my participation in this service is voluntary, and I
have the right to terminate my participation in the service at any time
without negative consequences.

I understand that I may be subject to certain risks as a consequence of
my participation in this service, including:

> \[grantee: list potential risks for the recovery support service --
> see Appendix G for some examples\]

I also understand that the organization is taking the following steps to
help protect me from those risks:

> \[grantee: list protections for risks identified above -- see Appendix
> G for some examples\]

Page 2 - Consent to Participate in Peer Recovery Support Services

If I have any questions about this peer-to-peer recovery support
services, I understand that I may contact:

> \[grantee: insert name of RCSP project director with phone number and
> email address\]

*Signed:*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Print name of participant or, if applicable, legal guardian)

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

(Signature)

*Witnessed:*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Print name of program staff)

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

(Signature)

This consent is effective as of the date of signing. It may be revoked
in writing at any time. This consent will expire 15 months after the
date of signing if not revoked before then.

# Appendix G: Analysis of Examples of Risks and Protections for Peer Recovery Support Services {#appendix-g-analysis-of-examples-of-risks-and-protections-for-peer-recovery-support-services .unnumbered}

+------------------+-------------------------+-------------------------+
| **Recovery       |                         |                         |
| Community        |                         |                         |
| Services         |                         |                         |
| Program**        |                         |                         |
|                  |                         |                         |
| **Protections    |                         |                         |
| for Participants |                         |                         |
| in Peer          |                         |                         |
| Services**       |                         |                         |
|                  |                         |                         |
| **Sample         |                         |                         |
| Framework for    |                         |                         |
| Analysis**       |                         |                         |
+------------------+-------------------------+-------------------------+
| **SAMHSA         | **Examples of Risks**   | **Examples of           |
| Guidelines**     |                         | Protections**           |
+------------------+-------------------------+-------------------------+
| **Client & Staff | -   Participant's       | -   Provide verbal and  |
| Protection from  |     issues/problems     |     written             |
| Risk**           |     beyond expertise of |     notification of     |
|                  |     peer provider       |     potential risks     |
|                  |                         |     associated with     |
|                  | -   Potential for       |     participation.      |
|                  |     mental anguish      |                         |
|                  |     and/or reoccurrence | -   Obtain informed     |
|                  |     of a mental         |     consent forms that  |
|                  |     condition (e.g.,    |     specify potential   |
|                  |     PTSD).              |     risks.              |
|                  |                         |                         |
|                  | -   Potential for       | -   Maintain referral   |
|                  |     relapse and/or      |     network and be      |
|                  |     destabilization.    |     capable of          |
|                  |                         |     providing referrals |
|                  | -   Public disclosure   |     to professional     |
|                  |     may expose program  |     service             |
|                  |                         |     organizations for   |
|                  | participants/volunteers |     help when           |
|                  |     to stigma &         |     necessary.          |
|                  |     discrimination.     |                         |
|                  |                         | -   Establish and       |
|                  |                         |     continually promote |
|                  |                         |     norms that support  |
|                  |                         |     self-care.          |
|                  |                         |                         |
|                  |                         | -   Provide ongoing     |
|                  |                         |     training,           |
|                  |                         |     supervision, and    |
|                  |                         |     support for peer    |
|                  |                         |     leaders who provide |
|                  |                         |     recovery support    |
|                  |                         |     services            |
|                  |                         |                         |
|                  |                         | -   Use mentors or      |
|                  |                         |     coaches.            |
|                  |                         |                         |
|                  |                         | -   Provide ongoing     |
|                  |                         |     written             |
|                  |                         |     communication about |
|                  |                         |     apvoluntary         |
|                  |                         |     participation.      |
|                  |                         |                         |
|                  |                         | -   Provide             |
|                  |                         |     opportunities to    |
|                  |                         |     participate without |
|                  |                         |     self-disclosure.    |
|                  |                         |                         |
|                  |                         | -   Maintain anonymity  |
|                  |                         |     in publications and |
|                  |                         |     public arenas.      |
+------------------+-------------------------+-------------------------+
| **Fair Selection | -   Exclusion from      | -   Describe the        |
| of               |     program and/or      |     diversity of        |
| Participants**   |     services based on   |     potential           |
|                  |     age, race,          |     participants from   |
|                  |     ethnicity, culture, |     program target      |
|                  |     language, sexual    |     community.          |
|                  |     orientation,        |                         |
|                  |     disability,         | -   Develop program     |
|                  |     literacy, gender,   |     leadership that     |
|                  |     and path to         |     reflects diversity  |
|                  |     recovery.           |     of target           |
|                  |                         |     community.          |
|                  | -   Unfair "targeting"  |                         |
|                  |     of population for   | -   Provide diversity   |
|                  |     participation based |     and cultural        |
|                  |     on age, race,       |     competency training |
|                  |     ethnicity, culture, |     for staff,          |
|                  |     language, sexual    |     volunteers and      |
|                  |     orientation,        |     participants.       |
|                  |     disability,         |                         |
|                  |     literacy, gender,   | -   Increase cultural   |
|                  |     and path to         |     competency through  |
|                  |     recovery.           |     hiring and          |
|                  |                         |     volunteer           |
|                  |                         |     recruitment         |
|                  |                         |     procedures.         |
|                  |                         |                         |
|                  |                         | -   Utilize peers in    |
|                  |                         |     outreach efforts.   |
|                  |                         |                         |
|                  |                         | -   Continue to assess  |
|                  |                         |     participation       |
|                  |                         |     barriers and        |
|                  |                         |     develop strategies  |
|                  |                         |     to address.         |
+------------------+-------------------------+-------------------------+
| **Absence of     | -   Coerced             | -   Provide on-going    |
| Coercion**       |     participation.      |     written and verbal  |
|                  |                         |     communication about |
|                  | -   Peer pressure to    |     voluntary nature of |
|                  |     participate.        |     participation.      |
|                  |                         |                         |
|                  | -   Access to program   | -   Provide range of    |
|                  |     "benefits"          |     opportunities for   |
|                  |     primarily based on  |     participation from  |
|                  |     level of            |     high to low         |
|                  |     participation.      |     visibility (i.e.,   |
|                  |                         |     some involving no   |
|                  | -   Monetary            |     disclosure of       |
|                  |     compensation for    |     recovery status).   |
|                  |     participation.      |                         |
|                  |                         | -   Obtain written      |
|                  | -   Mandatory           |     consent to          |
|                  |     participation       |     participate.        |
|                  |     attached to         |                         |
|                  |     continued access to | -   Establish feedback  |
|                  |     program or agency   |     & grievance         |
|                  |     services.           |     procedures that can |
|                  |                         |     be utilized by      |
|                  |                         |     program             |
|                  |                         |     participants to     |
|                  |                         |     communicate         |
|                  |                         |     perceived problem   |
|                  |                         |     areas.              |
|                  |                         |                         |
|                  |                         | -   Provide appropriate |
|                  |                         |     monetary and        |
|                  |                         |     non-monetary        |
|                  |                         |     incentives in fair  |
|                  |                         |     and equitable       |
|                  |                         |     manner.             |
+------------------+-------------------------+-------------------------+
| **Methods of     | -   Coerced             | -   Maintain            |
| Data             |     participation in    |     confidential        |
| Collection**     |     data collection     |     information         |
|                  |     effort.             |     separately, and in  |
|                  |                         |     locked cabinet.     |
|                  | -   Participant         |                         |
|                  |     mandated to provide | -   Train all project   |
|                  |     data.               |     staff and           |
|                  |                         |     volunteers in       |
|                  | -   Participant unable  |     project's policy    |
|                  |     to give informed    |     for maintaining     |
|                  |     consent.            |     confidentiality of  |
|                  |                         |     participants'       |
|                  | -   Properly            |     information.        |
|                  |     maintaining         |                         |
|                  |     confidential        | -   Consistently        |
|                  |     information (e.g.,  |     safeguard           |
|                  |     information not     |     confidentiality of  |
|                  |     properly stored in  |     participant         |
|                  |     locked file         |     information         |
|                  |     cabinet, or         |                         |
|                  |     electronically      | -   Utilize user names, |
|                  |     stored information  |     passwords, etc.     |
|                  |     not protected by    |     when confidential   |
|                  |     user name,          |     information is      |
|                  |     password, firewall, |     stored              |
|                  |     etc.)               |     electronically.     |
|                  |                         |                         |
|                  | -   Unauthorized access | -   Ensure that         |
|                  |     by program          |     staff/volunteers    |
|                  |     staff/volunteers to |     adhere to data      |
|                  |     confidential        |     collection policies |
|                  |     information (i.e.   |     and procedures      |
|                  |     names, contact      |     (including          |
|                  |     information, etc).  |     collecting only     |
|                  |                         |     that information    |
|                  | -   Staff and/or        |     that is absolutely  |
|                  |     volunteers not      |     necessary)          |
|                  |     adhering to data    |                         |
|                  |     collection &        | -   Establish a         |
|                  |     instrument          |     feedback and        |
|                  |     protocol.           |     grievance procedure |
|                  |                         |     for program         |
|                  |                         |     participants to     |
|                  |                         |     report problem      |
|                  |                         |     areas.              |
+------------------+-------------------------+-------------------------+
| **Privacy and    | -   Same as 1 thru 4    | -   Same as 1 thru 4    |
| C                |     above.              |     above.              |
| onfidentiality** |                         |                         |
+------------------+-------------------------+-------------------------+
| **Consent        | -   Lack of knowledge   | -   Emphasize voluntary |
| Procedures**     |     of consent          |     participation in    |
|                  |     procedure.          |     all activities,     |
|                  |                         |     including data      |
|                  | -   Low reading &       |     gathering, and      |
|                  |     comprehension       |     provide             |
|                  |     skills.             |     opportunities to    |
|                  |                         |     participate in      |
|                  | -   Complicated         |     activities that do  |
|                  |     language &          |     not require         |
|                  |     terminology in      |     disclosure.         |
|                  |     consent form.       |                         |
|                  |                         | -   Provide explanation |
|                  | -   Peer pressure to    |     of consent forms at |
|                  |     consent to          |     events.             |
|                  |     participate.        |                         |
|                  |                         | -   Read consent form   |
|                  |                         |     to participants to  |
|                  |                         |     clarify content.    |
|                  |                         |                         |
|                  |                         | -   Translate consent   |
|                  |                         |     forms in the        |
|                  |                         |     appropriate         |
|                  |                         |     language (use only  |
|                  |                         |     CSAT-approved       |
|                  |                         |     translation).       |
|                  |                         |                         |
|                  |                         | -   Provide translation |
|                  |                         |     at project events   |
|                  |                         |     when informing      |
|                  |                         |     participants of     |
|                  |                         |     consent procedures. |
+------------------+-------------------------+-------------------------+

# Appendix H: Additional Consideration: Peer vs. Professional Support Services {#appendix-h-additional-consideration-peer-vs.-professional-support-services .unnumbered}

+--------------------------------+-------------------------------------+
| **Issue**                      | **Strategy**                        |
+--------------------------------+-------------------------------------+
| -   Distinguishing between     | -   Number range CHAPTERImplement a |
|     Peer-to-Peer and           |     "Do No Harm" approach.          |
|     Professional Services.     |                                     |
|                                | -   Provide training for project    |
| -   Addressing specific issues |     staff/volunteers on nature and  |
|     when program participants  |     boundaries of peer services.    |
|     are both professionals and |                                     |
|     peers.                     | -   Have an ethics policy and plan, |
|                                |     and train project               |
| -   Addressing "turf" issues   |     staff/volunteers in ethics for  |
|     with other substance abuse |     peer services.                  |
|     treatment service          |                                     |
|     agencies.                  | -   Provide training for project    |
|                                |     staff on referral to other      |
|                                |     community (peer and             |
|                                |     professional) services.         |
|                                |                                     |
|                                | -   Develop and communicate         |
|                                |     guidelines for individuals who  |
|                                |     are both peers and              |
|                                |     professionals.                  |
|                                |                                     |
|                                | -   Reach out to professional       |
|                                |     service organizations to inform |
|                                |     them of peer services and       |
|                                |     opportunities for               |
|                                |     collaboration.                  |
+--------------------------------+-------------------------------------+

# Appendix I: Glossary {#appendix-i-glossary .unnumbered}

**[Grant:]{.underline}** A grant is the funding mechanism used by the
Federal Government when the principal purpose of the transaction is the
transfer of money, property, services, or anything of value to
accomplish a public purpose of support or stimulation authorized by
Federal statute. The primary beneficiary under a grant or cooperative
agreement is the public, as opposed to the Federal Government.

**[Peer]{.underline}:** An individual who shares the experience of
addiction and recovery, either directly or as a family member or
significant other.

**[Peer-to-Peer Recovery Support Services:]{.underline}** Recovery
support services designed and delivered by peers to assist others in or
seeking recovery, and/or their family members and significant others, to
initiate and/or sustain recovery from alcohol and drug use disorders and
closely related consequences.

**[Recovery Support Services]{.underline}**: Supportive services
designed to assist people in or seeking recovery and their family
members and significant others initiate and/or sustain recovery by
providing supports in four major areas: emotional, informational,
instrumental, and affiliational support. Recovery support services are
based, philosophically, on the notion that recovery is a larger
construct than sobriety or abstinence and embraces a reengagement with
the community based on resilience, health, and hope. Therefore, recovery
support services are designed to focus less on the pathology of
substance use disorders and more on maximizing opportunities to create a
lifetime of recovery and wellness for self, family, and community.

**[Recovery Community:]{.underline}** Persons having a history of
alcohol and drug problems who are in or seeking recovery or recovered,
including those currently in treatment, as well as family members,
significant others, and other supporters and allies.

#### [Stakeholder:]{.underline} A stakeholder is an individual, organization, constituent group, or other entity that has an interest in and will be affected by a proposed grant project. {#stakeholder-a-stakeholder-is-an-individual-organization-constituent-group-or-other-entity-that-has-an-interest-in-and-will-be-affected-by-a-proposed-grant-project. .unnumbered}

# Appendix J: RCO/FO Designation and Statement of Assurance {#appendix-j-rcofo-designation-and-statement-of-assurance .unnumbered}

[RCO/FO Designation]{.underline}

You must complete the designation below or your application will not be
reviewed.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is
applying for an RCSP grant as a

(Name of Applicant Organization)

(Check one of the following): \_\_\_\_\_ Recovery Community Organization
(RCO)

\_\_\_\_\_ Facilitating Organization (FO)

[Statement of Assurance]{.underline}

As the authorized representative of the applicant organization, I assure
SAMHSA that if *\[insert name of organization\]* application is within
the funding range for a grant award, the organization will provide the
SAMHSA Government Project Officer (GPO) with the following
documentation. I understand that if this documentation is not received
by the GPO within the specified timeframe, the application will be
removed from consideration for an award.

-   Official documentation that the applicant organization has been
    providing peer recovery support services or other relevant services
    engaging the recovery community in the design and delivery of
    recovery support services for a minimum of 2 years before the date
    of the application in the area(s) in which services are to be
    provided. Official documentation can be a copy of the organization's
    charter, its 501(c)(3) status, or other documents that definitively
    establish that the organization has provided relevant services for
    the last 2 years.

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

Signature of Authorized Representative Date

# Appendix K -- Confidentiality and Participant Protection {#appendix-k-confidentiality-and-participant-protection .unnumbered}

### 

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

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

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

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

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

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

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

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

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

```{=html}
<!-- -->
```
-   Explain how you will recruit and select participants. Identify who
    will select participants.

3.  [Absence of Coercion]{.underline}

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

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

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

4.  [Data Collection]{.underline}

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

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

```{=html}
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```
-   Provide in **Appendix 2, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

5.  [Privacy and Confidentiality]{.underline}

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

-   Describe:

```{=html}
<!-- -->
```
-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

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

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

6.  [Adequate Consent Procedures]{.underline}

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

-   State:

```{=html}
<!-- -->
```
-   Whether or not their participation is voluntary.

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

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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

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

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

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

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

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

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

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

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

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

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

Applicants must be aware that even if the Protection of Human Subjects
Regulations do not apply to all projects funded, the specific evaluation
design proposed by the applicant may require compliance with these
regulations.

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

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

### 

###  

# Appendix L: Sample RCSP Budget {#appendix-l-sample-rcsp-budget .unnumbered}

**Sample RCSP Budget and Narrative**

**Personnel:**

The Project Director will be responsible for oversight of the project
and will work closely with the Project Coordinator and Evaluator to
ensure all facets of the project are completed according to RCSP Request
for Applications (RFA) requirements. Budgeted at 20% FTE, the Project
Director will provide daily administrative, financial, and program
oversight of the project.

The agency is offering 0.05 FTE of the Director of Community Relations'
salary (\$3,000) as an in-kind contribution to the project. The Director
of Community Relations will assist Project Morning Star staff with
outreach to stakeholders and recovery community members leaving
treatment programs in the local area.

The Project Coordinator is a full-time (100% FTE) position and will be
responsible for the day-to-day operation of the project, including
supervision of the Project Associates and Secretary.

The two (2) Project Associates, each at 100% FTE, will plan and conduct
the day-to-day activities in the Peer Recovery Drop-In Center and run
support groups at partner sites throughout the State. The Project
Associates' primary responsibilities include outreach, leading peer
skill attainment and support groups, conducting computer labs,
maintaining the community resource file, providing peer coaching,
supervising the peer leaders, and assisting the Evaluator in meeting
GPRA requirements.

The Project Secretary, at 0.5 FTE, will be responsible for management of
the office, including the telephones, filing, and word processing and
copying of documents and materials for the project.

**Fringe Benefits:**

The following is an agency breakdown of fringe benefits:

FICA 7.65

Health Insurance 8.25

Dental Insurance 3.00

Life Insurance 1.00

Simple IRA 3.00

Workers Compensation .35

Unemployment Insurance .75

Fringe Benefits (24% of \$131,000 = \$31,440)

**Travel:**

As required by the RCSP RFA, the agency has budgeted for two trips to
Washington, D.C. for CSAT grantee meetings. Airfare for the first trip,
which is for 6 individuals, has been budgeted at \$700 per person. Per
diem has been budget at \$140/day for 6 individuals for 3 days. The
second trip is for 2 individuals at \$700 per person for travel, with
per diem budgeted at \$140/day for 2 individuals for 3 days.

Local travel has been budgeted at 1,500 miles a month at the rate of \$0
.40 a mile for 12 months. Local mileage will primarily be utilized by
the project associates to attend meetings at stakeholder agencies,
conduct outreach and recruiting activities, and lead peer support groups
at partner sites. Our project covers the entire State, and we have
weekly support groups at our six partner sites. Mileage is also included
for transporting participants in the van (see below) in the 6 cities
surrounding the Peer Resource Center (rural area of our State).

**Equipment:**

The applicant organization does not have capital to purchase a van;
therefore, we are requesting to purchase a 2005 Aerostar Van with grant
funds. The 7-passenger van will be used exclusively for the RCSP project
to transport approximately 80 participants to the project site and/or to
project activities. The estimated cost of \$25,000 will be depreciated
over a 5-year useful life.

Transportation is to cover the 6 cities in the rural area we serve,
which has no public transportation. The van will be utilized to bring
participants to the RCSP project where they will participate in peer
coaching, support groups, skills workshops, and related recovery
activities. We will also occasionally use the van to transport members
who have no transportation to other recovery support services. Purchase
price for the 2005 Aerostar van is \$25,000. Attached is documentation
on appropriate letterhead by leasing agent and car dealership showing
purchase price at \$25,000 and lease price at \$23,000 over the life of
the project. We also investigated the possibility of purchasing a used
van, but found none available.

A total of 8 computer systems @ \$1,400 are requested. Four (4)
computers are for staff, to be used in carrying out the day-to-day
functions of the RCSP project. Four (4) computers have been budgeted for
the RCSP project. These computers are for use by approximately 100
project participants for completing on-line GED training, preparing job
applications and resumes, and learning basic computer applications
(e.g., word processing, spread sheets, PowerPoint) as part of the
Center's job skills training initiative.

Funds in the amount of \$5,040 are requested for a copier, which is used
to reproduce hand-outs for the training workshops and support groups and
to duplicate other needed information and materials for the project.
(The cost of the copier represents a lease with a partnering
organization using space in our building, at the rate of \$700/month x
12 months @.60%).

**Supplies:**

Supplies have been budgeted at \$300/month for 12 months. Needed
supplies include the day-to-day office supplies (e.g., pens, paper,
folders, binders), as well as items required for the weekly skills
training workshops and computer labs.

Funds in the amount of \$800 are requested for 4 computer software
packages @ approximately \$200 per item). These will include word
processing and spreadsheet applications for the office, and educational
packages for use by the participants in the Resource Center.

**Contracts:**

(Note to Applicants: For consultants, estimate the number of days and
estimated cost/day or level of effort of 1 FTE for each consultant.
Provide a detailed justification for each. For any anticipated
contracts, provide the purpose, line item costs, and basis for the cost.
Please note that procurements must comply with the requirements of the
Code of Federal Regulations (see 45 CFR Part 74.40 or 45 CFR Part 92.36
as applicable). Generally, procurement standards require free and open
competition, lease vs. purchase analysis, cost analysis, and
justification for need.)

[Evaluation Contract]{.underline}

Janice Wilson, Ph.D. will serve as evaluator for the project. Dr. Wilson
will provide 20% of her time for the evaluation. Dr. Wilson will be
responsible for the process evaluation and meeting the RCSP GPRA
requirements. An Evaluation Assistant, at 20% FTE, will assist with date
collection and data management.

General supplies for the evaluation contract staff have been budgeted at
\$500.00 for paper, binders, folders, etc.

[Training Contract]{.underline}

Elizabeth Gibson, M.A., LCDC, be utilized for 40 days at \$250.00/day as
an expert training consultant. A self-identified person in recovery and
licensed chemical dependency counselor, Mr. Gibson will design and
conduct 2 train-the-trainer workshops for Project Staff and peer
leaders/coaches on support group facilitation. She will also provide
ongoing consultation on the peer coaching and skills-training
curriculum, and she will assist in writing the curricula. Ms. Gibson
will also present 2 workshops to staff and peer leaders on recovery
models and development of strength-based peer support activities.

**Other:**

Rent has been budgeted at \$500.00 a month at a rate of \$10.00 per
square foot. Office space for the RSCP Project includes 1 conference
room, 4 offices, 1 training room, and a front office area. (Note to
Applicants: Office space may not be included as a direct charge if an
indirect cost rate is negotiated and claimed for this grant. Specify who
owns the building where the program is located and the owner's
relationship to the program.)

Telephone has been budgeted at \$200.00 a month.

\$5,000 has been budgeted for the annual audit of the project, which
will be conducted by a Certified Public Accountant.

Postage has been budgeted at \$650/month x 12 months for a total
requested of \$7,800. This includes regular mail and Fed Ex service
(@\$200/month), as well as the monthly mailing of our newsletter (300
pieces at \$1.50 = \$450).

\$6,000 has been budgeted for books, magazines, videos, journals, and
existing training curricula focusing on recovery issues. These will be
used in the peer skills attainment workshops and recovery support
groups.

We are requesting \$2,000 for 8 non-entertainment community drug-free
activities (\$250.00 x 8 events per year) aimed at having participants
plan and implement recovery-themed events to create community awareness,
reduce stigma, recruit new participants, and increase community
partners. One of these events will be an observance of SAMHSA National
Alcohol and Drug Recovery Month. (Note to Applicants: Include activities
by name if known \[e.g., Recovery Walkathan, Community Sober Jam,
Recovery Expo\].)

Non-entertainment Peer Drug-Free Socialization Activities have been
budgeted for \$5,000 @ \$250.00 per event x 20 events. These periodic
activities provide opportunities for people in recovery to increase
social networking skills and to interact in different social settings
that promote drug-free attitudes. These activities are particularly
important for our project population because most of our participants
are new in recovery and many are returning to the community from
incarceration. Peer Drug-Free Socialization Activities include various
leisure and learning opportunities such as recovery-themed
movie/discussion sessions, coffee/book club meetings, recovery picnics,
and alcohol- and drug-free dances and outings. (Note to Applicants:
Include activities by name if known.)

\$5,000 has been allocated for peer instrumental support packages. These
packages include basic items needed by many people in early recovery,
including homeless people, returning ex-offenders, women with children,
and others with few resources and many needs. Items included in the
instrumental support packages include personal hygiene items
(toothbrush, toothpaste, comb, brush, soap, hand towel), simple food
supplies (canned goods, protein bars), and basic household items (paper
towels, toilet paper, vouchers for Laundromat). Each instrumental
package is valued at approximately \$15-\$20. Participants are allowed 2
instrumental support packages per quarter, and sign for them in a log
book. (Note to Applicants: Food is generally unallowable; however, a
limited amount of grant funds may be budgeted for specific justified
program activities such as those stated above.)

We have allocated \$2,800 for participant incentives for 2-3 peer
leaders who will facilitate support groups and/or serve as peer coaches.
Only peer leaders who complete our training program will be eligible for
the peer incentives. Each peer leader will receive a monthly incentive
of approximately \$80, provided they fulfill their responsibilities. We
execute letters of agreement with the peer leaders that detail the
requirements for these incentives, and will track the services they
provide to ensure they carry out the requirements.

\$6,000 has been allocated for GPRA incentives (up to \$20 per
participant to complete 2 follow-up surveys), to enable Project
Morningstar to meet our GPRA target of 150 individuals surveyed per
year.

Insurances: Liability insurance has been budgeted at \$2,500. Van
insurance has been budgeted at \$2,000. (Note to Applicants: This is the
allocable share of annual costs of \$2,500 (\$2,500/20 FTEs = \$125/FTE
\* 5 FTEs = \$625). This insurance may not be claimed as a direct charge
if an indirect cost rate is used for this grant.)

Printing costs are budgeted in the amount of \$1,000 for flyers and
newsletters. (Approximately 35% of the newsletter printing costs are
provided by a local vender who is in recovery as a contribution to the
project.)

Staff training and development expenses are requested in the amount of
\$5,000. These costs will be used for 5 training events @ \$1,000 per
event (to include tuition, materials, and travel costs). We are looking
into appropriate training events for each of the following: Project
Coordinator, two Project Associates, and two Peer Leaders. The trainings
will be selected to provide and/or enhance the knowledge and skills
needed to carry out a program of peer-to-peer recovery support services.
Topics under consideration include: motivational interviewing, conflict
resolution skills, job enhancement and/or job coaching skills; and
parenting skills.

**Indirect Costs:**

Indirect Costs have been budgeted at 15%, and a copy of the negotiated
indirect cost agreement is attached. (Note to Applicants: If you are
planning to negotiate an indirect cost rate, indicate so in this
section. Indirect costs may be charged as direct so long as your
organization treats all of these costs the same and all costs are
justified.)

**Total Budget Request: [\$ 349,691]{.underline}**

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

                                                                                                                              

  **[Personnel]{.underline}**                                                                                                 

                                                                                           **Salary                           
                                                                                           Being                              
                                                                                           Requested**                        

  **Job Title**                 **Name**              **Annual              **Level of     **SAMHSA**    **Other Sources      
                                                      Salary**              Effort**                     Non-Federal**        

  Project Director              R. Munoz              \$80,000              0.20           \$20,000                           

  Dir. Community Relations      J. Ruiz               \$60,000              0.05           none          In-kind              
                                                                                                         contribution         

  Project Coord.                J. Moss               \$40,000              1.0            \$40,000                           

  Project Assoc.                Unnamed               \$30,000              1.0            \$30,000                           

  Project Assoc.                Unnamed               \$30,000              1.0            \$30,000                           

  Secretary                     Unnamed               \$22,000              0.5            \$11,000                           

  **Subtotal -- Personnel**                                                                                                   **\$131,000**

                                                                                                                              

  **[Fringe                                                                                                                   **\$31,440**
  Benefits]{.underline}** (24%)                                                                                               

                                                                                                                              

  **[Travel]{.underline}**                                                                                                    

                                                                                                                              

  2 trips for SAMHSA Meetings                                                                                                 

  1^st^ Trip for 6 Attendees                                                                                                  

  (Airfare @ \$700 x 6 =                                                                                                      
  \$4,200) + (per diem                                                                                                        

  @ \$140 x 6 x 3 days =                                                                   \$6,720                            
  \$2,520)                                                                                                                    

  2^nd^ Trip for 2 Attendees                                                                                                  

  (Airfare @ 700 x 2 =                                                                                                        
  \$1,400) + (per diem                                                                                                        

  @ \$140 x 2 x 3 days = \$840)                                                            \$2,240                            

                                                                                                                              

  Local Travel (1,500                                                                      \$7,200                            
  miles/month x .40 x 12 mths.)                                                                                               

  **Subtotal -- Travel**                                                                                                      **\$16,160**

                                                                                                                              

  **[Equipment]{.underline}**                                                                                                 

                                                                                                                              

  2005 Aerostar Van(7                                                                      \$25,000                           
  passengers)                                                                                                                 

  Computers (8) @ \$1,400 per                                                              \$11,200                           
  computer system                                                                                                             

  Copier (shared lease with                                                                                                   
  partnering organization --                                                                                                  

  (\$700/month x 12 months                                                                 \$5,040                            
  @.60%)                                                                                                                      

                                                                                                                              

  **Subtotal -- Equipment**                                                                                                   **\$37,240**

                                                                                                                              

  **[Supplies]{.underline}**                                                                                                  

                                                                                                                              

  Office Supplies (\$300 x 12                                                              \$3,600                            
  mths.)                                                                                                                      

  Computer Software packages (4                                                            \$800                              
  packages @\$200)                                                                                                            

  **Subtotal -- Supplies**                                                                                                    **\$4,400**

                                                                                                                              

  **[Contractual                                                                                                              
  Costs]{.underline}**                                                                                                        

                                                                                                                              

  **Evaluation Contracts:**                                                                                                   

                                                                                           **Salary                           
                                                                                           Being                              
                                                                                           Requested**                        

  **Job Title**                            **Name**              **Annual   **Level of     **SAMHSA**    **Other Sources      
                                                                 Salary**   Effort**                     Non-Federal**        

  Evaluator                                J. Wilson             \$60,000   0.2            \$12,000                           

  Eval. Assistant                          To Be                 \$18,000   0.2            \$3,600                            
                                           Named                                                                              

                                                                                                                              **\$15,600**

                                                                                                                              

  Evaluation Supplies (General                                                             \$500                              
  Office)                                                                                                                     

                                                                                                                              

  **Training Contracts:**                                                                                                     

  E. Wilson (40 days x                                                                     \$10,000                           
  \$250/day)                                                                                                                  

                                                                                                                              

  **Subtotal -- Contracts**                                                                                                   **\$26,100**

                                                                                                                              

  **Other**                                                                                                                   

  Rent (500 Sq. Ft. x \$10)                                                                \$5,000                            

  Telephone (\$200 x 12)                                                                   \$2,400                            

  Audit                                                                                    \$5,000                            

  Postage (\$650 x 12 months)                                                              \$7,800                            

  Recovery Materials                                                                       \$6,000                            

  Community Drug-Free                                                                      \$2,000                            
  Activities (\$250 x 8                                                                                                       
  activities)                                                                                                                 

  Peer Drug-Free Socialization                                                             \$5,000                            
  Activities (\$250 x 20                                                                                                      
  activities)                                                                                                                 

  Instrumental Supports (125                                                               \$5,000                            
  clients x 2 packages x \$20)                                                                                                

  Peer Incentives (3 peers x 12                                                            \$2,880                            
  months x \$80)                                                                                                              

  GPRA Incentives (150                                                                     \$6,000                            
  individuals x 2 surveys x 20)                                                                                               

  Liability Insurance                                                                      \$2,500                            

  Van Insurance                                                                            \$2,000                            

  Printing                                                                                 \$2,000                            

  Staff Training and                                                                       \$5,000                            
  Development                                                                                                                 

  **Subtotal -- Other**                                                                                                       **\$58,580**

                                                                                                                              

  **Total Direct Charges**                                                                                                    **\$304,520**

                                                                                                                              

  **[Indirect                                                                                                                 
  Costs]{.underline}**                                                                                                        

  15% of Salary and Wages.                                                                                                    
  (Copy of negotiated                                                                                                         

  indirect cost rate agreement                                                                                                **\$45,171**
  attached.)                                                                                                                  

                                                                                                                              

  **[TOTAL]{.underline}**                                                                                                     **\$349,691**
  ----------------------------- ---------- ---------- ---------- ---------- ---------- --- ------------- --------------- ---- ---------------

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