# Updated -- 5/24/2006

#  OMB Approval No. 0985-0018

> Expiration: 3/31/2007

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# National Minority Aging Organizations

**Technical Assistance Centers**

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#  

**Program Announcement and**

**Grant Application Instructions**

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# U.S. Administration on Aging

**2006**

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

**Administration on Aging (AoA)**

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

######## Funding Opportunity Title: National Minority Aging Organizations --Technical Assistance Centers

**Announcement Type: Initial**

**Funding Opportunity Number: HHS-2006-AoA-HD-0607**

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

**Key Dates: The deadline date for receipt of applications is July 14,
2006**

**Executive Summary:**

The Administration on Aging (AoA) plans to award cooperative agreements
to National Minority Aging Organization Technical Assistance Centers
(NMAOs) for the development of culturally competent and linguistically
appropriate front line health promotion and disease prevention
strategies for racial and ethnic minority older individuals. Projects
will develop practical, nontraditional, community-based interventions
for reaching older individuals who experience barriers to accessing home
and community-based services due to language and low literacy as well as
other barriers directly related to cultural diversity.

Through this competition, AoA plans to award approximately four (4) new
cooperative agreements for new projects, for a first year total of
\$1,069,186. Each project should focus on one of the following four
major racial and ethnic minority groups: African American (1 project @
\$294,622); American Indian and Alaska Native (1 project @ \$127,669);
persons of Hispanic origin (1 project @ \$294,622); and Asian American
and Pacific Islander (1 project @ \$352,273). Projects will be funded
for a 3 year period, contingent upon the availability of federal funds.
Grantees are required to cover at least 25% of the total program costs
from non-federal cash or in-kind resources.

The NMAOs will incorporate the latest technology to generate and
disseminate knowledge in appropriate forms that can assist racial and
ethnic minority older individuals to practice positive health behaviors
that can strengthen their capacity to maintain active, independent life
styles. Technology may be used in any number of formats or strategies
from development and dissemination of CDs or DVDs or other portable
electronics for senior center or at home use by older individuals, to
PowerPoint Presentations for use by, as well as to train, senior center
and nutrition site staff, visiting service providers, family members,
etc. Technology can be especially helpful for reaching limited English
speaking older individuals, both directly and through mass media such as
PSAs. For many who may be unable to read, family members can be provided
a way to help seniors get clear information which they received from an
electronic device. The NMAOs will serve as national points of contact
for tools and information on health promotion and disease prevention.
They will pilot culturally competent activities and work products
tailored to meet the special needs of racial and ethnic minority older
individuals, including limited- English speaking individuals.

The awards will be cooperative agreements because the Administration on
Aging will be substantially involved in the development and execution of
the activities of the technical assistance centers. The Administration
on Aging will work closely with the grantees to affect collaborative
partnerships among the NMAO Centers. Consultation will be provided on
the development, modification and execution of Center work plans, the
identification of emerging issues, potential strategies and their impact
on racial and ethnic minority older individuals nationwide.

The Administration on Aging (AoA) wishes to promote improvement of the
health status of racial and ethnic minority older individuals by
increasing the efficiency of the NMAO Technical Assistance Centers
Program to disseminate culturally competent health promotion and disease
prevention information. This competition is open to public and private
non profit agencies and organizations, including faith- and
community-based organizations (FBOs and CBOs), with a nationally known
presence and the capacity to reach one of the target populations on a
nationwide basis. It is not limited to previous grantees. Awards made
under this competition will develop health promotion and disease
prevention information that specifically targets one of the four major
racial and ethnic minority groups of older individuals nationwide. For
this reason, the competition is limited to organizations with national
presence and the capacity to mount the type of strategic, broad based
effort that can reach large segments of each population. To be
considered for funding, applicants must be experienced in providing
health promotion and disease prevention education to racial and ethnic
minority older individuals, including persons with limited English
speaking proficiency on a nationwide basis. Applicants should ideally be
a well-established, known presence in their respective professional
communities, and must present a comprehensive plan to allow nationwide
access to products produced by the project.

**I. FUNDING OPPORTUNITY DESCRIPTION**

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

During the past decade, Congress has been increasingly focused on
efforts designed to assist in the elimination of health disparities
among older individuals, especially racial and ethnic minority
individuals. These efforts have been supported by language in successive
Congressional appropriation reports. The Older Americans Act of 1965, as
amended, includes provisions to Aincrease awareness of citizens of all
ages of the need to assume personal responsibility for their own
longevity.@[^1] The Administration on Aging (AoA) has long been an
active proponent of this principle. Further, the U.S. Secretary of
Health and Human Services has launched a Department-wide initiative
directed at identifying and/or developing effective, community-based
strategies for reducing or eliminating health disparities among racial
and ethnic minority individuals of all ages.

AoA=s history of promoting the development and demonstration of
strategies designed to decrease the prevalence of health disparities
among racial and ethnic minority older individuals has long been
evident. Again, on behalf of older individuals, the Assistant Secretary
for Aging is responding to Congress and the Secretary=s initiative by
calling for NMAOs to develop front line health promotion and disease
prevention strategies. Projects may demonstrate nontraditional, home and
community based interventions for reaching older individuals who
experience barriers to access that can be attributed to language and low
literacy as well as other barriers directly related to cultural
diversity.

**The National Minority Aging Organizations Technical Assistance Centers
Today**

Census Bureau estimates from 2004 show that there are 36 million people
over the age of 65 and if we reach back a decade, there are 48.8 million
people age 60 and over in the United States. Of the 60 plus population,
a little more than 18 percent of these older people are minority elders,
i.e. 8.5 percent are African American elders, and 6.3 percent are elders
of Hispanic origin. Older Asian Americans and Pacific Islanders and
individuals of Native American heritage compose the remainder of this
number. The number of non-Hispanic, White older individuals is projected
to increase significantly between now and the year 2030, while,
demographers project dramatic increases in the numbers of minority older
individuals. Demographers= projections for the age 65 plus population
indicate that by the year 2030, the older population will be more
diverse and the numbers of older persons in America will be twice what
they were in the year 2000. White non-Hispanic older individuals will
compose 72 percent of the older population, elders of Hispanic origin
will increase to 11 percent, African Americans, 10 percent, and Asian
Americans and Pacific Islanders along with American Indians and Alaska
Natives will make up about 5 percent. Further, the Census Bureau
predicts that, the evolving Amarital and family composition that is
occurring in the United States is likely to change the types of familial
support that are available to people at older ages.@ If current
demographic trends continue as projected, there is little doubt that
without an increased focus on health promotion and disease prevention
the need for services may increase proportionately.

Today, overall, racial and ethnic minority populations continue to be at
increased risk for cardiovascular and cerebral vascular diseases. Data
show that minority older individuals suffer from the same leading causes
of poor health as older white individuals. However, very often they
suffer disproportionately from those same conditions. In 2002, the death
rate for African Americans was higher than that for non-Hispanic Whites
for heart diseases, stroke, cancer, chronic lower respiratory diseases,
influenza and pneumonia, diabetes, HIV infection/AIDS, and homicide. In
fact, African American men were 1.5 times as likely to have new cases of
lung and prostate cancer and 1.8 times as likely to have new cases of
stomach cancer as compared to non Hispanic White men and they were 2
times as likely to die from these diseases. Asian American men suffer
from stomach cancer 114% percent more often than non-Hispanic White men.
Similarly, in 2001, American Indian and Alaska Native men had a 30
percent higher chance of being diagnosed with stomach and liver cancer
than non-Hispanic White men.

Among Hispanics, women are 2.2 times more likely to be diagnosed with
cervical cancer than non-Hispanic White women. American Indian and
Alaska Native women were 1.9 times as likely to die from cervical cancer
as compared to non-Hispanic White women and Asian American and Pacific
Islander women are 2.4 times as likely to fall ill from stomach cancer
as non-Hispanic White women. At the same time, in the case of breast and
cervical cancers, African American women were 20 percent less likely to
have been diagnosed with breast cancer and were 30 percent more likely
to die from the disease than non-Hispanic White women, despite having
the same screening rate for mammography;

Heart disease is the leading killer across most racial and ethnic
minority communities in the United States, accounting for 28.5% of all
deaths in 2002. Mexican Americans, who make up the largest share of the
U.S. Hispanic population, suffer in greater percentages than
non-Hispanic Whites from overweight and obesity, two of the leading risk
factors for heart disease. Premature death was higher for Hispanics
(23.5%) than non-Hispanics Whites (16.5%). In the Asian and Pacific
Islander community, 26 percent of deaths are caused by heart disease. In
2003, African American men were 20 percent more likely to die from heart
disease and African Americans of both sexes are 1.5 times more likely to
have high blood pressure as non-Hispanic whites. American Indian and
Alaska Natives are 1.2 times as likely as white adults to have heart
disease and 1.3 times as likely to have high blood pressure. While both
African American and American Indian and Alaska Native women were 1.6
times as likely as non-Hispanic White adults to be obese.

Persons of Hispanic origin living in the United States are twice as
likely to die from diabetes as non-Hispanic Whites. In 2002, Hispanics
were 1.6 times as likely as non-Hispanic whites to die from diabetes.
African Americans and American Indian and Alaska Native were,
respectively, 2.4 and 2.3 times more likely than non-Hispanic adults to
have been diagnosed with diabetes by a physician. Persons of Hispanic
origin have higher rates of high blood pressure and obesity than
non-Hispanic Whites. So, too, Native Hawaiians and Filipinos living in
Hawaii, have respectively, 2 and 3 times the rate of diabetes for non
Hispanic White Americans. Although Asian Americans and Pacific Islanders
have indicators of being one of the healthiest population groups in the
United States, there is great diversity within this racial and ethnic
minority group. Heart disease is a serious problem among Asian
Americans; while women of Vietnamese origin suffer from cervical cancer
at nearly five times the rate of non-Hispanic White women and
tuberculosis is higher among Asian Americans and Pacific Islanders
living in the United States.

The increasing population growth of racial and ethnic communities and
linguistic groups, each with its own cultural traits and health
profiles, presents a challenge to the fields of health care and
supportive services in this country. Circumstances unique to each racial
and ethnic community are presented to health care and social service
professionals daily. Many in the field of health care and supportive
services recognize the barriers language can present for elders of
Hispanic descent and AAPI older individuals. However, it is significant
to note that American Indian and Alaska Natives frequently contend with
issues that prevent them from receiving quality medical care. These
issues range from cultural barriers to geographic isolation and
inadequate sewage as well as low incomes.

The AoA expects that proposals from NMAOs will approach this priority
area in a manner that recognizes the diversity of racial and ethnic
minority older individuals, confronts fundamental issues such as the
anticipated impact of the growth of racial and ethnic minority older
populations, and the importance of the awareness of cultural
distinctions within each racial and ethnic minority population.

Examples of activities conducted by NMAO Technical Assistance Centers in
the area of health promotion and disease prevention include:

-   [African American]{.underline}: An NMAO Technical Assistance Center
    collaborated with the National Aging Network to establish four sites
    for the conduct of a faith‑based community health leadership program
    focused on reducing obesity as a leading risk factor for chronic
    disease. Each site enlisted 3 to 5 churches as participants, and
    published a quarterly newsletter. Thirty churches, through 6
    coalitions each, reached 300+ seniors.

-   [Asian American and Pacific Islander]{.underline}: An NMAO Technical
    Assistance Center partnered with 15 CBOs to conduct outreach that
    informed older AAPIs about the provisions of MMA, and its new
    preventative services and initiated an innovative lifestyle program
    in a Seattle Pacific Islander congregate meal site.

-   [Hispanic]{.underline}: A NMAO Technical Assistance Center
    disseminated: 1) health education materials in the Fotonovela format
    to 9 target cities through workshops, community centers and AoA
    evidence-based projects; 2) Bi-lingual PowerPoint presentations
    through 7 workshops nationwide; 3) a CD/DVD Prostate Cancer
    module; 4) materials on Diabetes; and 5) a Prototype immunization
    campaign package.

-   [American Indians and Alaska Natives]{.underline}: An NMAO Technical
    Assistance Center reached over 3,000 elders by conducting workshops
    and seminars at Indian Elder Conferences, disseminated information
    about, and promoted, healthy living, and published a quarterly
    newsletter featuring healthy living best practices.

-   All Technical Assistance Centers provided outreach and education on
    Medicare Part D and the transitional assistance program to members
    of the population group that they served.

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

The purpose of this competition is to award cooperative agreements for
National Minority Aging Organization Technical Assistance Centers to
develop culturally competent and linguistically appropriate front line
health promotion and disease prevention strategies that target racial
and ethnic minority older individuals. Projects will develop practical,
nontraditional, home and community-based interventions for reaching
older individuals who experience barriers to access that can be
attributed to language and low literacy as well as other barriers
directly related to cultural diversity. Health promotion and disease
prevention strategies proposed should seek to prevent, delay or manage
conditions that would hasten an older individual=s need for long term
care services. In defining project foci, applicants should be mindful of
the priorities of the Assistant Secretary for Aging, which focus on
integration of services and system changes that increase Aging Network
capacity, inter-agency collaboration and stimulate innovation on behalf
of older adults. Applicants under this announcement are required to
address the following objectives under the National Minority
Organizations Technical Assistance Centers Program:

-   Promote Nationwide Program Coverage. Applicants must provide a
    comprehensive plan with model strategies for potential replication
    across the nation. Nationwide program coverage is defined for this
    purpose as assuring that the information developed along with
    consultations and other technical assistance are readily available
    to those across the Nation who wish to replicate the strategies
    developed. Types and levels of information available shall be
    specified as well as the strategies or approaches by which access to
    materials for use by racial and ethnic minority communities across
    the nation can be achieved and/or enhanced. Examples of appropriate
    strategies that may be used to ensure nationwide program coverage
    include collaboration, formal partnering, sub-grants or contracts
    with other area, regional, statewide or national organizations,
    toll-free lines, web sites and web-based strategies, and both
    national and statewide media and outreach plans. Program performance
    measures will reflect program coverage by target population.

-   Improve access to health promotion and disease prevention strategies
    and/or programs designed to promote positive health behaviors.
    Applicants will be required to coordinate with the community- and
    faith-based organizations as well as professional, membership,
    regional and statewide organizations for purposes of piloting and
    adapting successful models or strategies for providing racial and
    ethnic minority older individuals access to culturally competent and
    linguistically appropriate front line health promotion and disease
    prevention information. Partnerships at the community level should
    be sought to expand the project=s network and facilitate outreach to
    the target populations, including older individuals with limited
    English speaking proficiency.

-   Promote the availability of quality health promotion information for
    the target populations by cooperating with the broader health,
    supportive services, academic and professional communities to reach
    an increased number of racial and ethnic minority older individuals,
    including persons with limited English speaking proficiency. Desired
    program results should be reflected in performance measures and
    tracked in project semi-annual reports:

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-   Increase the number of culturally competent and linguistically
    appropriate front line materials available to the target populations

-   Increase the kind and number of vehicles through which the target
    population can access appropriate health promotion and disease
    prevention information

-   Increase the numbers of older individuals reached; and

    Applicant plans for project priorities, work plan and activities
    should reflect

systems that will enhance and measure these program results.

-   Target training and educational materials to isolated and hard
    -to-reach populations. Applicants are required to identify specific
    target populations that are traditionally under served due to
    isolation, ethnic, cultural or language barriers, or other factors.
    Applicants will provide a plan to identify under served racial and
    ethnic minority older individuals, especially those with limited
    English speaking proficiency, and to reach them through innovative
    and collaborative methods. To achieve this, a comprehensive plan
    will specify the target population and discuss how barriers to this
    population will be overcome. Outreach strategies and measures of
    increased access by the target population must be included in the
    plan. Applicants must include signed letters of collaboration from
    organizations representing the target population that specifies the
    commitment, role, and activities of the applicant in addressing this
    objective.

To advance the above objectives, applications are sought from public or
nonprofit agencies and organizations, including federally recognized
tribes, faith- and community-based organizations, with a demonstrated
capacity to reach under served populations. Applicants must outline
plans to use effective models for the recruitment, training, and support
of persons who, with appropriate training, could provide volunteer or
peer service as expert resources and peer educators for racial and
ethnic minority older individuals in their communities. Applicants must
demonstrate that they have enlisted the assistance of appropriate
community-based organizations in the preparation of the application and
that these organizations are included in the project=s plans for
nationwide implementation. All applicants should demonstrate their
capacity and experience using quantitative performance outcome
information to support their activity and management decisions.

The applicant must provide a detailed plan for the management and
implementation of the grant. This includes:

-   presenting a systematic plan for project start-up;

-   providing a comprehensive plan for nationwide access to program
    results that identifies collaborations (including proposed or
    potential) and innovations designed to reach the targeted
    populations;

-   involving a variety of community- and faith-based, local, and state
    aging network services organizations, as well as appropriate
    regional and Federal agencies;

-   developing formal partnerships, collaborations and other
    arrangements as needed to address program objectives;

-   researching the demographics of the populations to be served, and
    identifying barriers to program access;

-   developing outreach strategies specifically designed to overcome
    these barriers and reach the target populations;

-   identifying a specific strategy for recruiting, training, and
    maintaining a pool of partners, volunteers and/or peer educators,
    including individuals with language and other skills and abilities
    to help reach racial and ethnic minority communities;

-   developing a training plan for staff, volunteers, and target
    populations tailored to the specific information required by each
    group to achieve program objectives;

-   developing outreach strategies and priority areas for health
    promotion and disease prevention information based on assessment of
    trends, issues and cases identified nationwide;

-   presenting a plan to evaluate project performance, including
    collection and reporting of information and measuring project
    progress addressing program objectives;

-   presenting a plan to utilize technology to disseminate information;
    and

-   presenting a plan to identify outcome and/or measures of success for
    the Technical Assistance Centers.

**[Statutory Authority:]{.underline}**

The statutory authority for grants and cooperative agreements under this
program announcement is contained in Title II and Title IV, of the Older
Americans Act, of 1956, as amended, P.L. 106-501 (42 U.S.C. 3001 et
seq.)

######## II. AWARD INFORMATION 

Award Type: Cooperative Agreement

Estimated Federal Funds Available for Year 1: \$1,069,186

Individual Annual Award Ceilings:

> African American \$294,622 - 1 project
>
> American Indian and Alaska Native \$127,669 - 1 project
>
> Persons of Hispanic origin \$294,622 - 1 project

Asian American and Pacific Islander \$352,273 - 1 project

Estimated Number of Awards: Up to 4

Estimated Length of Project: Up to three years

AoA plans to fund four (4) cooperative agreements through this
competition. The awards will be cooperative agreements because the
Administration on Aging will be substantially involved in the
development and execution of the activities of the technical assistance
centers. The cooperative agreement will describe the technical
assistance and support to be provided by the AoA project officer. The
cooperative agreement will also specify project performance criteria and
measures. The AoA project officer for these cooperative agreements will
provide technical assistance and support on grant management and
implementation issues, including execution of the cooperative agreement.
Specifically, the actions outlined below shall be carried out by each
partner in the cooperative agreements.

The Administration on Aging shall:

-   Collaborate with the Centers on the development, modification, and
    execution of the Center work plans;

-   Provide technical advice on the development of health promotion and
    disease prevention informational materials;

-   Review, provide technical advice, and approve work products; and

> Provide consultation on the identification of emerging issues in the
> field and on policy developments of particular impact on each NMAOs'
> target population.

The NMAO Centers shall:

-   Collaborate with the Administration on Aging on the development,
    modification, and execution of the Center work plan;

-   Assist the Administration on Aging in developing and sustaining
    state and community-based elder rights networks and in responding to
    inquiries concerning elder abuse; and

-   Evaluate the impact of Center activities.

The NMAO Centers and the Administration on Aging will work cooperatively
to determine the priority activities to be completed by the project and
develop the work plan for each year of the project. Within 45 days of
the award and 45 days of each continuation award, the grantees will
agree upon and adhere to work plans that detail expectations for major
activities, products, and reports during the current budget period. The
plan will specify actions to assure program access to target
populations. The work plans will include timetables for project and
activity implementation, staff assignments, and other areas that require
Administration on Aging consultation, review, and/or prior approval.
Either the Administration on Aging or the NMAO Centers can propose a
revision of the final work plan at any time.

The Administration on Aging will assist the project leadership to
understand the strategic goals and objectives, policy perspectives, and
priorities of the Assistant Secretary for Aging and the Department of
Health and Human Services by sharing such information via e-mail,
conference calls, briefings, and other consultations. The Administration
on Aging will also share information with the project about other
federally sponsored projects and activities relevant to the interests of
NMAO Centers' activities.

[]{.mark}

The Administration on Aging, will, if possible, be represented at
meetings of the project's steering/advisory/policy committee. AoA should
be advised in advance of major media, outreach, or other project events,
and be offered the opportunity to attend, as appropriate.

**III. ELIGIBILITY INFORMATION**

**1. Eligible Applicants**

Through this competition, AoA plans to fund four projects. The
competition is limited to public/private non-profit organizations (proof
of non-profit status is required), including faith-based organizations
and federally-financed tribes.

**2. Cost Sharing or Matching**

Under this Older Americans Act (OAA) program, AoA will fund no more than
75% of the project=s total cost, which means the applicant must cover at
least 25% of the project=s total cost with non-federal resources. In
other words, for every three (3) dollars received in federal funding,
the applicant must contribute at least one (1) dollar in non-federal
resources toward the project=s total cost (i.e., the amount on line 18g
of the SF 424). This Athree-to-one@ ratio is reflected in the formula
included under Item 18 in Attachment A. You can use this formula to
calculate your minimum required match. A common error applicants make is
to match 25% of the federal share, rather than 25% of the project=s
total cost. In accordance with 48 USC 1469a (d), matching requirements
are waived for grantee applicants from Guam and the U.S. Virgin Islands.

**3. Application Screening Criteria**

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

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

1\. Applications must be submitted electronically via
[www.grants.gov]{.underline} by midnight July 14, 2006. All other hard
copy submissions for which approval has been requested and received (per
Section IV(6)) must be received in AoA by 5:00 PM Eastern time on July
14, 2006.

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

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

IV. **APPLICATION AND SUBMISSION INFORMATION**

All applicants are required to submit electronically through
[http://www.grants.gov]{.underline} by midnight July 14, 2006.

EXCEPTIONS TO THIS REQUIREMENT MAY ONLY BY MADE BY THE AOA GRANTS
OFFICE. CONTACT STEPHEN DANIELS (202-357-3464). EXCEPTIONS MAY ONLY BE
MADE TO ALLOW FOR CATASTROPIC EVENTS SUCH AS TORNADOES, FLOODS, ETC.

PLEASE NOTE THAT APPLICANTS ARE RESPONSIBLE FOR MAILING OR HAND
DELIVERING APPLICATIONS TO AOA IN SUFFICIENT TIME TO BE RECEIVED BY 5:00
PM EASTERN TIME JULY 14, 2006.

## 1. Address to Request Application Package 

> Application materials can be obtained from
> [http://www.grants.gov]{.underline} or
> [http://www.aoa.gov/doingbus/fundopp/fundopp.asp]{.underline}.

Applicants with prior approval may write for materials to:

U.S. Department of Health and Human Services

Administration on Aging

Dianne A. Freeman

Center for Wellness and Community Based Services

Washington, D.C. 20201

> Or: call: Dianne A. Freeman at 202-357-3536
>
> e-mail: [Dianne.Freeman@aoa.hhs.gov]{.underline}

U.S. Department of Health and Human Services

Administration on Aging

Margaret Graves

Center for Wellness and Community Based Services

Washington, D.C. 20201

> Or: call: Margaret Graves at 202-357-3502
>
> email: [Margaret.Graves@aoa.hhs.gov]{.underline}

Please note that AoA is requiring applications for this announcement to
be submitted electronically through
[www.grants.gov](http://www.grants.gov/). The Grants.gov registration
process can take several days. If your organization is not currently
registered with [www.grants.gov]{.underline}, please begin this process
immediately. For assistance with [www.grants.gov]{.underline}, please
contact Arthur Miller at AoA=s Grants.gov helpdesk at 202-357-3438. At
[www.grants.gov]{.underline}, 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.

Applications submitted via [www.grants.gov]{.underline} :

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

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

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

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

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

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

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

**2. Content and Form of Application Submission**

r.  **DUNS Number**

> The Office of Management and Budget requires applicants to provide a
> Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number
> when applying for Federal grants or cooperative agreements on or after
> October 1, 2003. It is entered on the SF 424. It is a unique,
> nine-digit identification number, which provides unique identifiers of
> single business entities. The DUNS number is free and easy to obtain.
>
> Organizations can receive a DUNS number at no cost by calling the
> dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
> using this link:
> https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf.

a.  **Project Narrative**

> The Project Narrative must be double-spaced, on 8 2@ x 11@ paper with
> 1@ margins on both sides, and a font size of not less than 11. You can
> use smaller font sizes to fill in the Standard Forms and Sample
> Formats. The suggested length for the Project Narrative is ten to
> twenty pages; twenty pages is the maximum length allowed. AoA will not
> accept applications with a Project Narrative that exceeds 20 pages.
> The Project Work Plan, Letters of Cooperation, and Vitae of Key
> Personnel are not counted as part of the Project Narrative for
> purposes of the 20-page limit, but all of the other sections noted
> below are included in the limit.
>
> The components counted as part of the 20 page limit include:

-   Summary/Abstract

-   Problem Statement

-   Goal(s) and Objective(s)

-   Proposed Intervention

-   Special Target Populations and Organizations

-   Outcomes

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

> The Project Narrative is the most important part of the application,
> since it will be used as the primary basis to determine whether or not
> your project meets the minimum requirements for grants under Title IV
> of the Older Americans Act. The Project Narrative should provide a
> clear and concise description of your project. AoA recommends that
> your project narrative include the following components:
>
> **Summary/Abstract.** This section should include a one page-300 words
> maximum - description of the proposed project, including: the goal,
> priority area(s), target population, activities, products and
> measurable outcomes. Detailed instructions for completing the
> summary/abstract are included in Attachment E of this document.
>
> **Problem Statement.** 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
> targeted 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.)
>
> **Goals and Objectives.** This section should consist of a description
> of the project=s goal(s) and major objectives in terms of the priority
> area(s). Unless the project involves multiple, complex interventions,
> we recommend you have only one overall goal.
>
> **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 the AProblem Statement@. You should
> also describe the rationale for using the particular intervention,
> including factors such as: Alessons learned@ for similar projects
> previously tested in your community, or in other areas of the country;
> factors in the larger environment that have created the Aright
> conditions@ for the intervention (e.g., existing social, economic or
> political factors that you=ll be able to take advantage of, etc.).
> Also note any major barriers you anticipate encountering, and how your
> project will be able to overcome those barriers. Be sure to describe
> the role and makeup of strategic partnerships you plan to involve in
> implementing the intervention, including other organizations, funders,
> and/or consumer groups.
>
> **Special Target Populations and Organizations.** This section should
> describe how you plan to systematically involve community-based
> organizations experienced with the target population in the planning
> and implementation of the proposed statewide project. Specifically,
> your application should discuss proposed strategies for targeting
> minority and hard-to-reach populations, including low-income, rural,
> isolated, and limited English-speaking individuals. (Suggested length:
> one to two pages.)
>
> **Outcomes.** This section of the project narrative must clearly
> identify the [measurable]{.underline} outcome(s) that will result from
> the project. (NOTE: AoA will not fund any project that does not
> include measurable outcomes). This section should also describe how
> the project=s findings might benefit the field at large, (e.g., how
> the findings could help other organizations throughout the nation to
> address the same or similar problems.) List measurable outcomes in the
> attached Work Plan Grid (Attachment D) under AMeasurable Outcomes@ in
> addition to any discussion included in the narrative along with a
> description of how the project might benefit the field at large.
> (Suggested Length: one to two pages.)
>
> A Ameasurable outcome@ is an observable end-result that describes how
> a particular intervention benefits consumers. Examples of outcomes
> include: Evidence that requests for financial planning information
> have stimulated awareness of the need to develop a financial plan for
> the future. Such evidence can include an increase in the number of
> requests for a type of financial instrument that has been adapted to a
> Auser friendly@ format or translated into a language other than
> English. Examples of other outcomes can include evidence that
> alliances formed with national organizations that have women as their
> primary constituents have resulted in the dissemination of
> information, consultations and/or the conduct of workshops and other
> informational seminars at the local level. A measurable outcome is not
> a measurable Aoutput@, such as: the number of clients served; the
> number of training sessions held; or the number of service units
> provided.
>
> You should keep the focus of this section on describing
> [what]{.underline} outcome(s) will be produced by the project. You
> should use the Evaluation section noted below to describe
> [how]{.underline} the outcome(s) will be measured and reported. Your
> application will be scored on the clarity and nature of your proposed
> outcomes, not on the number of outcomes cited.
>
> **Project Management.** 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 project; monitoring the project=s on-going progress, preparation of
> reports; communications with other partners and AoA. It should also
> describe the approach that will be used to monitor and track progress
> on the project=s tasks and objectives. (Suggested Length: one to two
> pages.)
>
> **Evaluation**. This section should describe the method(s), techniques
> and tools that will be used to: 1) measure the success of the proposed
> intervention, products and practices in achieving anticipated
> outcomes; and 2) document project Alessons learned@ (both positive and
> negative) that will be useful to other SMP projects interested in
> replicating the intervention. This section should also include a
> self-assessment of prior performance data and a plan for addressing
> those areas identified for improvement. (Suggested Length: one to two
> pages.)
>
> **Dissemination.** This section should describe the method that will
> be used to disseminate the project=s successful products and practices
> in a timely manner and in easily understandable formats, to other SMP
> projects who might be interested in using these as models to improve
> practice, service delivery, program and partnership development.
> (Suggested Length: one to two pages.)
>
> **Organizational Capability Statement.** Each application should
> include an organizational capability statement and vitae for key
> project personnel. The organizational capability statement should
> describe how the applicant agency (or the particular division of a
> larger agency which will have responsibility for this project) is
> organized, the nature and scope of its work and/or the capabilities it
> possesses. This description should cover capabilities of the applicant
> agency not included in the program narrative, such as any current or
> previous relevant experience and/or the record of the project team in
> preparing cogent and useful reports, publications, and other products.
> If appropriate, include an organization chart showing the relationship
> of the project to the current organization. Please attach short vitae
> for key project staff only. Neither vitas nor an organizational chart
> will count towards the narrative page limit. Also include information
> about any contractual organization(s) that will have a significant
> role(s) in implementing project and achieving project goals.
>
> **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 (including start- and end-dates), and
> the lead person/partner or collaborator responsible for completing the
> task. The work plan must clearly identify the actions and timetable to
> implement statewide program coverage. Please use the sample work plan
> format included in Attachment D. (Suggested Length and Format: use the
> sample grid; alternatively, not more than two pages preferably
> presented in bulleted format.)
>
> **Letters of Commitment from Key Participating Organizations and
> Agencies.** Include confirmation of the commitments to the project
> (should it be funded) made by [key]{.underline} collaborating
> organizations and agencies in this part of the application. Any
> organization that is specifically named to have a significant role in
> carrying out the project should be considered an essential
> collaborator. The signed letters of collaboration must specify the
> commitment, role, and resources/activities that will be provided in
> support of the applicant. Strategies to reach targeted populations
> must be documented with letters of commitment that detail the specific
> role/function in support of the project=s effort that will be played
> by the collaborating organization. The organization=s expertise,
> experience, and access to the targeted population(s) should also be
> described in the letter of commitment.
>
> For applications submitted electronically via Grants.gov, signed
> letters of commitment should be scanned and included as attachments.
> Applicants unable to scan the signed letters of commitment may fax
> them to the AoA Grants Management Office at 202-357-3466 by the
> application submission deadline. The Program Announcement number
> should appear at the top of each page faxed.

3.  **Submission Dates and Times**

> The deadline for the submission of applications under this program
> announcement is July 14, 2006. Applications must be: submitted
> electronically by midnight on this date; other hard copy submissions
> for which approval has been requested and received (per Section IV(6))
> must be received by 5:00 PM Eastern Time.
>
> Applications that fail to meet the application due date will be
> returned without review and will receive no further consideration.
>
> Applicants applying through Grants.gov will automatically receive a
> tracking number and date of receipt verification electronically once
> the application has been successfully received and validated in
> Grants.gov.
>
> **4. Intergovernmental Review**
>
> This funding opportunity announcement is not subject to the
> requirements of Executive Order 12372, AIntergovernmental Review of
> Federal Programs@
>
> **5. Funding Restrictions**
>
> The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

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

-   Continuation of existing projects without expansion or new and
    innovative approaches

    **6. Other Submission Requirements**

> Electronic submissions must be sent to: http://www.grants.gov.
>
> Applicants submitting their application through
> [www.grants.gov]{.underline} must register in the Central Contractor
> Registry (CCR) database in order to be able to submit the application.
> One element of the CCR is the DUNS number (see section IV.2), which
> must be obtained separately from CCR registration. Information about
> CCR is available at [http://www.grants.gov/CCRRegister]{.underline}.
> You must also register with a Credential Provider to receive a
> username and password to securely submit your grant application.
> Information is available at
> [http://www.grants.gov/CredentialProvider]{.underline}.
>
> Applicants unable to submit their application via
> [www.grants.gov]{.underline} may request permission to submit a hard
> copy from the AoA Project Officers:
>
> Dianne A. Freeman, (202) 357-3536 or
> [dianne.freeman@aoa.hhs.gov.]{.underline} or
>
> Margaret Graves, (202) 357-3802 or
> [margaret.graves@aoa.hhs.gov.]{.underline}
>
> If you mail or hand deliver your application, you must submit one
> original application and two copies, plus a completed application
> checklist to AoA. The application deadline for applications sent by
> U.S. Postal Service must be post-marked by midnight July 14, 2006, or
> hand-delivered is 5:00 PM Eastern Time on TBD to the below address:
>
> Submissions using the regular, U.S. Postal Service must be addressed
> to:
>
> Department of Health and Human Services
>
> Administration on Aging
>
> Grants Management Division
>
> Washington, DC 20201
>
> Attention: Stephen Daniels
>
> Submissions by courier, overnight delivery, delivered in person, etc.,
> should be addressed to:
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Grants Management Division
>
> One Massachusetts Avenue, N.W., Room 4604
>
> Washington, D.C. 20201
>
> Attention: Stephen Daniels

V.  **APPLICATION REVIEW INFORMATION**

**[Criteria]{.underline}**

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

-   Purpose and Need for Assistance - (20 points);

-   Approach/Method B Workplan and Activities - (30 points);

-   Outcomes/Evaluation/Dissemination - (30 points); and

-   Level of Effort - (20 points).

> a\. [Purpose and Need for Assistance]{.underline} [Weight: 20
> points]{.underline}

-   Does the proposed project clearly identify and adequately respond to
    the target population(s), and is it consistent with the objectives
    of the NMAO Technical Assistance Centers Program? (10 points)

-   Does the applicant substantiate how the project would address the
    current gaps in the development and dissemination of health
    promotion and disease prevention information to racial and ethnic
    minority older individuals, including those with limited English
    speaking proficiency? Is the problem identified for target
    populations consistent with the AoA program=s purpose and
    objectives? (5 points)

-   Does the application adequately and appropriately describe and
    document the key problem(s)/condition(s) relevant to its purposes?
    Is the proposed project justified in terms of the most recent,
    relevant, and available information and knowledge? (5 points)

> b\. [Approach, Work Plan and Activities]{.underline} [Weight: 30
> points]{.underline}

-   Does the applicant present a well-thought out approach for
    nationwide program coverage and experience with the target
    population? Has the applicant demonstrated a thorough familiarity
    with the objectives, current work, status and future trends in
    health promotion and disease prevention for racial and ethnic
    minority communities? Does the applicant clearly define its
    commitment to and plans to address the program objectives? Does the
    project take into account barriers and opportunities that may impact
    on the project=s success? Does the proposal include plans to explore
    models developed by others in the health and supportive services
    field, as well as for sharing its own results with AoA and others in
    the field? (10 points)

-   Is the project work plan clear and comprehensive? Does it include
    sensible and feasible time frames for the accomplishment of tasks
    presented? Does the work plan include specific objectives and tasks
    that are linked to measurable outcomes? 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?
    (10 points)

-   Has the applicant identified needs of he target population,
    including isolated, disadvantaged, and limited English-speaking
    populations for basic, comprehensive, health promotion and disease
    prevention information and presented a well-defined collaboration
    strategy for reaching these groups? Are the proposed strategies
    cost-effective, appropriate to the target population? Has the
    applicant identified appropriate aging, federal, state, community-
    and faith-based organizations, and specified the roles of these
    partner organizations in implementing the project? (10 points)

> c\. [Project Outcomes, Evaluation and Dissemination]{.underline}
> [Weight: 30 points]{.underline}

-   Are the expected project outcomes directly linked to the objectives
    of the NMAO Technical Assistance Centers Program? Are the
    benefits/results clear, realistic, and consistent with the purpose
    of the project? Can the proposed outcomes be quantified and
    measured, consistent with the definition of a project outcome
    contained in Section II of the Program Announcement? (10 points)

-   Does the project evaluation 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)? Does the plan
    include the qualitative and/or quantitative methods necessary to
    reliably measure outcomes? Is the evaluation also designed to
    capture Alessons 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? (10 points)

-   Will the dissemination plan transmit relevant and easy to use
    information to parties that might be interested in making use of its
    findings in a timely manner? Will the plan allow information to be
    expedited to those who might want to replicate the project? How will
    the project make use of the aging network in the dissemination of
    project findings? (10 points)

> d\. [Level of Effort]{.underline}: [Weight: 20 points]{.underline}

-   Do the proposed project director(s), key staff and consultants have
    the background, experience, and other qualifications required to
    carry out their designated roles? Has the applicant demonstrated
    capacity and experience in using quantitative performance outcome
    information to support their activity and management decisions? (5
    points)

-   Are letters from participating organizations included, as
    appropriate, and do they express the clear commitment and areas of
    responsibility of those organizations, consistent with the work plan
    description of their intended roles and contributions? Is each
    targeted population identified by the applicant supported by letters
    of commitment from appropriate organizations that specify their role
    in facilitating outreach and access to this population? (5 points)

-   Is the budget justified with respect to the adequacy and
    reasonableness of resources requested? Is the time commitment of the
    proposed director and other key project personnel sufficient to
    assure proper direction, management and timely completion of the
    project? Are budget line items clearly delineated and consistent
    with work plan objectives? (10 points)

**2. Review and Selection Process**

> An independent review panel of at least three individuals will
> evaluate applications that pass the screening. These reviewers are
> experts in their field, and are drawn from academic institutions,
> non-profit organizations, state and local government, and federal
> government agencies other than AoA. Based on the specific programmatic
> considerations as outlined under section I, Funding Opportunity
> Description, the reviewers will comment on and score the applications,
> focusing their comments and scoring decisions on the criteria
> identified above.
>
> Final award decisions will be made by the Assistant Secretary for
> Aging (ASA). In making these decisions, the ASA will take into
> consideration: recommendations of the review panel; reviews for
> programmatic and grants management compliance; the reasonableness of
> the estimated cost to the government considering the available funding
> and anticipated results; and the likelihood that the proposed project
> will result in the benefits expected.

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

**VI. AWARD ADMINISTRATION INFORMATION**

**1. Award Notices**

Successful applicants will receive an Approval letter and a Notice of
Financial Assistance Award via U.S. Mail. The Notice of Financial
Assistance Award is the authorizing document, and will be signed by the
AoA grants officer, the AoA authorizing official, and the AoA budget
office. Unsuccessful applicants will be notified in writing within 30
days.

###### 2. Administrative and National Policy Requirements

The award is subject to DHHS Administrative Requirements, which can be
found in 45CFR Part 74 and 92 and AoA Standard Terms and Conditions
which are included with each grant Award Packet.

**3. Reporting**

An original and two copies of the SF-269 (Financial Status Report) and
the AoA program progress report are due semi-annually. Awardees will
receive a copy of the required program progress report form with their
Notice of Financial Assistance Award. Final performance and SF-269
reports are due 90 days after the end of the project period. For more
information see DHHS / AoA Standard Terms and Conditions.

**VII. AGENCY CONTACTS**

> [Project Officer:]{.underline}
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Dianne A. Freeman
>
> Telephone: (202) 357-3436, e-mail: Dianne.Freeman@aoa.hhs.gov

[Project Officer:]{.underline}

> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Margaret Graves
>
> Telephone: (202) 357-3502, e-mail: Margaret.Graves@aoa.hhs.gov
>
> [Grants Management Specialist]{.underline}:
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Stephen Daniels
>
> Telephone: (202) 357-3464, e-mail:
> [Stephen.Daniels@aoa.hhs.gov]{.underline}

**VIII. OTHER INFORMATION**

A.  **Order of Application Elements**

    To expedite the processing of applications, we request that you
    arrange the components of

your application in the following order:

> 1\. SF 424 B Application for Federal Assistance.
>
> 2\. SF 424A B Budget Information.
>
> 3\. Separate Budget Narrative/Justification (See Attachments for
> Sample Format).
>
> 4\. SF 424B B Assurances. Note: Be sure to complete this form
> according to
>
> instructions and have it signed and dated by the authorized
> representative (see
>
> item 18d on the SF 424).
>
> 5\. Certification
>
> 6\. Proof of non-profit status
>
> 7\. Copy of the applicant\'s most recent indirect cost agreement, as
> necessary.
>
> 8\. Project Narrative with Work Plan (See Attachment for Sample Work
> Plan
>
> Format).
>
> 9\. Organizational Capability Statement and Vitae for Key Project
> Personnel.
>
> 10\. Letters of Commitment from Key Partners.
>
> 11\. ASurvey on Ensuring Equal Opportunity for Applicants@ (Optional
> non-profit applicants)

**B. The Paperwork Reduction Act of 1995 (P.L. 104-13)**

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

The project description and budget justification is approved under OMB
control number 0985-0018 which expires on 3/31/07.

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

**ATTACHMENTS**

**Attachment A:**

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

**Attachment B:**

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

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

**Attachment F:**

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

#  Attachment A

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

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

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

###### a. Standard Form 424

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

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

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

• New . • Continuation • Revision

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

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

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

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

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

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

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

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

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

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

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

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

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

matters related to this application.

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

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

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

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

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

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

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

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

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

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

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

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

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

There are three types of match: 1.) non-federal cash; 2.) non-federal
non-cash (i.e., in-kind); and 3.) program income. In general, costs
borne by the applicant and cash contributions of any and all third
parties involved in the project, including sub-grantees, contractors and
consultants, are considered [cash matching funds]{.underline}.
Generally, most contributions from third parties will be non-cash (i.e.,
in-kind) matching funds. Examples of [non-cash (in-kind)
match]{.underline} include: volunteered time and use of facilities to
hold meetings or conduct project activities. A third form of non-federal
match is projected [program income]{.underline} derived from activities
of the project such as participant fees and sale of publications. [Only
program income that is to be used as part of the required match should
be shown on Line 18.]{.underline}

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

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

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

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

**b. Standard Form 424A**

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

##### Section A ‑ Budget Summary

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

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

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

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

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

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

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

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

###### d. Certification Regarding Lobbying

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

###### e. Other Application Components

**Survey on Ensuring Equal Opportunity for Applicants**

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

**Proof of Non-Profit Status**

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

## Indirect Cost Agreement

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

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

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

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

+-----+-----+------+------+------+-----------------------------------+
| **  | **  | #    | *    | ##   | ### Justification                 |
| Obj | Fed | #### | *Non | ## * |                                   |
| ect | era |  Non | -Fed | [TOT |                                   |
| C   | l** | -Fed | eral | AL]{ |                                   |
| las |     | eral | I    | .und |                                   |
| s** | #   |      | n-Ki | erli |                                   |
|     |  Fu | ##   | nd** | ne}* |                                   |
| **C | nds | ###  |      |      |                                   |
| ate |     | Cash |      |      |                                   |
| 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!)                      |
+-----+-----+------+------+------+-----------------------------------+

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

Attachment C: 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** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+

**Attachment C: 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** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| ###  |      |      |    |      |                                   |
| ## T |      |      |    |      |                                   |
| OTAL |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+

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

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

  **Measurable                                                                                           
  Outcome(s):**                                                                                          

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

  1\.                                                                                                    

                                                                                                         

                                                                                                         

                                                                                                         

  2\.                                                                                                    

                                                                                                         

                                                                                                         

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

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

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

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

  3\.                                                                                                                                                      

                                                                                                                                                           

                                                                                                                                                           

                                                                                                                                                           

  4\.                                                                                                                                                      

                                                                                                                                                           

                                                                                                                                                           

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

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

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

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

  5\.                                                                                                                                                      

                                                                                                                                                           

                                                                                                                                                           

                                                                                                                                                           

  6\.                                                                                                                                                      

                                                                                                                                                           

                                                                                                                                                           

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

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

**Attachment E**

Instructions for Completing the Project Summary/Abstract

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

```{=html}
<!-- -->
```
-   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.

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

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

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

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

Yes No

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

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

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

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

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

\$5,000,000 or more

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

Yes No

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

Yes No

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

> Yes No

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

Yes No

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

Yes No

# Survey Instructions on Ensuring Equal Opportunity for Applicants

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

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

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

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

4\. Self-identify.

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

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

7.  Self-explanatory.

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
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
2202-4651.

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

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

[^1]:
    > OAA, section 401(4)