# Instructions for Preparing

# Applications for

# Congressional Mandates

# Under Title IV of the Older Americans Act

# 

# 

# 

# 

# 

# U.S. Administration on Aging

# 2008

# [Contents]{.underline}

# 

+-----------------------------------------------------------------+----+
| # I. Standard Forms                                             | #  |
+-----------------------------------------------------------------+----+
| #                                                               | #  |
+-----------------------------------------------------------------+----+
| #  1. SF 424                                                    | #  |
+-----------------------------------------------------------------+----+
| #  - Match Requirement                                          | #  |
+-----------------------------------------------------------------+----+
| #  2. SF 424A                                                   | #  |
+-----------------------------------------------------------------+----+
| #  - Separate Budget Justification Requirement                  | #  |
+-----------------------------------------------------------------+----+
| # SF 424B                                                       | #  |
|                                                                 |    |
| 3.  **AoA Certification**                                       |    |
|                                                                 |    |
| 4.  **DUNS Number**                                             |    |
|                                                                 |    |
| ##                                                              |    |
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|                                                                 | #  |
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|                                                                 | #  |
+-----------------------------------------------------------------+----+
| ######### II. Project Narrative                                 | #  |
+-----------------------------------------------------------------+----+
|                                                                 | #  |
+-----------------------------------------------------------------+----+
| **1. Summary/Abstract**                                         | #  |
+-----------------------------------------------------------------+----+
| **2. Problem Statement**                                        | #  |
+-----------------------------------------------------------------+----+
| **3. Goal(s) and Objectives**                                   | #  |
+-----------------------------------------------------------------+----+
| **4. Proposed Intervention**                                    | #  |
+-----------------------------------------------------------------+----+
| **5. Outcome(s) and Benefits**                                  | #  |
+-----------------------------------------------------------------+----+
| **6. Evaluation**                                               | #  |
+-----------------------------------------------------------------+----+
| **7. Dissemination**                                            | #  |
+-----------------------------------------------------------------+----+
| **8. Work Plan**                                                | #  |
+-----------------------------------------------------------------+----+
| **9. Project Management**                                       | #  |
+-----------------------------------------------------------------+----+
| **10. Vitae of Key Project Personnel**                          | #  |
+-----------------------------------------------------------------+----+
| **11. Letters of Commitment from Key Partner Organizations**    | #  |
+-----------------------------------------------------------------+----+
|                                                                 | #  |
+-----------------------------------------------------------------+----+
| **III. Grant Review Process and Evaluation Criteria**           |    |
+-----------------------------------------------------------------+----+
|                                                                 |    |
+-----------------------------------------------------------------+----+
| **IV. Application Submission**                                  |    |
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|                                                                 | #  |
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| ## ATTACHMENTS                                                  | #  |
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|                                                                 | #  |
+-----------------------------------------------------------------+----+
| ##  Budget Narrative -- Sample Format                           | #  |
+-----------------------------------------------------------------+----+
| **Budget Narrative -- Sample Format with Examples**             | #  |
+-----------------------------------------------------------------+----+
| **Project Work Plan -- Sample Format**                          | #  |
+-----------------------------------------------------------------+----+
| **Survey on Ensuring Equal Opportunity for Applicants**         | #  |
+-----------------------------------------------------------------+----+
| **Instructions for Completing the Summary/Abstract**            | #  |
+-----------------------------------------------------------------+----+
|                                                                 | #  |
+-----------------------------------------------------------------+----+

# 

# Instructions for Preparing Applications for 

# New Non-Competitive Grant Awards 

# Under Title IV of the Older Americans Act

###### I. STANDARD FORMS

  -----------------------------------------------------------------------
  This document provides step-by-step instructions for completing all
  necessary forms and documents required by the U.S. Administration on
  Aging (AoA) for non-competitive grant awards authorized under Title IV
  of the Older Americans Act, including special instructions for
  completing Standard Budget Forms 424 and 424A. Standard Forms 424 and
  424A are used for a wide variety of federal grant programs, but each
  federal agency has the discretion to determine which information
  elements it is going to require of its grantees. The AoA does not
  require all the information on these standard forms, so you should use
  the instructions in this document in lieu of the standard instructions
  attached to SF 424 and 424A to complete these forms. Please note that
  single-sided copies of all required forms must be used in submitting
  your application.

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

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###### a. Standard Form 424

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

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

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

• New . • Continuation • Revision

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

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

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

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

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

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

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

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

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

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

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

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

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

matters related to this application.

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

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

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

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

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

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

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

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

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

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

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

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

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

There are two types of match: 1.) non-federal cash and 2.) non-federal
non-cash (i.e., in-kind). In general, costs borne by the applicant and
cash contributions of any and all third parties involved in the project,
including sub-grantees, contractors and consultants, are considered
[cash matching funds]{.underline}. Generally, most contributions from
third parties will be non-cash (i.e., in-kind) matching funds. Examples
of [non-cash (in-kind) match]{.underline} include: volunteered time and
use of facilities to hold meetings or conduct project activities.

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

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

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

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

**2. [Standard Form 424A]{.underline}**

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

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

##### 

##### Section A ‑ Budget Summary

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

##### Section B ‑ Budget Categories

Column 3: Enter the breakdown of how you plan to use the federal funds
being

> requested by object class category (see instructions for each object
> class category below).

Column 4: Enter the breakdown of how you plan to use the non-federal
share by object class category.

Column 5: Enter the total funds required for the project (the sum of
Columns 3 and 4) by object class category.

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

[Line 6a]{.underline}: [Personnel]{.underline}: Enter total costs of
salaries and wages of applicant/grantee staff. Do

> not include the costs of consultants (consultant costs should be
> included on Line 6h ‑ Other.) [In the Justification]{.underline}:
> Identify the project director, if known. Specify the key staff, their
> titles, a brief summary of project related duties, and the percentage
> of time commitments in the budget justification.

[Line 6b]{.underline}: [Fringe Benefits]{.underline}: Enter the total
costs of fringe benefits unless treated as part of

> an approved indirect cost rate. [In the Justification]{.underline}:
> Provide a breakdown of amounts and percentages that comprise fringe
> benefit costs, such as health insurance, FICA, retirement insurance,
> etc.

[Line 6c]{.underline}: [Travel]{.underline}: Enter total costs of
[out‑of‑town travel]{.underline} (travel requiring per diem) for

> staff of the project. Do not enter costs for consultant\'s travel
> (consultant's travel costs should be included in line 6h. [In the
> Justification]{.underline}: Include the total number of trips,
> destinations, purpose, length of stay, subsistence allowances, and
> transportation costs (including mileage rates).

[Line 6d]{.underline}: [Equipment]{.underline}: Enter the total costs of
all equipment to be acquired by the project. For all grantees,
\"equipment\" is non‑expendable tangible personal property having a
useful life of more than one year and an acquisition cost of \$5,000 or
more per unit. If the item does not meet the \$5,000 threshold, include
it in your budget under Supplies, line 6e. [In the
Justification]{.underline}: Equipment to be purchased with federal funds
must be justified as necessary for the conduct of the project. The
equipment must be used for project-related functions; the equipment, or
a reasonable facsimile, must not be otherwise available to the applicant
or its sub‑grantees. The justification also must contain plans for the
use or disposal of the equipment after the project ends.

[Line 6e]{.underline}: [Supplies:]{.underline} Enter the total costs of
all tangible expendable personal property

> (supplies) other than those included on line 6d. [In the
> Justification:]{.underline} Provide a general description of types of
> items included.

[Line 6f]{.underline}: [Contractual]{.underline}: Enter the total costs
of all contracts, including (1) procurement

> contracts and contracts with organizations for the provision of
> technical assistance. Do not include payments to individuals on this
> line. [In the Justification]{.underline}: Attach a list of contractors
> indicating the name of the organization, the purpose of the contract,
> and the estimated dollar amount. If the name of the contractor, scope
> of work, and estimated costs are not available or have not been
> negotiated, indicate when this information will be available.
> **Whenever the applicant/grantee intends to delegate a substantial
> part (one-third, or more) of the project work to another entity, the
> applicant/grantee must provide a completed copy of Section B, Budget
> Categories for each contractor, along with supporting information and
> justifications.**

[Line 6g]{.underline}: [Construction]{.underline}: Leave blank since
construction is not an allowable costs under this AoA program.

[Line 6h]{.underline}: [Other]{.underline}: Enter the total of all other
costs. Such costs, where applicable, may

> include, but are not limited to: administrative costs NOT included in
> an organization's approved indirect cost rate such as, insurance,
> medical and dental costs (i.e. for project volunteers this is
> different from personnel fringe benefits), space and equipment
> rentals/lease, computer use; non-contractual fees and travel paid
> directly to *individual* consultants; [local]{.underline}
> transportation (all travel which does not require per diem is
> considered local travel); postage; printing and publication; training
> and staff development costs (e.g., registration fees). If a cost does
> not clearly fit under another category, and it qualifies as an
> allowable cost, then, rest assured, this is where it belongs. [In the
> Justification:]{.underline} Provide a reasonable explanation for items
> in this category. For individual consultants, explain the nature of
> services provided and the relation to activities in the work plan.
> Describe the types of activities for staff development costs.

[Line 6i]{.underline}: [Total Direct Charges]{.underline}: Show the
totals of Lines 6a through 6h.

[Line 6j]{.underline}: [Indirect Charges]{.underline}: Enter the total
amount of indirect charges (costs), if any. If

> no indirect costs are requested, enter \"none.\" Indirect charges may
> be requested if: (1) the applicant has a current indirect cost rate
> agreement approved by the Department of Health and Human Services or
> another federal agency; or (2) the applicant is a state or local
> government agency. [State governments should enter the amount of
> indirect costs determined in accordance with DHHS
> requirements.]{.underline}

[Line 6k]{.underline}: [Total]{.underline}: Enter the total amounts of
Lines 6i and 6j.

[Line 7]{.underline}: [Program Income]{.underline}: As appropriate,
include the estimated amount of income, if any, you expect to be
generated from this project that you wish to designate as match (equal
to the amount shown for Item 15(f) on Form 424). **[Note]{.underline}:**
Any program income indicated at the bottom of Section B and for item
15(f) on the face sheet of Form 424 will be included as part of
non-federal match and will be subject to the rules for documenting
completion of this pledge. If program income is expected, but is not
needed to achieve required match, **do** **not** include that portion
here or on Item 15(f) of the Form 424 face sheet. Any anticipated
program income that will not be applied as grantee match should be
described in the Level of Effort section of the Program Narrative.

##### Section C ‑ Non‑Federal Resources

[Line 12]{.underline}: Enter the amounts of non‑federal resources that
will be used in carrying out the proposed project, by source (Applicant,
State, Other) and enter the total amount in column (e). Do not include
program income unless it is used to meet the match requirement. Keep in
mind that if the proposed program income used to meet the match
requirement is not met (thereby reducing the level of the match) the
amount of federal funds available to the grantee may be reduced.

[Section D ‑ Forecasted Cash Needs]{.underline} - Not applicable.

[Section E ‑ Budget Estimate of Federal Funds Needed for Balance of the
Project]{.underline}

[Line 20]{.underline}: NOTE: Leave this line blank. Section E is
relevant only for **multi-year** grant applications, where the project
period is 24 months or longer. This section does not apply to grant
awards where the project period is less than 17 months.

###### Section F ‑ Other Budget Information

Line 21: [N/A]{.underline}

[Line 22]{.underline}: [Indirect Charges]{.underline}: Enter the type of
indirect rate (provisional, predetermined,

> final or fixed) to be in effect during the funding period, the base to
> which the rate is applied, and the total indirect costs. **Include a
> copy of your current Indirect Cost Rate Agreement.**

[Line 23]{.underline}: [Remarks]{.underline}: Provide any other comments
deemed necessary.

###### 3. Standard Form 424B - Assurances

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

###### 4. AoA Certification 

This form contains certifications that are required of the applicant
organization regarding (a) lobbying; (b) debarment, suspension, and
other responsibility matters; and (3) drug-free workplace requirements.
Please note that a duly authorized representative of the applicant
organization must attest to the applicant's compliance with these
certifications.

**5. [DUNS Number]{.underline}**

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

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

**II**. **PROJECT NARRATIVE**

The Project Narrative is the most important part of the application,
since it will be used as the primary basis by AoA to determine whether
or not your project meets the minimum requirements for grants under
Title IV of the Older Americans Act.

The Project Narrative should provide a **clear and concise** description
of your project. AoA requests that your project narrative be presented
in the following format:

1.  Summary/Abstract

```{=html}
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1.  Problem Statement

2.  Goal(s) and Objectives

3.  Proposed Intervention

4.  Outcome(s) and Benefits

5.  Project Management

6.  Evaluation

7.  Dissemination

8.  Work Plan

9.  Vitae for Key Project Personnel

10. Letters of Commitment from Key Partner Organizations

The Project Narrative must be [double-spaced, on single-sided 8 ½" x 11"
plain white paper with 1" margins on both sides, and a font size of not
less than 11.]{.underline} You can use smaller font sizes to fill in the
Standard Forms and Sample Formats. The suggested length for the Project
Narrative is 10 to 20 pages; 20 pages is the maximum length allowed.
[AoA will not accept applications with a Project Narrative that exceeds
20 pages.]{.underline} NOTE: The Project Work Plan and the Vitae for Key
Project Personnel, are not counted as part of the Project Narrative for
purposes of the 20-page limit.

The contents of each component of the Project Narrative should be as
follows:

1.  **Summary/Abstract.** This section should include a brief - **no
    more than 300 words maximum** - description of the proposed project,
    including: the goal, the list of objectives and the products to be
    developed. Instructions for completing the summary/abstract are
    included in the appendix of this document.

2.  **Problem Statement.** This section should describe, in both
    quantitative and qualitative terms, the nature and scope of the
    particular problem or issue the proposed intervention is designed to
    address, including how the project will potentially affect the
    elderly population and/or their caregivers (including specific
    subgroups within those populations), and possibly the health care
    and social services systems (e.g, the use of health care and/or
    nursing home services).

3.  **Goal(s) and Objectives.** This section should consist of a
    description of the project's goal(s) and major objectives. NOTE:
    Unless the project involves multiple, complex interventions, we
    recommend you have only one overall goal. (include this information
    in the attached project Work Plan grid)

4.  **Proposed Intervention.** This section should provide a clear and
    concise description of the intervention you are proposing to use to
    address the problem described in section 2. You should also describe
    the rationale for using the particular intervention, including
    factors such as: "lessons learned" for similar projects previously
    tested in your community or elsewhere; factors in the larger
    environment that have created the "right conditions" for the
    intervention (e.g., social, economic or political factors that you
    will be able to take advantage of, etc.). You should also describe
    any major barriers you anticipate encountering, and how the project
    is designed to overcome those barriers. Finally, describe the role
    and makeup of any strategic partnerships you plan to involve in
    implementing the intervention.

5.  **Outcome(s) and Benefits**. This section should clearly identify
    the [measurable]{.underline} outcome(s) that will result from the
    project \-- see the section below for a definition of a "measurable
    outcome." (NOTE: AoA will not fund any project that does not include
    measurable outcomes.) This section also should describe how the
    project's findings will benefit the field at large, e.g., how the
    findings could help other communities to address the same or similar
    problems. (also list outcomes in the top section of the first page
    of the attached Work Plan grid)

> NOTE: You should keep this section focused on describing
> [what]{.underline} outcome(s) will be produced by the project. You
> should use the Evaluation section noted below to described
> [how]{.underline} the outcome(s) will be measured and reported.
>
> DEFINITION OF A MEASURABLE OUTCOME:
>
> A "measurable outcomes" is an observable end-result of a project.
> Measurable outcomes can include the project's effect on people,
> organizations, or community conditions, or a change in our exiting
> knowledge base. Examples include: a change in a client's financial,
> health and/or functional status, mental well-being, knowledge, skill,
> attitude, awareness, or behavior. Other examples include a change in
> the degree to which consumers exercise choice over the types of
> services they receive, or the degree to which consumers are satisfied
> with the way a service is delivered. Additional examples include: a
> change in the cost-efficiency and/or cost-effectiveness of a service
> delivery system; or, new knowledge that can contribute to the field of
> aging.
>
> An outcome [IS NOT]{.underline} a project **output**, such as the
> number of clients served, the number of training sessions conducted,
> the number of service units provided, or tangible products and/or
> reports.
>
> **NOTE: Your application will be scored on the clarity and nature of
> your proposed outcome(s), NOT on the number of outcomes you cite. It
> is totally appropriate for a project to have only ONE outcome that it
> is trying to achieve through the intervention reflected in the
> project's design**.

6.  **Evaluation**. This section should describe the method that will be
    used to evaluate whether or not the proposed intervention achieved
    its measurable outcome(s). The evaluation should also be designed to
    capture "lessons learned" -- both positive and negative - from the
    project that will be useful to people interested in replicating the
    intervention, if it proves successful. The section should describe
    the quantitative and qualitative tools and techniques that will be
    used to measure whether or not the project achieved its stated
    outcome(s), and how the "lessons learned" will be identified and
    documented.

7.  **Dissemination.** This section should describe the method that will
    be used to disseminate the project's results and findings in a
    timely manner, and in easily understandable formats, to people who
    might be interested in using the information to inform practice,
    service delivery, program development, and/or policy-making.

8.  **Project Work Plan**. The Project Work Plan should reflect and be
    consistent with the Project Narrative and Budget. It should include
    a statement of the project's overall goal, anticipated outcome(s),
    key objectives, and the major tasks / action steps that will be
    pursued to achieve the goal and outcome(s). For each major task /
    action step, the work plan should identify the timeframes involved
    (including start and end dates), and the lead person responsible for
    completing the task. A Sample Work Plan format for your use is
    included in the Attachments. (use the sample Work Plan grid)

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

10. **Key Personnel and Contract Organizations.** Include short vitae
    for the key staff that will be involved in implementing the project.
    Also include a description of the capabilities of any contractual
    organization(s) that will have a significant role(s) in implementing
    project and achieving project goals.

11. **Letters of Commitment From Key Partner Organizations**

## Include confirmation of the commitments to the project made by [key]{.underline} collaborating organizations and agencies in this part of the application. Any organization that is to have a significant role in implementing the project work plan should be considered a key partner organization. 

**III. GRANT REVIEW PROCESS AND EVALUATION CRITERIA**

Non-competitive grant applications may be reviewed by a panel of at
least three experts, who will score the application, based on the
following criteria.

## 

1\. Problem Statement (Weight: 5 points)

> Does the proposal clearly define the nature and scope of the problem
> or issue to be addressed, including how it affects the elderly
> population and/or their caregivers and specific subgroups within those
> populations? Does the proposal demonstrate that the applicant
> organization has an understanding of the current research that has
> been published on the particular problem or issue, including the
> current state-of-the-art related to the implementation of projects
> similar to the one being proposed, as well as alternative approaches
> that have been used to address the problem or issues?

2\. Significance (Weight: 10 points)

> Is the project innovative and will it generate new knowledge that will
> be of practical value to the field of aging for program design,
> service delivery, and/or policy-making purposes? Do the project and
> its findings, if successful, have the potential to benefit significant
> numbers of older people and/or their caregivers, either directly or
> indirectly? Does the project design lend itself to replication in
> other geographic areas and/or for other populations, if it proves
> successful?

3\. Statement of Goal(s), Objectives and Outcome(s) (Weight: 10 points)

> Does the application include a clear goal statement and clear
> objectives? Are the proposed outcomes measurable and consistent with
> the definition of "measurable outcome" contained in Section II.5 of
> these instructions? Do the goal(s), objective(s) and outcome(s)
> clearly relate to the problem being addressed? NOTE AGAIN: AoA will
> not fund any application that does not include clearly defined
> measurable outcomes.

4.  Proposed Intervention (Weight: 20 points)

> Is the intervention clearly defined? Does it reflect a coherent and
> feasible approach for successfully addressing the identified problem
> and achieving the identified outcome(s)? Does the project take into
> account barriers and opportunities that exist in the larger
> environment that may impact on the project's success? Does the
> intervention optimize the use of potential partnerships with other
> organizations and/or consumer groups, as appropriate?

5\. Evaluation (Weight: 10 points)

> Does the evaluation plan reflect a thoughtful and well-designed
> approach that will be able to successfully measure whether or not the
> project has achieved its proposed outcome(s)? Is the evaluation also
> designed to capture "lessons learned" from the overall effort that
> might be of use to others in the field of aging, especially those who
> might be interested in replicating the project?

6\. Dissemination (Weight: 10 points)

> Does the dissemination plan focus on getting relevant, useful and easy
> to use information in a timely manner to parties that might be
> interested in making use of its findings, particularly to those who
> might want to replicate the project?

7\. Project Work Plan (Weight: 15 points)

> Is the project work plan clear and comprehensive? Is it well-ordered
> and does it include a sensible timeline for accomplishing the
> identified tasks and objectives? Are the sequence and timing of events
> logical and realistic? Do the objectives and tasks clearly relate to
> the anticipated outcome(s)?

8.  Project Management (Weight: 10 points)

> Does the proposal include a clear and coherent management plan? Are
> the roles and responsibilities of project staff, consultants and
> partners clearly defined and linked to specific objectives and tasks?
> Are the qualifications of the project staff, consultants and/or
> partners, and the proposed level of effort, adequate to carry out the
> project? Does the plan include a strategy for monitoring project
> activities?

9\. Project Budget (Weight: 10 points)

> Is the budget justified with respect to the adequacy and
> reasonableness of the resources requested? Is the time commitment and
> qualifications of the proposed director and other key project staff
> sufficient to assure proper direction, management and completion of
> the project? Are budget line items consistent with the work plan
> objectives and action steps?

## IV. APPLICATION SUBMISSION

Application materials can be obtained from
[http://www.grants.gov](http://www.grants.gov/) using the Funding
Opportunity Number for the appropriate grant opportunity. Grantees
applying for new non-competitive funding receive a letter including the
Funding Opportunity Number for their grant program.

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

Applications submitted via [www.grants.gov](http://www.grants.gov/) :

-   You may access the electronic application for this program on
    [www.Grants.gov](http://www.Grants.gov/). You must search the
    downloadable application page by the Funding Opportunity Number
    ([Insert Number]{.mark}) or CFDA number ([Insert Number]{.mark}).

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

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

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

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

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

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

The Office of Management and Budget (OMB) has approved an HHS form to
collect information on the number of faith-based groups applying for HHS
grants. Non-profit organizations, excluding private universities, are
now required to include a completed survey with their grant application
packet. The OMB approved HHS "Survey on Ensuring Equal Opportunity for
Applicants" form is available on
[www.grants.gov](http://www.grants.gov/) and a copy is attached. (see
Attachments).

**[FOR FURTHER INFORMATION CONTACT:]{.underline}** U.S. Department of
Health and Human Services, Administration on Aging, Office of Grants
Management, Washington, D.C. 20001, telephone: [(202) 357-3464.]{.mark}

**[ATTACHMENTS]{.underline}**

**Sample Budget Narrative Format with Examples**

**Sample Budget Narrative Format**

**Sample Work Plan Format**

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

**Instructions for Completing the Summary/Abstract**

**Budget Narrative, Page 1 -- Sample Format with EXAMPLES**

+------+------+------+------+------+----------------------------------+
| >    | *    | **N  | **N  | # T  | ### Justification                |
| **Ob | *Fed | on-F | on-F | OTAL |                                  |
| ject | eral | eder | eder |      |                                  |
| > C  | Fun  | al** | al** |      |                                  |
| lass | ds** |      |      |      |                                  |
| > Ca |      | **Ca | **I  |      |                                  |
| tego |      | sh** | n-Ki |      |                                  |
| ry** |      |      | nd** |      |                                  |
+------+------+------+------+------+----------------------------------+
| *    | \$40 |      | \$5  | \$45 | Project Supervisor (name) =      |
| *Per | ,000 |      | ,000 | ,000 | .3FTE @ \$50,000/yr = \$15,000   |
| sonn |      |      |      |      |                                  |
| el** |      |      |      |      | Project Director (name) = 1FTE @ |
|      |      |      |      |      | \$30,000 = \$30,000              |
+------+------+------+------+------+----------------------------------+
| **Fr | \$12 | 0    | 0    | \$12 | Fringes on Supervisor and        |
| inge | ,600 |      |      | ,600 | Director @ 28% of salary.        |
| Be   |      |      |      |      |                                  |
| nefi |      |      |      |      | FICA (7.65%) = \$3,442           |
| ts** |      |      |      |      |                                  |
|      |      |      |      |      | Health (12%) = \$5,400           |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Dental (5% ) = \$2,250           |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Life (2%) = \$ 900               |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Workers Comp Insurance (.75%) =  |
|      |      |      |      |      | \$ 338                           |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Unemployment Insurance (.6%) =   |
|      |      |      |      |      | \$ 270                           |
+------+------+------+------+------+----------------------------------+
| **   | \$3  | 0    | \$   | \$3  | Travel to Annual Grantee         |
| Trav | ,000 |      | 967  | ,967 | Meeting:                         |
| el** |      |      |      |      |                                  |
|      |      |      |      |      | Airfare: 1 RT x 2 people x       |
|      |      |      |      |      | \$750/RT = \$1,500               |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Lodging: 3 nights x 2 people x   |
|      |      |      |      |      | \$100/night = \$ 600             |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Per Diem: 4 days x 2 people x    |
|      |      |      |      |      | \$40/day = \$ 320                |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Out-of-Town Project Site Visits  |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Car mileage: 3 trips x 2 people  |
|      |      |      |      |      | x 350 miles /trip                |
|      |      |      |      |      |                                  |
|      |      |      |      |      | x \$ .365/mile = \$ 767          |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Lodging: 3 trips x 2 people x 1  |
|      |      |      |      |      | night/ trip x \$50/night = \$300 |
|      |      |      |      |      |                                  |
|      |      |      |      |      | Per Diem: 3 trips x 2 people x   |
|      |      |      |      |      | 2days/trip x \$40/day = \$480    |
+------+------+------+------+------+----------------------------------+

Budget Narrative, Page 2 Sample Format with EXAMPLES

###### 

+-----+-----+------+------+------+-----------------------------------+
| **  | **  | ###  | *    | ##   | ### Justification                 |
| Obj | Fed | ## * | *Non | ## * |                                   |
| ect | era | Non- | -Fed | [TOT |                                   |
| C   | l** | Fede | eral | AL]{ |                                   |
| las |     | ral* | I    | .und |                                   |
| s** | #   |      | n-Ki | erli |                                   |
|     |  Fu | #### | nd** | ne}* |                                   |
| **C | nds | # *C |      |      |                                   |
| ate |     | ash* |      |      |                                   |
| gor |     |      |      |      |                                   |
| y** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | No equipment requested            |
| *Eq |     |      |      |      |                                   |
| uip |     |      |      |      |                                   |
| men |     |      |      |      |                                   |
| t** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **S | \   |      | \$2  | \$3  | Laptop computer for use in client |
| upp | $1, |      | ,000 | ,500 | intakes = \$1,340                 |
| lie | 500 |      |      |      |                                   |
| s** |     |      |      |      | Consumable supplies (paper, pens, |
|     |     |      |      |      | etc.)                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$100/mo x 12 months = \$1,200    |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Copying \$80/mo x 12 months = \$, |
|     |     |      |      |      | 960                               |
+-----+-----+------+------+------+-----------------------------------+
| **C | \$2 | \$50 | 0    | \    | Contracts to A,B,C direct service |
| ont | 00, | ,000 |      | $250 | providers (name providers)        |
| rac | 000 |      |      | ,000 |                                   |
| tua |     |      |      |      | adult day care contractor =       |
| l** |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor in home=  |
|     |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor-NF =      |
|     |     |      |      |      | \$50,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | personal care/companion provider  |
|     |     |      |      |      | = \$50,000                        |
|     |     |      |      |      |                                   |
|     |     |      |      |      | See detailed budget justification |
|     |     |      |      |      | for each provider (and then       |
|     |     |      |      |      | provide it!)                      |
+-----+-----+------+------+------+-----------------------------------+

+-----+-----+------+------+------+-----------------------------------+
| Bud |     |      |      |      |                                   |
| get |     |      |      |      |                                   |
| N   |     |      |      |      |                                   |
| arr |     |      |      |      |                                   |
| ati |     |      |      |      |                                   |
| ve, |     |      |      |      |                                   |
| P   |     |      |      |      |                                   |
| age |     |      |      |      |                                   |
| 3   |     |      |      |      |                                   |
| --  |     |      |      |      |                                   |
| Sam |     |      |      |      |                                   |
| ple |     |      |      |      |                                   |
| For |     |      |      |      |                                   |
| mat |     |      |      |      |                                   |
| w   |     |      |      |      |                                   |
| ith |     |      |      |      |                                   |
| EX  |     |      |      |      |                                   |
| AMP |     |      |      |      |                                   |
| LES |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **O | \$  | \$8  | \$19 | \$37 | Local conference registration fee |
| the | 10, | ,000 | ,800 | ,800 | (name conference) = \$ 200        |
| r** | 000 |      |      |      |                                   |
|     |     |      |      |      | Printing brochures (50,000 @ \$   |
|     |     |      |      |      | .05 ea) = \$ 2,500                |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video production = \$19,800       |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video Reproduction = \$ 3,500     |
|     |     |      |      |      |                                   |
|     |     |      |      |      | NF Respite Training Manual        |
|     |     |      |      |      | reproduction                      |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$3/manual x \$2000 manuals = \$  |
|     |     |      |      |      | 6,000                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Postage \$150/mo x 12 months = \$ |
|     |     |      |      |      | 1,800                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Caregiver Forum meeting room      |
|     |     |      |      |      | rentals                           |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$200/day x 12 forums = \$ 2,400  |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Respite Training Scholarships =   |
|     |     |      |      |      | \$1,600                           |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | None                              |
| *In |     |      |      |      |                                   |
| dir |     |      |      |      |                                   |
| ect |     |      |      |      |                                   |
| Cha |     |      |      |      |                                   |
| rge |     |      |      |      |                                   |
| s** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| ##  | \$2 | \$60 | \$27 | \    |                                   |
| ### | 65, | ,800 | ,767 | $354 |                                   |
|  TO | 700 |      |      | ,267 |                                   |
| TAL |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+

Budget Narrative -- Page 1 -- Sample Format

+-----+------+------+------+------+-----------------------------------+
| >   | *    | **N  | **N  | # T  | ### Justification                 |
|  ** | *Fed | on-F | on-F | OTAL |                                   |
| Obj | eral | eder | eder |      |                                   |
| ect | Fun  | al** | al** |      |                                   |
| >   | ds** |      |      |      |                                   |
|  Cl |      | **Ca | **I  |      |                                   |
| ass |      | sh** | n-Ki |      |                                   |
| > C |      |      | nd** |      |                                   |
| ate |      |      |      |      |                                   |
| gor |      |      |      |      |                                   |
| y** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Pe |      |      |      |      |                                   |
| rso |      |      |      |      |                                   |
| nne |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| **  |      |      |      |      |                                   |
| Fri |      |      |      |      |                                   |
| nge |      |      |      |      |                                   |
| B   |      |      |      |      |                                   |
| ene |      |      |      |      |                                   |
| fit |      |      |      |      |                                   |
| s** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Tr |      |      |      |      |                                   |
| ave |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Eq |      |      |      |      |                                   |
| uip |      |      |      |      |                                   |
| men |      |      |      |      |                                   |
| t** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+

**Budget Narrative -- Page 2 -- Sample Format**

+------+------+------+----+------+-----------------------------------+
| >    | *    | **N  | *  | # T  | ### Justification                 |
| **Ob | *Fed | on-F | *N | OTAL |                                   |
| ject | eral | eder | on |      |                                   |
| > C  | Fun  | al** | -F |      |                                   |
| lass | ds** |      | ed |      |                                   |
| > Ca |      | **Ca | er |      |                                   |
| tego |      | sh** | al |      |                                   |
| ry** |      |      | ** |      |                                   |
|      |      |      |    |      |                                   |
|      |      |      | *  |      |                                   |
|      |      |      | *I |      |                                   |
|      |      |      | n- |      |                                   |
|      |      |      | Ki |      |                                   |
|      |      |      | nd |      |                                   |
|      |      |      | ** |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **Su |      |      |    |      |                                   |
| ppli |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **C  |      |      |    |      |                                   |
| ontr |      |      |    |      |                                   |
| actu |      |      |    |      |                                   |
| al** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| *    |      |      |    |      |                                   |
| *Oth |      |      |    |      |                                   |
| er** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **   |      |      |    |      |                                   |
| Indi |      |      |    |      |                                   |
| rect |      |      |    |      |                                   |
| C    |      |      |    |      |                                   |
| harg |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| #    |      |      |    |      |                                   |
| #### |      |      |    |      |                                   |
|  *TO |      |      |    |      |                                   |
| TAL* |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+

Project Work Plan, Page 1 -- Sample Format

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

  **Measurable                                                                                                                                               
  Outcome(s):**                                                                                                                                              

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

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

  1\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

                                                                                                                                                             

  2\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

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

Project Work Plan, Page 2 -- Sample Format

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

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

  3\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  4\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

Project Work Plan, Page 3 -- Sample Format

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

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

  5\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  6\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

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

![](media/image1.png){width="0.6145833333333334in"
height="0.6458333333333334in"}

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

Yes No

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

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

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

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

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

\$5,000,000 or more

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

Yes No

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

Yes No

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

> Yes No

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

Yes No

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

Yes No

#  {#section-56 .unnumbered}

#  Survey Instructions on Ensuring Equal Opportunity for Applicants

# 

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

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

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

4\. Self-identify.

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

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

7.  Self-explanatory.

8.  Self-explanatory

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
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[Instructions for Completing the Project Summary/Abstract]{.underline}

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

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-   To ensure uniformity, please limit the length to no more than 300
    words on a single page with a font size of not less than 11,
    doubled-spaced.

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

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

**Products --** materials, deliverables.

-   **A model abstract/summary is provided below**:

The grantee, Okoboji University, supports this three year Dementia
Disease demonstration (DD) project in collaboration with the local
Alzheimer's Association

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

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