**FY-2004 Child Survival and Health Grants Program (CSHGP)**

Issuance Date: August 20, 2003

Closing Date: November 24, 2003

Closing Time: 11:00 A.M. EST

Subject: Request for Applications (RFA) No. M/OP/GH/HSR-04-003

FY-2004 Child Survival and Health Grants Program (CSHGP)

The United States Agency for International Development (USAID) Bureau
for Global Health, Office of Health, Infectious Disease and Nutrition
(GH/HIDN) is seeking applications from U.S. Private and Voluntary
Organizations (PVOs), engaged in international health and development,
to implement activities under the Child Survival and Health Grants
Program (CSHGP). Please refer to the Program Description for a complete
statement of goals and expected results.

The authority for the RFA is found in the Foreign Assistance Act of
1961, as amended.

Pursuant to 22 CFR 226.81, it is USAID policy not to award profit under
assistance instruments. However, all reasonable, allocable and allowable
expenses, both direct and indirect, which are related to the agreement
program and are in accordance with applicable cost standards (22 CFR
226, OMB Circular A-122 for non-profit organization, OMB Circular A-21
for universities, and the Federal Acquisition Regulation (FAR) Part 31
for profit organizations), may be paid under the agreement.

USAID reserves the right to fund any or none of the applications
submitted in response to this RFA. Awards will be made subject to the
availability of funds.

For the purposes of this program, this RFA is being issued and consists
of this cover letter and the following:

1\. Section A -- Program Description;

2\. Section B -- Grant Application Instructions;

3\. Section C -- Selection Criteria;

4\. Section D - Certifications, Assurances and Other Statements

of Applicant/Grantee;

5\. Annexes

For the purposes of this RFA, the term "Grant" is synonymous with
"Cooperative Agreement"; \"Grantee\" is synonymous with \"Recipient\";
and

\"Grant Officer\" is synonymous with \"Agreement Officer\".

If you decide to submit an application, it should be received by the
closing date and time indicated at the top of this cover letter at the
place designated below for receipt of applications. Applications and
modifications thereof shall be submitted in envelopes with the name and
address of the applicant and RFA \# (referenced above) inscribed
thereon, to:

**[(By U.S. Mail)]{.underline}**

Attn: USAID/GH/HIDN Room 3.7.75

Ronald Reagan Building International Trade Center

1300 Pennsylvania Ave. N.W.

Washington, D.C. 20523-7600

\(202\) 712-1444

**[(By All Other Means of Delivery)]{.underline}**

ATTN: USAID

Ronald Reagan Building International Trade Center

Washington, DC \*

\*Please use the phone at the visitor's desk to contact **Ms. Susan
Youll at x2-1444, Mr. Tom Hall at x2-1692 or Ms. Sharon Arscott-Mills at
x2-4014.** Any prospective applicant who has questions concerning the
contents of this RFA should submit them **[in writing]{.underline} to
Ms. Susan Youll (<syoull@USAID.gov>)** by close of business **September
26, 2003**. Any additional information regarding this RFA will be
furnished through an amendment to this RFA. Clarification on this RFA
will also be available at the RFA Conference scheduled for September 8,
2003. See [ANNEX A]{.underline} for the RFA Conference Announcement.

Send a copy of the complete application to the **USAID Mission** in the
country(s) of the proposed program by close of business **December 5,
2003**. It is the responsibility of the PVO to ensure that the USAID
Mission receives a copy. See [ANNEX B]{.underline} for the current
Mission addresses.

Issuance of this RFA does not constitute an award commitment on the part
of the Government, nor does it commit the Government to pay for costs
incurred in the preparation and submission of an application. Further,
the Government reserves the right to reject any or all applications
received. In addition, final award of any resultant grant(s) cannot be
made until funds have been fully appropriated, allocated and committed
through internal USAID procedures. While it is anticipated that these
procedures will be successfully completed, potential applicants are
hereby notified of these requirements and conditions for award.
Applications are submitted at the risk of the applicant; should
circumstances prevent award of a cooperative agreement, all preparation
and submission costs are at the applicant\'s expense.

The preferred method of distribution of USAID procurement information is
via the Internet. This RFA and any future amendments can be downloaded
from the Agency Web Site. The World Wide Web Address is
http://www.fedgrants.gov. Select "Applicant" from the home page, then
either \"Offices\", "Posted Dates", or "Activity Category" under AID.
The following screen will then list RFA listing based upon which
category you chose. Receipt of this RFA through INTERNET must be
confirmed by written notification to the contact person noted below. It
is the responsibility of the recipient of the application document to
ensure that it has been received from INTERNET in its entirety and USAID
bears no responsibility for data errors resulting from transmission or
conversion processes.

In the event of an inconsistency between the documents comprising this
RFA, it shall be resolved by the following descending order of
precedence:

\(a\) Section C - Selection Criteria;

\(b\) Section B - Grant Application Instructions;

\(c\) The Program Description;

\(d\) This Cover Letter.

Applicants should retain for their records one copy of all enclosures
which accompany their application.

Sincerely,

Lisa M. Bilder

Branch Chief

M/OP/GH/HSR

Office of Procurement

Table of Contents

> Page

SECTION A - PROGRAM DESCRIPTION .. . . . . . . . . . . . . . . . . . .6

SECTION B -- GRANT APPLICATION INSTRUCTIONS . . . . . . . . . . . . . 12

I.  General Guidelines . . . . . . . . . . . . . . . . . . . 12

II. Award Categories . . . . . . . . . . . . . . . . . . . . 13

III. Technical Application . . . . . . . . . . . . . . . . . .16

IV. Cost Application . . . . . . . . . . . . . . . . . . . . 36

V.  Required Documentation . . . . . . . . . . . . . . . . . 37

SECTION C -- SELECTION CRITERIA . . . . . . . . . . . . . . . . . . . 42

I.  Eligibility Requirements . . . . . . . . . . . . . . . . 42

II. Program Restrictions . . . . . . . . . . . . . . . . . . 44

III. Technical Evaluation Criteria . . . . . . . . . . . . . .45

SECTION D -- USAID DOCUMENTS . . . . . . . . . . . . . . . . . . . . .50

PART I -- CERTIFICATIONS AND ASSURANCES . . . . . . . . . . . . 50

PART II -- OTHER STATEMENTS OF RECIPIENT . . . . . . . . . . . .57

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY

AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS . . . .61

KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG

TRAFFICKING . . . . . . . . . . . . . . . . . . . . . . . . . .63

PARTICIPANT CERTIFICATION NARCOTICS OFFENSES AND DRUG

TRAFFICKING . . . . . . . . . . . . . . . . . . . . . . . . . .64

ANNEXES

(A) RFA Conference Announcement. . . . . . . . . . . . . . . . 65

(B) Mission Contacts . . . . . . . . . . . . . . . . . . . . . 67

(C) Technical Reference Materials . . . . . . . . . . . . . . .76

(D) Guidance: 2003 Child Survival and Health Grants Program. . 77

(E) Screening Form . . . . . . . . . . . . . . . . . . . . . . 78

(F) Program Recipients . . . . . . . . . . . . . . . . . . . . 80

(G) Budget Forms . . . . . . . . . . . . . . . . . . . . . . . 81

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# SECTION A: PROGRAM DESCRIPTION

# 

## [Overview of the Child Survival and Health Grants Program]{.smallcaps}

**A. Background**

Since 1985, USAID has supported community-based child survival programs
implemented by U.S. PVOs and their local partners. The program is
intended to enhance the participation of PVOs in reducing infant, child,
maternal and HIV/Tuberculosis(TB)-related mortality in developing
countries and to strengthen their organizational, managerial and
technical competencies in these areas. PVOs and their local partners
provide high quality, sustainable child survival and health
interventions in a variety of program settings, from the smallest, most
remote communities to large, district-wide programs, partnering with
community groups, district and national health authorities.

The Child Survival and Health Grants Program (CSHGP) is housed in the
Bureau for Global Health's Office of Health, Infectious Diseases and
Nutrition (GH/HIDN), (previously in the Office of Private, Voluntary
Cooperation in the Bureau for Democracy, Conflict, and Humanitarian
Assistance---DCHA/PVC). The CSHGP has evolved over the last two years to
include additional program areas (e.g., TB, Family Planning) and more
accurately represent the breadth of programs that PVOs implement while
also reflecting USAID's expanding HIV/AIDS and infectious diseases
programs. The "New This Year" section of this document provides
additional changes which the CSHGP team believes will further strengthen
the PVO contribution in improving child and maternal health.

**B.** **Overall Program Strategy/Direction in GH/HIDN**

With the move to GH/HIDN, the CSHGP and the PVOs were afforded
opportunities to address new technical areas (TB and Family Planning) as
well as increasing the impact of programs through a new grant category
(Expanded Impact). GH/HIDN strongly supports and values the role that
PVOs and their local partners play in improving the quality of life of
some of the most disadvantaged populations in developing countries. It
is the intention of the CSHGP to continue to strengthen the quality of
community-based programs while offering new opportunities for innovative
programming based on input from the PVOs. The CSHGP continues to support
applications from eligible countries nominated by the USAID Field
Missions. In addition, this year's RFA also highlights the GH priority
countries for maternal and child health, family planning, HIV/AIDS and
infectious diseases, including malaria and TB. This priority country
list may be used as a basis for targeting programs in future
consultation with PVOs.

**C. Program Components**

In addition to the PVO grants, the CSHGP supports the CORE Group (The
Child Survival Collaborations and Resources Group), a network of over 35
PVOs, the majority of which are current or past recipients of the Child
Survival and Health Grants Program. The goal of CORE is to assist member
organizations to reduce child, maternal and HIV/TB-related mortality by
improving the health of under-served populations. The members of CORE
are citizen-supported, U.S.-based PVOs which are generally non-profit
organizations supported by individuals, groups, and corporations, in
addition to receiving USAID support. Collectively, CORE members have a
presence in more than 140 countries. They have had enormous impact
throughout the world in addressing not only the challenges of child
survival and health but also those of agriculture, education, economics,
poverty alleviation, medical care, sanitation, environmental problems
and the growth of democracy. For more information, see the CORE website:
<http://www.coregroup.org/.>

The CSHGP also provides resources to ORC/Macro International under the
Child Survival and Technical Support Project (CSTS+) to provide
technical assistance to the PVOs, as well as project management
assistance to the CSHGP team including monitoring and evaluation of
programs. For more information, see the ORC/MACRO website:
[http://www.childsurvival.com/.](http://www.macroint.com/csts/)

#########  {#section-17 .unnumbered}

######### New This Year

Based on the CSHGP direction in GH/HIDN, described briefly above, and in
consultations with PVOs, the following changes are made in this year's
RFA, and more fully defined in subsequent sections. Please read
carefully and note changes.

-   A PVO may submit up to **[two]{.underline}** applications in
    response to this RFA. This means that a PVO may be the prime or lead
    recipient on only two applications for submission; however, a PVO
    may be a sub-grantee on any number of applications. An exception to
    the two application limit per PVO is allowed under the Expanded
    Impact category for applications proposing a 100% Family Planning
    program.

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-   As of September 30, 2003, a PVO may be a recipient of no more than
    **[six]{.underline}** ongoing child survival and health programs at
    any one time. An Expanded Impact program with a 100% Family Planning
    component is the exception to this limit.

-   All cooperative agreements will be awarded for a 4- to 5-year period
    only.

-   Applications for all grant categories should be no longer than 27
    pages, including the Executive Summary and Body of the Application.

-   Cost Extension application guidance is revised and located in a
    separate section. Cost Extension applications no longer need to
    include the entire Mid-term Evaluation report with the submission of
    the applications; only portions are requested. See the "Technical
    Guidance" section on Cost Extensions for these details.

-   The Technical Application and Evaluation Criteria have been revised
    to reflect a greater emphasis on the Situational Analysis,
    development of Program Strategies, and Monitoring and Evaluation
    plans. These sections are more heavily weighted in the total score
    of an application.

-   Only Entry and Mentoring categories are required to address the
    organizational development section of the application. For the
    Standard, Cost Extension and Expanded Impact categories, the concept
    of capacity building of local partners is integrated into other
    sections.

-   Country eligibility is based upon Mission self-nomination and Global
    Health priority country lists for Maternal and Child Health, Family
    Planning, HIV/AIDS, and Infectious Diseases, including TB and
    Malaria.

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-   Programs proposing a maternal neonatal health component (where
    applicable and based on the situational analysis) are encouraged to
    identify and analyze barriers, as well as promising approaches, to
    programming for birth and immediate post-partum care in the home
    and/or to identify approaches for incorporating essential newborn
    care actions into home birth programming. (e.g., Adapting Home-Based
    Life Saving Skills or Community-Based Life Saving Skills to specific
    contexts.)

######### Global Health Strategic Objectives and CSHGP Results

The CSHGP contributes to the Global Health Bureau's five strategic
support objectives:

> SO 1: Increased use by women and men of voluntary practices that
> contribute to reduced unintended and mistimed pregnancies.
>
> SO 2: Increased use of key maternal health and nutrition
> interventions;

SO 3: Increased use of key child health and nutrition interventions;

> SO 4: Increased use of improved, effective and sustainable responses
> to reduce HIV transmission and to mitigate the impact of the HIV/AIDS
> pandemic; and,
>
> SO 5: Increased use of effective interventions to reduce the threat of
> infectious diseases of major public health importance.

The objective (revised) of the CSHGP is to:

> \-***Support U.S.-based PVOs and their local partners to carry out
> effective, quality child and maternal health and nutrition, family
> planning, HIV/AIDS and infectious disease programs that measurably
> improve infant, child and maternal health and nutrition, and
> contribute to the reduction of infant, child and maternal mortality,
> unintended pregnancies and to the reduction of mortality due to TB and
> HIV/AIDS.***

Contributions to the achievement of the CSHGP objective, GH's Strategic
Support Objectives and the PVO's program objectives will be measured
through the following intermediate results (IR):

IR1: Increased use, coverage and quality of child and maternal health,
and nutrition and infectious disease programs implemented by PVOs and
their local partners.

###### 

USAID invests resources in well designed, technically sound,
cost-effective programs that focus on activities and strategies which
are expected to have the greatest and most sustainable reductions in
child, maternal and HIV/TB-related mortality, and unintended
pregnancies. The CSHGP will continue to strengthen the PVO/NGO's and
local partners' ability to increase coverage (scale up) as well as to
design, monitor, evaluate and manage quality, sustainable CSH programs.

> **IR2: Increased sustainability of child and maternal health and
> nutrition and infectious disease programs/interventions initiated by
> PVOs and their partners.**

The intention of this result is for PVOs to develop and implement
strategies/approaches which are fully integrated at the appropriate
level (e.g., community, facility, district, sub-regional, national)
and/or scaled up so that the positive health benefits derived from the
program interventions are maintained over time to the greatest number of
beneficiaries possible. Capacity building of the local partners will be
a key to the success of achievement of this result.

> **IR3: Child and maternal health and nutrition and infectious disease
> program strategies, tools and approaches developed/adapted, tested and
> applied**.

This result will support USAID's approach to improving child and
maternal health and nutrition, as well as reducing infectious disease
burden, and is focused on developing and applying effective, low-cost
interventions that address the principal causes of morbidity and
mortality, and the reduction of unintended pregnancies. Under this
result, the PVO grantees will continue to develop, adapt and/or scale up
successful approaches.

**D. CSHGP Technical Interventions**

To achieve the above Intermediate Results, the CSHGP supports programs
that implement one or more of the following interventions (based on the
situational analysis and prioritization of interventions):

Immunization

Nutrition (including micronutrient promotion or supplementation)

Breastfeeding

Control of diarrheal disease [^1]

Pneumonia case management

Control of malaria

Maternal and newborn care

Child Spacing in the context of an integrated child survival program

Family Planning [^2]

Tuberculosis

HIV/AIDS including orphans and other vulnerable children and youth in
AIDS-affected areas

Other infectious disease activities may be appropriate in certain sites,

where they have an impact on child mortality.

GH/HIDN supports integrated programs to provide the necessary services
most effectively. The Integrated Management of Childhood Illness (IMCI),
including community and household IMCI (C/HH-IMCI), is an integration
strategy that is being adopted by PVOs and is supported by the CSHGP. In
countries where IMCI is the MOH method of integration, and for CSHGP
projects that will include all of the IMCI interventions, IMCI may be
the most appropriate approach. However, for projects that will only
include some of the IMCI interventions or in countries that have not
adopted IMCI fully, the PVO may adapt or modify the IMCI approach, or
develop some other method of integrating the interventions.

USAID believes that PVOs have a strategic role to play in family
planning programs and TB prevention and control programs, interventions
which were added under the CSHGP in 2002, as well as programs focusing
on orphans and other vulnerable children and youth in AIDS-affected
areas (added this year). It is critical that applicants weigh their
comparative advantage and bring the relevant experience to bear if they
propose to work in these areas. For more information on all technical
areas and interventions, see [ANNEX C]{.underline}, Technical Reference
Materials.

**[Family Planning]{.underline}:**

An application with a Family Planning (FP) component will serve the
objective of reducing unwanted pregnancies with sensitivities to the
differing family planning needs of women over their reproductive years.
Key family planning outcomes most appropriate for a CSHGP program
include, but are not limited to, correct voluntary use of contraceptive
methods, reduction of unmet need for services, spacing births 3-5 years,
and increased age at sexual debut and age at birth of first child.
Successful applicants will participate in yearly meetings dedicated to
sharing experiences and lessons learned in family planning program
implementation.

For any proposed PVO program in which FP is one of the interventions,
the FP component should be **30% or more of the proposed intervention
mix.** If appropriate, applications can be 100% FP in focus. Any effort
less than 30% will be considered a Child Spacing intervention that is
part of an integrated child survival program. A PVO may also propose a
program with a FP component that integrates FP into a general
development or sector specific program under the Expanded Impact
category.

For a detailed description of allowable uses of FP/RH funds, please
refer to [ANNEX D]{.underline} (2003 CSH Program Fund Guidance), and
specifically, the "Guidance on Definition and Use of the Family Planning
and Reproductive Health (FP/RH) Funds". For a discussion of the
legislative and policy requirements affecting the use of FP/RH funds,
see Section II., Program Restrictions.

**[Tuberculosis (Primary focus is on infectious cases in
adults)]{.underline}:**

USAID fully supports the World Health Organization's DOTS strategy.
Applications should include a TB component **ONLY** if there is a
clearly defined role for the PVO within the context of a National TB
Control Program. Applicants do not necessarily have to address all
elements of the DOTS strategy but should identify their primary niche
within the overall DOTS Framework.

PVOs may propose a program with only a TB intervention (100% level of
effort) or may choose to include a TB intervention as part of an
integrated child/maternal health program, or as an integrated HIV/AIDS
and TB program.

**[Orphans and Other Vulnerable Children and Youth in AIDS-affected
Areas:]{.underline}**

Most children of AIDS-affected families are cared for by their relatives
or neighbors, or in many areas, by formal or informal community groups
that support both vulnerable children and households. However, the scale
of the pandemic is causing enormous strain on these traditional coping
mechanisms. The foundation of an effective response is to strengthen the
capacity of families and communities to continue to provide care for
increasing numbers of vulnerable children and adolescents.

PVOs may propose a program, under any of the grant funding categories,
with an intervention that mobilizes and builds the capacity of local
initiatives that provide direct support and protection of orphans and
vulnerable children and their families. This program may choose to
support community coalitions or structures that provide ongoing support
to vulnerable children identified by the community, and according to
criteria developed by the community. These types of community efforts
have the potential to reach large numbers of children through structures
that are sustainable and can continue long after initial funds and
technical assistance are no longer available. These initiatives may be
carried out by local non-governmental organizations (NGOs),
community-based organizations (CBOs), faith-based organizations (FBOs),
women's groups, community committees, coalitions of these groups, and
other local bodies. For example, a PVO program may propose to engage
community-led initiatives that provide support to orphans and other
vulnerable children and youth in AIDS-affected areas, and integrate or
link these activities with other HIV prevention and care efforts.

For further information on strategies and principles of implementation,
refer to the document, *Children on the Brink 2002* (USAID, UNAIDS,
UNICEF document), on the USAID website:
<http://www.usaid.gov/pop_health/aids/Publications/index.html>

#  

# SECTION B - GRANT APPLICATION INSTRUCTIONS

## I. GENERAL PREPARATION GUIDELINES

Depending on the grant category the PVO is applying for, requirements
may vary. It is incumbent on the applicants to ensure that they respond
specifically to criteria/questions relating to the relevant grant
category and also taking special note of any additional requirements
related to TB, family planning, and/or orphans and other vulnerable
children and youth in AIDS-affected areas.

Read the entire RFA. Respond to criteria as appropriate, including
attachments where requested. Ensure that the application addresses all
items cited in the Technical Application Guidelines and Evaluation
Criteria sections.

1\. Follow the formatting instructions below. Applications that do not
follow the instructions will not be reviewed favorably.

All applications shall be typed, and on standard, letter‑sized paper (8
½\" x 11\"). The body of the applications must be no more than 25
numbered pages for all categories and all **attachments** must be 35
pages [or less.]{.underline} Applications with more than 25 numbered
pages in the body [will NOT be reviewed]{.underline}. All attachments
should be clearly marked, included at the end of the application, and
listed in the table of contents. All attachments and/or supplementary
documents must be in English or accompanied by an English translation.

Type face/characters must be no smaller than 10 (ten) characters per
inch (10 CPI) or 12 points. "CPI" is fixed pitch spacing per inch. There
are two exceptions to the above instruction: 1) budgets may be in a
slightly smaller font (10 point), and 2) tables may use smaller fonts,
but must be easily readable.

A PVO Screening Form is provided in [ANNEX E]{.underline} for completion
and submission with the application. This Form assists in identifying
where required PVO information is located in the application.

2\. The application package must include: **one** version on diskette in
Microsoft Word 97; **one** unbound double-sided original and **two**
double-sided copies (**one unbound and one bound)** of the application,
each with a complete set of attachments. Please do **not** use dividers
to separate sections of the application.

3\. The title page of the application should include the **[name and
address of the applicant,]{.underline}** and the **[RFA
number]{.underline}**.

4\. **Submit the application package on or before November 24, 2003,**
to one of the following addresses:

**[Mailing Address]{.underline}: [Courier Address]{.underline}:**

Global Health USAID/GH/HIDN

Office of Health, Infectious Room 3.07,

Disease and Nutrition Ronald Reagan Building

USAID/GH/HIDN 1300 Pennsylvania Ave. NW

Room 3.07, RRB Washington, D.C. 20004-3002

Washington, D.C. 20523-3700 (202) 712-1444 / (202) 712-1692

5\. Send a copy of the complete application to the USAID Mission in the
country of the proposed program by close of business **December 5,
2003**. It is the responsibility of the PVO to ensure that the USAID
Mission receives a copy. See [ANNEX B]{.underline} for the current
Mission addresses.

6\. All applications received by the deadline will be reviewed for
responsiveness to the specifications outlined in these guidelines and
the application format. Section C addresses the technical evaluation
procedures for the applications. Applications which are submitted late
or are incomplete will not be considered in the review process.

7\. Applicants should retain for their records one copy of the
application and all enclosures which accompany their application.
Erasures or other changes must be initialed by the person signing the
application. To facilitate the competitive review of the applications,
USAID will consider only applications conforming to the format
prescribed below and under the Technical and Cost Application sections.

8\. The following are the page limits:

**Budget Information: No limit**

**Title Page: 1 page**

**Screening Form: 1 page (provided in [ANNEX E]{.underline})**

**Executive Summary: 2 pages**

**Body of Application: 25 pages (All Categories)**

**Technical Attachments: 35 pages**

> [Technical Attachments consist of:]{.underline}
>
> Map of Program Area
>
> Mentoring Agreement **(if applicable)**
>
> Work Plan
>
> Legal Authorization to Operate in Target Country(s)
>
> Letters of Support
>
> Program Matrix
>
> Organizational Chart

Management/Human Resources Table

Training Plan

CVs and/or Job Descriptions

> [Cost Application Attachments consist of (no limit):]{.underline}
>
> List of Federally Funded Contracts and Assistance (if applicable)
>
> Certifications
>
> Current Negotiated Indirect Cost Rate Agreement

## For additional information: 

<http://fedgrants.gov/Applicants/AID/OP/WAS/activity_1.html>

## 

## 

## II. AWARD CATEGORIES

Under this RFA, USAID/GH/HIDN requests applications under five (5)
categories of funding: Entry, Mentoring, Standard, Cost Extension and
Expanded Impact categories. All categories are open to all U.S. PVOs
registered with USAID. The first two categories are geared towards PVOs
that have never participated in the program before. GH/HIDN encourages
new entrants to the CSHGP program to apply through either of these
categories. The third category -- Standard -- is the main category in
which current and past recipients have competed. The Cost Extension
category is open to only those PVOs which have an existing CSHGP program
which ends in September 2004.

All applications within a particular category (i.e. Entry, Standard,
Cost Extension, etc.) will only compete with other applications in the
same funding category; they will not compete across the other
categories. PVOs may apply for more than one grant category. However,
USAID will not award concurrent Cooperative Agreements to an Entry PVO
under both the Entry Program and another category. PVOs may propose any
mix of interventions keeping in mind that depth rather than breadth is
desirable. Any intervention may be proposed at 100% level of effort, if
applicable.

Submission of a Detailed Implementation Plan (DIP) is a requirement for
all PVOs who are awarded a new grant program under any of the five
categories. During the first seven months of the new program, PVO
recipients complete an in-depth assessment and analysis of the current
health situation in the program site (usually through a Knowledge,
Practices and Coverage (KPC) Survey), establish strong partnerships with
local counterparts and jointly prepare a work plan (the DIP) for
submission to USAID.

1.  **Entry Category** (four to five years, up to \$1,100,000)

USAID encourages applications from PVOs that have at least 5 years of
experience implementing community health programs in developing
countries and have never received a prior grant under the CSHGP. Under
this category, the intention is to encourage new development partners to
participate in the program in order to build their capacity in child and
maternal health and infectious disease interventions, programming and
management. Experienced organizations with substantial development and
health expertise should not apply under this category.

2.  **Mentoring Category** (four to five years**,** up to \$1,700,000)

The second option through which PVOs may enter into the CSHGP is the
Mentoring category. This program involves a partnership between two U.S.
PVOs, where a more experienced PVO helps to build the capacity of a PVO
that has never been funded through the Child Survival and Health Grants
Program but has some international health and development experience.
The more experienced PVO must have successfully completed at least one
CSHGP project (or, previously, a CSGP project). This category of funding
is intended to encourage PVOs with less experience in community-based
child survival and health programs to engage in these activities.
GH/HIDN encourages PVOs to consider developing this kind of partnership.

A single award will be made to only one recipient (either the mentor or
mentored, as determined by the partners), with the partner as a
sub-recipient. The application should propose a management structure,
determined by both partners to best meet their respective needs. Both
the applicant and the sub-recipient must demonstrate a formal documented
presence in the proposed country.

**[Please note]{.underline}**: For the Mentoring Category, provide as an
**attachment** a **signed**, draft agreement between the two
organizations submitting this application. Include the defined roles,
responsibilities and accountability of each partner organization. In the
event that this application is recommended for funding, a finalized
agreement will be required for submission to USAID.

To help PVOs contact others that might be interested in a partnership, a
list is attached of past and current Child Survival and Health Grants
Program recipients meeting the requirements to function as a more
experienced PVO in the Mentoring category. (See [ANNEX F]{.underline}
for previous program recipients).

3.  **Standard Category** (four to five years, up to \$1,500,000)

This is a highly competitive funding category, requiring substantial
experience in child and maternal health, family planning, HIV/AIDS
and/or infectious disease (e.g. TB) programs. Successful applicants
demonstrate a strong ability to implement effective programs and set
higher standards for both their organizations and the PVO community.
These programs propose viable and innovative strategies, utilizing
methods or materials for implementing activities that may be adapted by
other organizations or applicable on a wider scale. Under this Standard
category, applications recommended for funding may be negotiated as
Grants rather than Cooperative Agreements with USAID.

**4. Cost Extension Category** (four to five years, up to \$1,500,000)

This category provides support to PVOs with a CSHGP program that is
ending in September, 2004. A Cost Extension provides additional funding
for a modified program description to an existing CSHGP cooperative
agreement. Cost Extensions must emphasize sustainability and further
refinement of an existing program. They may also include an increase in
number of beneficiaries, geographic area and/or interventions.
Achievement of results under the original program should be
demonstrated.

**5. Expanded Impact Category** (five years, up to \$2,500,000)

Under this category, PVOs have the flexibility to propose proven
strategies, methods or interventions that will be taken to scale
sub-nationally/ nationally. This category does not restrict a PVO to a
confined, geographic site (usually the community/district level) as in
the other traditional CSH grant categories (i.e., Standard, Cost
Extension). Although a PVO is not required to have carried out a
previous CSHGP program in the country of interest, it is highly
recommended that the PVO have a relevant program in place, regardless of
where previous funding has come from. It is very unlikely that
"scale-up" would occur without strong, existing partnerships and
documentation of results and successful outcomes.

The aim of the Expanded Impact Program is to attain broader impact by
collaborating with other PVOs, agencies, private sector, regional and
national governments, etc. The partners will expand program activities
to reach an increased number of beneficiaries with the potential for
greater impact on overall infant, child, maternal and HIV/TB-related
morbidity and mortality rates, or the reduction of mistimed or
unintended pregnancies. Expanded Impact is not intended to "scale-up" a
traditional Standard CSH program with a mix of interventions or expand
an existing program by either increasing the number of interventions or
adding a neighboring district to the target area. Rather, the
expectation is that an Expanded Impact proposal will focus on a
successful intervention(s), strategy or approach and apply this at a
sub-national/national scale or multi-country level, or through the PVO's
broader development program within a particular country(s).

Under the Expanded Impact category, PVOs may propose a program that
integrates a CSH intervention (one or more as appropriate) such as FP,
HIV/AIDS, etc., into their: 1) existing general development program; or
2) existing sector specific development program such as HIV/AIDS, food
commodity distribution, civil society or education. All programs should
have an existing infrastructure in which to incorporate a CSH activity,
reach significant populations, be programmed into the PVO's national or
multi-country program level, and have funding available for the existing
infrastructure for the life of program. The approach utilized by the PVO
should be based upon the organization's other successful scale-up
initiatives or a successful intervention methodology. It is anticipated
that PVOs proposing to integrate a CSH intervention will have
substantial national or multi-country presence or a well established
sector specific program in which to integrate the intervention.

The following provides [illustrative]{.underline} examples of
interventions that would be entertained under the Expanded Impact
category:

-   The issue of re-treatment of bednets and/or broadening the reach of
    ITNs at the community level is addressed throughout a region of a
    country through, for example, women's groups, development of
    alliances, consortia of PVOs and/or NGOs.

-   A PVO seeks to make Family Planning an integral part of its general
    development programs at a country or multi-country level or desires
    to incorporate Family Planning into existing sector specific
    programs (e.g. maternal health, HIV/AIDS, civil society, education,
    food distribution programs).

-   A "bundled" or multi-PVO proposal is submitted by a group of PVOs
    proposing to collaborate on a coordinated intervention or strategy
    throughout a region or at national level.

## TECHNICAL APPLICATION GUIDELINES 

## 

## [Guidelines for Entry, Mentoring, Standard and Expanded Impact Categories]{.underline}

1.  **Executive Summary**

This section should contain the information that the PVO believes best
represents its proposed program.

-   [Guidance]{.underline}:

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-   The application category

-   Program location

-   Problem statement

-   Estimated number of beneficiaries, broken down by children under
    five, women of reproductive age and orphans and vulnerable children,
    if applicable. [For TB]{.underline}, give the population of the
    community that will be covered by DOTS and the estimated number of
    TB cases in the area. [For Family Planning]{.underline}, estimate
    the target population broken down by age group and gender as
    appropriate.

-   A breakdown of the estimated level of effort devoted to each
    intervention using the list of interventions in Section I (e.g.,
    immunizations -- 30%, control of diarrheal diseases -- 45%, and
    pneumonia case management -- 25%. If IMCI is proposed, do NOT list
    IMCI - 35%, rather list as above)

-   Local partners involved in program implementation

-   The proposed start and end dates

-   The level of funding

-   Name and position of the local USAID Mission representative with
    whom the proposed program has been thoroughly discussed, prior to
    submission

-   Main authors of the document

-   Contact person at HQ for the proposed program (also to be listed in
    SF424)

**2. Description of the PVO Applicant**

This section of the application provides information about the applicant
organization. The section should provide evidence that the PVO has the
ability to carry out a successful program. For Mentoring and other
programs that involve partnering of two or more U.S. PVOs, all of the
following information should be provided for [each]{.underline} of the
U.S. PVO partners.

-   [Guidance]{.underline}:

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-   Describe the U.S. PVO applicant -- including its general purpose,
    mission statement, goals, annual budget (including funding sources),
    major sectors of involvement and main methods of operation.

-   Discuss the organization's experience in designing, implementing,
    monitoring and evaluating international, community-level programs in
    the proposed child and maternal health, family planning, HIV/AIDS
    and/or TB interventions.

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-   Describe the organization\'s operations, current agreements and
    working relationships with the host country government and other
    organizations within the country proposed in this application.
    Documentation of current legal authorization for the U.S. PVO or
    in-country partner to operate in the host country must be provided
    in an **attachment**. Also in the attachments, please include draft
    Memorandums of Understanding (MOUs) with partners if applicable.

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-   [For the Mentoring Category]{.underline}: Provide as an
    **attachment** a **signed**, draft agreement between the two
    organizations submitting this application. Include the defined
    roles, responsibilities, and accountability of each partner
    organization. In the event that this application is approved for
    funding, the agreement must be finalized before the award is made by
    USAID.

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-   [Applications with a TB Component:]{.underline} must demonstrate the
    ability to ensure the implementation of a quality TB program in one
    of the following ways:

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-   Significant past performance in the implementation of TB prevention
    and control programs in country. Provide information on where
    programs have been carried out, a brief description of the
    interventions, strategies, project partners and cure rates;

-   Technical capacity at the PVO Headquarters with demonstrated field
    experience in implementing TB prevention and control programs
    (include the individual's C.V. in an **attachment**). Within the
    work plan, the applicant needs to clearly demonstrate how TB
    technical capacity development will be achieved at the country
    level, to ensure appropriate implementation;

-   Organizations for which TB is a new activity must include in the
    proposal, partnership with an organization with TB experience that
    will provide technical assistance and capacity development. Describe
    the partner organization's TB experience and include a letter of
    support from the institution that confirms their support for the
    project and gives a description of the technical assistance they
    will provide to the project. The work plan and budget must reflect
    this involvement.

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-   [Applications with a FP Component]{.underline} should:

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-   Demonstrate the organization's commitment and willingness to
    integrate FP into its program activities.

-   Demonstrate past performance in the implementation of FP programs
    including information on where programs have been implemented,
    successful strategies, and partners.

-   PVOs with limited experience in FP should describe steps that will
    be taken to strengthen organizational capacity and prepare for
    successful FP program implementation. These should be reflected in
    the budget narrative and the work plan.

    -   [Applicants for programs with a component focusing on orphans
        and other vulnerable children and youth in AIDS-affected
        areas]{.underline} should demonstrate:

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-   Commitment to an approach that supports the strengthening of
    community-owned initiatives to provide ongoing support to vulnerable
    children and youth in AIDS-affected areas.

-   Commitment to a participatory process to regularly review: what is
    working and what is not working; and use this information to
    contribute to improving the quality and coverage of activities.

> This commitment could be demonstrated by technical expertise based on
> past experience or partnership with an organization(s) that will
> provide the necessary technical assistance and capacity building.

**3. Situational Analysis**

This section of the application presents a preliminary assessment which
provides relevant health data to support improving child survival,
maternal health and reducing the burden of other infectious diseases and
mistimed and unintended pregnancies. This analysis serves as the basis
for the selection of interventions and major strategies for the proposed
program.

-   [Guidance (Expanded Impact will address as applicable)]{.underline}:

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-   Briefly describe the location of the proposed program and provide a
    map(s) with scale in an **attachment**. Estimate the total
    population, breaking out children under five years of age and women
    of reproductive age (15-49 years) living in the program site.
    Estimate the number of villages or other community unit that are in
    the target area. Please cite the sources of data. [Programs with a
    TB component]{.underline} will include a breakout of the target
    beneficiaries, keeping in mind that TB programs should not target
    children under five or only women. [Programs with a FP
    component]{.underline} will provide a description of the target
    population and break-out population data for all targeted sub-groups
    remembering that beneficiary populations for FP may include male and
    female adolescent and adult populations. [Programs with a component
    focusing on orphans and other vulnerable children and youth in
    AIDS-affected areas]{.underline} will include a description of the
    HIV/AIDS situation, and any information on the numbers of orphans
    and vulnerable children.

-   Provide an overview by discussing the current health status of the
    population. Please cite the leading causes of under-five morbidity
    and mortality and maternal morbidity and mortality. Please cite
    sources of data. Provide a justification if the proposed program and
    selected interventions do not address the leading causes of
    morbidity and mortality cited above (e.g., other donors are
    addressing the intervention; the data of the subpopulation for the
    intervention are not reflected in the national statistics). Discuss
    relevant data that support an intervention in TB, family planning or
    orphans and other vulnerable children in AIDS affected areas, if
    applicable.

> **Special Note for applications that include a TB component
> (regardless of grant category):** In contrast to most of the
> interventions addressed in the CSHGP, it is important to note that the
> targeted beneficiaries for a TB intervention are primarily adults. The
> situational analysis should provide a description of the population
> the proposed program will address (number of beneficiaries, etc.).

**Special Note for applications that include a FP component:** The
situational analysis should address issues and include data relevant to
FP programs.

**Special Note for applications that include a component focusing on
orphans and vulnerable children and youth in AIDS-affected areas:** The
situational analysis should describe the relative source of
vulnerability for children and youth (i.e., orphans due to HIV/AIDS,
conflict, famine, poverty, etc.)

-   The PVO should respond to the following **[as
    applicable]{.underline}**, but should also include other relevant
    information which supports the applicants' proposed interventions,
    methodology, etc.

> The situational analysis overview may include, but is not limited to,
> the following:

-   Socio-economic characteristics of the population (such as economy,
    religion, gender equity, ethnic groups, literacy or other) that have
    an impact on health status. [For FP components]{.underline}, discuss
    the extent to which the target population is marginalized or hard to
    reach.

-   Current status of health care services in the site, including
    existing services (i.e., the PVO, other U.S. PVOs, the MOH, local
    NGOs, the private commercial sector and traditional health
    providers), where people currently seek care, the current level of
    access and barriers to access (e.g., cost for services, distance to
    facilities, and transportation) -- particularly for disadvantaged
    groups. [For TB components**,**]{.underline} describe the existing
    service, including coverage and quality, as it pertains to the
    diagnosis and delivery of TB treatment services including: detection
    of TB cases; type and availability of TB diagnostic laboratory
    services; system for providing TB treatment (public and private
    sector), including directly observed treatment; treatment protocols;
    source and availability of TB drug pharmaceuticals; and the
    monitoring and evaluation system**.** [For FP
    components]{.underline}, provide information on the access to
    services and quality of care available to target populations. [For
    components focusing on orphans and vulnerable children and youth in
    AIDS affected areas]{.underline}, provide information on the
    availability of HIV/AIDS prevention and care activities, and whether
    they incorporate orphans and other vulnerable children into their
    programs.

-   Provide relevant information on pertinent household behaviors and
    care seeking practices. The applicant is **[not]{.underline}**
    expected to have conducted a survey, but general knowledge of the
    local population should be evident.

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-   [For TB components]{.underline}, describe the structure of the
    National TB Program, its national TB policy, and status of any
    global initiative-type applications. (e.g., Global Fund for AIDS, TB
    and Malaria or GFATM; Stop TB Global Drug Facility.)

-   [For FP components]{.underline}, discuss the availability and
    sources of FP commodities in the project area.

-   [For components focusing on orphans and vulnerable children and
    youth in AIDS affected areas]{.underline}, discuss the availability
    and sources of support -- whether governmental, NGO, or other types
    of support.

-   Briefly describe other sector programs the PVO is involved with in
    the same geographic area (e.g., Title II, education, agriculture)
    where innovative opportunities may exist for synergies of programs
    (e.g., HEARTH model into Title II programs).

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-   [For Expanded Impact category, if applicable,]{.underline} describe
    the general development or sector specific program(s) in which the
    intervention(s) will be integrated including its geographic reach,
    the extent to which the PVO is committed to the sector and/or the
    general development program (e.g. funding, etc.), implementing
    partners, and strategies for integrating the intervention into the
    existing program.

-   [For components focusing on orphans and vulnerable children and
    youth in AIDS affected areas]{.underline}, describe the development
    or sector specific programs that will be linked to these activities
    to provide multi-sector support to vulnerable children and their
    families in AIDS-affected areas, if applicable.

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-   Briefly describe health sector programs other agencies are involved
    with in the same geographic area which may provide an opportunity
    for partnering. (e.g., Agency X is distributing bed nets and PVO Y
    conducts malaria education)

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-   Briefly describe the type and background of the partner
    organization(s) and/or groups with which the applicant organization
    will work and why they were selected.

-   Describe the process used to involve all relevant stakeholders
    (e.g., MOH, community and local partners) in the selection of the
    site, interventions and strategies. [For TB
    interventions]{.underline}, describe the current efforts of national
    and international partners in the country and how the proposed
    location and activity(s) complement the activities of the other
    partners and the National TB Program. Applications need not take on
    all elements of DOTS but should be clear about how their proposed
    interventions will contribute to the implementation of the DOTS
    framework.

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-   In an **attachment**, include a letter showing specific support for
    the proposed program from each of the cooperating governmental
    and/or other organizations with which the program will establish a
    formal relationship. Each letter must be dated within three months
    of the application submission.

#### 4. Program Strategy and Interventions 

### 

This section should provide a clear picture of the proposed program and
overall strategies, details on the proposed technical interventions and
approaches to implement those interventions, including training and how
sustainability of those interventions will be addressed. It will be
important to clearly define linkages with other programs and how synergy
among programs will be developed.

-   [Guidance]{.underline}**:**

### 

-   Provide the goal and objectives of the proposed program.

-   Provide an overview of the program strategy; please link the
    strategy with the situational analysis.

-   Describe the linkage and how the program is consistent with the
    relevant USAID Mission Strategic Objective and intermediate results
    and CSHGP intermediate results.

-   As mentioned in the situational analysis, further discuss how this
    program might develop partnerships with other programs and/or health
    facilities in the proposed program area and country/region. Include
    those of the applicant PVO, other PVOs, USAID field missions,
    networks or associations of NGOs, local organizations, private
    commercial and traditional providers, and the government. [For TB
    components]{.underline}, this will possibly include the GFATM, GDF
    and HIV/AIDS programs.

-   Discuss the approach the program will take, including tools to be
    used, to build the capacity of the local partner, to jointly
    identify the broad areas of capacity to be built, and to assist the
    local partner in its organizational development. It is not necessary
    to provide specific objectives and indicators for sustainability and
    capacity building in the application -- these will be further
    developed in the DIP (including indicators), if the program is
    funded. [For TB components]{.underline}, the local partner can be
    the NTP, the private sector and/or an NGO.

-   Discuss any plans to collaborate with local networks/associations of
    NGOs/PVOs.

-   As identified in the situational analysis, further describe the
    selected child survival, maternal health, family planning, TB and
    other interventions in terms of approaches.

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-   Describe the proposed approaches which will be used to address each
    intervention area.

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-   Discuss how the approaches used will foster behavior change at the
    individual, family, health worker and community levels.

-   Within these levels address issues of quality and access (including
    gender inequality) as well as intervention integration.

-   Please present the program's training activities/plan in table
    format, **as an attachment**.

-   [For TB components]{.underline}**,** identify and justify the
    component(s) of the DOTS Strategy to be strengthened in relationship
    to the NTP's policies and the investment of other partners/donors.
    Due to the complex nature of TB programs, applicants are not
    required to address all aspects of the DOTS program. HOWEVER, the
    proposed activity(s) need to be appropriate and coordinated closely
    with other actors in the TB sector. If appropriate, efforts to
    strengthen linkages or integrate TB and HIV programs are encouraged.

-   [For the Expanded Impact category**,** if applicable,]{.underline}
    clarify how the intervention(s) will be integrated into the existing
    program infrastructure.

-   [For components focusing on orphans and vulnerable children and
    youth in AIDS affected areas,]{.underline} describe how community
    efforts will be supported so that they are community-driven instead
    of externally driven in order to develop structures that can
    continue without ongoing support by the PVO - structures that can
    provide support to children over the long-term. Key to this
    description is how the PVO will enhance: 1) quality; 2) scale; 3)
    and long-term potential of the efforts. If a community-based
    activity for orphans and vulnerable children and youth does not
    currently exist, explain your approach to working with the community
    to initiate and mobilize around this issue.

-   Where applicable, programs proposing a maternal neonatal health
    component are encouraged to identify and analyze barriers, as well
    as promising approaches, to programming for antenatal, birth and
    immediate post-partum care in the home or for incorporating
    essential newborn care actions into home birth programming. (e.g.,
    adapting Home-Based Life Saving Skills or Community-based Life
    Saving Skills to specific contexts.)

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-   [For TB components, FP components and components focusing on orphans
    and vulnerable children and youth in AIDS affected
    areas]{.underline}, describe how capacity of the U.S. PVO
    headquarters and local field staff will be strengthened in this
    technical area.

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-   [For Expanded Impact Category]{.underline}, please address issues of
    scale-up and sustainability.

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-   Discuss any operations research ideas that may be carried out in the
    program.

-   Describe how the proposed strategy is consistent with MOH policies,
    or how the MOH agrees with the PVO approach if they differ. Provide
    an explanation of and justification for, any proposed intervention
    that differs from the MOH policy in the proposed country.

-   [For countries in transition]{.underline}, or in a post-conflict
    phase, briefly describe any measures that the applicant will take to
    ensure that the program does instigate or exacerbate conflict in
    program areas (e.g., do no harm framework) and describe plans to
    maintain the continuity of program interventions should conflict
    ensue.

**5. Organizational Development**

**For Entry and Mentoring Categories Only**

This section describes how the new applicants (under Entry and Mentoring
categories), will use this grant to strengthen the institutional
capacity of the U.S. PVO. It should specify the expected areas in which
this development will take place. (i.e., institutional, individual and
organizational levels) See the Technical Reference Materials in [ANNEX
C]{.underline} for information and resources on organizational
development and capacity building. Also, please note that a baseline and
final assessment of the PVO's organizational capacity is a requirement
for funded programs.

-   [Guidance for Entry and Mentoring Categories Only]{.underline}**:**

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-   Identify specific organizational needs that might be addressed by
    the U.S. PVO. Reference any institutional assessments the
    organization may have already carried out.

-   State the organizational development objectives for increasing the
    PVO's capacity. Describe how the PVO will use this program to
    strengthen the capacity of the organization - including the
    [level]{.underline} of the organization that will be affected (e.g.,
    health unit at headquarters, the PVO local office staff).

-   Explain how lessons learned from this program will be shared with
    other programs implemented by the PVO -- and the international
    health community.

-   Describe how the PVO intends to measure and/or document
    organizational change. This section may be cross-referenced with the
    Performance Monitoring and Evaluation Section. Discuss how the
    current capacity of the PVO will be assessed and provide indicators
    to measure progress towards objectives.

**6. Performance Monitoring and Evaluation**

-   [Guidance]{.underline}:

> **[Ensure that objectives and indicators are grounded in the
> situational analysis and the selected interventions and program
> strategy.]{.underline}**

-   Discuss how progress towards program objectives will be measured.
    Describe how current data on indicators will be collected, analyzed
    and used for program management.

-   Describe the types of baseline assessments, studies or surveys that
    will be carried out. Include baselines of PVO and local partner
    capacity, qualitative and population-based assessments.

-   Describe the current data collection systems that already exist in
    the program area, how/if the program's data collection will
    complement or be different from the existing system, and how they
    will link to each other. (This includes MOH service delivery
    statistics.)

-   Ensure that at the proposed field level, an individual with
    substantial experience in monitoring and evaluating community health
    or child survival programs is available to the program.

-   [For TB applications]{.underline}, the World Health Organization has
    established a set of internationally recognized and accepted
    indicators and tools for reporting, monitoring and evaluating TB
    programs. Applicants are expected to use or implement this system
    (if it does not exist) within the structure of the National TB
    Program and not create a new or parallel system.

-   [For programs focusing on orphans and vulnerable children and youth
    in AIDS-affected areas,]{.underline} community-led efforts focusing
    on providing support and services to orphans and other vulnerable
    children and youth in AIDS-affected areas are relatively new and
    there is a dearth of information about what works best in various
    contexts. Describe how the proposed program will regularly assess
    the effectiveness and the relevance of their activities in order to
    identify what is working and what is not working and to strengthen
    subsequent activities.

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-   **In the attachments**, provide a matrix or other graphic to present
    the information which summarizes the proposed program\'s goal,
    results-based objective(s) and major activities. These should be the
    same as already discussed in the narrative of earlier sections. In
    addition, include indicator(s) for measuring the achievement of each
    objective. The matrix on the following page is a composite example
    drawing from what various PVOs have submitted in the past. If the
    applicant PVO has standardized a particular approach, such as a
    logical framework or a results framework, please use the
    organization's preferred format.

> *The graphic should provide the reader with a concise summary of the
> proposed program, what the program will hold itself accountable to
> achieve and how the program will measure these outcomes and impact.*

**Example of a Program Matrix to**

**Display Program Goals and Objectives**

Goal:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+---------------+---------------+------------------+------------------+
| OBJECTIVES    | INDICATORS    | MEASUREMENT      | MAJOR PLANNED    |
|               |               | METHODS          | ACTIVITIES       |
+---------------+---------------+------------------+------------------+
| \* Objective  | \*            | \* measurement   | \* activity(s)   |
| 1             | indicator(s)  | method(s)        |                  |
|               |               |                  | \* activity      |
| \* Objective  | \* indicator  | \* measurement   |                  |
| 2             |               | method           | \* activity      |
|               | \* indicator  |                  |                  |
| \* Objective  |               | \* measurement   | \* activity      |
| 3             | \* indicator  | method           |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  |                  |
|               | \* indicator  |                  |                  |
+---------------+---------------+------------------+------------------+

**Definitions**

Goal: A statement of the long-term aim of the project. While the
complete fulfillment of a goal may not be possible or verifiable within
the life-span of the project, the achievement of the project\'s more
specific objectives should contribute to the realization of the goal.

Objective: A statement of what the program plans to achieve during the
life of the project. This achievement is the highest level result that a
program can materially affect with its efforts.

Indicator: An indicator specifies [what]{.underline} is measured to
determine whether the objective has been achieved. This includes both
process and outcome.

Targets: A target is the planned value of the indicator at the end of
the project (e.g., 70% of children fully immunized by project end). In
the above matrix, targets can be stated in the objective statement or in
the indicators. Illustrative, end-of-program targets should be provided
in the application. If the program is funded, targets can be adjusted in
the DIP according to baseline survey results.

Measurement

Method: The measurement method identifies the source of the data for
each of the identified indicators. (e.g., initial and final KPC Survey).

Planned

Activities: Activities support the achievement of the objective. These
include inputs, processes and outputs of the program.

**7. Management Plan**

This section provides an overview of the management of the proposed
program. Please highlight those areas of program management that were
not discussed in other sections.

[Guidance]{.underline}:

**a. Organizational Structure**

-   Describe the proposed management structure for this program. Include
    the responsibilities of all principal organizations and staff
    involved, reporting relationships, authority and lines of
    communication within and between each of these organizations. Please
    include job descriptions and CVs of key staff (headquarters
    backstop, project director and M&E position) **as attachments**.

-   **In the attachments**, please provide an organizational chart that
    clearly delineates the key personnel responsible for technically
    backstopping this program in the PVO U.S. headquarters office and
    managing this program in the in-country office. Describe how they
    fit into the overall organization and the linkages between the
    headquarters, regional (if applicable) and field program personnel.

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-   [For Applications with a FP component,]{.underline} describe how
    technical expertise in FP will be accessed and assured in the
    program. Note: Applicants are encouraged to commit staff with FP
    expertise to the program to provide oversight and technical support
    to the FP component. If there are no plans to designate FP staff,
    then provide a clear indication of how this expertise will be
    accessed and budgeted (i.e., technical consultants).

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-   [For Applications with components focusing on orphans and vulnerable
    children and youth in AIDS-affected areas,]{.underline} describe how
    the program will assure the availability of technical expertise on
    working with communities to enhance community-led initiatives and on
    working with orphans and vulnerable children and youth in
    AIDS-affected areas.

**b. Human Resource Management**

-   **In the attachments**, please provide a **[table]{.underline}** of
    ALL persons who will contribute to achieving the results of the
    program. This may include, but is not limited to: PVO headquarters
    and field staff, local partner staff, MOH staff, community health
    workers and private sector providers. For each type of worker
    provide: 1) the number of workers in that category, 2)
    organizational affiliation, 3) main responsibilities, 4) percent of
    effort devoted to project activities, and 5) entity responsible for
    remunerating the worker (e.g., the PVO, MOH, community, volunteer).

c.  **Financial Management**

-   Discuss the roles and responsibilities of project staff vis-à-vis
    budgeting, monitoring and reporting on the financial status of the
    project, to ensure accountability in the use of U.S. Government and
    matching funds.

**8. Project Work Plan**

*(Provide as an attachment)*

[Guidance]{.underline}:

-   In table format, please present a brief, one to two page work plan,
    which reflects the overall program approach and budget. Be sure to
    include a separate table for the program's training plan as
    described in the Program Strategy section.

> **[Guidelines for Cost Extension Category Only]{.underline}**

1.  **Executive Summary**

[Guidance for Cost Extension Category Only:]{.underline}

This section should contain the information that the PVO believes best
represents its proposed program.

-   The application category

-   Program location

-   Problem statement

-   Estimated number of beneficiaries, broken down by children under
    five, women of reproductive age and orphans and vulnerable children
    as applicable. [For TB]{.underline}, give the population of the
    community that will be covered by DOTS and the estimated number of
    TB cases in the area. [For FP]{.underline}, estimate the target
    population broken down by age group and gender as appropriate.

-   Program goals, objectives and major strategies, including how the
    program builds on and expands the original program.

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-   A breakdown of the estimated level of effort devoted to each
    intervention using the list of interventions in Section I (e.g.,
    immunizations -- 30%, control of diarrheic diseases -- 45%, and
    pneumonia case management -- 25%. If IMCI is proposed, do NOT list
    IMCI - 35%, rather list as above)

-   Local partners involved in program implementation

-   The proposed start and end dates

-   The level of funding

-   Name and position of the local USAID Mission representative with
    whom the proposed program has been thoroughly discussed, prior to
    submission

-   Main authors of the document

-   Contact person at HQ for the proposed program (also to be listed in
    SF424)

**2. Description of the PVO and PVO Program**

[Guidance for Cost Extension Category Only:]{.underline}

This section of the application provides information about the past
performance of the previous (or ongoing) program, which is the basis of
this application.

-   Describe progress in achieving results and targets in the original
    program.

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-   Discuss the results of the Mid-term Evaluation, steps the applicant
    took to address the recommendations of the evaluation and any
    outstanding issues that remain.

-   As an **attachment**, provide a summary or list the MTE findings and
    recommendations. **NOTE: The applicant does not need to include the
    MTE report.**

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-   [Applications which include the addition of a TB
    component]{.underline} must demonstrate past performance in
    implementing TB programs in one of the following ways:

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-   Significant past performance in the implementation of TB prevention
    and control programs in country. Provide information on where
    programs have been carried out and a brief description of the
    interventions, strategies, project partners and cure rates;

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-   Technical capacity at the PVO Headquarters with demonstrated field
    experience in implementing TB prevention and control programs
    (include the individual's C.V. in an **attachment**). Within the
    proposal, the applicant needs to clearly demonstrate how TB
    technical capacity development will be achieved at the country level
    to ensure appropriate implementation;

-   Organizations, for which TB is a new activity, must include in the
    proposal an organization with TB experience that will provide
    technical assistance and capacity development. Describe the partner
    organization's TB experience and include a letter of support from
    the institution that confirms their support for the project and a
    description of the technical assistance they will provide to the
    project. The work plan and budget must reflect this involvement.

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-   [Applications with a FP Component]{.underline} should:

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-   Demonstrate the organization's commitment and willingness to
    integrate FP into its program activities.

-   Demonstrate past performance in the implementation of FP programs
    including information on where programs have been implemented,
    successful strategies, and partners.

-   PVOs with limited experience in FP should describe steps that will
    be taken to strengthen organizational capacity and prepare for
    successful FP program implementation. These should be reflected in
    the budget narrative and the work plan.

    -   [Applicants for programs with a component focusing on orphans
        and other vulnerable children and youth in AIDS-affected
        areas]{.underline} should demonstrate:

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-   Commitment to an approach that supports the strengthening of
    community-owned initiatives to provide ongoing support to vulnerable
    children and youth in AIDS-affected areas.

-   Commitment to a participatory process to regularly review: what is
    working and what is not working; and use this information to
    contribute to improve quality and coverage of activities. If no
    program currently exists, the applicant should describe their
    approach to initiating a community-based program.

> This commitment could be demonstrated by technical expertise based on
> past experience or partnership with an organization(s) that will
> provide the necessary technical assistance and capacity building.

**3. Situational Analysis**

[Guidance for Cost Extension Category Only:]{.underline}

This section of the application presents an assessment which provides
relevant health data to improving child survival, maternal health and
reducing the burden of other infectious diseases and serves as the basis
for the selection of interventions and major strategies for the proposed
program.

-   Provide a brief description**,** which includes the target area and
    population (the target area should include the original program area
    and additional areas, if any), as well as the major causes of
    morbidity and mortality for children under five and women of
    reproductive age. Please cite sources of data. Mention any changes
    in the health status and/or leading causes of morbidity and
    mortality based upon available data.

-   Provide a justification if the proposed program and selected
    interventions do not address the leading causes of morbidity and
    mortality cited above (e.g., other donors are addressing the
    intervention; the data of the subpopulation for the intervention are
    not reflected in the national data statistics). Discuss relevant
    data that support an intervention in TB or OVC, if applicable.
    Please cite sources of data.

> **Special Note for applications which include a TB component:** In
> comparison to most of the interventions addressed in the CSHGP, it is
> important to note that the targeted beneficiaries for a TB
> intervention are primarily adults. The situational analysis should
> provide a description of the population the proposed program will
> address (number of beneficiaries, etc.). The PVO should respond to the
> following **[as applicable]{.underline}**, but should also include
> other relevant information which supports the applicants' proposed
> intervention, methodology, etc.

-   [For TB interventions]{.underline}, describe the existing services,
    including coverage and quality, as it pertains to the diagnosis and
    delivery of TB treatment, including: detection of TB cases; type and
    availability of TB diagnostic laboratory services; system for
    providing TB treatment (public and private sector), including
    directly observed treatment; treatment protocols; source and
    availability of TB drug pharmaceuticals; and the monitoring and
    evaluation system.

-   [For TB interventions]{.underline}, describe the structure of the
    National TB Program, its national TB policy, and status of any
    global initiative-type applications. (e.g., Global Fund for AIDS, TB
    and Malaria or GFATM; Stop TB Global Drug Facility.)

**Special Note for applications that include a FP component:** The
situational analysis should address issues and include data relevant to
FP programs.

-   [For FP components]{.underline}, provide a description of the target
    population and break-out population data for all targeted sub-groups
    remembering that beneficiary populations for FP may include male and
    female adolescent and adult populations.

-   [For FP components]{.underline}, discuss the extent to which the
    target population is marginalized or hard to reach.

-   [For FP components]{.underline}, provide information on the access
    to services and quality of care available to target populations.

-   [For FP components]{.underline}, discuss the availability and
    sources of FP commodities in the project area.

> **Special Note for applications that include a component focusing on
> orphans and vulnerable children and youth in AIDS-affected areas:**
> The situational analysis should describe the relative source of
> vulnerability for children and youth (i.e., orphans due to HIV/AIDS,
> conflict, famine, poverty, etc.) Also, include information on the
> availability of HIV/AIDS prevention and care activities, and other
> sources of support and whether they incorporate orphans and other
> vulnerable children.

-   Briefly describe the existing partnerships/new partnerships
    developed to implement the Cost Extension activities and provide a
    brief description of those organizations**.**

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-   Describe the process used to involve all relevant stakeholders
    (e.g., MOH, community and local partners), including any new areas,
    in the selection of the site, interventions and strategies.

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-   [For TB components]{.underline}, describe the current efforts of
    national and international partners in the country and how the
    proposed location and activity(s) complement the activities of the
    other partners and the National TB Program.

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-   **In the attachments**, include a letter showing specific support
    for the proposed program from each of the cooperating governmental
    and/or other organizations with which the program will establish a
    formal relationship. Each letter must be dated within three months
    of the application submission.

#### Program Strategy and Interventions 

[Guidance for Cost Extension Category Only:]{.underline}

### 

This section should provide a clear picture of proposed program and
overall strategies, detail on the proposed technical interventions and
approaches to implement those interventions, including training and how
sustainability of those interventions will be addressed. It will be
important to clearly define linkages with other programs and how
synergies among programs will be developed.

### 

-   Provide the goal and objectives of the proposed program.

-   Provide an overview of the program strategy; please link the
    strategy to the progress achieved to date (since the MTE) as
    discussed in the program description and the situational analysis.

-   Discuss significant changes in approach and/or interventions from
    the original program and give the reasons for change.

-   Briefly describe how the results achieved in the original program
    will be maintained.

-   As mentioned in the situational analysis, further describe the
    sustainability strategy for the current site.

-   If the applicant is including new areas, discuss how old and new
    sites will be integrated.

-   Describe how the program will support the USAID Mission's strategic
    objectives and the CSHGP's intermediate results.

-   As mentioned in the situational analysis, further discuss the
    relationship this program will have with current or future
    health-related activities and/or health facilities in the proposed
    program area and country/region. Include those of the applicant PVO,
    other PVOs, USAID field missions, networks or associations of NGOs,
    local organizations, private commercial and traditional providers,
    and the government. [For TB components]{.underline}, this will
    possibly include the GFATM, GDF and HIV/AIDS programs.

-   Discuss the approach the program will take (including tools to be
    used), to continue to build a strong relationship with the local
    partner, to jointly identify the broad areas of capacity to be
    built, and to assist the local partner in its organizational
    development. [For TB components]{.underline}, the local partner can
    be the MOH NTP staff, the private sector and/or an NGO, but
    regardless of the partner the overall program must be closely
    coordinated with the NTP.

-   As identified in the situational analysis, further describe the
    selected child survival, maternal health, TB and other
    interventions.

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-   Discuss the approaches used in the current program and how they will
    foster behavior change at the individual, family, health worker,
    facility and community levels in the new program.

-   Within these levels, address in detail issues of quality and access
    (including gender inequality), as well as intervention integration
    and sustainability.

-   Please provide the program's training plan in table format and
    include it **in the attachments**.

-   Where applicable based on the situational analysis, programs
    proposing a maternal neonatal health component are encouraged to
    identify and analyze barriers, as well as promising approaches, to
    programming for antenatal, birth and immediate post-partum care in
    the home and/or to identify approaches for incorporating essential
    newborn care actions into home birth programming. (e.g., Adapting
    Home-Based Life Saving Skills or Community-Based Life Saving Skills
    to specific contexts.)

-   [For TB components]{.underline}, identify and justify the
    component(s) of the DOTS Strategy to be strengthened in relationship
    to the NTP's policies and the investment of other partners/donors.
    Due to the complex nature of TB programs, applicants are not
    required to address all aspects of the DOTS program HOWEVER the
    proposed activity(s) need to be appropriate and coordinated closely
    with other actors in the TB sector. If appropriate, efforts to
    strengthen linkages or integrate TB and HIV programs are encouraged.

-   [For programs focusing on orphans and vulnerable children and youth
    in AIDS affected areas,]{.underline} describe how community efforts
    will be supported so that they are community-driven instead of
    externally driven in order to develop structures that can continue
    without ongoing support by the PVO - structures that can provide
    support to children over the long-term. Key to this description is
    how the PVO will enhance: 1) quality; 2) scale; 3) and long-term
    potential of the efforts. If a community-based activity for orphans
    and vulnerable children and youth does not currently exist, explain
    the approach to working with the community to initiate and mobilize
    around this issue.

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-   [If the applicant is proposing a TB component, FP component and/or a
    component focusing on orphans and vulnerable children and youth in
    AIDS-affected areas]{.underline}, describe how capacity of the U.S.
    PVO headquarters and local field staff will be strengthened in this
    technical area.

-   Discuss operations research ideas that may be carried out in the
    program.

-   Describe how the proposed intervention is consistent with MOH
    policies, or how the MOH agrees with the PVO approach if they
    differ. Provide an explanation of and justification for, any
    proposed intervention that differs from the MOH policy in the
    proposed country.

-   [For countries in transition]{.underline}, or in a post-conflict
    phase, briefly describe any measures that the applicant will take to
    ensure that the program does instigate or exacerbate conflict in
    program areas (e.g., do no harm framework) and describe plans to
    maintain the continuity of program interventions should conflict
    ensue.

**5. Performance Monitoring and Evaluation**

[Guidance for Cost Extension Category Only:]{.underline}

> **[Ensure that objectives and indicators are grounded in the
> situational analysis, the selected interventions and program strategy
> and in the sustainability plan.]{.underline}**

-   Discuss how progress towards program objectives will be measured
    (i.e., behavior change, sustainability). Describe how current data
    on indicators will be collected, analyzed and used for program
    management.

-   Discuss how current program activities will be monitored and the
    indicators to be used. Discuss how this relates directly to the
    sustainability of the current program.

-   Describe the types of baseline assessments, studies or surveys that
    will be carried out and budgeted for. Include baselines of PVO and
    local partner capacity, qualitative assessments, and
    population-based assessments.

-   [For TB applications]{.underline}, the World Health Organization has
    established a set of internationally recognized and accepted
    indicators and tools for reporting, monitoring and evaluating TB
    programs. Applicants are expected to use or implement this system
    (if it does not exist) within the structure of the National TB
    Program and not create a new or parallel system.

-   Describe the current data collection system(s) that already exist in
    the program area, how/if the program's data collection will
    complement or be different from the existing system, and how they
    will link to each other. (This includes MOH service delivery
    statistics.)

-   [For programs focusing on orphans and vulnerable children and youth
    in AIDS-affected areas,]{.underline} community-led efforts focusing
    on providing support and services to orphans and other vulnerable
    children and youth in AIDS-affected areas are relatively new and
    there is a dearth of information about what works best in various
    contexts. Describe how programs will regularly assess the
    effectiveness and the relevance of their activities in order to
    identify what is working and what is not working and to strengthen
    subsequent activities.

-   Ensure that at the proposed field level, an individual with
    substantial experience in monitoring and evaluating community health
    or child survival programs is available to the program.

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-   **In the attachments,** provide a matrix or other graphic to present
    the information which summarizes the proposed program\'s goal,
    results-based objective(s) and major activities. These should be the
    same as already discussed in the narrative of earlier sections. In
    addition, include indicator(s) for measuring the achievement of each
    objective, targets achieved and sustainability of the current
    program. The matrix on the following page is a composite example
    drawing from what various PVOs have submitted in the past. If the
    applicant PVO has standardized a particular approach, such as a
    logical framework or a results framework, please use the
    organization's preferred format.

> *The graphic should provide the reader with a concise summary of the
> proposed program, what the program will hold itself accountable to
> achieve and how the program will measure these outcomes and impact.*

**Example of a Program Matrix to**

**Display Program Goals and Objectives**

Goal:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+---------------+---------------+------------------+------------------+
| OBJECTIVES    | INDICATORS    | MEASUREMENT      | MAJOR PLANNED    |
|               |               | METHODS          | ACTIVITIES       |
+---------------+---------------+------------------+------------------+
| \* Objective  | \*            | \* measurement   | \* activity(s)   |
| 1             | indicator(s)  | method(s)        |                  |
|               |               |                  | \* activity      |
| \* Objective  | \* indicator  | \* measurement   |                  |
| 2             |               | method           | \* activity      |
|               | \* indicator  |                  |                  |
| \* Objective  |               | \* measurement   | \* activity      |
| 3             | \* indicator  | method           |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  |                  |
|               | \* indicator  |                  |                  |
+---------------+---------------+------------------+------------------+

**Definitions**

Goal: A statement of the long-term aim of the project. While the
complete fulfillment of a goal may not be possible or verifiable within
the life-span of the project, the achievement of the project\'s more
specific objectives should contribute to the realization of the goal.

Objective: A statement of what the program plans to achieve during the
life of the project. This achievement is the highest level result that a
program can materially affect with its efforts.

Indicator: An indicator specifies [what]{.underline} is measured to
determine whether the objective has been achieved. This includes both
process and outcome.

Targets: A target is the planned value of the indicator at the end of
the project (e.g., 70% of children are fully immunized by project end).
In the above matrix, targets can be stated in the objective statement or
in the indicators. Illustrative, end-of-program targets should be
provided in the application. If the program is funded, targets can be
adjusted in the DIP according to baseline survey results.

Measurement

Method: The measurement method identifies the source of the data for
each identified indicator. (e.g., initial and final KPC Survey).

Planned

Activities: Activities support the achievement of the objective. These
include inputs, processes and outputs of the program.

**6. Management Plan**

[Guidance for Cost Extension Category Only:]{.underline}

This section provides an overview of the management of the proposed
program. Please highlight those areas of program management that were
not discussed in other sections.

-   Provide a brief summary of key staff involved with the proposed
    program (please include job descriptions and CVs for key staff
    including headquarters backstop, project field director and M&E
    position as **attachments**). If changes in the management plan are
    envisaged from the original grant, then please discuss these
    differences in management structure, both organizational and
    financial, that will be applied in this extension. Include changes
    in responsibilities, reporting relationships, budgeting, etc.

-   **In the attachments**, please provide an organizational chart that
    clearly delineates the key personnel responsible for technically
    backstopping this program in the PVO U.S. headquarters office and
    managing this program in the in-country office. Describe how they
    fit into the overall organization, and the linkages between the
    headquarters, regional (if applicable), and field program personnel.

-   **In the attachments**, provide a **[table]{.underline}** of ALL
    persons who will contribute to achieving the results of the program.
    This may include, but is not limited to: PVO headquarters and field
    staff, local partner staff, MOH staff, community health workers and
    private sector providers. For each type of worker provide: 1) the
    number of workers in that category, 2) organizational
    affiliation, 3) main responsibilities, 4) percent of effort devoted
    to project activities, and 5) entity responsible for remunerating
    the worker (e.g., the PVO, MOH, community, volunteer).

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-   [For Applications with a FP component,]{.underline} describe how
    technical expertise in FP will be accessed and assured in the
    program. Note: Applicants are encouraged to commit staff with FP
    expertise to the program to provide oversight and technical support
    to the FP component. If there are no plans to designate FP staff,
    then provide a clear indication of how this expertise will be
    accessed and budgeted (i.e., technical consultants).

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-   [For Applications with components focusing on orphans and vulnerable
    children and youth in AIDS-affected areas,]{.underline} describe how
    the program will assure the availability of technical expertise on
    working with communities to enhance community-led initiatives and on
    working with orphans and vulnerable children and youth in
    AIDS-affected areas.

**7. Project Work Plan**

*(Provide as an attachment)*

[Guidance for Cost Extension Category Only:]{.underline}

-   In table format, please present a brief, one to two page work plan,
    which reflects the overall program approach and budget. Be sure to
    include a separate table for the program's training plan as
    described in the Program Strategy section.

**IV. COST APPLICATION**

##  Budget Preparation and Submission Instructions

#### [Standard Form 424 & 424A]{.underline}

##### 

##### Standard Form 424 is the standard form used by applicants as the required face sheet for applications submitted for Federal assistance. Standard Form 424A is the form used by applicants for presenting overall budget information. These forms (424 & 424A), along with detailed instructions for completing them, are included in [ANNEX G]{.underline} of this document. Please pay careful attention to the budget instructions. There are specific criteria that must be met for this program, some of which may have been amended since the previous RFA. Failure to accurately complete these forms could result in a non-funded application. 

The Standard Form 424A, [Section A,]{.underline} requests costs
organized by [headquarters]{.underline} and [field]{.underline}, and by
Federal and Non-Federal. This information should be the same as that
presented in other sections. Federal refers to the funds requested from
USAID and Non-Federal refers to funding from the applicant and other
sources. The amounts for Federal and Non-Federal presented here should
be the same as the Estimated Funding presented on Standard Form 424,
15.a and b, plus any entry for e. The total program amount on SF 424
should be the same amount presented in Section A and in Section B. For
further information regarding use of Non-Federal funds, refer to the
discussion of budget narrative and "cost-share" in this section of the
RFA.

**Headquarters Costs** are *direct* costs incurred by the U.S PVO head
office in the United States in support of the child survival and health
programs overseas. This does not duplicate established indirect cost
rates. USAID will support up to 15% of the direct costs of the USAID
funds in the program budget at the PVO's U.S. headquarters (or joint
headquarters in the applications for Mentoring) for support to the field
program, and for improving child survival and health technical and
operational capabilities of the PVO(s). This amount may be exceeded by
up to 20% of the proposed [direct costs if the application clearly shows
how any additional funds will improve the PVO's institutional capacity
for child survival and health programming]{.underline}. USAID will
support up to 20% of headquarters costs for Entry Programs. The
headquarters budget should be directly related to the description of how
the PVO builds and maintains technical and operational capacity. In
addition to backstopping and site visits to the field program, types of
activities that PVOs have included in the past are continuing education
opportunities for staff, information exchange and technical networking
among PVOs, reference materials, and observational visits to other field
programs of the same PVO or other PVOs. All headquarters costs must be
appropriately distributed in the correct amounts and contained within
the correct categories of Standard Form 424A, Section B, as per the
guidelines in [ANNEX G]{.underline}.

**Field costs** should include all funds designated for expenditure
within the host-country for carrying out the planned program. All field
costs must be appropriately distributed in the correct amounts and
contained within the correct categories of Standard Form 424A, Section
B, as per the guidelines in this RFA.

Standard Form 424A, [Section B]{.underline} is divided into eleven
"[Object Class Categories]{.underline}". The Object Class Categories
must be presented in two columns, "[Federal]{.underline}", which are the
costs being funded by the USAID portion of the over-all program budget,
and "[Non-Federal]{.underline}", which are the costs covered by the PVO
cost-share portion of the entire program budget. The entire program
budget must be appropriately distributed and contained within these
categories and columns. The categories include Personnel, Fringe
Benefits, Travel, Equipment, Supplies, Contractual, Construction, Other,
Total Direct Charges, Indirect Charges, and Totals. The Construction
category does [not]{.underline} apply to this program. Program costs
proposed for "training" and for "sub-grants" must be included in the
\"Other\" Object Class Category. For further elaboration on each of the
Object Class Categories, please refer to the instructions in [ANNEX
G]{.underline}. [ANNEX G]{.underline} includes a sample Standard Form
424 and 424A.

**Cost Share --** An Applicant must contribute from its non-U.S.
Government resources, at least 25% of the total cost of the proposed
program.

####### Detailed Budget and Budget Narrative

### 

The detailed budget and narrative should follow the SF 424 and 424A and
should fully define and support the line item costs for both the
Federally-funded (USAID) and Non-Federally funded (PVO cost-share)
portions of the budget. Based on the calculations shown in the
narrative, the Cognizant Technical Officer (CTO) and the Agreement
Officer should be able to easily verify all costs for the proposed
program. The costs proposed for "training" and "sub-grants" must be
itemized in the explanation of the Object Class Categories within the
budget narrative, so that they may be subsequently negotiated and
included in the appropriate category of the Cooperative Agreement
Budget.

All costs contained in the budget should accurately reflect the planned
level of program activities in the program design. For example, the
training budget should reflect the specific training activities to be
undertaken by the program. If 20% of the program approach includes
training, then the budget should reflect the detailed training costs for
this level of activity. This same principle should be maintained
throughout the budget when itemizing all field costs.

Applications for all program categories should include a detailed
procurement plan containing explicit information on how procurements
will be accomplish-ed. Carefully read the guidance in 22 CFR 228.
**GH/HIDN will [NOT]{.underline} authorize the use of USAID funding for
any restricted goods. GH/HIDN does [NOT]{.underline} seek waivers for
the purchase of non-U.S. motor vehicles, pharmaceuticals, used
equipment, seeds or pesticides. The applicant should consider funding
such commodities with the Non-Federal portion of the program budget.**

The recipient is expected to comply with USAID Eligibility Rules for
Goods and Services in the Standard Provisions and 22 CFR Part 228, and
use its cost-share for any goods and services that do not comply with
these rules.

**V. Required Documentation**

Certain documents are required to be submitted by an applicant in order
for a Grant Officer to make a determination of responsibility. However,
it is USAID policy not to burden applicants with undue reporting
requirements if that information is readily available through other
sources.

The following sections describe the documentation that applicants for
Assistance award must submit to USAID prior to award. See Section B.I
regarding page limits. Applicants are encouraged to be as concise as
possible, but still provide the necessary detail to address the
following:

**A. A copy of the program description as detailed in the applicant's
application, on a 3-1/2" diskette, formatted in Word97 or Excel97.**

B.  Include a budget with an accompanying budget narrative which
    provides in detail the total costs for implementation of the program
    the organization is proposing. The budget should be submitted using
    Standard Form 424 and 424A included in this RFA ([ANNEX
    G]{.underline}). **The budget and budget narrative shall also be
    included on the 3-1/2" diskette, formatted in Word97 or Excel97, and
    should contain:**

\- the breakdown of all costs associated with the program according to
costs of, if applicable, headquarters, regional and/or country offices;

\- the breakdown of all costs according to each partner organization
involved in the program;

\- the costs associated with external, expatriate technical assistance
and those associated with local in-country technical assistance;

\- the breakdown of the financial and in-kind contributions of all
organizations involved in implementing this Cooperative Agreement;

\- potential contributions of non-USAID or private commercial donors to
this Cooperative Agreement;

\- the procurement plan for commodities (note that contraceptives and
other health commodities will not be provided under this Cooperative
Agreement).

C. A current Negotiated Indirect Cost Rate Agreement;

D. Required certifications and representations (as attached):

E. Cost share must be at least 25% of the total estimated amount. If the
applicant proposes a cost share of less than 25%, it will be deemed as
not responsive, and will be removed from further consideration.

F. Applicants who do not currently have a Negotiated Indirect Cost Rate
Agreement (NICRA) from their cognizant agency shall also submit the
following information:

1\. Copies of the applicant\'s financial reports for the previous 3-year

period, which have been audited by a certified public accountant or

other auditor satisfactory to USAID;

2\. Projected budget, cash flow and organizational chart;

3\. A copy of the organization\'s accounting manual.

G. Applicants should submit any additional evidence of responsibility
deemed necessary for the Grant Officer to make a determination of
responsibility. The applicant should submit a list of all past and
current U.S. government contracts, cooperative agreements and grants;
this will be included in the **attachments** section. The information
submitted should substantiate that the Applicant:

1\. Has adequate financial resources or the ability to obtain such

resources as required during the performance of the award.

2\. Has the ability to comply with the award conditions, taking into

account all existing and currently prospective commitments of the

applicant, nongovernmental and governmental.

3\. Has a satisfactory record of performance. Past relevant

unsatisfactory performance is ordinarily sufficient to justify a

finding of non-responsibility, unless there is clear evidence of

subsequent satisfactory performance.

4\. Has a satisfactory record of integrity and business ethics; and

5\. Is otherwise qualified and eligible to receive a grant under

applicable laws and regulations (e.g., EEO).

H. Applicants that have never received a grant, cooperative agreement or
contract from the U.S. Government are required to submit a copy of their
accounting manual. If a copy has already been submitted to the U.S.
Government, the applicant should advise which Federal Office has a copy.

In addition to the aforementioned guidelines, the applicant is requested
to take note of the following:

I. Unnecessarily Elaborate Applications - Unnecessarily elaborate
brochures or other presentations beyond those sufficient to present a
complete and effective application in response to this RFA are not
desired and may be construed as an indication of the applicant\'s lack
of cost consciousness. Elaborate art work, expensive paper and bindings,
and expensive visual and other presentation aids are neither necessary
nor wanted.

J. Acknowledgement of Amendments to the RFA - Applicants shall
acknowledge receipt of any amendment to this RFA by signing and
returning the amendment. The Government must receive the acknowledgement
by the time specified for receipt of applications.

K. Receipt of Applications - Applications must be received at the place
designated and by the date and time specified in the cover letter of
this RFA.

L. Submission of Applications:

1\. Applications and modifications thereof shall be submitted in sealed
envelopes or packages (1) addressed to the office specified in the Cover
Letter of this RFA, and (2) showing the time specified for receipt, the
RFA number, and the name and address of the applicant.

2\. Telegraphic applications will not be considered; however,
applications may be modified by written or telegraphic notice, if that
notice is received by the time specified for receipt of applications.

M. Preparation of Applications:

1\. Applicants are expected to review, understand and comply with all
aspects of this RFA. Failure to do so will be at the applicant\'s risk.

2\. Each applicant shall furnish the information required by this RFA.
The applicant shall sign the application and print or type its name on
the Cover Page of the technical and cost applications. Erasures or other
changes must be initialed by the person signing the application.
Applications signed by an agent shall be accompanied by evidence of that
agent\'s authority, unless that evidence has been previously furnished
to the issuing office.

3\. Applicants who include data that they do not want disclosed to the
public for any purpose or used by the U.S. Government except for
evaluation purposes, should:

\(a\) Mark the title page with the following legend:

\"This application includes data that shall not be disclosed outside the
U.S. Government and shall not be duplicated, used, or disclosed - in
whole or in part - for any purpose other than to evaluate this
application. If, however, a grant is awarded to this applicant as a
result of - or in connection with - the submission of this data, the
U.S. Government shall have the right to duplicate, use, or disclose the
data to the extent provided in the resulting grant. This restriction
does not limit the U.S. Government\'s right to use information contained
in this data if it is obtained from another source without restriction.
The data subject to this restriction are contained in sheets; and

\(b\) Mark each sheet of data it wishes to restrict with the following
legend:

\"Use or disclosure of data contained on this sheet is subject to the
restriction on the title page of this application.\"

N. Explanation to Prospective Applicants - Any prospective applicant
desiring an explanation or interpretation of this RFA must request it in
writing within three weeks of receipt of the application to allow a
reply to reach all prospective applicants before the submission of their
applications. Oral explanations or instructions given before award of a
Grant will not be binding. Any information given to a prospective
applicant concerning this RFA will be furnished promptly to all other
prospective applicants as an amendment of this RFA, if that information
is necessary in submitting applications or if the lack of it would be
prejudicial to any other prospective applicants.

O. Award:

1\. The Government may award one or more Agreements resulting from this
RFA to the responsible applicant(s) whose application(s) conforming to
this RFA offers the greatest value (see also Section II of this RFA).
The Government may (a) reject any or all applications, (b) accept other
than the lowest cost application, (c) accept more than one application
(see Section III, Selection Criteria), (d) accept alternate
applications, and (e) waive informalities and minor irregularities in
applications received.

2\. The Government may award one or more Agreement(s) on the basis of
initial applications received, without discussions. Therefore, each
initial application should contain the applicant\'s best terms from a
cost and technical standpoint.

3\. A written award mailed or otherwise furnished to the successful
applicant(s) within the time for acceptance specified either in the
application(s) or in this RFA (whichever is later) shall result in a
binding Agreement without further action by either party. Before the
application\'s specified expiration time, the Government may accept an
application, whether or not there are negotiations after its receipt,
unless a written notice of withdrawal is received before award.
Negotiations conducted after receipt of an application do not constitute
a rejection or counteroffer by the Government.

4\. Neither financial data submitted with an application nor
representations concerning facilities or financing, will form a part of
the resulting Agreement(s).

P. Authority to Obligate the Government - The Grant Officer is the only
individual who may legally commit the Government to the expenditure of
public funds. No costs chargeable to the proposed Agreement may be
incurred before receipt of either a fully executed Agreement or a
specific, written authorization from the Grant Officer.

#  SECTION C - SELECTION CRITERIA

The criteria presented below have been tailored to the requirements of
this particular RFA.

## I. Eligibility Requirements

1\. The PVO **must** meet the following two criteria (initial screening)
in order for their proposal to be reviewed:

a)  Be a **U.S. PVO**, currently registered with USAID at the time of
    application submission. Under the Mentoring program, each PVO must
    be registered.

b)  Receive at least 20% of its total annual financial support for its
    international programs from non-U.S. government sources.

2\. **Organizational Requirements** or applicant requirements -- To be
eligible for funding under the Child Survival and Health Grants Program,
an organization must:

a)  Contribute, from its non-U.S. Government resources, at least 25% of
    the total cost of the proposed program.

b)  Have at least five years experience implementing health-related
    programs in a developing country.

c)  Be operational in the country where the child survival and health
    program is proposed, which is documented by a signed agreement with
    the host government and included in the application. Documentation
    should include legal authorization to operate in the target country.
    Previous health program experience in the target country is
    **[not]{.underline}** required.

3\. **Program Requirements** -- Proposed programs must meet the
following requirements to be considered for funding:

a)  Be in an eligible country or countries. A program may include
    contiguous countries, or those for which there is a clear rationale
    for proposing a single program that is active in more than one
    country. The program must meet all the criteria listed in each
    country involved. See the list of Eligible Countries below.

b)  Be consistent with USAID\'s country or regional-specific program
    priorities in the health sector; the application must document
    [consultation with the USAID Mission in the early design
    phase]{.underline} of the program. Appropriate USAID offices with
    oversight for non-presence countries are included in [ANNEX
    B]{.underline}. GH/HIDN solicits USAID Mission review for proposed
    programs.

c)  Be consistent with the national child survival and maternal health,
    family planning, TB and HIV/AIDS policies in the targeted country.

d)  Involve formal documented partnerships with a local government,
    non-governmental organization (NGO), community partner or other
    local organization. All applications must be prepared in
    collaboration with the program partners in the proposed site or
    country.

e)  Assign at least one public health professional at the PVO's U.S.
    headquarters to be responsible for Child Survival and Health Grants
    Program activities (e.g. Child Survival Technical backstop).

f)  Assign to the program, at the proposed field site, one full-time
    staff person with substantial and appropriate experience in
    implementing community health or child survival programs (e.g. Field
    Program Manager).

## 4. Funding Priorities - Priorities are for programs that:

a)  Apply effective, innovative, integrated child survival and maternal
    health as well as other health strategies (TB, FP and HIV/AIDS)
    deliverable at reasonable costs, with a high potential for
    sustainability and scale-up and expansion -- within the capability
    of the applicant and its partners.

b)  Propose interventions that reflect a well-thought-out overall
    program strategy; are within the manageable interests and technical
    capabilities of the PVO; will have the greatest impact on the target
    population (depth versus breadth); and will support the priorities
    of the relevant USAID field mission*.*

> ***PVOs are [reminded]{.underline} that proposing an increased number
> of interventions is not necessarily advantageous.***

**ELIGIBLE COUNTRY LIST**

The eligible country list reflects:

-   Mission nomination, and

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-   GH priority countries for Child Survival, Maternal Health, Family
    Planning, HIV/AIDS and Infectious Diseases (including TB and
    Malaria).

The identified GH priority countries serve to encourage strategic
planning in the selection of interventions and program approaches for
eligible countries. It is not a requirement that a PVO address all or
any of the identified GH priorities for a particular country, nor is it
reflected in the evaluation criteria (i.e., no additional points).

**ELIGIBLE COUNTRY LIST**

+---------------+---------------+---------------+---------------------+
| **Africa**    | **Asia &**    | **Europe &**  | **Latin America**   |
|               |               |               |                     |
|               | **Near East** | **Eurasia**   | **& Caribbean**     |
+---------------+---------------+---------------+---------------------+
| Angola 3,4    | Bangladesh    | Albania       | Antigua & Barbuda   |
|               | 2,4,5         |               |                     |
| Benin 3,4     |               | Armenia 5     | Barbados            |
|               | Cambodia      |               |                     |
| Botswana      | 1,2,4,5       | Azerbaijan 4  | Bolivia 4,5         |
|               |               |               |                     |
| Burkina Faso  | East Timor 4  | Bosni         | Brazil 1,4,5        |
|               |               | a/Herzegovina |                     |
| Burundi 3,4   | India 1,2,4,5 |               | Dominican Republic  |
|               |               | Georgia 4,5   | 1,4,5               |
| Cameroon      | Indonesia     |               |                     |
|               | 1,2,4,5       | Kyrgyzstan 5  | Ecuador 4,5         |
| Cape Verde    |               |               |                     |
|               | Jordan 4      | Macedonia     | El Salvador 4,5     |
| Chad          |               |               |                     |
|               | Laos 5        | Romania 5     | Grenada             |
| Côte d'Ivoire |               |               |                     |
|               | Nepal 1,2,4   | Russia 1,4,5  | Guatemala 4         |
| Djibouti      |               |               |                     |
|               | Pakistan      | Tajikistan    | Haiti 1,4,5         |
| DR Congo      | 2,4,5         | 4,5           |                     |
| 2,3,4,5       |               |               | Honduras 1,4,5      |
|               | Philippines   | Turkmenistan  |                     |
| Eritrea 3,4   | 2,4,5         | 4,5           | Jamaica             |
|               |               |               |                     |
| Ethiopia      | Thailand 4    | Ukraine 1,5   | Mexico 4,5          |
| 1,2,3,4,5     |               |               |                     |
|               | Vietnam 4,5   | Uzbekistan    | Nicaragua 4         |
| Gambia        |               | 4,5           |                     |
|               | West          |               | Peru 2,4,5          |
| Ghana 1,2,3,4 | Bank/Gaza 4   |               |                     |
|               |               |               | St. Kitts & Nevis   |
| Guinea 3,4    | Yemen 4       |               |                     |
|               |               |               | St. Lucia           |
| Guinea Bissau |               |               |                     |
|               |               |               | St. Vincent &       |
| Kenya         |               |               | Grenadines          |
| 1,2,3,4,5     |               |               |                     |
|               |               |               | Suriname            |
| Liberia 3,4   |               |               |                     |
|               |               |               | Trinidad & Tobago   |
| Lesotho       |               |               |                     |
|               |               |               |                     |
| Madagascar    |               |               |                     |
| 2,3,4         |               |               |                     |
|               |               |               |                     |
| Malawi        |               |               |                     |
| 1,2,3,4,5     |               |               |                     |
|               |               |               |                     |
| Mali 2,3,4    |               |               |                     |
|               |               |               |                     |
| Mauritania    |               |               |                     |
|               |               |               |                     |
| Mozambique    |               |               |                     |
| 1,2,3,4       |               |               |                     |
|               |               |               |                     |
| Namibia 4     |               |               |                     |
|               |               |               |                     |
| Niger         |               |               |                     |
|               |               |               |                     |
| Nigeria       |               |               |                     |
| 1,2,3,4,5     |               |               |                     |
|               |               |               |                     |
| Rwanda 1,3,4  |               |               |                     |
|               |               |               |                     |
| Senegal       |               |               |                     |
| 1,2,3,4,5     |               |               |                     |
|               |               |               |                     |
| Sierra Leone  |               |               |                     |
| 3,4           |               |               |                     |
|               |               |               |                     |
| South Africa  |               |               |                     |
| 1,4,5         |               |               |                     |
|               |               |               |                     |
| Sudan 4       |               |               |                     |
|               |               |               |                     |
| Swaziland     |               |               |                     |
|               |               |               |                     |
| Tanzania      |               |               |                     |
| 1,2,3,4       |               |               |                     |
|               |               |               |                     |
| Togo          |               |               |                     |
|               |               |               |                     |
| Uganda        |               |               |                     |
| 1,2,3,4,5     |               |               |                     |
|               |               |               |                     |
| Zambia        |               |               |                     |
| 1,2,3,4       |               |               |                     |
+---------------+---------------+---------------+---------------------+

**GH Priority Countries**

1 -- HIV/AIDS

2 -- Family Planning

3 -- Malaria

4 - Maternal & Child Health

5 -- Tuberculosis (does not indicate priority, just the presence of a

USAID supported TB activity/program in country. TB proposals can be

submitted for any country on the list.)

## II. Program Restrictions

a)  Child Survival and Health Grants Program funds may **NOT** be
    proposed for the following types of activities: income generation or
    literacy training. GH/HIDN realizes these activities may be critical
    to achieving program objectives and would support these activities
    if funded under the PVO cost-share.

b)  USAID will **[NOT]{.underline}** review applications for programs
    for which the main purpose is: **research; equipping hospitals,
    orphanages or other residential facilities; curative care in
    hospitals; surgical procedures and prosthetics; construction;
    manufacturing of pharmaceuticals, bednets, or other health aids;
    evacuation of children to the U.S. for medical treatment; emergency
    relief activities; or adoptions.** These activities are beyond the
    scope of the Child Survival and Health Grants Program.

c)  All successful applications which incorporate family planning (as
    opposed to child spacing in the context of an integrated child
    survival program) will receive FP/RH funds which are subject to
    USAID legislative and policy requirements as set forth in the
    Standard Grant Provisions for USAID family planning activities.
    However, because one of these policy requirements, the Mexico City
    Policy, is not yet included in the Standard Provisions, please see
    the following link for information on this requirement. **This
    website should be reviewed and requirements considered before
    submitting application**:

    (http//www.usaid.gov/procurement_bus_opp/procurement/cib/pdf/cib0108r.pdf)

d)  GH/HIDN will **NOT** review applications that are otherwise beyond
    the scope of the Child Survival and Health Grants Program as
    determined by USAID.

In addition to the above Program Restrictions, the following
**limitations** may apply:

a)  A PVO may submit up to **[two]{.underline}** applications for
    submission in response to this RFA. This means that a PVO may only
    be the prime or lead recipient on two applications for submission;
    however, a PVO may be a sub-grantee on any number of applications.
    For instance, a PVO may submit and be the prime on separate Standard
    and Cost Extension applications, and also, serve as a mentor
    (sub-grantee) on a Mentoring application as long as this PVO is not
    the prime on the Mentoring application. An Expanded Impact
    application with a 100% Family Planning intervention is the
    exception to the limit of 2 applications per PVO**.** A PVO may only
    submit one application under this exception.

b)  As of September 30, 2003, a PVO may be a recipient of no more than
    **[six]{.underline}** ongoing child survival and health programs at
    any one time. An Expanded Impact program with a 100% Family Planning
    intervention is the exception to this limit under the FY 2004 RFA.

The technical applications will be evaluated in accordance with the
Technical Evaluation Criteria set forth below. **The cost application of
all applicants submitting a technically acceptable application will be
evaluated by the Agreement Officer for general reasonableness, and
allowable and allocable costs. To the extent that they are necessary,
and if an award is made based on the initial applications, then cost
negotiations will be conducted with all applicants whose applications,
after technical review and evaluation, have a reasonable chance of being
selected for award. Awards will be made to responsible applicants whose
applications** **offer the greatest value, cost and other factors
considered.**

**III. Technical Evaluation Criteria**

Applicants should note that these criteria serve to: (a) identify the
significant issues which applicants should address in their applications
and (b) set the standard against which all applications will be
evaluated. To facilitate the review of applications, applicants should
organize the narrative sections of their applications in the same order
as the selection criteria. Awards will be recommended based on the
ranking of proposals according to the technical selection criteria.
Close adherence to the criteria is necessary but does not guarantee a
successful review**.** For each technical evaluation criteria section,
the required line item components for that section will be evaluated
individually on a qualitative scale of Excellent, Very Good, Good, Fair,
and Poor.

+----------------------------------+----+-------+------+-------+------+
| **Evaluation Criteria**          | *  |       |      |       |      |
|                                  | *M |       |      |       |      |
|                                  | ax |       |      |       |      |
|                                  | im |       |      |       |      |
|                                  | um |       |      |       |      |
|                                  | Po |       |      |       |      |
|                                  | in |       |      |       |      |
|                                  | ts |       |      |       |      |
|                                  | f  |       |      |       |      |
|                                  | or |       |      |       |      |
|                                  | Ca |       |      |       |      |
|                                  | te |       |      |       |      |
|                                  | go |       |      |       |      |
|                                  | ry |       |      |       |      |
|                                  | ** |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
|                                  | *  | **M   | **St | *     | **Ex |
|                                  | *E | entor | anda | *Cost | pand |
|                                  | nt | ing** | rd** | E     | ed** |
|                                  | ry |       |      | xtens |      |
|                                  | ** |       |      | ion** | **   |
|                                  |    |       |      |       | Impa |
|                                  |    |       |      |       | ct** |
+----------------------------------+----+-------+------+-------+------+
| **[Budget                        |    |       |      |       |      |
| Information]{.underline}**       |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- SF 424, detailed budget and   |    |       |      |       |      |
| budget narrative completed.      |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- USAID and cost-share funds,   |    |       |      |       |      |
| HQ & field costs are realistic.  |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Program activities are        |    |       |      |       |      |
| adequately budgeted.             |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Clear, concise budget         |    |       |      |       |      |
| narrative                        |    |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **Budget Total**                 | *  | **5** | *    | **3** | *    |
|                                  | *5 |       | *3** |       | *3** |
|                                  | ** |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **[Executive                     |    |       |      |       |      |
| Summary]{.underline}**           |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- A clear, comprehensive        |    |       |      |       |      |
| summary of the proposed program. |    |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **Executive Summary Total**      | *  | **5** | *    | **2** | *    |
|                                  | *5 |       | *2** |       | *2** |
|                                  | ** |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **[Description of the PVO        |    |       |      |       |      |
| Applicant or                     |    |       |      |       |      |
| Program]{.underline}**           |    |       |      |       |      |
|                                  |    |       |      |       |      |
| **For ALL grant categories       |    |       |      |       |      |
| except Cost Extension:**         |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Organization's purpose,       |    |       |      |       |      |
| mission, major                   |    |       |      |       |      |
|                                  |    |       |      |       |      |
| sectors clearly presented and    |    |       |      |       |      |
| congruent with                   |    |       |      |       |      |
|                                  |    |       |      |       |      |
| proposed program.                |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Demonstrated past performance |    |       |      |       |      |
| in technical/program areas.      |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Proposals including TB; the   |    |       |      |       |      |
| applicant should demonstrate     |    |       |      |       |      |
| past performance in implementing |    |       |      |       |      |
| TB control programs, have        |    |       |      |       |      |
| in-house technical capacity or   |    |       |      |       |      |
| have identified a project        |    |       |      |       |      |
| partner with such experience.    |    |       |      |       |      |
|                                  |    |       |      |       |      |
| **For Cost Extension:**          |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Demonstrated results under    |    |       |      |       |      |
| original program                 |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Evidence that Mid-term        |    |       |      |       |      |
| Evaluation recommendations are   |    |       |      |       |      |
| being addressed.                 |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Proposals including TB; the   |    |       |      |       |      |
| applicant should demonstrate     |    |       |      |       |      |
| past performance in implementing |    |       |      |       |      |
| TB control programs, have        |    |       |      |       |      |
| in-house technical capacity or   |    |       |      |       |      |
| have identified a project        |    |       |      |       |      |
| partner with such experience.    |    |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **Description Total**            | ** | *     | *    | *     | *    |
|                                  | 10 | *10** | *5** | *15** | *5** |
|                                  | ** |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **[Situational                   |    |       |      |       |      |
| Analysis]{.underline}**          |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Clear and comprehensive       |    |       |      |       |      |
| assessment of the                |    |       |      |       |      |
|                                  |    |       |      |       |      |
| relevant health status of the    |    |       |      |       |      |
| selected                         |    |       |      |       |      |
|                                  |    |       |      |       |      |
| population, existing services,   |    |       |      |       |      |
| key household                    |    |       |      |       |      |
|                                  |    |       |      |       |      |
| and care-seeking behaviors,      |    |       |      |       |      |
| socioeconomic                    |    |       |      |       |      |
|                                  |    |       |      |       |      |
| status and other parameters      |    |       |      |       |      |
| (constraints and                 |    |       |      |       |      |
|                                  |    |       |      |       |      |
| opportunities) which support the |    |       |      |       |      |
| selection of                     |    |       |      |       |      |
|                                  |    |       |      |       |      |
| the proposed interventions.      |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Proposals including TB should |    |       |      |       |      |
| present a                        |    |       |      |       |      |
|                                  |    |       |      |       |      |
| comprehensive assessment of the  |    |       |      |       |      |
| TB burden and                    |    |       |      |       |      |
|                                  |    |       |      |       |      |
| TB control program in the target |    |       |      |       |      |
| area.                            |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Letters of collaboration and  |    |       |      |       |      |
| endorsement                      |    |       |      |       |      |
|                                  |    |       |      |       |      |
| included, (a separate letter     |    |       |      |       |      |
| from the NTP if                  |    |       |      |       |      |
|                                  |    |       |      |       |      |
| application includes TB).        |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Brief description of other    |    |       |      |       |      |
| programs (PVOs,                  |    |       |      |       |      |
|                                  |    |       |      |       |      |
| other organizations, USAID field |    |       |      |       |      |
| mission                          |    |       |      |       |      |
|                                  |    |       |      |       |      |
| programs, global initiatives,    |    |       |      |       |      |
| etc.) and                        |    |       |      |       |      |
|                                  |    |       |      |       |      |
| opportunities for synergies of   |    |       |      |       |      |
| program                          |    |       |      |       |      |
|                                  |    |       |      |       |      |
| interventions and strategies.    |    |       |      |       |      |
|                                  |    |       |      |       |      |
| \- Relevant stakeholders         |    |       |      |       |      |
| appropriately involved in the    |    |       |      |       |      |
| selection of site, interventions |    |       |      |       |      |
| and/or strategies and            |    |       |      |       |      |
| methodologies that will be       |    |       |      |       |      |
| scaled up.                       |    |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+
| **Situational Analysis Total**   | ** | *     | **   | *     | **   |
|                                  | 15 | *15** | 25** | *20** | 25** |
|                                  | ** |       |      |       |      |
+----------------------------------+----+-------+------+-------+------+

+---------------------------------+----+-------+------+-------+------+
| **Evaluation Criteria           | *  | **M   | **St | *     | **   |
| Continued**                     | *E | entor | anda | *Cost | Expa |
|                                 | nt | ing** | rd** | E     | nded |
|                                 | ry |       |      | xtens | Impa |
|                                 | ** |       |      | ion** | ct** |
+---------------------------------+----+-------+------+-------+------+
| **[Program Strategy and         |    |       |      |       |      |
| Interventions]{.underline}**    |    |       |      |       |      |
|                                 |    |       |      |       |      |
| **[As applicable for ALL grant  |    |       |      |       |      |
| categories:]{.underline}**      |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Clear, realistic goals and   |    |       |      |       |      |
| objectives.                     |    |       |      |       |      |
|                                 |    |       |      |       |      |
| Strategies and interventions    |    |       |      |       |      |
| are sound and                   |    |       |      |       |      |
|                                 |    |       |      |       |      |
| will achieve results.           |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Strategies demonstrate       |    |       |      |       |      |
| knowledge of the population and |    |       |      |       |      |
| clearly link with the           |    |       |      |       |      |
| situational analysis.           |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- USAID field mission and      |    |       |      |       |      |
| CSHGP strategic                 |    |       |      |       |      |
|                                 |    |       |      |       |      |
| objectives and relevant         |    |       |      |       |      |
| intermediate results            |    |       |      |       |      |
|                                 |    |       |      |       |      |
| provided and how the PVO        |    |       |      |       |      |
| program objectives              |    |       |      |       |      |
|                                 |    |       |      |       |      |
| support those                   |    |       |      |       |      |
| objectives/results.             |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Clear description of how the |    |       |      |       |      |
| program will relate to other    |    |       |      |       |      |
| health activities in the        |    |       |      |       |      |
| program area.                   |    |       |      |       |      |
|                                 |    |       |      |       |      |
| -For components focusing on     |    |       |      |       |      |
| orphans and vulnerable children |    |       |      |       |      |
| and youth in AIDS-affected      |    |       |      |       |      |
| areas: Clear description of how |    |       |      |       |      |
| the program will relate to, and |    |       |      |       |      |
| collaborate with, other         |    |       |      |       |      |
| HIV/AIDS prevention and care    |    |       |      |       |      |
| activities.                     |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- For TB, identified and       |    |       |      |       |      |
| justified component(s) of the   |    |       |      |       |      |
| DOTS Strategy to be             |    |       |      |       |      |
| strengthened in relationship to |    |       |      |       |      |
| the NTP's DOTS program and the  |    |       |      |       |      |
| investment of other             |    |       |      |       |      |
| partners/donors.                |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Clear description of the     |    |       |      |       |      |
| selected CS, maternal health,   |    |       |      |       |      |
| FP/RH, TB, HIV/AIDS and other   |    |       |      |       |      |
| interventions, including        |    |       |      |       |      |
| essential elements such as      |    |       |      |       |      |
| quality, access, training, etc. |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Clear description of how     |    |       |      |       |      |
| approaches will                 |    |       |      |       |      |
|                                 |    |       |      |       |      |
| foster behavior change at the   |    |       |      |       |      |
|                                 |    |       |      |       |      |
| individual/family/health        |    |       |      |       |      |
| worker/health                   |    |       |      |       |      |
|                                 |    |       |      |       |      |
| facility/community levels.      |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Role of local partners       |    |       |      |       |      |
| clearly described.              |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Program approach is          |    |       |      |       |      |
| consistent with MOH policies,   |    |       |      |       |      |
| or MOH agrees with PVO          |    |       |      |       |      |
| approach.                       |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- For components focusing on   |    |       |      |       |      |
| orphans and vulnerable children |    |       |      |       |      |
| and youth in AIDS affected      |    |       |      |       |      |
| areas: Clear description of the |    |       |      |       |      |
| approach to be taken to         |    |       |      |       |      |
| identify children and youth who |    |       |      |       |      |
| are most vulnerable in HIV/AIDS |    |       |      |       |      |
| affected areas.                 |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- For components focusing on   |    |       |      |       |      |
| orphans and vulnerable children |    |       |      |       |      |
| and youth in AIDS affected      |    |       |      |       |      |
| areas: Clear description of how |    |       |      |       |      |
| the approach will foster        |    |       |      |       |      |
| sustainable efforts without     |    |       |      |       |      |
| undermining current initiatives |    |       |      |       |      |
| or develop dependence on PVO.   |    |       |      |       |      |
|                                 |    |       |      |       |      |
| **Additional for Expanded       |    |       |      |       |      |
| Impact:**                       |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Issues of sustainability and |    |       |      |       |      |
| scale-up fully addressed and    |    |       |      |       |      |
| realistic to the situation.     |    |       |      |       |      |
|                                 |    |       |      |       |      |
| **Additional for Cost           |    |       |      |       |      |
| Extension:**                    |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Sustainability strategy is   |    |       |      |       |      |
| sound and will achieve results. |    |       |      |       |      |
+---------------------------------+----+-------+------+-------+------+
| **Program Strategy and          | ** | *     | **   | *     | **   |
| Interventions Total**           | 15 | *15** | 30** | *25** | 25** |
|                                 | ** |       |      |       |      |
+---------------------------------+----+-------+------+-------+------+
| **[Organizational               |    |       |      |       |      |
| Development]{.underline}**      |    |       |      |       |      |
|                                 |    |       |      |       |      |
| **For Entry and Mentoring       |    |       |      |       |      |
| categories only:**              |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Objectives and strategies    |    |       |      |       |      |
| for building PVO and local      |    |       |      |       |      |
| partner capacity clearly        |    |       |      |       |      |
| described.                      |    |       |      |       |      |
|                                 |    |       |      |       |      |
| \- Clear plan for documenting   |    |       |      |       |      |
| change and sharing lessons      |    |       |      |       |      |
| learned from this program       |    |       |      |       |      |
| within PVO.                     |    |       |      |       |      |
+---------------------------------+----+-------+------+-------+------+
| **Organizational Development    | ** | *     | **   | *     | **   |
| Total**                         | 15 | *15** | NA** | *NA** | NA** |
|                                 | ** |       |      |       |      |
+---------------------------------+----+-------+------+-------+------+

+---------------------------------+----+-------+------+-------+-------+
| **Evaluation Criteria           | *  | **M   | **St | *     | **Exp |
| Continued**                     | *E | entor | anda | *Cost | anded |
|                                 | nt | ing** | rd** | E     | Imp   |
|                                 | ry |       |      | xtens | act** |
|                                 | ** |       |      | ion** |       |
+---------------------------------+----+-------+------+-------+-------+
| **[Performance Monitoring and   |    |       |      |       |       |
| Evaluation]{.underline}**       |    |       |      |       |       |
|                                 |    |       |      |       |       |
| **For ALL grant categories:**   |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Process to gather, analyze   |    |       |      |       |       |
| and use data in                 |    |       |      |       |       |
|                                 |    |       |      |       |       |
| management of project is        |    |       |      |       |       |
| clearly articulated             |    |       |      |       |       |
|                                 |    |       |      |       |       |
| and realistic.                  |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Planned baseline studies are |    |       |      |       |       |
| clearly outlined, budgeted for, |    |       |      |       |       |
| and appropriate.                |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- How program data collection  |    |       |      |       |       |
| will relate to                  |    |       |      |       |       |
|                                 |    |       |      |       |       |
| MOH (or other existing) system  |    |       |      |       |       |
| is clearly                      |    |       |      |       |       |
|                                 |    |       |      |       |       |
| described and the two           |    |       |      |       |       |
| complement each other.          |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Indicators match program     |    |       |      |       |       |
| objectives, and                 |    |       |      |       |       |
|                                 |    |       |      |       |       |
| define what will be measured to |    |       |      |       |       |
| evaluate                        |    |       |      |       |       |
|                                 |    |       |      |       |       |
| achievements.                   |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Indicators to measure        |    |       |      |       |       |
| objectives are consistent with  |    |       |      |       |       |
| globally and/or nationally      |    |       |      |       |       |
| accepted standards.             |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- For proposals including TB,  |    |       |      |       |       |
| applicant is using or           |    |       |      |       |       |
| implementing the WHO TB M&E     |    |       |      |       |       |
| system within the structure of  |    |       |      |       |       |
| the National TB Program and not |    |       |      |       |       |
| creating a new or parallel      |    |       |      |       |       |
| system.                         |    |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **Performance Monitoring and    | ** | *     | **   | *     | *     |
| Evaluation Total**              | 15 | *15** | 25** | *25** | *25** |
|                                 | ** |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **[Management                   |    |       |      |       |       |
| Plan]{.underline}**             |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Clear organizational, human  |    |       |      |       |       |
| resource and financial          |    |       |      |       |       |
| management structures in place. |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Roles and responsibilities   |    |       |      |       |       |
| of key staff and project        |    |       |      |       |       |
| partners are clear.             |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Sufficient and appropriate   |    |       |      |       |       |
| human resources, including      |    |       |      |       |       |
| backstopping from headquarters, |    |       |      |       |       |
| are devoted to the program.     |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Work plan reflects program   |    |       |      |       |       |
| approach, objectives and        |    |       |      |       |       |
| budget.                         |    |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **Management Plan Total**       | ** | *     | *    | **5** | *     |
|                                 | 15 | *15** | *5** |       | *10** |
|                                 | ** |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **[Collaboration with USAID     |    |       |      |       |       |
| Field Mission]{.underline}**    |    |       |      |       |       |
|                                 |    |       |      |       |       |
| \- Letter of support,           |    |       |      |       |       |
| congruence with Mission         |    |       |      |       |       |
| Strategic Objective/results, or |    |       |      |       |       |
| other evidence of "active"      |    |       |      |       |       |
| participation.                  |    |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **Collaboration with USAID      | *  | **5** | *    | **5** | **5** |
| Field Mission Total**           | *5 |       | *5** |       |       |
|                                 | ** |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+
| **GRAND TOTAL**                 | *  | **    | **1  | **    | **    |
|                                 | *1 | 100** | 00** | 100** | 100** |
|                                 | 00 |       |      |       |       |
|                                 | ** |       |      |       |       |
+---------------------------------+----+-------+------+-------+-------+

> **SECTION D**

**U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT**

**CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF RECIPIENT
\[1\]\[2\]**

## PART I - CERTIFICATIONS AND ASSURANCES

1\. ASSURANCE OF COMPLIANCE WITH LAWS AND REGULATIONS GOVERNING
NON-DISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS

\(a\) The recipient hereby assures that no person in the United States
shall, on the bases set forth below, be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination
under, any program or activity receiving financial assistance from
USAID, and that with respect to the grant for which application is being
made, it will comply with the requirements of:

\(1\) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42
U.S.C. 2000-d), which prohibits discrimination on the basis of race,
color or national origin, in programs and activities receiving Federal
financial assistance;

\(2\) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794),
which prohibits discrimination on the basis of handicap in programs and
activities receiving Federal financial assistance;

\(3\) The Age Discrimination Act of 1975, as amended (Pub. L. 95-478),
which prohibits discrimination based on age in the delivery of services
and benefits supported with Federal funds;

\(4\) Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et
seq.), which prohibits discrimination on the basis of sex in education
programs and activities receiving Federal financial assistance (whether
or not the programs or activities are offered or sponsored by an
educational institution); and

\(5\) USAID regulations implementing the above nondiscrimination laws,
set forth in Chapter II of Title 22 of the Code of Federal Regulations.

\(b\) If the recipient is an institution of higher education, the
Assurances given herein extend to admission practices and to all other
practices relating to the treatment of students or clients of the
institution, or relating to the opportunity to participate in the
provision of services or other benefits to such individuals, and shall
be applicable to the entire institution unless the recipient establishes
to the satisfaction of the USAID Administrator that the institution\'s
practices in designated parts or programs of the institution will in no
way affect its practices in the program of the institution for which
financial assistance is sought, or the beneficiaries of, or participants
in, such programs.

\(c\) This assurance is given in consideration of and for the purpose of
obtaining any and all Federal grants, loans, contracts, property,
discounts, or other Federal financial assistance extended after the date
hereof to the recipient by the Agency, including installment payments
after such date on account of applications for Federal financial
assistance which were approved before such date. The recipient
recognizes and agrees that such Federal financial assistance will be
extended in reliance on the representations and agreements made in this
Assurance, and that the United States shall have the right to seek
judicial enforcement of this Assurance. This Assurance is binding on the
recipient, its successors, transferees, and assignees, and the person or
persons whose signatures appear below are authorized to sign this
Assurance on behalf of the recipient.

2\. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

\(a\) Instructions for Certification

\(1\) By signing and/or submitting this application or grant, the
recipient is providing the certification set out below.

\(2\) The certification set out below is a material representation of
fact upon which reliance was placed when the agency determined to award
the grant. If it is later determined that the recipient knowingly
rendered a false certification, or otherwise violates the requirements
of the Drug-Free Workplace Act, the agency, in addition to any other
remedies available to the Federal Government, may take action authorized
under the Drug-Free Workplace Act.

\(3\) For recipients other than individuals, Alternate I applies.

\(4\) For recipients who are individuals, Alternate II applies.

\(b\) Certification Regarding Drug-Free Workplace Requirements

Alternate I

\(1\) The recipient certifies that it will provide a drug-free workplace
by:

\(A\) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the applicant\'s/grantee\'s workplace and
specifying the actions that will be taken against employees for
violation of such prohibition;

\(B\) Establishing a drug-free awareness program to inform employees
about\--

1\. The dangers of drug abuse in the workplace;

2\. The recipient\'s policy of maintaining a drug-free workplace;

3\. Any available drug counseling, rehabilitation, and employee
assistance programs; and

4\. The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;

\(C\) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (b)(1)(A);

\(D\) Notifying the employee in the statement required by paragraph
(b)(1)(A) that, as a condition of employment under the grant, the
employee will\--

1\. Abide by the terms of the statement; and

2\. Notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five days after such
conviction;

\(E\) Notifying the agency within ten days after receiving notice under
subparagraph (b)(1)(D)1. from an employee or otherwise receiving actual
notice of such conviction;

\(F\) Taking one of the following actions, within 30 days of receiving
notice under subparagraph (b)(1)(D)2., with respect to any employee who
is so convicted\--

1\. Taking appropriate personnel action against such an employee, up to
and including termination; or

2\. Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such purposes by
a Federal, State, or local health, law enforcement, or other appropriate
agency;

\(G\) Making a good faith effort to continue to maintain a drug- free
workplace through implementation of paragraphs (b)(1)(A), (b)(1)(B),
(b)(1)(C), (b)(1)(D), (b)(1)(E) and (b)(1)(F).

\(2\) The recipient shall insert in the space provided below the site(s)
for the performance of work done in connection with the specific grant:

Place of Performance (Street address, city, county, state, zip code)

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

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

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

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

Alternate II

The recipient certifies that, as a condition of the grant, he or she
will not engage in the unlawful manufacture, distribution, dispensing,
possession or use of a controlled substance in conducting any activity
with the grant.

3\. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS \-- PRIMARY COVERED TRANSACTIONS \[3\]

\(a\) Instructions for Certification

1\. By signing and submitting this proposal, the prospective primary
participant is providing the certification set out below.

2\. The inability of a person to provide the certification required
below will not necessarily result in denial of participation in this
covered transaction. The prospective participant shall submit an
explanation of why it cannot provide the certification set out below.
The certification or explanation will be considered in connection with
the department or agency\'s determination whether to enter into this
transaction. However, failure of the prospective primary participant to
furnish a certification or an explanation shall disqualify such person
from participation in this transaction.

3\. The certification in this clause is a material representation of
fact upon which reliance was placed when the department or agency
determined to enter into this transaction. If it is later determined
that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

4\. The prospective primary participant shall provide immediate written
notice to the department or agency to whom this proposal is submitted if
at any time the prospective primary participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

5\. The terms \"covered transaction,\" \"debarred,\" \"suspended,\"
\"ineligible,\" lower tier covered transaction,\" \"participant,\"
\"person,\" \"primary covered transaction,\" \"principal,\"
\"proposal,\" and \"voluntarily excluded,\" as used in this clause, have
the meaning set out in the Definitions and Coverage sections of the
rules implementing Executive Order 12549. \[4\] You may contact the
department or agency to which this proposal is being submitted for
assistance in obtaining a copy of those regulations.

6\. The prospective primary participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency entering into this
transaction.

7\. The prospective primary participant further agrees by submitting
this proposal that it will include the clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion\--Lower Tier Covered Transaction,\" \[5\] provided by the
department or agency entering into this covered transaction, without
modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.

8\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is
erroneous. A participant may decide the methods and frequency by which
it determines the eligibility of its principals. Each participant may,
but is not required to, check the Non-procurement List.

9\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealing.

10\. Except for transactions authorized under paragraph 6 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

\(b\) Certification Regarding Debarment, Suspension, and Other
Responsibility Matters\--Primary Covered Transactions

\(1\) The prospective primary participant certifies to the best of its
knowledge and belief, that it and its principals:

\(A\) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any Federal department or agency;

\(B\) Have not within a three-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local)
transaction or contract under a public transaction; violation of Federal
or State antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;

\(C\) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph (1)(B) of this
certification;

\(D\) Have not within a three-year period preceding this
application/proposal had one or more public transactions (Federal, State
or local) terminated for cause or default.

\(2\) Where the prospective primary participant is unable to certify to
any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

4\. CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment or modification of any Federal
contract, grant, loan, or cooperative agreement.

\(2\) If any funds other than Federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to influence
an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL,
\"Disclosure of Lobbying Activities,\" in accordance with its
instructions.

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all sub-awards at
all tiers (including subcontracts, sub-grants, and contracts under
grants, loans, and cooperative agreements) and that all sub-recipients
shall certify and disclose accordingly.

This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, United
States Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than \$10,000 and not
more than \$100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief,
that: If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, \"Disclosure
Form to Report Lobbying,\" in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering
into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a
civil penalty of not less than \$10,000 and not more than \$100,000 for
each such failure.

5\. Prohibition on Assistance to Drug Traffickers for Covered Countries
and Individuals (ADS 206)

USAID reserves the right to terminate this \[Agreement/Contract\], to
demand a refund or take other appropriate measures if the \[Grantee/
Contractor\] is found to have been convicted of a narcotics offense or
to have been engaged in drug trafficking as defined in 22 CFR Part 140.
The undersigned shall review USAID ADS 206 to determine if any
certifications are required for Key Individuals or Covered Participants.

If there are COVERED PARTICIPANTS: USAID reserves the right to terminate
assistance to, or take or take other appropriate measures with respect
to, any participant approved by USAID who is found to have been
convicted of a narcotics offense or to have been engaged in drug
trafficking as defined in 22 CFR Part 140.

6\. CERTIFICATION OF RECIPIENT

The recipient certifies that it has reviewed and is familiar with the
proposed grant format and the regulations applicable thereto, and that
it agrees to comply with all such regulations, except as noted below
(use a continuation page as necessary):

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

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

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

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

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

Solicitation No. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_ \_\_\_\_­­­­­

Application/Proposal No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

Date of Application/Proposal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_

Name of Recipient
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[\_]{.underline}
\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[1\] FORMATS: Rev. 06/16/97 (ADS 303.6, E303.5.6a) \[2\] When these
Certifications, Assurances, and Other Statements of Recipient are used
for cooperative agreements, the term \"Grant\" means \"Cooperative
Agreement\". \[3\] The recipient must obtain from each identified
sub-grantee and (sub) contractor, and submit with its
application/proposal, the Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion \-- Lower Tier Transactions, set
forth in Attachment A hereto. The recipient should reproduce additional
copies as necessary. \[4\] See ADS Chapter E303.5.6a, 22 CFR 208, ANNEX
F1, App A. \[5\] For USAID, this clause is entitled \"Debarment,
Suspension, Ineligibility, and Voluntary Exclusion (March 1989)\" and is
set forth in the grant standard provision entitled \"Debarment,
Suspension, and Related Matters\" if the recipient is a U.S.
nongovernmental organization, or in the grant standard provision
entitled \"Debarment, Suspension, and Other Responsibility Matters\" if
the recipient is a non-U.S. nongovernmental organization.

##  PART II - OTHER STATEMENTS OF RECIPIENT

1\. AUTHORIZED INDIVIDUALS

The recipient represents that the following persons are authorized to
negotiate on its behalf with the Government and to bind the recipient in
connection with this application or grant:

Name Title Telephone No. Facsimile No.

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

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

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

2\. TAXPAYER IDENTIFICATION NUMBER (TIN)

If the recipient is a U.S. organization, or a foreign organization which
has income effectively connected with the conduct of activities in the
U.S. or has an office or a place of business or a fiscal paying agent in
the U.S., please indicate the recipient\'s TIN:

TIN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. CONTRACTOR IDENTIFICATION NUMBER - DATA UNIVERSAL NUMBERING SYSTEM
(DUNS) NUMBER

\(a\) In the space provided at the end of this provision, the recipient
should supply the Data Universal Numbering System (DUNS) number
applicable to that name and address. Recipients should take care to
report the number that identifies the recipient\'s name and address
exactly as stated in the proposal.

\(b\) The DUNS is a 9-digit number assigned by Dun and Bradstreet
Information Services. If the recipient does not have a DUNS number, the
recipient should call Dun and Bradstreet directly at 1-800-333-0505. A
DUNS number will be provided immediately by telephone at no charge to
the recipient. The recipient should be prepared to provide the following
information:

\(1\) Recipient\'s name.

\(2\) Recipient\'s address.

\(3\) Recipient\'s telephone number.

\(4\) Line of business.

\(5\) Chief executive officer/key manager.

\(6\) Date the organization was started.

\(7\) Number of people employed by the recipient.

\(8\) Company affiliation.

\(c\) Recipients located outside the United States may obtain the
location and phone number of the local Dun and Bradstreet Information
Services office from the Internet Home Page at
http://www.dbisna.com/dbis/customer/custlist.htm. If an offeror is
unable to locate a local service center, it may send an e-mail to Dun
and Bradstreet at globalinfo@dbisma.com.

The DUNS system is distinct from the Federal Taxpayer Identification
Number

(TIN) system.

DUNS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. LETTER OF CREDIT (LOC) NUMBER

If the recipient has an existing Letter of Credit (LOC) with USAID,
please indicate the LOC number:

LOC:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. PROCUREMENT INFORMATION

\(a\) Applicability. This applies to the procurement of goods and
services planned by the recipient (i.e., contracts, purchase orders,
etc.) from a supplier of goods or services for the direct use or benefit
of the recipient in conducting the program supported by the grant, and
not to assistance provided by the recipient (i.e., a sub-grant or
sub-agreement) to a sub-grantee or sub-recipient in support of the
sub-grantee\'s or sub-recipient\'s program. Provision by the recipient
of the requested information does not, in and of itself, constitute
USAID approval.

\(b\) Amount of Procurement. Please indicate the total estimated dollar
amount of goods and services which the recipient plans to purchase under
the grant:

\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(c\) Nonexpendable Property. If the recipient plans to purchase
nonexpendable equipment which would require the approval of the
Agreement Officer, please indicate below (using a continuation page, as
necessary) the types, quantities of each, and estimated unit costs.
Nonexpendable equipment for which the Agreement Officer\'s approval to
purchase is required is any article of nonexpendable tangible personal
property charged directly to the grant, having a useful life of more
than one year and an acquisition cost of \$5,000 or more per unit.

TYPE/DESCRIPTION(Generic) QUANTITY ESTIMATED UNIT COST

\(d\) Source, Origin, and Componentry of Goods. If the recipient plans
to purchase any goods/commodities which are not of U.S. source and/or
U.S. origin, and/or does not contain at least 50% componentry which are
not at least 50% U.S. source and origin, please indicate below (using a
continuation page, as necessary) the types and quantities of each,
estimated unit costs of each, and probable source and/or origin, to
include the probable source and/or origin of the components if less than
50% U.S. components will be contained in the commodity. \"Source\" means
the country from which a commodity is shipped to the cooperating country
or the cooperating country itself if the commodity is located therein at
the time of purchase. However, where a commodity is shipped from a free
port or bonded warehouse in the form in which received therein,
\"source\" means the country from which the commodity was shipped to the
free port or bonded warehouse. Any commodity whose source is a non-Free
World country is ineligible for USAID financing. The \"origin\" of a
commodity is the country or area in which a commodity is mined, grown,
or produced. A commodity is produced when, through manufacturing,
processing, or substantial and major assembling of components, a
commercially recognized, new commodity results, which is substantially
different in basic characteristics or in purpose or utility from its
components. Merely packaging various items together for a particular
procurement or re-labeling items does not constitute production of a
commodity. Any commodity whose origin is a non-Free World country is
ineligible for USAID financing. \"Components\" are the goods which go
directly into the production of a produced commodity. Any component from
a non-Free World country makes the commodity ineligible for USAID
financing.

TYPE/DESCRIPTION QUANTITY ESTIMATED GOODS PROBABLE GOODS PROBABLE

(Generic) UNIT COST COMPONENTS SOURCE COMPONENTS ORIGIN

\(e\) Restricted Goods. If the recipient plans to purchase any
restricted goods, please indicate below (using a continuation page, as
necessary) the types and quantities of each, estimated unit costs of
each, intended use, and probable source and/or origin. Restricted goods
are Agricultural Commodities, Motor Vehicles, Pharmaceuticals,
Pesticides, Rubber Compounding Chemicals and Plasticizers, Used
Equipment, U.S. Government-Owned Excess Property, and Fertilizer.

TYPE/DESCRIPTION QUANTITY ESTIMATED PROBABLE INTENDED USE

(Generic) UNIT COST SOURCE ORIGIN

\(f\) Supplier Nationality. If the recipient plans to purchase any goods
or services from suppliers of goods and services whose nationality is
not in the U.S., please indicate below (using a continuation page, as
necessary) the types and quantities of each good or service, estimated
costs of each, probable nationality of each non-U.S. supplier of each
good or service, and the rationale for purchasing from a non-U.S.
supplier. Any supplier whose nationality is a non-Free World country is
ineligible for USAID financing.

TYPE/DESCRIPTION QUANTITY ESTIMATED PROBABLE SUPPLIER NATIONALITY
RATIONALE

(Generic) UNIT COST (Non-U.S. Only) for NON-US

\(g\) Proposed Disposition. If the recipient plans to purchase any
nonexpendable equipment with a unit acquisition cost of \$5,000 or more,
please indicate below (using a continuation page, as necessary) the
proposed disposition of each such item. Generally, the recipient may
either retain the property for other uses and make compensation to USAID
(computed by applying the percentage of federal participation in the
cost of the original program to the current fair market value of the
property), or sell the property and reimburse USAID an amount computed
by applying to the sales proceeds the percentage of federal
participation in the cost of the original program (except that the
recipient may deduct from the federal share \$500 or 10% of the
proceeds, whichever is greater, for selling and handling expenses), or
donate the property to a host country institution, or otherwise dispose
of the property as instructed by USAID.

TYPE/DESCRIPTION(Generic) QUANTITY ESTIMATED UNIT COST PROPOSED
DISPOSITION

6\. PAST PERFORMANCE REFERENCES

On a continuation page, applicants must submit a **list** of all
contracts, grants, or cooperative agreements involving **similar or
related** programs over the past three years, and the name, address, and
telephone number of the Contract/Agreement Officer or other contact
person.

7\. TYPE OF ORGANIZATION

The recipient, by checking the applicable box, represents that -

\(a\) If the recipient is a U.S. entity, it operates as \[ \] a
corporation incorporated under the laws of the State of, \[ \] an
individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a state or local governmental organization, \[ \] a
private college or university, \[ \] a public college or university, \[
\] an international organization, or \[ \] a joint venture; or

\(b\) If the recipient is a non-U.S. entity, it operates as \[ \] a
corporation organized under the laws of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (country), \[
\] an individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a nongovernmental educational institution, \[ \] a
governmental organization, \[ \] an international organization, or \[ \]
a joint venture.

8\. ESTIMATED COSTS OF COMMUNICATIONS PRODUCTS

The following are the estimate(s) of the cost of each separate
communications product (i.e., any printed material \[other than non-
color photocopy material\], photographic services, or video production
services) which is anticipated under the grant. Each estimate must
include all the costs associated with preparation and execution of the
product. Use a continuation page as necessary.

9.  CERTIFICATE OF COMPLIANCE

Include the self-certifications pertaining to compliance with applicable
Federal and USAID-accepted policies for personnel, travel, and
procurement systems. If the [Recipient Certificate of
Compliance]{.underline} has been completed for other USAID grants, it is
not necessary to resubmit -- instead, include a copy of a previous
Recipient Certificate of Compliance in the application. A previous copy
of the USAID [Certifications, Assurances and Other Statements of
Applicant/Grantee]{.underline} may be included in the application if it
has been completed within one year of the due date for this application.
If not, then it must be updated and attached. If the applicant has not
yet completed these certifications, a self-certification package may be
obtained from:

Mr. Steve Tashjian, Branch Chief Phone:202-712-5321

USAID/M/OP/PS/OCC FAX: 202-216-3395

Ronald Reagan Building, Room 7.08‑061

1300 Pennsylvania Ave., NW

Washington, D.C., 20523-7802

Attachment A

##  CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY 

##  AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS

\(a\) Instructions for Certification

1\. By signing and submitting this proposal, the prospective lower tier
participant is providing the certification set out below.

2\. The certification in this clause is a material representation of
fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition
to other remedies available to the Federal Government, the department or
agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.

3\. The prospective lower tier participant shall provide immediate
written notice to the person to whom this proposal is submitted if at
any time the prospective lower tier participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

4\. The terms \"covered transaction,\" \"debarred,\" \"suspended,\"
ineligible, \"lower tier covered transaction,\" \"participant,\"
\"person,\" \"primary covered transaction,\" \"principal,\"
\"proposal,\" and \"voluntarily excluded,\" as used in this clause, has
the meanings set out in the Definitions and Coverage sections of rules
implementing Executive Order 12549. 1/ You may contact the person to
which this proposal is submitted for assistance in obtaining a copy of
those regulations.

5\. The prospective lower tier participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this
transaction originated.

6\. The prospective lower tier participant further agrees by submitting
this proposal that it will include this clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion\--Lower Tier covered Transaction,\" 2/ without modification,
in all lower tier covered transactions and in all solicitations for
lower tier covered transactions.

7\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is
erroneous. A participant may decide the method and frequency by which it
determines the eligibility of its principals. Each participant may, but
is not required to, check the Non procurement List.

8\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

9\. Except for transactions authorized under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or
debarment.

\(b\) Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion\--Lower Tier Covered Transactions

\(1\) The prospective lower tier participant certifies, by submission of
this proposal, that neither it nor its principals is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal
department or agency.

\(2\) Where the prospective lower tier participant is unable to certify
to any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

Solicitation No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[\_]{.underline} \_\_

Application/Proposal No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application/Proposal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Applicant/Sub-grantee
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1/ See ADS Chapter 303, 22 CFR 208.

2/ For USAID, this clause is entitled \"Debarment, Suspension,
Ineligibility, and Voluntary Exclusion (March 1989)\" and is set forth
in the USAID grant standard provision for U.S. nongovernmental
organizations entitled \"Debarment, Suspension, and Related Matters\"
(see ADS Chapter 303), or in the USAID grant standard provision for
non-U.S. nongovernmental organizations entitled \"Debarment, Suspension,
and Other Responsibility Matters\" (see ADS Chapter 303).

##  KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING

I hereby certify that within the last ten years:

1\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

2\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

3\. I am not and have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

Signature: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_

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

Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_

Title/Position: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Date of Birth:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain key individuals of organizations must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

##  PARTICIPANT CERTIFICATION NARCOTICS OFFENSES AND DRUG 

##  TRAFFICKING

1\. I hereby certify that within the last ten years:

a\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

b\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

c\. I am not or have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

2\. I understand that USAID may terminate my training if it is
determined that I engaged in the above conduct during the last ten years
or during my USAID training.

Signature:
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Birth:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain participants must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

FORMATS: Rev. 06/16/97 (ADS 303.6, E303.5.6a) When these Certifications,
Assurances, and Other Statements of Recipient are used for cooperative
agreements, the term \"Grant\" means \"Cooperative Agreement\". The
recipient must obtain from each identified sub-grantee and (sub)
contractor, and submit with its application/proposal, the Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
\-- Lower Tier Transactions, set forth in Attachment A hereto. The
recipient should reproduce additional copies as necessary. See ADS
Chapter E303.5.6a, 22 CFR 208, ANNEX F1, App A. For USAID, this clause
is entitled \"Debarment, Suspension, Ineligibility, and Voluntary
Exclusion (March 1989)\" and is set forth in the grant standard
provision entitled \"Debarment, Suspension, and Related Matters\" if the
recipient is a U.S. nongovernmental organization, or in the grant
standard provision entitled \"Debarment, Suspension, and Other
Responsibility Matters\" if the recipient is a non-U.S. nongovernmental
organization.

##### 

# ANNEX A

# ANNOUNCEMENT

# GLOBAL HEALTH/ INFECTIOUS DISEASES AND NUTRITION

# CHILD SURVIVAL AND HEALTH GRANTS PROGRAM 2004 RFA PVO CONFERENCE

The U.S. Agency for International Development, Bureau for Global Health,
Office of Health, Infectious Disease and Nutrition (USAID/GH/HIDN) is
pleased to announce the Child Survival and Health Grants Program (CSHGP)
--- a competitive assistance program open to all U.S. private and
voluntary organizations (PVOs) that engage in health programming as part
of their international development efforts and are registered with
USAID.

**[Program Objective and Authority]{.underline}:**

The CSHGP will continue to support U.S. PVOs and their local partners to
carry out quality child and maternal health and nutrition, family
planning, HIV/AIDS and infectious disease programs that measurably
improve infant, child and maternal health and nutrition, and contribute
to the reduction of infant, child and maternal mortality. Cooperative
Agreements are executed pursuant to the authority of the Foreign
Assistance Act of 1961, as amended, subject to the availability of
funds.

**[FY 2003 Child Survival and Health Grants Program]{.underline}:**

The Child Survival and Health Grants Program seeks well-designed,
technically-sound, cost-effective programs that employ innovative
activities and strategies through which programs may expect to make the
greatest sustainable impact on improving the health and reducing
mortality of children under five. In addition, this program emphasizes
PVO activities that strengthen the capacity of their local partners in
implementing child survival and health programs that achieve sustainable
benefits, which will continue after USAID funding is completed.

**[Eligibility Requirements:]{.underline}**

To be eligible for funding under the Child Survival and Health Grants
Program, an organization must:

1)  be a U.S. PVO registered with USAID;

2)  contribute a cost match of 25% of the total cost of the proposed
    project, from its non-US Government resources;

3)  have prior experience (5 years minimum) implementing community
    health related projects.

# 

# [RFA Conference]{.underline}:

The annual PVO Conference to present the new RFA is scheduled for
September 8, 2003. The meeting will be held at the Hilton Silver Spring,
8727 Colesville Road, Silver Spring, MD 20910. For more information:
[http://www.hilton.com/en/hi/hotels/index.jhtml;jsessionid=UZC0VJLVWY3U4CSGBIWMVCQKIYFC5UUC?ctyhocn=DCASSHF
A block of rooms for the night of September 7 is being held for the
participants at a special rate of \$99.00 per night. To receive the
special rate, contact the hotel reservations department at 301-589-5200,
and ask for a reservation under the \"RFA Workshop\". The deadline to
make room reservations is August 17, 2003. Coffee and tea will be served
at 8:30 and the meeting will begin at 9:00 on September 8 in the
Chesapeake Room located on the second floor of the Hilton.\
](http://www.hilton.com/en/hi/hotels/index.jhtml;jsessionid=UZC0VJLVWY3U4CSGBIWMVCQKIYFC5UUC?ctyhocn=DCASSHF  A block of rooms for the night of September 7 is being held for the participants at a special rate of $99.00 per night. To receive the special rate, contact the hotel reservations department at 301-589-5200, and ask for a reservation under the \)

Please register for the conference on the CSTS+ Project's website
<http://www.childsurvival.com/> When completed the conference agenda
will be posted on the CSHGP website
<http://www.usaid.gov/pop_health/home/Funding/cs_grants/cs_index.html>
and the CSTS+ website. For more information on the conference, please
contact Nicole Barcikowski at 202/712-4655 or <nbarcikowski@usaid.gov>.

The RFA will be issued on or about the week of August 18, 2003. The RFA
and any further modifications can also be downloaded through website.
<http://fedgrants.gov/Applicants/AID/OP/WAS/activity_1.html>

**\*\*PLEASE BRING A COPY OF THE CSHGP 2004 RFA WITH YOU AS ONE WILL NOT
BE PROVIDED\*\***

##### 

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##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

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##### ANNEX B

# USAID MISSION CONTACTS LIST / ADDRESSES

(In Alphabetical Order by Country)

+-----------+---+-----------------+-------------------+-------------------+
| **        | * |                 | **Official        | **Commercial      |
| Country** | * |                 | Address**         | Courier**         |
|           | C |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | P |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | * |                 |                   |                   |
|           | * |                 |                   |                   |
+===========+===+=================+===================+===================+
| Albania   | P |                 | DOS/USAID         | USAID/American    |
|           | a |                 |                   | Embassy           |
|           | m |                 | 9510 Tirana Place |                   |
|           | e |                 |                   | 103 Rruga e       |
|           | l |                 | Washington, DC    | Elbasanit         |
|           | a |                 | 20521-9510        |                   |
|           | W |                 |                   | Tirana, Albania   |
|           | y |                 |                   |                   |
|           | v |                 |                   | Tel:              |
|           | i |                 |                   | 355-42-247289     |
|           | l |                 |                   | Ext. 1570         |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | - |                 |                   |                   |
|           | S |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | p |                 |                   |                   |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | s |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | r |                 |                   |                   |
|           | o |                 |                   |                   |
|           | j |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Angola    | C |                 | DOS/USAID         | USAID/Angola      |
|           | a |                 |                   |                   |
|           | t |                 | 2550 Luanda Place | Rua Kwame         |
|           | h |                 |                   | Nkrumah, 31       |
|           | y |                 | Washington, DC    | Fourth Floor      |
|           | B |                 | 20521-2550        |                   |
|           | o |                 |                   | Luanda, Angola    |
|           | w |                 |                   |                   |
|           | e |                 |                   | Tel:              |
|           | s |                 |                   | 24                |
|           | , |                 |                   | 4-2-399-518/19/20 |
|           | G |                 |                   |                   |
|           | D |                 |                   |                   |
|           | O |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Antigua & | J |                 | DOS/USAID         | USAID/Kingston    |
| Barbuda   | o |                 |                   |                   |
|           | a |                 | 3210 Kingston     | 2 Haining Road    |
| (CRP)     | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Armenia   | [ |                 | DOS/USAID         | USAID/Yerevan     |
|           | ] |                 |                   |                   |
|           | { |                 | 7020 Yerevan      | #18 Baghramian    |
|           | . |                 | Place             | Street            |
|           | m |                 |                   |                   |
|           | a |                 | Washington, DC    | Yerevan, Armenia, |
|           | r |                 | 20521-7020        | 375019            |
|           | k |                 |                   |                   |
|           | } |                 |                   | Tel:              |
|           |   |                 |                   | 7-3742-151-955    |
|           | E |                 |                   |                   |
|           | d |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | J |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | e |                 |                   |                   |
|           | s |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| A         | G |                 | DOS/USAID         | USAID             |
| zerbaijan | e |                 |                   | /Caucasus/Tbilisi |
|           | o |                 | 7060 Tbilisi      |                   |
|           | r |                 | Place             | 20 Telavi Street, |
|           | g |                 |                   | 5^th^ Floor       |
|           | e |                 | Washington, DC    |                   |
|           | ( |                 | 20521-7060        | Tbilisi, 380036,  |
|           | G |                 |                   | Rep. Of Georgia   |
|           | e |                 |                   |                   |
|           | g |                 |                   | Tel: 995-32)      |
|           | i |                 |                   | 778-540           |
|           | ) |                 |                   |                   |
|           | M |                 |                   |                   |
|           | a |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | d |                 |                   |                   |
|           | z |                 |                   |                   |
|           | e |                 |                   |                   |
|           | , |                 |                   |                   |
|           | M |                 |                   |                   |
|           | D |                 |                   |                   |
|           |   |                 |                   |                   |
|           | P |                 |                   |                   |
|           | r |                 |                   |                   |
|           | o |                 |                   |                   |
|           | j |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | M |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | g |                 |                   |                   |
|           | e |                 |                   |                   |
|           | m |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | S |                 |                   |                   |
|           | p |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| B         | T |                 | DOS/USAID         | U.S. Embassy      |
| angladesh | a |                 |                   |                   |
|           | r |                 | 6120 Dhaka Place  | Madani Avenue,    |
|           | a |                 |                   |                   |
|           | O |                 | Washington, DC    | Baridhara, GPO    |
|           | ' |                 | 20521-6120        | Box 323           |
|           | D |                 |                   |                   |
|           | a |                 |                   | Dhaka-1212,       |
|           | y |                 |                   | Bangladesh        |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | V |                 |                   |                   |
|           | O |                 |                   |                   |
|           | G |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | s |                 |                   |                   |
|           | M |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | g |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | T |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           |   |                 |                   |                   |
|           | C |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | y |                 |                   |                   |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | C |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | m |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | a |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | r |                 |                   |                   |
|           | o |                 |                   |                   |
|           | g |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | V |                 |                   |                   |
|           | O |                 |                   |                   |
|           | C |                 |                   |                   |
|           | o |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           | d |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Barbados  | J |                 | DOS/USAID         | USAID/Kingston    |
|           | o |                 |                   |                   |
| (CRP)     | a |                 | 3210 Kingston     | 2 Haining Road    |
|           | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Benin     | P |                 | DOS/USAID         | USAID/Cotonou     |
|           | a |                 |                   |                   |
|           | s |                 | 2120 Cotonou      | Rue Caporal Anani |
|           | c |                 | Place             | Bernard           |
|           | a |                 |                   |                   |
|           | l |                 | Washington, DC    | B.P. 2120         |
|           | Z |                 | 20521-2120        |                   |
|           | i |                 |                   | Cotonou, Benin    |
|           | n |                 |                   |                   |
|           | z |                 |                   | Tel: 229-30-0500  |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | d |                 |                   |                   |
|           | o |                 |                   |                   |
|           | h |                 |                   |                   |
|           | o |                 |                   |                   |
|           | u |                 |                   |                   |
|           | e |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Bolivia   | E |                 | American Embassy  | USAID/Bolivia     |
|           | d |                 |                   |                   |
|           | g |                 | USAID/La Paz      | 109 Calles No. 9  |
|           | a |                 |                   |                   |
|           | r |                 | Unit #3914        | Obrajes           |
|           | M |                 |                   |                   |
|           | u |                 | APO AA 34032      | La Paz, Bolivia   |
|           | n |                 |                   |                   |
|           | o |                 |                   | Tel:              |
|           | z |                 |                   | 591-2-786-544     |
|           | , |                 |                   | Ext. 3308         |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Bosnia &  | B |                 | DOS/USAID 7130    | C/O American      |
| He        | a |                 | Sarajevo Place    | Embassy           |
| rzegovina | b |                 |                   |                   |
|           | e |                 | Washington, DC    | 1 Suborna Street  |
|           | t |                 | 20521-5740        |                   |
|           | t |                 |                   | Sofia- 1000,      |
|           | e |                 |                   | Bulgaria          |
|           | P |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | v |                 |                   |                   |
|           | o |                 |                   |                   |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Botswana  | M |                 | Regional Center   | USAID             |
|           | i |                 | S. Africa\        |                   |
|           | c |                 | USAID/RCSA\       | 100 Totius Street |
|           | h |                 | Department of     |                   |
|           | e |                 | State\            | Groenkloof X5     |
|           | l |                 | Washington, DC    |                   |
|           | e |                 | 20521-2170\       | P.O. 43 Pretoria  |
|           | R |                 | Tel: 267-324-449\ |                   |
|           | u |                 | Fax: 267-324-404  | Pretoria 0027,    |
|           | s |                 |                   | South Africa      |
|           | s |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | l |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | I |                 |                   |                   |
|           | V |                 |                   |                   |
|           | / |                 |                   |                   |
|           | A |                 |                   |                   |
|           | I |                 |                   |                   |
|           | D |                 |                   |                   |
|           | S |                 |                   |                   |
|           | D |                 |                   |                   |
|           | i |                 |                   |                   |
|           | r |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Brazil    | J |                 | American          | USAID/American    |
|           | a |                 | Embassy/USAID     | Embassy           |
|           | i |                 |                   |                   |
|           | m |                 | Unit \# 350       | SES Avenida das   |
|           | e |                 |                   | Nacoes            |
|           | R |                 | APO AA 34030-7500 |                   |
|           | o |                 |                   | Quadra 801 Lote 3 |
|           | j |                 |                   |                   |
|           | a |                 |                   | Brasilia-         |
|           | s |                 |                   | DF-70403-900,     |
|           | , |                 |                   | Brazil            |
|           | T |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | n |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Burkina   | F |                 | DOS/USAID         | USAID/Mali (WARP) |
| Faso      | e |                 |                   |                   |
|           | l |                 | 2050 Bamako Place | Immeuble          |
| (WARP)    | i |                 |                   | Dotembougou       |
|           | x |                 | Washington, DC    |                   |
|           | A |                 | 20521-2310        | Rue Rayyond       |
|           | w |                 |                   | Poincarre & Rue   |
|           | a |                 |                   | 319               |
|           | n |                 |                   |                   |
|           | t |                 |                   | Quartier du       |
|           | a |                 |                   | Fleuve, Bamako,   |
|           | n |                 |                   | Mali              |
|           | g |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Burundi   | B |                 | > PHN Officer     | USAID/Burundi     |
|           | a |                 | >                 |                   |
| (REDSO)   | r |                 | > USAID/Bujumbura | C/O American      |
|           | b |                 | >                 | Embassy           |
|           | a |                 | > Department of   |                   |
|           | r |                 | > State           | Avenue Des USA    |
|           | a |                 | >                 |                   |
|           | C |                 | > Washington,     | B.P. 1720         |
|           | a |                 | > D.C. 20521-2100 |                   |
|           | s |                 |                   | Bujumbura-        |
|           | h |                 |                   | Burundi           |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | A |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | t |                 |                   |                   |
|           | y |                 |                   |                   |
|           | M |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | g |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Cambodia  |   | Mark White,     | American Embassy  | USAID/Cambodia    |
|           |   | Chief           |                   |                   |
|           |   |                 | USAID/Phnom Penh  | No. 18 Mongkul    |
|           |   | Ngudup Paljor,  |                   | Eam Street #228   |
|           |   | MCH Advisor     | Box P             |                   |
|           |   |                 |                   | Phnom Penh,       |
|           |   |                 | APO AP 96546      | Cambodia          |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 855-23-427-640    |
+-----------+---+-----------------+-------------------+-------------------+
| Cameroon  |   | Felix Awantang, | DOS/USAID         | USAID/Mali (WARP) |
|           |   | Regional CS     |                   |                   |
| (WARP)    |   | Advisor         | 2050 Bamako Place | Immeuble          |
|           |   |                 |                   | Dotembougou       |
|           |   |                 | Washington, DC    |                   |
|           |   |                 | 20521-2310        | Rue Rayyond       |
|           |   |                 |                   | Poincarre & Rue   |
|           |   |                 |                   | 319               |
|           |   |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           |   |                 |                   | Fleuve, Bamako,   |
|           |   |                 |                   | Mali              |
+-----------+---+-----------------+-------------------+-------------------+
| Cape      |   | []{.mark}       | DOS/USAID         | USAID/Mali (WARP) |
| Verde     |   |                 |                   |                   |
|           |   | Felix Awantang, | 2050 Bamako Place | Immeuble          |
| (WARP)    |   | Regional CS     |                   | Dotembougou       |
|           |   | Advisor         | Washington, DC    |                   |
|           |   |                 | 20521-2310        | Rue Rayyond       |
|           |   |                 |                   | Poincarre & Rue   |
|           |   |                 |                   | 319               |
|           |   |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           |   |                 |                   | Fleuve, Bamako,   |
|           |   |                 |                   | Mali              |
+-----------+---+-----------------+-------------------+-------------------+
| Chad      |   | []{.mark}       | DOS/USAID         | USAID/Mali (WARP) |
|           |   |                 |                   |                   |
| (WARP)    |   | Felix Awantang, | 2050 Bamako Place | Immeuble          |
|           |   | Regional CS     |                   | Dotembougou       |
|           |   | Advisor         | Washington, DC    |                   |
|           |   |                 | 20521-2310        | Rue Rayyond       |
|           |   |                 |                   | Poincarre & Rue   |
|           |   |                 |                   | 319               |
|           |   |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           |   |                 |                   | Fleuve, Bamako,   |
|           |   |                 |                   | Mali              |
+-----------+---+-----------------+-------------------+-------------------+
| Congo,    |   | Reggie Hawkins, | USAID/Kinshasa    | 198 Isiro Avenue  |
| D         |   | PHN Officer     |                   |                   |
| emocratic |   |                 | Unit 31550        | Kinshasa/Gombe    |
| Republic  |   | Lina Piripiri,  |                   |                   |
| of        |   | CSD Program     | APO AE 09828      | DROC              |
|           |   | Specialist      |                   |                   |
|           |   |                 |                   | Tel: 243-12-21533 |
|           |   |                 |                   |                   |
|           |   |                 |                   | Fax: 243-88-03274 |
+-----------+---+-----------------+-------------------+-------------------+
| Cote      |   | []{.mark}       | DOS/USAID         | USAID/Mali (WARP) |
| d'Ivoire  |   |                 |                   |                   |
|           |   | Felix Awantang, | 2050 Bamako Place | Immeuble          |
| (WARP)    |   | Regional CS     |                   | Dotembougou       |
|           |   | Advisor         | Washington, DC    |                   |
|           |   |                 | 20521-2310        | Rue Rayyond       |
|           |   |                 |                   | Poincarre & Rue   |
|           |   |                 |                   | 319               |
|           |   |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           |   |                 |                   | Fleuve, Bamako,   |
|           |   |                 |                   | Mali              |
+-----------+---+-----------------+-------------------+-------------------+
| Djibouti  |   | []{.mark}       | USAID/Nairobi     | USAID Offices-    |
|           |   |                 |                   | REDSO/ESA         |
| (REDSO)   |   | Maura Barry,    | Unit \# 64102     |                   |
|           |   | Technical       |                   | Kasarani Road     |
|           |   | Advisor         | APO AE 09831-4102 |                   |
|           |   |                 |                   | Nairobi, Africa   |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 254-2-862-400,402 |
|           |   |                 |                   |                   |
|           |   |                 |                   | Fax:              |
|           |   |                 |                   | 254-              |
|           |   |                 |                   | 2-860-949,870,562 |
+-----------+---+-----------------+-------------------+-------------------+
| Dominican |   | []{.mark}       | USAID/Santo       | American Embassy  |
| Republic  |   |                 | Domingo           |                   |
|           |   | Henry Welhous,  |                   | USAID/Santo       |
|           |   | PVO Liaison     | Unit #5541        | Domingo           |
|           |   |                 |                   |                   |
|           |   |                 | APO AA 34041-5541 | Leopoldo Navarro  |
|           |   |                 |                   | 12                |
|           |   |                 |                   |                   |
|           |   |                 |                   | Santo Domingo     |
|           |   |                 |                   |                   |
|           |   |                 |                   | Dominican         |
|           |   |                 |                   | Republic          |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel: 809-731-7018 |
+-----------+---+-----------------+-------------------+-------------------+
| Ecuador   |   | []{.mark}       | USAID/GH/RCS      |                   |
|           |   |                 | 3.6-032           |                   |
| []{.mark} |   | Mary            |                   |                   |
|           |   | Vandenbroucke   | 1300 Pennsylvania |                   |
| []{.mark} |   |                 | Avenue, NW        |                   |
|           |   |                 |                   |                   |
|           |   |                 | Washington, DC    |                   |
|           |   |                 | 20523             |                   |
|           |   |                 |                   |                   |
|           |   |                 | 202-712-4758      |                   |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} |   | []{.mark}       | USAID/San         | USAID/El Salvador |
|           |   |                 | Salvador          |                   |
| El        |   | Silvia de       |                   | Urbanizacion Y    |
| Salvador  |   | Gonzalez, PVO   | Unit \# 3110      | Blvd Santa Elena  |
|           |   | Liaison         |                   |                   |
|           |   |                 | APO AA 34023      | Antiquo           |
|           |   | Officer         |                   | Cuscatlan, La     |
|           |   |                 |                   | Libertad,         |
|           |   |                 |                   |                   |
|           |   |                 |                   | El Salvador       |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 503-2-981-666     |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} |   | []{.mark}       | American          | USAID/Indonesia   |
|           |   |                 | Embassy/USAID     |                   |
| East      |   | Jim Lehman,     |                   | C/o American      |
| Timor     |   | Technical       | Box #4            | Embassy           |
|           |   | Officer         |                   |                   |
| []{.mark} |   |                 | APO AP 96520      | Jl. Medan Merdeka |
|           |   |                 |                   | Selatan 3-5       |
| []{.mark} |   |                 |                   |                   |
|           |   |                 |                   | Jakarta 10110,    |
|           |   |                 |                   | Indonesia         |
|           |   |                 |                   |                   |
|           |   |                 |                   | 62-21-344-2211    |
+-----------+---+-----------------+-------------------+-------------------+
| Eritrea   |   | Linda Lou       | DOS/USAID         | USAID/Asmara      |
|           |   | Kelly, Mission  |                   |                   |
|           |   | Technical       | 7170 Asmara Place | Debretabor Sr.,   |
|           |   | Officer         |                   | House #15         |
|           |   |                 | Washington, DC    |                   |
|           |   |                 | 20521-7170        | Asmara, Eritrea   |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 291-1-122-133     |
|           |   |                 |                   |                   |
|           |   |                 |                   | Fax: 291-1-123093 |
+-----------+---+-----------------+-------------------+-------------------+
| Ethiopia  |   | Susan Anthony,  | DOS/USAID         | USAID/Ethiopia    |
|           |   | HPN Officer     |                   |                   |
|           |   |                 | 2030 Addis Ababa  | Riverside         |
|           |   | Kassahun Abate  | Place             | Building          |
|           |   | Belay, HPN      |                   |                   |
|           |   |                 | Washington, DC    | Asmara Rd & Bole  |
|           |   | Holly Dempsey,  | 20521-2030        | (Olympia)         |
|           |   | HIV/AIDS        |                   |                   |
|           |   | Advisor         |                   | PO Box 1014       |
|           |   |                 |                   |                   |
|           |   |                 |                   | Addis Ababa,      |
|           |   |                 |                   | Ethiopia          |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 251-1-510-716     |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} |   | []{.mark}       | DOS/USAID         | USAID/Mali (WARP) |
|           |   |                 |                   |                   |
| Gambia    |   | Felix Awantang, | 2050 Bamako Place | Immeuble          |
|           |   | Regional CS     |                   | Dotembougou       |
| (WARP)    |   | Advisor         | Washington, DC    |                   |
|           |   |                 | 20521-2310        | Rue Rayyond       |
| []{.mark} |   |                 |                   | Poincarre & Rue   |
|           |   |                 |                   | 319               |
|           |   |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           |   |                 |                   | Fleuve, Bamako,   |
|           |   |                 |                   | Mali              |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} |   | []{.mark}       | DOS/USAID         | USAID             |
|           |   |                 |                   | /Caucasus/Tbilisi |
| Georgia   |   | George          | 7060 Tbilisi      |                   |
|           |   | Matardze,       | Place             | Fifth Floor, 20   |
|           |   | Health Advisor  |                   | Telavi Street     |
|           |   |                 | Washington, DC    |                   |
|           |   |                 | 20521-7060        | Tbilisi 380036,   |
|           |   |                 |                   | Republic of       |
|           |   |                 |                   | Georgia           |
|           |   |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           |   |                 |                   | 995-32-93-89-50;  |
|           |   |                 |                   | 77-85-40;         |
|           |   |                 |                   | 92-25-47          |
+-----------+---+-----------------+-------------------+-------------------+
| Ghana     | D |                 | DOS/USAID         | USAID/Ghana       |
|           | r |                 |                   |                   |
|           | . |                 | 2020 Accra Place  | E45/3             |
|           | J |                 |                   | Independence Ave. |
|           | a |                 | Washington, DC    |                   |
|           | n |                 | 20521-2020        | Accra, Ghana      |
|           | P |                 |                   |                   |
|           | a |                 |                   | Tel:              |
|           | e |                 |                   | 233-2             |
|           | h |                 |                   | 1-225-087/228-467 |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           |   |                 |                   |                   |
|           | U |                 |                   |                   |
|           | r |                 |                   |                   |
|           | s |                 |                   |                   |
|           | u |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | N |                 |                   |                   |
|           | a |                 |                   |                   |
|           | d |                 |                   |                   |
|           | o |                 |                   |                   |
|           | l |                 |                   |                   |
|           | n |                 |                   |                   |
|           | y |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | P |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | C |                 |                   |                   |
|           | h |                 |                   |                   |
|           | i |                 |                   |                   |
|           | e |                 |                   |                   |
|           | f |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Grenada   | J |                 | DOS/USAID         | USAID/Kingston    |
|           | o |                 |                   |                   |
| (CRP)     | a |                 | 3210 Kingston     | 2 Haining Road    |
|           | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Guatemala | I |                 | USAID/Guatemala   | USAID/Guatemala   |
|           | s |                 |                   |                   |
|           | a |                 | American Embassy  | 1 Calle 7-66,     |
|           | b |                 |                   | Zone 9            |
|           | e |                 | Unit #3323        |                   |
|           | l |                 |                   | 01009 Guatemala   |
|           | S |                 | APO AA 34024      |                   |
|           | t |                 |                   | Guatemala, C.A.   |
|           | o |                 |                   |                   |
|           | u |                 |                   | Tel: 502-332-0202 |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Guinea    | K |                 | DOS/USAID         | USAID/Guinea      |
|           | a |                 |                   |                   |
|           | t |                 | 2110 Conakry      | Camayenne         |
|           | h |                 | Place             | Corniche Nord     |
|           | y |                 |                   |                   |
|           | J |                 | Washington, DC    | Quartier Cameroun |
|           | a |                 | 20521-2110        |                   |
|           | c |                 |                   | Conakry, Guinea   |
|           | q |                 |                   |                   |
|           | u |                 |                   | Tel: 224-41-2163  |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | p |                 |                   |                   |
|           | r |                 |                   |                   |
|           | o |                 |                   |                   |
|           | d |                 |                   |                   |
|           | u |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Guin      | F |                 | DOS/USAID         | USAID/Mali (WARP) |
| ea-Bissau | e |                 |                   |                   |
|           | l |                 | 2050 Bamako Place | Immeuble          |
| (WARP)    | i |                 |                   | Dotembougou       |
|           | x |                 | Washington, DC    |                   |
|           | A |                 | 20521-2310        | Rue Rayyond       |
|           | w |                 |                   | Poincarre & Rue   |
|           | a |                 |                   | 319               |
|           | n |                 |                   |                   |
|           | t |                 |                   | Quartier du       |
|           | a |                 |                   | Fleuve, Bamako,   |
|           | n |                 |                   | Mali              |
|           | g |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} | [ |                 | DOS/USAID         | USAID/Haiti       |
|           | ] |                 |                   |                   |
| Haiti     | { |                 | 3400              | #17 Harry Truman  |
|           | . |                 | Port-au-Prince    | Blvd.             |
|           | m |                 | Place             |                   |
|           | a |                 |                   | Port-au-Prince,   |
|           | r |                 | Washington, DC    | Haiti             |
|           | k |                 | 20521-3400        |                   |
|           | } |                 |                   | Tel: 509-229-3034 |
|           |   |                 |                   |                   |
|           | Y |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | s |                 |                   |                   |
|           | M |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | e |                 |                   |                   |
|           | B |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | d |                 |                   |                   |
|           | , |                 |                   |                   |
|           | T |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | n |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | d |                 |                   |                   |
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|           | V |                 |                   |                   |
|           | O |                 |                   |                   |
|           | L |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} | [ |                 | USAID/Tegucigalpa | USAID/Honduras    |
|           | ] |                 |                   |                   |
| Honduras  | { |                 | Unit \# 2927      | Avenida La Paz    |
|           | . |                 |                   |                   |
|           | m |                 | APO AA 34022      | Frente Embajada   |
|           | a |                 |                   | Americana         |
|           | r |                 |                   |                   |
|           | k |                 |                   | Tegucigalpa D.C., |
|           | } |                 |                   | Honduras          |
|           |   |                 |                   |                   |
|           | H |                 |                   | Tel: 504-36-9320  |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | b |                 |                   |                   |
|           | C |                 |                   |                   |
|           | a |                 |                   |                   |
|           | u |                 |                   |                   |
|           | d |                 |                   |                   |
|           | i |                 |                   |                   |
|           | l |                 |                   |                   |
|           | l |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} | [ |                 | DOS/USAID         | USAID/American    |
|           | ] |                 |                   | Embassy           |
| India     | { |                 | 9000 New Delhi    |                   |
|           | . |                 | Place             | Shantipath,       |
|           | m |                 |                   | Chanakyapuri      |
|           | a |                 | Washington, DC    |                   |
|           | r |                 | 20521-9000        | New Delhi         |
|           | k |                 |                   | 110-021, India    |
|           | } |                 |                   |                   |
|           |   |                 |                   | Tel:              |
|           | S |                 |                   | 91-11-611-3033    |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | e |                 |                   |                   |
|           | s |                 |                   |                   |
|           | h |                 |                   |                   |
|           | S |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
|           | u |                 |                   |                   |
|           | p |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | V |                 |                   |                   |
|           | O |                 |                   |                   |
|           | L |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
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|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| []{.mark} | [ |                 | American          | USAID/Indonesia   |
|           | ] |                 | Embassy/USAID     |                   |
| Indonesia | { |                 |                   | C/o American      |
|           | . |                 | Box #4            | Embassy           |
|           | m |                 |                   |                   |
|           | a |                 | APO AP 96520      | Jl. Medan Merdeka |
|           | r |                 |                   | Selatan 3-5       |
|           | k |                 |                   |                   |
|           | } |                 |                   | Jakarta 10110,    |
|           |   |                 |                   | Indonesia         |
|           | S |                 |                   |                   |
|           | r |                 |                   | 62-21-344-2211    |
|           | i |                 |                   |                   |
|           | D |                 |                   |                   |
|           | u |                 |                   |                   |
|           | r |                 |                   |                   |
|           | j |                 |                   |                   |
|           | a |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | B |                 |                   |                   |
|           | o |                 |                   |                   |
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|           | d |                 |                   |                   |
|           | i |                 |                   |                   |
|           | h |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | d |                 |                   |                   |
|           | j |                 |                   |                   |
|           | o |                 |                   |                   |
|           | , |                 |                   |                   |
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|           | V |                 |                   |                   |
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|           | L |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Jamaica   | [ |                 | USAID/Jamaica\    | USAID/Jamaica     |
|           | ] |                 | Department of     | Local             |
|           | { |                 | State\            | Addresses**:**\   |
|           | . |                 | Washington D.C.   | United States     |
|           | m |                 | 20521-3210        | Agency for        |
|           | a |                 |                   | International     |
|           | r |                 |                   | Development\      |
|           | k |                 |                   | 2 Haining Road\   |
|           | } |                 |                   | Kingston 5\       |
|           |   |                 |                   | Jamaica, W.I.\    |
|           | M |                 |                   | Tel: (876) 926    |
|           | a |                 |                   | 3645/9\           |
|           | r |                 |                   | Fax: (876) 929    |
|           | g |                 |                   | 9944              |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | e |                 |                   |                   |
|           | t |                 |                   |                   |
|           | S |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | o |                 |                   |                   |
|           | , |                 |                   |                   |
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|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
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|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Jordan    | S |                 | USAID/Amman       | USAID Office      |
|           | a |                 |                   |                   |
|           | l |                 | Unit #70206       | Attn: Salwa Qteit |
|           | w |                 |                   |                   |
|           | a |                 | APO AE 09892-0206 | c/o American      |
|           | Q |                 |                   | Embassy, Abdoun   |
|           | t |                 |                   |                   |
|           | e |                 |                   | Amman, Jordan     |
|           | i |                 |                   |                   |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Kenya     | S |                 | USAID/Nairobi     | USAID offices     |
|           | h |                 |                   |                   |
|           | e |                 | Unit \# 64102     | Kasarani Road     |
|           | i |                 |                   |                   |
|           | l |                 | APO AE 09831-4102 | Nairobi, Kenya    |
|           | a |                 |                   |                   |
|           | M |                 |                   | Tel: 254-2-862400 |
|           | a |                 |                   | Ext. 2818         |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
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|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| K         | A |                 | DOS/USAID         | USAID/Almaty      |
| yrgyzstan | n |                 |                   |                   |
|           | g |                 | 7030 Almaty Place | c/o American      |
|           | e |                 |                   | Embassy           |
|           | l |                 | Washington, DC    |                   |
|           | a |                 | 20521-7030        | 97A Furmanov      |
|           | L |                 |                   | Street            |
|           | o |                 |                   |                   |
|           | r |                 |                   | 480091 Almaty,    |
|           | d |                 |                   | Kazakstan         |
|           | , |                 |                   |                   |
|           | H |                 |                   | Tel:              |
|           | e |                 |                   | 7-3272-506636     |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Laos      | [ |                 | American Embassy  | American Embassy  |
|           | ] |                 |                   |                   |
|           | { |                 | USAID/Vientaine   | Rue de            |
|           | . |                 |                   | Bartholonie       |
|           | m |                 | Box V             |                   |
|           | a |                 |                   | B.P. 114          |
|           | r |                 | APO, AP 96546     |                   |
|           | k |                 |                   | That Dam          |
|           | } |                 |                   |                   |
|           |   |                 |                   | Vientian, Lao PDR |
|           | S |                 |                   |                   |
|           | c |                 |                   |                   |
|           | o |                 |                   |                   |
|           | t |                 |                   |                   |
|           | t |                 |                   |                   |
|           | R |                 |                   |                   |
|           | o |                 |                   |                   |
|           | l |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
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|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Liberia   | A |                 | DOS/USAID         | USAID/Freetown    |
|           | d |                 |                   |                   |
|           | a |                 | 8800 Monrovia     | Department of     |
|           | m |                 | Place             | State             |
|           | s |                 |                   |                   |
|           | L |                 | Washington, DC    | WDC, 20523-0001   |
|           | i |                 | 20521-8800        |                   |
|           | n |                 |                   |                   |
|           | c |                 |                   |                   |
|           | o |                 |                   |                   |
|           | l |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Lesotho   | M |                 | USAID/RCSA/DOS    | USAID             |
|           | i |                 |                   |                   |
|           | c |                 | Washington, DC    | 100 Totius Street |
|           | h |                 | 20521-2170        |                   |
|           | e |                 |                   | Groenkloof X5     |
|           | l |                 | Tel: 267-324-449  |                   |
|           | e |                 |                   | P.O. 43 Pretoria  |
|           | R |                 | Fax: 267-324-404  |                   |
|           | u |                 |                   | Pretoria 0027,    |
|           | s |                 |                   | South Africa      |
|           | s |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | l |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
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|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | I |                 |                   |                   |
|           | V |                 |                   |                   |
|           | / |                 |                   |                   |
|           | A |                 |                   |                   |
|           | I |                 |                   |                   |
|           | D |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Macedonia | A |                 | DOS/USAID         | USAID             |
|           | f |                 |                   |                   |
|           | r |                 | 7120 Skopje Place | Jurij Gargarin    |
|           | o |                 |                   | 15/3              |
|           | d |                 | Washington., D.C. |                   |
|           | i |                 | 20521-7120        | 1000 Skopje       |
|           | t |                 |                   |                   |
|           | a |                 |                   | FYR Macedonia     |
|           | S |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | j |                 |                   |                   |
|           | a |                 |                   |                   |
|           | , |                 |                   |                   |
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|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| M         | W |                 | DOS/USAID         | USAID/Madagascar  |
| adagascar | e |                 |                   |                   |
|           | n |                 | > 2040            | Immeuble Vonisoa  |
|           | d |                 | > Antananarivo    | III               |
|           | y |                 | > Place           |                   |
|           | B |                 |                   | Avenue Docteur    |
|           | e |                 | Washington, DC    | Ravohangy         |
|           | n |                 | 20521-2040        |                   |
|           | a |                 |                   | Anosy,            |
|           | z |                 |                   | Antananarivo 101  |
|           | e |                 |                   |                   |
|           | r |                 |                   | Madagascar        |
|           | g |                 |                   |                   |
|           | a |                 |                   | Tel: 261-2-254-89 |
|           |   |                 |                   |                   |
|           | B |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | j |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | A |                 |                   |                   |
|           | n |                 |                   |                   |
|           | d |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
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|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | a |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Malawi    | M |                 | DOS/USAID         | USAID/Lilongwe    |
|           | e |                 |                   |                   |
|           | x |                 | 2280 Lilongwe     | NICO House, 1st   |
|           | o |                 | Place             | Floor             |
|           | n |                 |                   |                   |
|           | N |                 | Washington, DC    | Lilongwe 3,       |
|           | y |                 | 20521-2280        | Malawi            |
|           | i |                 |                   |                   |
|           | r |                 |                   | Tel: 265-782-455  |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
|           | o |                 |                   |                   |
|           | , |                 |                   |                   |
|           | T |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | n |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Mali      | A |                 | DOS/USAID         | USAID/Mali        |
|           | n |                 |                   |                   |
|           | n |                 | 2050 Bamako Place | Immeuble          |
|           | H |                 |                   | Dotemougou        |
|           | i |                 | Washington, DC    |                   |
|           | r |                 | 20521-2050        | Rue Raymond       |
|           | s |                 |                   | Poincarre & Rue   |
|           | c |                 |                   | 319               |
|           | h |                 |                   |                   |
|           | e |                 |                   | Quartier du       |
|           | y |                 |                   | Fleuve            |
|           | , |                 |                   |                   |
|           | H |                 |                   | Bamako, Mali      |
|           | e |                 |                   |                   |
|           | a |                 |                   | Tel: 223-223-602  |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | D |                 |                   |                   |
|           | e |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | o |                 |                   |                   |
|           | p |                 |                   |                   |
|           | m |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           |   |                 |                   |                   |
|           | S |                 |                   |                   |
|           | i |                 |                   |                   |
|           | x |                 |                   |                   |
|           | t |                 |                   |                   |
|           | e |                 |                   |                   |
|           | Z |                 |                   |                   |
|           | i |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | r |                 |                   |                   |
|           | u |                 |                   |                   |
|           | m |                 |                   |                   |
|           | u |                 |                   |                   |
|           | g |                 |                   |                   |
|           | a |                 |                   |                   |
|           | b |                 |                   |                   |
|           | e |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| M         | F |                 | DOS/USAID         | USAID/Mali (WARP) |
| auritania | e |                 |                   |                   |
|           | l |                 | 2050 Bamako Place | Immeuble          |
| (WARP)    | i |                 |                   | Dotembougou       |
|           | x |                 | Washington, DC    |                   |
|           | A |                 | 20521-2310        | Rue Rayyond       |
|           | w |                 |                   | Poincarre & Rue   |
|           | a |                 |                   | 319               |
|           | n |                 |                   |                   |
|           | t |                 |                   | Quartier du       |
|           | a |                 |                   | Fleuve, Bamako,   |
|           | n |                 |                   | Mali              |
|           | g |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Mexico    | N |                 | DOS/USAID         | USAID/Mexico      |
|           | a |                 |                   |                   |
|           | n |                 | 8700 Mexico Place | Paseo de la       |
|           | c |                 |                   | Reforma No 35     |
|           | y |                 | Washington, DC,   |                   |
|           | A |                 | 20521-8700        | Col Cuauhtemoc    |
|           | l |                 |                   |                   |
|           | v |                 |                   | 06500-Mexico D.F. |
|           | e |                 |                   | Mexico            |
|           | y |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| M         | J |                 | DOS/USAID         | USAID/Mozambique  |
| ozambique | a |                 |                   |                   |
|           | m |                 | 2330 Maputo Place | JAT Complex       |
|           | e |                 |                   |                   |
|           | s |                 | Washington, DC    | Rua 1231, No. 41  |
|           | W |                 | 20521-2310        |                   |
|           | a |                 |                   | Bairro Central    |
|           | t |                 |                   | "C"               |
|           | s |                 |                   |                   |
|           | o |                 |                   | Maputo,           |
|           | n |                 |                   | Mozambique        |
|           | , |                 |                   |                   |
|           | H |                 |                   | Tel:              |
|           | e |                 |                   | 258-1-490-726     |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Namibia   | K |                 | DOS/USAID         | USAID/Namibia     |
|           | i |                 |                   |                   |
|           | r |                 | 2540 Windhoek     | 6^th^ Floor,      |
|           | k |                 | Place             | Southern Life     |
|           | L |                 |                   | Tower             |
|           | a |                 | Washington, DC    |                   |
|           | z |                 | 20521-2540        | Post Street Mall  |
|           | e |                 |                   |                   |
|           | l |                 |                   | Windhoek, Namibia |
|           | l |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | I |                 |                   |                   |
|           | V |                 |                   |                   |
|           | / |                 |                   |                   |
|           | A |                 |                   |                   |
|           | I |                 |                   |                   |
|           | D |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Nepal     | [ |                 | DOS/USAID         | USAID/Nepal       |
|           | ] |                 |                   |                   |
|           | { |                 | 6190 Kathmandu    | Kalamati Durbar   |
|           | . |                 |                   |                   |
|           | m |                 | Washington, DC    | Rabi Bhawan       |
|           | a |                 | 20521-6190        |                   |
|           | r |                 |                   | Kathmandu, Nepal  |
|           | k |                 |                   |                   |
|           | } |                 |                   | Tel:              |
|           |   |                 |                   | 977-              |
|           | D |                 |                   | 1-270-144/271-703 |
|           | h |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | m |                 |                   |                   |
|           | p |                 |                   |                   |
|           | h |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | R |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Nicaragua | [ |                 | American Embassy  | USAID/Nicaragua   |
|           | ] |                 |                   |                   |
|           | { |                 | USAID/Managua     | C/o American      |
|           | . |                 |                   | Embassy           |
|           | m |                 | Unit #2712, Box   |                   |
|           | a |                 | #9                | Pista Sub-urbano  |
|           | r |                 |                   |                   |
|           | k |                 | APO AA 34021      | De Los Semaforos  |
|           | } |                 |                   | de la Centro      |
|           |   |                 |                   |                   |
|           | I |                 |                   | America dos       |
|           | v |                 |                   | Cuadras Abajo     |
|           | a |                 |                   |                   |
|           | n |                 |                   | Frente de Syscom  |
|           | T |                 |                   |                   |
|           | e |                 |                   | Managua,          |
|           | r |                 |                   | Nicaragua         |
|           | c |                 |                   |                   |
|           | e |                 |                   | Tel:              |
|           | r |                 |                   | 505-2-670-502     |
|           | o |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           |   |                 |                   |                   |
|           | A |                 |                   |                   |
|           | l |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | z |                 |                   |                   |
|           | o |                 |                   |                   |
|           | W |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | d |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | D |                 |                   |                   |
|           | e |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | o |                 |                   |                   |
|           | p |                 |                   |                   |
|           | m |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Niger     | [ |                 | DOS/USAID         | USAID/Mali (WARP) |
|           | ] |                 |                   |                   |
| (WARP)    | { |                 | 2050 Bamako Place | Immeuble          |
|           | . |                 |                   | Dotembougou       |
|           | m |                 | Washington, DC    |                   |
|           | a |                 | 20521-2310        | Rue Rayyond       |
|           | r |                 |                   | Poincarre & Rue   |
|           | k |                 |                   | 319               |
|           | } |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           | F |                 |                   | Fleuve, Bamako,   |
|           | e |                 |                   | Mali              |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | x |                 |                   |                   |
|           | A |                 |                   |                   |
|           | w |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Nigeria   | L |                 | DOS/USAID         | USAID/Nigeris     |
|           | y |                 |                   |                   |
|           | n |                 | 8320 Abuja Place  | Metro Plaza,      |
|           | n |                 |                   | 3^rd^ Floor       |
|           | G |                 | Washington, DC    |                   |
|           | o |                 | 20521-8320        | Plot 992, Zakaria |
|           | r |                 |                   | Maimalari St.     |
|           | t |                 |                   |                   |
|           | o |                 |                   | Central Business  |
|           | n |                 |                   | District          |
|           | , |                 |                   |                   |
|           | S |                 |                   | PMB 519, Garki    |
|           | u |                 |                   |                   |
|           | p |                 |                   | Abuja, Nigeria    |
|           | e |                 |                   |                   |
|           | r |                 |                   | Tel:              |
|           | v |                 |                   | 227-72-26-61/64   |
|           | i |                 |                   | Ext 4027          |
|           | s |                 |                   |                   |
|           | i |                 |                   | Fax: 227-73-51-36 |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           | G |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | D |                 |                   |                   |
|           | e |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | o |                 |                   |                   |
|           | p |                 |                   |                   |
|           | m |                 |                   |                   |
|           | e |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Pakistan  | [ |                 | 8100 Islamabad    | American          |
|           | ] |                 | Place             | Embassy/Islamabad |
|           | { |                 |                   |                   |
|           | . |                 | Dulles, VA        | Ramna 5           |
|           | m |                 | 20521-8100        | Diplomatic        |
|           | a |                 |                   | Enclave           |
|           | r |                 |                   |                   |
|           | k |                 |                   | Islamabad,        |
|           | } |                 |                   | Pakistan          |
|           |   |                 |                   |                   |
|           | S |                 |                   |                   |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | A |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | f |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | S |                 |                   |                   |
|           | p |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Peru      | [ |                 | USAID/Lima        | USAID/Lima        |
|           | ] |                 |                   |                   |
|           | { |                 | American          | Av. La Encalada   |
|           | . |                 | Embassy/USAID     |                   |
|           | m |                 |                   | Monterrico        |
|           | a |                 | Unit #3760        |                   |
|           | r |                 |                   | Lima, Peru        |
|           | k |                 | APO AA 34031      |                   |
|           | } |                 |                   | Tel:              |
|           |   |                 |                   | 511-              |
|           | D |                 |                   | 433-3200/433-0555 |
|           | r |                 |                   |                   |
|           | . |                 |                   |                   |
|           | L |                 |                   |                   |
|           | u |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | S |                 |                   |                   |
|           | e |                 |                   |                   |
|           | m |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | , |                 |                   |                   |
|           | T |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | h |                 |                   |                   |
|           | n |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | P |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Ph        | [ |                 | USAID/Manila      | USAID/Philippines |
| ilippines | ] |                 |                   |                   |
|           | { |                 | FPO AP 96515      | 8^th^ Floor, PNB  |
|           | . |                 |                   | Financial Center  |
|           | m |                 |                   |                   |
|           | a |                 |                   | Roxas Blvd.,      |
|           | r |                 |                   |                   |
|           | k |                 |                   | 1308 Pasay City,  |
|           | } |                 |                   | Philippines       |
|           |   |                 |                   |                   |
|           | J |                 |                   |                   |
|           | o |                 |                   |                   |
|           | h |                 |                   |                   |
|           | n |                 |                   |                   |
|           | D |                 |                   |                   |
|           | u |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | w |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | V |                 |                   |                   |
|           | O |                 |                   |                   |
|           | L |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Romania   | [ |                 | DOS/USAID         | USAID/Romania     |
|           | ] |                 |                   |                   |
|           | { |                 | 5260 Bucharest    | Blvd. Natiunilor  |
|           | . |                 | Pl.               | Unite, 1          |
|           | m |                 |                   |                   |
|           | a |                 | Washington., D.C. | Block 108A,       |
|           | r |                 | 20521-5260        | "Gemenii          |
|           | k |                 |                   | SITRATCO"         |
|           | } |                 |                   |                   |
|           |   |                 |                   | Floors 6-9,       |
|           | D |                 |                   | Sector 5          |
|           | r |                 |                   |                   |
|           | . |                 |                   | Bucharest,        |
|           | G |                 |                   | Romania           |
|           | a |                 |                   |                   |
|           | b |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | P |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | u |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | S |                 |                   |                   |
|           | p |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Russia    | [ |                 | American          | American          |
|           | ] |                 | Embassy/Moscow    | Embassy/Moscow    |
| []{.mark} | { |                 |                   |                   |
|           | . |                 | PSC 77            | USAID/Moscow      |
|           | m |                 |                   |                   |
|           | a |                 | APO AE 09721      | Novinsky Bulvar,  |
|           | r |                 |                   | 19/23             |
|           | k |                 |                   |                   |
|           | } |                 |                   | 121099 Moscow,    |
|           |   |                 |                   | Russia            |
|           | S |                 |                   |                   |
|           | y |                 |                   |                   |
|           | l |                 |                   |                   |
|           | v |                 |                   |                   |
|           | a |                 |                   |                   |
|           | E |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
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|           | u |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
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|           | l |                 |                   |                   |
|           | 8 |                 |                   |                   |
|           | / |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 3 |                 |                   |                   |
|           |   |                 |                   |                   |
|           | B |                 |                   |                   |
|           | e |                 |                   |                   |
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|           | s |                 |                   |                   |
|           | y |                 |                   |                   |
|           | B |                 |                   |                   |
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|           | o |                 |                   |                   |
|           | w |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | P |                 |                   |                   |
|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
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|           | f |                 |                   |                   |
|           | 9 |                 |                   |                   |
|           | / |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 3 |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Rwanda    | B |                 | DOS/USAID         | USAID/Rwanda      |
|           | a |                 |                   |                   |
|           | r |                 | 2210 Kigali Place | Avenue Pail VI    |
|           | b |                 |                   |                   |
|           | a |                 | Washington, DC    | B.P. 2848         |
|           | r |                 | 20521-2210        |                   |
|           | a |                 |                   | Kigali, Rwanda    |
|           | S |                 |                   |                   |
|           | o |                 |                   | Tel:              |
|           | w |                 |                   | 5601-2            |
|           | , |                 |                   | -3-2126/2127/2128 |
|           | P |                 |                   |                   |
|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| St. Kitts | J |                 | DOS/USAID         | USAID/Kingston    |
| & Nevis   | o |                 |                   |                   |
|           | a |                 | 3210 Kingston     | 2 Haining Road    |
| (CRP)     | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| St. Lucia | J |                 | DOS/USAID         | USAID/Kingston    |
|           | o |                 |                   |                   |
| (CRP)     | a |                 | 3210 Kingston     | 2 Haining Road    |
|           | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| St.       | J |                 | DOS/USAID         | USAID/Kingston    |
| Vincent & | o |                 |                   |                   |
| G         | a |                 | 3210 Kingston     | 2 Haining Road    |
| renadines | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
| (CRP)     | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
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|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Suriname  | J |                 | DOS/USAID         | USAID/Kingston    |
|           | o |                 |                   |                   |
| (CRP)     | a |                 | 3210 Kingston     | 2 Haining Road    |
|           | n |                 | Place             |                   |
|           | A |                 |                   | Kingston 5,       |
|           | t |                 | Washington, DC    | Jamaica           |
|           | k |                 | 20521-3210        |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Senegal   | D |                 | DOS/USAID         | USAID/Senegal     |
|           | r |                 |                   |                   |
|           | . |                 | 2130 Dakar Place  | Hotel Ngor        |
|           | M |                 |                   | Diarama           |
|           | a |                 | Washington, DC    |                   |
|           | t |                 | 20521-2130        | Almadies          |
|           | a |                 |                   |                   |
|           | r |                 |                   | Dakar, Senegal    |
|           | C |                 |                   |                   |
|           | a |                 |                   | Tel:              |
|           | m |                 |                   | 221-21-869-61-70  |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | S |                 |                   |                   |
|           | p |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Sierra    | K |                 | DOS/USAID         | USAID/Freetown    |
| Leone     | a |                 |                   |                   |
|           | t |                 | USAID/ Freetown   | Department of     |
|           | h |                 |                   | State             |
|           | y |                 | 2160 Freetown     |                   |
|           | J |                 | Place             | WDC, 20523-0001   |
|           | a |                 |                   |                   |
|           | c |                 | Washington, DC    | Tel: 224-41-2163  |
|           | q |                 | 20521-2160        |                   |
|           | u |                 |                   |                   |
|           | a |                 |                   |                   |
|           | r |                 |                   |                   |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | p |                 |                   |                   |
|           | r |                 |                   |                   |
|           | o |                 |                   |                   |
|           | d |                 |                   |                   |
|           | u |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | i |                 |                   |                   |
|           | v |                 |                   |                   |
|           | e |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| South     | D |                 | 100 Totius Street |                   |
| Africa    | O |                 |                   |                   |
|           | S |                 | Groenkloof x5     |                   |
| Anita     | / |                 |                   |                   |
| Sampon,   | U |                 | P.O. 43 Pretoria  |                   |
| Technical | S |                 |                   |                   |
| Officer   | A |                 | Pretoria 0027,    |                   |
|           | I |                 | South Africa      |                   |
|           | D |                 |                   |                   |
|           |   |                 | Tel:              |                   |
|           | 9 |                 | 27-12-323-8869,   |                   |
|           | 3 |                 | 342-1048          |                   |
|           | 0 |                 |                   |                   |
|           | 0 |                 | Fax:              |                   |
|           | P |                 | 27-12-323-6443    |                   |
|           | r |                 |                   |                   |
|           | e |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | P |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | c |                 |                   |                   |
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|           |   |                 |                   |                   |
|           | W |                 |                   |                   |
|           | a |                 |                   |                   |
|           | s |                 |                   |                   |
|           | h |                 |                   |                   |
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|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
|           | t |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | D |                 |                   |                   |
|           | C |                 |                   |                   |
|           |   |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 5 |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 1 |                 |                   |                   |
|           | - |                 |                   |                   |
|           | 9 |                 |                   |                   |
|           | 3 |                 |                   |                   |
|           | 3 |                 |                   |                   |
|           | 0 |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Sudan     | D |                 | USAID/Khartoum    |                   |
|           | O |                 |                   |                   |
| Connie    | S |                 | C/O American      |                   |
| Davis,    | / |                 | Embassy           |                   |
| Health    | U |                 |                   |                   |
| Advisor   | S |                 | Khartoum, Sudan   |                   |
|           | A |                 |                   |                   |
|           | I |                 |                   |                   |
|           | D |                 |                   |                   |
|           |   |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | K |                 |                   |                   |
|           | h |                 |                   |                   |
|           | a |                 |                   |                   |
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|           | u |                 |                   |                   |
|           | m |                 |                   |                   |
|           | P |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           |   |                 |                   |                   |
|           | W |                 |                   |                   |
|           | a |                 |                   |                   |
|           | s |                 |                   |                   |
|           | h |                 |                   |                   |
|           | i |                 |                   |                   |
|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
|           | t |                 |                   |                   |
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|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | D |                 |                   |                   |
|           | C |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 5 |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 1 |                 |                   |                   |
|           | - |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 0 |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Swaziland | M |                 | Regional Center   | USAID             |
|           | i |                 | S. Africa\        |                   |
|           | c |                 | USAID/RCSA\       | 100 Totius Street |
|           | h |                 | Department of     |                   |
|           | e |                 | State\            | Groenkloof X5     |
|           | l |                 | Washington, DC    |                   |
|           | e |                 | 20521-2170\       | P.O. 43 Pretoria  |
|           | R |                 | Tel: 267-324-449\ |                   |
|           | u |                 | Fax: 267-324-404  | Pretoria 0027,    |
|           | s |                 |                   | South Africa      |
|           | s |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | l |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | I |                 |                   |                   |
|           | V |                 |                   |                   |
|           | / |                 |                   |                   |
|           | A |                 |                   |                   |
|           | I |                 |                   |                   |
|           | D |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| T         | D |                 | USAID/CAR/Almaty  |                   |
| ajikistan | O |                 |                   |                   |
|           | S |                 | Park Palace       |                   |
| Angela    | / |                 | Building          |                   |
| Lord,     | U |                 |                   |                   |
| Regional  | S |                 | 41 Kazibek bi     |                   |
| Health    | A |                 | Street            |                   |
| Advisor   | I |                 |                   |                   |
|           | D |                 | Almaty, 480100    |                   |
|           |   |                 |                   |                   |
|           | 7 |                 | Republic of       |                   |
|           | 0 |                 | Kazakhstan        |                   |
|           | 3 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | A |                 |                   |                   |
|           | l |                 |                   |                   |
|           | m |                 |                   |                   |
|           | a |                 |                   |                   |
|           | t |                 |                   |                   |
|           | y |                 |                   |                   |
|           | P |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | c |                 |                   |                   |
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|           |   |                 |                   |                   |
|           | W |                 |                   |                   |
|           | a |                 |                   |                   |
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|           | h |                 |                   |                   |
|           | i |                 |                   |                   |
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|           | g |                 |                   |                   |
|           | t |                 |                   |                   |
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|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | D |                 |                   |                   |
|           | C |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 5 |                 |                   |                   |
|           | 2 |                 |                   |                   |
|           | 1 |                 |                   |                   |
|           | - |                 |                   |                   |
|           | 7 |                 |                   |                   |
|           | 0 |                 |                   |                   |
|           | 3 |                 |                   |                   |
|           | 0 |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Tanzania  | V |                 | DOS/USAID         | USAID/Tanzania    |
|           | i |                 |                   |                   |
|           | c |                 | 2140 Dar es       | 686 Old Bagomoyo  |
|           | k |                 | Salaam Place      | Road              |
|           | y |                 |                   |                   |
|           | C |                 | Washington, DC    | Dar es Salaam,    |
|           | h |                 | 20521-2140        | Tanzania          |
|           | u |                 |                   |                   |
|           | w |                 |                   | Tel:              |
|           | a |                 |                   | 255-22-211-7537   |
|           | , |                 |                   |                   |
|           | P |                 |                   | FAX:              |
|           | r |                 |                   | 022-2-11-6559     |
|           | o |                 |                   |                   |
|           | j |                 |                   |                   |
|           | e |                 |                   |                   |
|           | c |                 |                   |                   |
|           | t |                 |                   |                   |
|           | M |                 |                   |                   |
|           | g |                 |                   |                   |
|           | t |                 |                   |                   |
|           | . |                 |                   |                   |
|           | S |                 |                   |                   |
|           | p |                 |                   |                   |
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|           | c |                 |                   |                   |
|           | i |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | t |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Thailand  | [ |                 | []{.mark}         | []{.mark}         |
|           | ] |                 |                   |                   |
| (Burma    | { |                 | American Embassy  | USAID/Cambodia    |
| Border    | . |                 |                   |                   |
| Area)     | m |                 | USAID/Phnom Penh  | No. 18 Mongkul    |
|           | a |                 |                   | Eam Street #228   |
|           | r |                 | Box P             |                   |
|           | k |                 |                   | Phnom Penh,       |
|           | } |                 | APO AP 96546      | Cambodia          |
|           |   |                 |                   |                   |
|           | L |                 | []{.mark}         | Tel:              |
|           | o |                 |                   | 855-23-427-640    |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | B |                 |                   |                   |
|           | r |                 |                   |                   |
|           | a |                 |                   |                   |
|           | d |                 |                   |                   |
|           | s |                 |                   |                   |
|           | h |                 |                   |                   |
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|           | w |                 |                   |                   |
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|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
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|           | l |                 |                   |                   |
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|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Togo      | [ |                 | DOS/USAID         | USAID/Mali (WARP) |
|           | ] |                 |                   |                   |
| (WARP)    | { |                 | 2050 Bamako Place | Immeuble          |
|           | . |                 |                   | Dotembougou       |
|           | m |                 | Washington, DC    |                   |
|           | a |                 | 20521-2310        | Rue Rayyond       |
|           | r |                 |                   | Poincarre & Rue   |
|           | k |                 |                   | 319               |
|           | } |                 |                   |                   |
|           |   |                 |                   | Quartier du       |
|           | F |                 |                   | Fleuve, Bamako,   |
|           | e |                 |                   | Mali              |
|           | l |                 |                   |                   |
|           | i |                 |                   |                   |
|           | x |                 |                   |                   |
|           | A |                 |                   |                   |
|           | w |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | t |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | g |                 |                   |                   |
|           | , |                 |                   |                   |
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|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
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|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Trinidad  | [ |                 | DOS/USAID         | USAID/Kingston    |
| & Tobago  | ] |                 |                   |                   |
|           | { |                 | 3210 Kingston     | 2 Haining Road    |
| (CRP)     | . |                 | Place             |                   |
|           | m |                 |                   | Kingston 5,       |
|           | a |                 | Washington, DC    | Jamaica           |
|           | r |                 | 20521-3210        |                   |
|           | k |                 |                   |                   |
|           | } |                 |                   |                   |
|           |   |                 |                   |                   |
|           | J |                 |                   |                   |
|           | o |                 |                   |                   |
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|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
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|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Tur       | [ |                 | DOS/USAID         | USAID/CAR/Almaty  |
| kmenistan | ] |                 |                   |                   |
|           | { |                 | 7030 Almaty Place | Park Palace       |
|           | . |                 |                   | Building          |
|           | m |                 | Washington, DC    |                   |
|           | a |                 | 20521-7030        | 41 Kazibek bi     |
|           | r |                 |                   | Street            |
|           | k |                 |                   |                   |
|           | } |                 |                   | Almaty, 480100    |
|           |   |                 |                   |                   |
|           | A |                 |                   | Republic of       |
|           | n |                 |                   | Kazakhstan        |
|           | g |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | L |                 |                   |                   |
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|           | d |                 |                   |                   |
|           | , |                 |                   |                   |
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|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
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|           | n |                 |                   |                   |
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|           | H |                 |                   |                   |
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|           | a |                 |                   |                   |
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|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Uganda    | [ |                 | DOS/USAID         | c/o American      |
|           | ] |                 |                   | Embassy           |
|           | { |                 | 2190 Kampala      |                   |
|           | . |                 | Place             | P.O. Box 7856     |
|           | m |                 |                   |                   |
|           | a |                 | Washington, DC    | 42 Nakasero Road  |
|           | r |                 | 20521-2190        |                   |
|           | k |                 |                   | Kampala, Uganda   |
|           | } |                 |                   |                   |
|           |   |                 |                   |                   |
|           | S |                 |                   |                   |
|           | u |                 |                   |                   |
|           | z |                 |                   |                   |
|           | a |                 |                   |                   |
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|           | u |                 |                   |                   |
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|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Ukraine   | [ |                 | []{.mark}         | []{.mark}         |
|           | ] |                 |                   |                   |
|           | { |                 | USAID/Kyiv        | USAID/Kyiv        |
|           | . |                 |                   |                   |
|           | m |                 | American Embassy  | Nyzhny Val 19     |
|           | a |                 |                   |                   |
|           | r |                 | Unit \# 3914      | Kyiv, Ukraine     |
|           | k |                 |                   |                   |
|           | } |                 | APO AA 34032      | Tel:              |
|           |   |                 |                   | 380-44-462-5678   |
|           | N |                 | []{.mark}         |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | c |                 |                   |                   |
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|           | G |                 |                   |                   |
|           | o |                 |                   |                   |
|           | d |                 |                   |                   |
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|           | , |                 |                   |                   |
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|           | H |                 |                   |                   |
|           | N |                 |                   |                   |
|           | O |                 |                   |                   |
|           | f |                 |                   |                   |
|           | f |                 |                   |                   |
|           | i |                 |                   |                   |
|           | c |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| U         | [ |                 | DOS/USAID         | USAID/CAR/Almaty  |
| zbekistan | ] |                 |                   |                   |
|           | { |                 | 7030 Almaty Place | Park Palace       |
|           | . |                 |                   | Building          |
|           | m |                 | Washington, DC    |                   |
|           | a |                 | 20521-7030        | 41 Kazibek bi     |
|           | r |                 |                   | Street            |
|           | k |                 |                   |                   |
|           | } |                 |                   | Almaty, 480100    |
|           |   |                 |                   |                   |
|           | A |                 |                   | Republic of       |
|           | n |                 |                   | Kazakhstan        |
|           | g |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | a |                 |                   |                   |
|           | L |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
|           | d |                 |                   |                   |
|           | , |                 |                   |                   |
|           | R |                 |                   |                   |
|           | e |                 |                   |                   |
|           | g |                 |                   |                   |
|           | i |                 |                   |                   |
|           | o |                 |                   |                   |
|           | n |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Vietnam   | [ |                 | US Embassy-Hanoi  | USAID Vietnam     |
|           | ] |                 |                   | Office            |
|           | { |                 | PSC 461, Box 400  |                   |
|           | . |                 |                   | Rose Garden Tower |
|           | m |                 | FPO AP96521-0002  |                   |
|           | a |                 |                   | 6 Ngoc Khanh      |
|           | r |                 |                   | Street            |
|           | k |                 |                   |                   |
|           | } |                 |                   | Hanoi, Vietnam    |
|           |   |                 |                   |                   |
|           | D |                 |                   |                   |
|           | a |                 |                   |                   |
|           | n |                 |                   |                   |
|           | i |                 |                   |                   |
|           | e |                 |                   |                   |
|           | l |                 |                   |                   |
|           | L |                 |                   |                   |
|           | e |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | t |                 |                   |                   |
|           | t |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Yemen     | [ |                 | USAID/Amman       | American Embassy  |
|           | ] |                 |                   |                   |
|           | { |                 | Unit \# 70206     | P.O. Box 354      |
|           | . |                 |                   |                   |
|           | m |                 | APO AE 09892-0206 | Amman 11118       |
|           | a |                 |                   | Jordan            |
|           | r |                 |                   |                   |
|           | k |                 |                   |                   |
|           | } |                 |                   |                   |
|           |   |                 |                   |                   |
|           | D |                 |                   |                   |
|           | o |                 |                   |                   |
|           | u |                 |                   |                   |
|           | g |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | l |                 |                   |                   |
|           | e |                 |                   |                   |
|           | r |                 |                   |                   |
|           | , |                 |                   |                   |
|           | H |                 |                   |                   |
|           | e |                 |                   |                   |
|           | a |                 |                   |                   |
|           | l |                 |                   |                   |
|           | t |                 |                   |                   |
|           | h |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+
| Zambia    | D |                 | DOS/USAID         | USAIDZambia       |
|           | y |                 |                   |                   |
|           | n |                 | 2310 Lusaka Place | 351 Independence  |
|           | e |                 |                   | Ave.              |
|           | s |                 | Washington, DC    |                   |
|           | s |                 | 20521-2310        | Lusaka, Zambia    |
|           | K |                 |                   |                   |
|           | a |                 |                   | Tel:              |
|           | s |                 |                   | 260-1-254-303     |
|           | u |                 |                   |                   |
|           | n |                 |                   | Fax:              |
|           | g |                 |                   | 967-1-238-843     |
|           | a |                 |                   |                   |
|           | m |                 |                   |                   |
|           | i |                 |                   |                   |
|           | , |                 |                   |                   |
|           | C |                 |                   |                   |
|           | S |                 |                   |                   |
|           | A |                 |                   |                   |
|           | d |                 |                   |                   |
|           | v |                 |                   |                   |
|           | i |                 |                   |                   |
|           | s |                 |                   |                   |
|           | o |                 |                   |                   |
|           | r |                 |                   |                   |
+-----------+---+-----------------+-------------------+-------------------+

**ANNEX C**

**TECHNICAL REFERENCE MATERIALS**

**http://www.usaid.gov/pop_health/home/Funding/cs_grants/guidelines.html
[]{.mark}**

**ANNEX D**

**[Guidance on the Definition and Use of the Child
Survival]{.smallcaps}**

**[and]{.smallcaps}**

**[Health Programs Fund]{.smallcaps}**

**[FY 2003 Update]{.smallcaps}**

**http://www.usaid.gov/pop_health/home/Funding/index.html**

**ANNEX E**

**SCREENING FORM**

FY 2004 RFA Child Survival and Health Grants Program

**Application Screening Form**

**Name of Applicant Organization:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Country applying
for:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Duration of Program:** \_\_\_\_years **Category**: Entry Standard
Mentoring Cost Extension Expanded Impact

**Interventions (%)**: (Total = 100%)

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 9%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 9%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 10%" />
<col style="width: 5%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>EPI</strong></td>
<td><strong>BF</strong></td>
<td><strong>NUT</strong></td>
<td><strong>Micro-nutrient</strong></td>
<td><strong>Vit A</strong></td>
<td><strong>CDD</strong></td>
<td><strong>PCM</strong></td>
<td><strong>Malaria</strong></td>
<td><strong>MNC</strong></td>
<td><strong>Child Spacing</strong></td>
<td><strong>FP</strong></td>
<td><strong>HIV/AIDS</strong></td>
<td><strong>TB</strong></td>
<td><p><strong>Other</strong></p>
<p><strong>Disease</strong></p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

# IMCI: Yes No C-IMCI: Yes No Resubmission: Yes No

**[Yes/No]{.underline}** **[Eligibility Criteria from RFA (check as
appropriate)]{.underline}:**

1\. \_\_\_\_ **Registered PVO** (PVO registered with USAID as of
11/24/03)

2\. \_\_\_\_ **Eligible Country** (Proposed program is in an eligible
country, see RFA eligible country list)

3\. \_\_\_\_ **U.S.-PVO** (Application includes evidence that PVO has
office with staff in U.S.)

4\. \_\_\_\_ **Country Presence** (Annex includes signed document from
host country government providing PVO with legal status to operate in
country) **Reference document page number in application**:
\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. \_\_\_\_ **Key Personnel** (Qualified public health professional
listed for HQ and one FTE in field)

6\. \_\_\_\_ **Disk** (Disk included with application)

7\. \_\_\_\_ **424/424A/Budget Narrative** (All in application)

8.\_\_\_\_\_ **USAID Request \$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
(Maximum for Entry: \$1,100,000; Standard: \$1,500,000;

Mentoring: \$1,700,000; Cost Extension \$1,500,000; Expanded Impact:
\$2,500,000)

9\. \_\_\_\_\_ **PVO Cost Share at 25%**

10\. \_\_\_\_ **Technical Application** **Complete** (Includes:
Executive Summary, PVO Description, Situational Analysis, Program
Strategy, Organizational Development (for Entry and Mentoring), M&E,
Management Plan, Work Plan)

11\. \_\_\_\_ **27 Pages** (Maximum length for Technical Application,
excluding attachments)

12\. **\_\_\_\_ Past Performance References** (Attachment: List of all
contracts/agreements for similar programs in

country for last 3 years; Not Applicable for Cost Extensions.)

13\. **List** **Local
Partner(s):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

14\. **Number of Project Beneficiaries (Direct)- Children Under
5:\_\_\_\_\_\_\_\_\_\_\_\_\_ /
WRA:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Number of Total Project Beneficiaries:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

15\. **Name of Person consulted with at USAID
Mission:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

16\. **Point of Contact at Applicant Organization for Notification of
Application Status:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Address where letter notifying Applicant of Application Status should
be sent:**

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

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

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

**ANNEX F**

**PROGRAM RECIPIENTS**

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

ADRA - Adventist Development and Relief Agency

AFRICARE - Africare, Inc.

AKF - Aga Khan Foundation

CARE - Cooperative for Assistance and Relief

Everywhere

CCF - Christian Children\'s Fund, Inc.

CRS - Catholic Relief Services

CWI - Concern Worldwide (U.S.), Inc.

CII (FSP) - Counterpart International, Inc

CURAMERICAS - Curamericas (formerly Andean Rural Health

Care)

ESPERANCA - Esperanca, Inc.

FOCAS - Foundation of Compassionate American

Samaritans

HAI - Health Alliance International

HKI - Helen Keller Worldwide

HOPE - Project HOPE (The People-to-People Health

Foundation)

IEF - International Eye Foundation

IRC - International Rescue Committee

MAP - MAP International

MCI - Mercy Corps International

MCDI - Medical Care Development International

MIHV - Minnesota International Health Volunteers

PATH - Program for Appropriate Technology in Health

PCI - Project Concern International

PFD - Partners for Development

PLAN - PLAN International USA, Inc (Childreach)

PSBI - The Pearl S. Buck International, Inc

PSI - Population Services International

SAWSO - The Salvation Army World Service Office

SC - Save the Children Federation, Inc.

WRC - World Relief Corporation

###### WV - World Vision 

**ANNEX G**

**BUDGET FORMS AND INSTRUCTIONS**

**Standard Form 424** OMB Approval No. 0348-0043

+--------+--------+---+---+--------+-----------------+--------+---+---+
| ###### |        |   |   |        | 2\. DATE        | App    |   |   |
| # APPL |        |   |   |        | SUBMITTED       | licant |   |   |
| ICATIO |        |   |   |        |                 | Iden   |   |   |
| N FOR  |        |   |   |        |                 | tifier |   |   |
| FEDERA |        |   |   |        |                 |        |   |   |
| L ASSI |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 | NA     |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 1\.    |        |   |   |        | 3\. DATE        | State  |   |   |
| TYPE   |        |   |   |        | RECEIVED BY     | Appli  |   |   |
| OF     |        |   |   |        | STATE           | cation |   |   |
| SUBMI  |        |   |   |        |                 | Iden   |   |   |
| SSION: |        |   |   |        |                 | tifier |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Appli  |        | R |   |        | NA              | NA     |   |   |
| cation |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Constr |        | C |   |        | 4\. DATE        | F      |   |   |
| uction |        | o |   |        | RECEIVED BY     | ederal |   |   |
|        |        | n |   |        | FEDERAL AGENCY  | Iden   |   |   |
|        |        | s |   |        |                 | tifier |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| X      |        | N |   |        |                 | NA     |   |   |
| Non-   |        | o |   |        |                 |        |   |   |
| Constr |        | n |   |        |                 |        |   |   |
| uction |        | - |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 5\.    |        |   |   |        |                 |        |   |   |
| APPLI  |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| INFOR  |        |   |   |        |                 |        |   |   |
| MATION |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| *      |        |   |   |        | ######## Orga   |        |   |   |
| *Legal |        |   |   |        | nizational Unit |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| ame:** |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A      |        |   |   |        | Name and        |        |   |   |
| ddress |        |   |   |        | telephone       |        |   |   |
| (give  |        |   |   |        | number of       |        |   |   |
| only   |        |   |   |        | person to be    |        |   |   |
| c      |        |   |   |        | contacted on    |        |   |   |
| ounty, |        |   |   |        | matters         |        |   |   |
| state, |        |   |   |        | involving this  |        |   |   |
| and    |        |   |   |        | application     |        |   |   |
| zip    |        |   |   |        | (give area      |        |   |   |
| code): |        |   |   |        | code)           |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 6\.    |        |   |   |        | 7\. TYPE OF     |        | M |   |
| EM     |        |   |   |        | APPLICATION:    |        |   |   |
| PLOYER |        |   |   |        | (enter          |        |   |   |
| ID     |        |   |   |        | appropriate     |        |   |   |
| ENTIFI |        |   |   |        | letter in box)  |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| NUMBER |        |   |   |        |                 |        |   |   |
| (EIN): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        | A. State        | H.     |   |   |
|        |        |   |   |        |                 | Indep  |   |   |
|        |        |   |   |        |                 | endent |   |   |
|        |        |   |   |        |                 | School |   |   |
|        |        |   |   |        |                 | Dist   |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 8\.    |        |   |   |        | B. County       | I.     |   |   |
| TYPE   |        |   |   |        |                 | State  |   |   |
| OF     |        |   |   |        |                 | Cont   |   |   |
| APPLI  |        |   |   |        |                 | rolled |   |   |
| CATION |        |   |   |        |                 | Insti  |   |   |
|        |        |   |   |        |                 | tution |   |   |
|        |        |   |   |        |                 | of     |   |   |
|        |        |   |   |        |                 | Higher |   |   |
|        |        |   |   |        |                 | Le     |   |   |
|        |        |   |   |        |                 | arning |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| [X]    |        |   |   |        | C. Municipal    | J.     |   |   |
| {.unde |        |   |   |        |                 | Indian |   |   |
| rline} |        |   |   |        |                 | Tribe  |   |   |
| New    |        |   |   |        |                 |        |   |   |
| Contin |        |   |   |        |                 |        |   |   |
| uation |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| vision |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| If     |        |   |   |        | D. Township     | K.     |   |   |
| Rev    |        |   |   |        |                 | Indi   |   |   |
| ision, |        |   |   |        |                 | vidual |   |   |
| enter  |        |   |   |        |                 |        |   |   |
| appro  |        |   |   |        |                 |        |   |   |
| priate |        |   |   |        |                 |        |   |   |
| let    |        |   |   |        |                 |        |   |   |
| ter(s) |        |   |   |        |                 |        |   |   |
| in     |        |   |   |        |                 |        |   |   |
| b      |        |   |   |        |                 |        |   |   |
| ox(es) |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A.     |        | D |   |        | E. Interstate   | L.     |   |   |
| In     |        | . |   |        |                 | Profit |   |   |
| crease |        | D |   |        |                 | Organi |   |   |
| Award  |        | e |   |        |                 | zation |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| B.     |        | E |   |        | F.              | M.     |   |   |
| De     |        | . |   |        | Inter-municipal | Other  |   |   |
| crease |        | O |   |        |                 | (sp    |   |   |
| Award  |        | t |   |        |                 | ecify) |   |   |
|        |        | h |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | ( |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | f |   |        |                 |        |   |   |
|        |        | y |   |        |                 |        |   |   |
|        |        | ) |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| C.     |        |   |   |        | G. Special      |        |   |   |
| In     |        |   |   |        | Dist.           |        |   |   |
| crease |        |   |   |        |                 |        |   |   |
| Du     |        |   |   |        |                 |        |   |   |
| ration |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 10\.   |        |   |   |        | 9\. NAME OF     |        |   |   |
| C      |        |   |   |        | FEDERAL AGENCY  |        |   |   |
| ATALOG |        |   |   |        |                 |        |   |   |
| OF     |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| MESTIC |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| UMBER: |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| NA     |        |   |   |        | USAID/BHR/PVC   |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| TITLE: |        |   |   |        | 11\.            |        |   |   |
|        |        |   |   |        | DESCRIPTIVE     |        |   |   |
|        |        |   |   |        | TITLE OF        |        |   |   |
|        |        |   |   |        | APPLICANT\'S    |        |   |   |
|        |        |   |   |        | PROJECT:        |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 12\.   |        |   |   |        |                 |        |   |   |
| AREAS  |        |   |   |        |                 |        |   |   |
| AF     |        |   |   |        |                 |        |   |   |
| FECTED |        |   |   |        |                 |        |   |   |
| (C     |        |   |   |        |                 |        |   |   |
| ities, |        |   |   |        |                 |        |   |   |
| Cou    |        |   |   |        |                 |        |   |   |
| nties, |        |   |   |        |                 |        |   |   |
| S      |        |   |   |        |                 |        |   |   |
| tates, |        |   |   |        |                 |        |   |   |
| etc.): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 13\.   |        | 1 |   |        |                 |        |   |   |
| PR     |        | 4 |   |        |                 |        |   |   |
| OPOSED |        | \ |   |        |                 |        |   |   |
| P      |        | . |   |        |                 |        |   |   |
| ROJECT |        | C |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | G |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | E |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | L |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | F |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| START  | END    | a |   |        | b\. Project     |        |   |   |
| DATE   | DATE   | \ |   |        |                 |        |   |   |
|        |        | . |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        | N |   |        | NA              |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 15\.   |        |   |   |        | 16\. IS         |        |   |   |
| EST    |        |   |   |        | APPLICATION     |        |   |   |
| IMATED |        |   |   |        | SUBJECT TO      |        |   |   |
| FU     |        |   |   |        | REVIEW BY STATE |        |   |   |
| NDING: |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS?  |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    | \$     |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| ederal |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| b      | \$     |   |   |        | a\. YES. THIS   |        |   |   |
| App    |        |   |   |        | PREAPPLICAT     |        |   |   |
| licant |        |   |   |        | ION/APPLICATION |        |   |   |
|        |        |   |   |        | WAS MADE        |        |   |   |
|        |        |   |   |        | AVAILABLE TO    |        |   |   |
|        |        |   |   |        | THE STATE       |        |   |   |
|        |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS   |        |   |   |
|        |        |   |   |        | REVIEW ON:      |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| c\.    | \$ NA  |   |   |        |                 |        |   |   |
| State  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    | \$ NA  |   |   |        | DATE            |        |   |   |
| Local  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| e\.    | \$     |   |   |        | B. NO.          |        |   |   |
| Other  |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | PROGRAM IS NOT  |        |   |   |
|        |        |   |   |        | COVERED BY E.O. |        |   |   |
|        |        |   |   |        | 12372           |        |   |   |
|        |        |   |   |        |                 |        |   |   |
|        |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | OR PROGRAM HAS  |        |   |   |
|        |        |   |   |        | NOT BEEN        |        |   |   |
|        |        |   |   |        | SELECTED BY     |        |   |   |
|        |        |   |   |        | STATE FOR       |        |   |   |
|        |        |   |   |        | REVIEW          |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| f\.    | \$     |   |   |        |                 |        |   |   |
| P      |        |   |   |        |                 |        |   |   |
| rogram |        |   |   |        |                 |        |   |   |
| Income |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| g\.    | \$     |   |   |        |                 |        |   |   |
| TOTAL  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 17\.   |        |   |   |        | Yes If \"Yes\", | No     |   |   |
| IS THE |        |   |   |        | attach an       |        |   |   |
| APP    |        |   |   |        | explanation     |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| DELI   |        |   |   |        |                 |        |   |   |
| NQUENT |        |   |   |        |                 |        |   |   |
| ON ANY |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DEBT?  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 18\.   |        |   |   |        |                 |        |   |   |
| TO THE |        |   |   |        |                 |        |   |   |
| BEST   |        |   |   |        |                 |        |   |   |
| OF MY  |        |   |   |        |                 |        |   |   |
| KNO    |        |   |   |        |                 |        |   |   |
| WLEDGE |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| B      |        |   |   |        |                 |        |   |   |
| ELIEF, |        |   |   |        |                 |        |   |   |
| ALL    |        |   |   |        |                 |        |   |   |
| DATA   |        |   |   |        |                 |        |   |   |
| IN     |        |   |   |        |                 |        |   |   |
| THIS   |        |   |   |        |                 |        |   |   |
| AP     |        |   |   |        |                 |        |   |   |
| PLICAT |        |   |   |        |                 |        |   |   |
| ION/PR |        |   |   |        |                 |        |   |   |
| EAPPLI |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| ARE    |        |   |   |        |                 |        |   |   |
| TRUE   |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| CO     |        |   |   |        |                 |        |   |   |
| RRECT, |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| CUMENT |        |   |   |        |                 |        |   |   |
| HAS    |        |   |   |        |                 |        |   |   |
| BEEN   |        |   |   |        |                 |        |   |   |
| DULY   |        |   |   |        |                 |        |   |   |
| AUTH   |        |   |   |        |                 |        |   |   |
| ORIZED |        |   |   |        |                 |        |   |   |
| BY THE |        |   |   |        |                 |        |   |   |
| GOV    |        |   |   |        |                 |        |   |   |
| ERNING |        |   |   |        |                 |        |   |   |
| BODY   |        |   |   |        |                 |        |   |   |
| OF THE |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| WILL   |        |   |   |        |                 |        |   |   |
| COMPLY |        |   |   |        |                 |        |   |   |
| WITH   |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| AT     |        |   |   |        |                 |        |   |   |
| TACHED |        |   |   |        |                 |        |   |   |
| ASSU   |        |   |   |        |                 |        |   |   |
| RANCES |        |   |   |        |                 |        |   |   |
| IF THE |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| IS     |        |   |   |        |                 |        |   |   |
| AW     |        |   |   |        |                 |        |   |   |
| ARDED. |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    |        |   |   |        | b\. Title       | c\.    |   |   |
| Type   |        |   |   |        |                 | Tel    |   |   |
| Name   |        |   |   |        |                 | ephone |   |   |
| of     |        |   |   |        |                 | Number |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    |        |   |   |        |                 | e\.    |   |   |
| Sig    |        |   |   |        |                 | Date   |   |   |
| nature |        |   |   |        |                 | Signed |   |   |
| of     |        |   |   |        |                 |        |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+

Standard Form 424 (REV 4-92); Prescribed By OMB Circular A-102

## 

#  

**INSTRUCTIONS FOR THE SF 424**

Public reporting burden for this collection of information is estimated
to average 45 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0043), Washington, DC 20503.

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

This is a standard form used by applicants as a required facesheet for
preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that
States which have established a review and comment procedure in response
to Executive Order 12372 and have selected the program to be included in
their process, have been given an opportunity to review the applicant\'s
submission.

Item: Entry:

1\. Self-explanatory.

2\. Date application submitted to Federal agency (or State if
applicable) & applicant\'s control number (if applicable).

3\. State use only (if applicable).

4\. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project, leave
blank.

5\. Legal name of applicant, name of primary organizational unit, which
will undertake the assistance activity, complete address of the
applicant, and the name and telephone number of the person to contact on
matters related to this application.

6\. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.

7\. Enter the appropriate letter in the space provided.

8\. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:

\- \"New\" means a new assistance award.

\- \"Continuation\" means an extension for an additional funding/budget
period for a project with a projected completion date.

\- \"Revision\" means any change in the Federal Government\'s financial
obligation or contingent liability from an existing obligation.

9\. Name of Federal agency from which assistance is being requested with
this application.

10\. Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.

Item: Entry:

11\. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a separate
sheet. If appropriate (e.g., construction or real property projects),
attach a map showing project location. For preapplications, use a
separate sheet to provide a summary description of this project.

12\. List only the largest political entities affected (e.g., State,
counties, cities).

13\. Self-explanatory.

14\. List the applicant\'s Congressional District and any District(s)
affected by the program or project.

15\. 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. If both basic and supplemental amounts are included, show
breakdown on an attached sheet. For multiple program funding, use totals
and show breakdown using same categories as item 15.

16\. Applications should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to the State inter government review process.

17\. This question applies to the applicant organization, not the person
who signs as the authorized representative. Categories of debt include
delinquent audit disallowances loans and taxes.

18\. To be signed by the authorized representative of the applicant. A
copy of the governing body\'s authorization for you to sign this
application as 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.)

**SF 424 Back (Rev. 4-92)**

####  

### Standard Form 424A

### Budget Information - Non-Construction Programs

+---------+---------+---------+---------+---------+---------+---------+
| **      |         |         |         |         |         |         |
| SECTION |         |         |         |         |         |         |
| A -     |         |         |         |         |         |         |
| BUDGET  |         |         |         |         |         |         |
| SU      |         |         |         |         |         |         |
| MMARY** |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Grant   | Catalog | Es      |         | New or  |         |         |
| Program | of      | timated |         | Revised |         |         |
|         | Federal | Unob    |         | Budget  |         |         |
| F       |         | ligated |         |         |         |         |
| unction | D       | Funds   |         |         |         |         |
|         | omestic |         |         |         |         |         |
| Or      | Ass     |         |         |         |         |         |
| A       | istance |         |         |         |         |         |
| ctivity | Number  |         |         |         |         |         |
|         |         |         |         |         |         |         |
| {a}     | {b}     |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
|         |         | Federal | Non-    | Federal | Non-    | Total   |
|         |         |         | Federal |         | Federal |         |
|         |         | {c}     |         | {e}     |         | {g}     |
|         |         |         | {d}     |         | {f}     |         |
+---------+---------+---------+---------+---------+---------+---------+
| 1\.     | \$ NA   | \$ NA   | \$ NA   | \$      | \$      | \$      |
| Headq   |         |         |         |         |         |         |
| uarters |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| 2\.     | NA      | NA      | NA      |         |         |         |
| Field   |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| 3\. NA  | NA      | NA      | NA      | NA      | NA      | NA      |
+---------+---------+---------+---------+---------+---------+---------+
| 4\. NA  | NA      | NA      | NA      | NA      | NA      | NA      |
+---------+---------+---------+---------+---------+---------+---------+
| 5       | \$ NA   | \$ NA   | \$ NA   | \$      | \$      | \$      |
| .TOTALS |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| #####   |         |         |         |         |         |         |
| #### SE |         |         |         |         |         |         |
| CTION B |         |         |         |         |         |         |
|  -- BUD |         |         |         |         |         |         |
| GET CAT |         |         |         |         |         |         |
| EGORIES |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| 6\.     |         | USAID   |         | RE      |         | Total   |
| Object  |         | PROGRAM |         | CIPIENT |         |         |
| Class   |         |         |         | FUNDS   |         | {5}     |
| Cat     |         |         |         |         |         |         |
| egories |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
|         |         | \(1\)   | \(2\)   | {3}     | {4}     |         |
|         |         | Federal | Non-    |         |         |         |
|         |         |         | Federal |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| a\.     |         | \$      | \$      | \$ NA   | \$ NA   | \$      |
| Pe      |         |         |         |         |         |         |
| rsonnel |         |         |         |         |         |         |
| (1)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| b\.     |         |         |         | NA      | NA      |         |
| Fringe  |         |         |         |         |         |         |
| B       |         |         |         |         |         |         |
| enefits |         |         |         |         |         |         |
| (1)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| c\.     |         |         |         | NA      | NA      |         |
| Travel  |         |         |         |         |         |         |
| (1)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| d\.     |         |         |         | NA      | NA      |         |
| Eq      |         |         |         |         |         |         |
| uipment |         |         |         |         |         |         |
| (3)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| e\.     |         |         |         | NA      | NA      |         |
| S       |         |         |         |         |         |         |
| upplies |         |         |         |         |         |         |
| (3)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| f\.     |         |         |         | NA      | NA      |         |
| Cont    |         |         |         |         |         |         |
| ractual |         |         |         |         |         |         |
| (3)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| g\.     |         |         |         | NA      | NA      |         |
| Const   |         |         |         |         |         |         |
| ruction |         |         |         |         |         |         |
| N/A     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| h\.     |         |         |         | NA      | NA      |         |
| Other   |         |         |         |         |         |         |
| (1),    |         |         |         |         |         |         |
| (2)     |         |         |         |         |         |         |
| (see    |         |         |         |         |         |         |
| notes)  |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| i\.     |         |         |         | NA      | NA      |         |
| Total   |         |         |         |         |         |         |
| Direct  |         |         |         |         |         |         |
| Charges |         |         |         |         |         |         |
| (sum of |         |         |         |         |         |         |
| 6a-6h)  |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| j\.     |         |         |         | NA      | NA      |         |
| I       |         |         |         |         |         |         |
| ndirect |         |         |         |         |         |         |
| Charges |         |         |         |         |         |         |
| (4)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| k\.     |         | \$      | \$      | \$      | \$      | \$      |
| TOTALS  |         |         |         |         |         |         |
| (sum of |         |         |         |         |         |         |
| 6i and  |         |         |         |         |         |         |
| 6j)     |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
|         |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| 7\.     |         | \$      | \$      | \$      | \$      | \$      |
| Program |         |         |         |         |         |         |
| Income  |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+

**STANDARD FORM 424A (cont\'d)**

  -------------------- ---------- ----------- ---------- ---------- ----------
  **SECTION C -                                                     
  NON-FEDERAL                                                       
  RESOURCES**                                                       

  \(a\) Grant Program             \(b\)       \(c\)      \(d\)      \(e\)
                                  Applicant   State      Other      TOTALS
                                                         Sources    

  8\. Headquarters                \$          \$ NA      \$         \$

  9\. Field                                   NA                    

  10\. NA                         NA          NA         NA         

  11\. NA                         NA          NA         NA         

  12\. TOTAL (sum of              \$          \$ NA      \$         \$
  lines 8-11)                                                       

  **SECTION D -                                                     
  FORECASTED CASH                                                   
  NEEDS**                                                           

  13\. Federal         Total for  1st Quarter 2^nd^      3rd        4th
                       1st Year               Quarter    Quarter    quarter

                       \$         \$          \$         \$         \$

  14\. Non-Federal                                                  

  15\. TOTAL (sum of                                                
  lines 13 and 14)                                                  

  **SECTION E - BUDGET                                              
  ESTIMATES OF FEDERAL                                              
  FUNDS NEEDED FOR                                                  
  BALANCE OF THE                                                    
  PROJECT**                                                         

  \(a\) Grant Program             Future                            
                                  Funding                           
                                  Periods                           

                                  \(b\) First \(c\)      \(d\)      \(e\)
                                              Second     Third      Fourth

  16\. Headquarters               \$          \$         \$         \$

  17\. Field                                                        

  18\. NA                         NA          NA         NA         NA

  19\. NA                         NA          NA         NA         NA

  20\. TOTAL (sum of              \$          \$         \$         \$
  lines 16-19)                                                      

  **SECTION F - OTHER                                               
  BUDGET INFORMATION**                                              

  21\. Direct Charges:            22\.                              
                                  Indirect                          
                                  Charges:                          

  23\. Remarks:                                                     
  -------------------- ---------- ----------- ---------- ---------- ----------

**Authorized for Local Reproduction Standard Form 424 A (Rev. 4-92) Page
2**

#### 

**Standard Form 424A (cont\'d.)**

#####  INSTRUCTIONS FOR THE SF 424A

Public reporting burden for this collection of information is estimated
to average 180 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0044), Washington, DC 20503.

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

**General Instructions**

This form is designed so that application can be made for funds from one
or more grant programs. In preparing the budget, adhere to any existing
Federal grantor agency guidelines, which prescribe how, and whether
budgeted amounts should be separately show for different functions or
activities within the program. For some programs, grantor agencies may
require budgets to be separately shown by function or activity. For
other programs, grantor agencies may require a breakdown by function or
activity. Sections A, B, C and D should include budget estimates for the
whole project except when applying for assistance which requires Federal
authorization in annual or other funding period increments. In the
latter case, Section A, B, C and D should provide the budget for the
first budget period (usually a year) and Section E should present the
need for Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class categories
shown in Lines a-k of Section B.

**Section A. Budget Summary Lines 1-4 Columns (a) and (b)**

For applications pertaining to a *single* Federal grant program (Federal
Domestic Assistance Catalog number) and *not requiring* a functional or
activity breakdown, enter on Line 1 under Column (a) the catalog program
title and the catalog number in Column (b).

For applications pertaining to a *single* program *requiring* budget
amounts by multiple functions or activities, enter the name of each
activity or function on each line in Column (a), and enter the catalog
number in Column (b). For applications pertaining to multiple programs
where none of the programs require a breakdown by function or activity,
enter the catalog program title on each line in *Column (a)* and the
respective catalog number on each line in Column (b).

For applications pertaining to *multiple* programs where one or more
programs require a breakdown by function or activity, prepare a separate
sheet for each program requiring

the breakdown. Additional sheets should be used when one form does not
provide adequate space for all breakdown of

data required. However, when more than one sheet is used,

the first page should provide the summary totals by programs.

**Lines 1-4, Columns (c) through (g)**

*For new applications*, leave Columns (c) and (d) blank. For each line
Entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the
appropriate amounts of funds needed to support the project for the first
funding period (usually a year).

*For continuing grant program applications*, submit these forms before
the end of each funding period as required by the grantor agency. Enter
in Column (c) and (d) the estimated amounts of funds which will remain
unobligated at the end of the grant funding period only if the Federal
grantor agency instructions provide for this. Otherwise, leave these
columns blank. Enter in columns (e) and (f) the amounts of funds needed
for the upcoming period. The amount(s) in Column (g) should be the sum
of amounts in Columns (e) and (f).

*For supplemental grants and changes* to existing grants, do not use
Columns (c) and (d). Enter in Column (e) the amount of the increase or
decrease of Federal funds and enter in Column (f) the amount of the
increase of non-Federal funds. In Column (g) enter the new total
budgeted amount (Federal and non-Federal) which includes the total
previous authorized budgeted amounts plus or minus, as appropriate, the
amounts shown in Columns (e) and (f). The amounts(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).

**Line 5 -** Show the totals for all columns used.

**SF 424A (Rev. 4-92) Page 3**

**Standard Form 424A (cont\'d.)**

**INSTRUCTIONS FOR THE SF 424A (continued)**

**Section B. Budget Categories**

In the column headings (1) enter Federal, and (2) enter Non-Federal.
When additional sheets are prepared for Section A, provide similar
column headings on each sheet. For each program, function or activity,
fill in the total requirements for funds (both Federal and non-Federal)
by object class categories.

**Lines 6a-i -** Show the totals of Lines 6a to 6h in each column.

**Line 6j** - Show the amount of indirect cost.

**Line 6k** - Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount in
column (5), Line 6k, should be the same as the total amount shown in
Section A, Column (g), Line 5. For supplemental grants and changes to
grants, the total amount of the increase or decrease as shown in Columns
(1)-(4), Line 6k should be the same as the sum of the amounts in Section
A, Columns (e) and (f) on Line 5.

**Line 7** - Enter the estimated amount of income, if any, expected to
be generated from this project. Do not add or subtract this amount from
the total project amount. Show under the program narrative statement the
nature and source of income. The estimated amount of program income may
be considered by the federal grantor agency in determining the total
amount of the grant.

**Section C. Non-Federal Resources**

**Lines 8-11** - Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.

**Column (a)** - Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.

**Column (b)** - Enter the contribution to be made by the applicant.

**Column (c)** - Enter the amount of the State\'s cash and in-kind
contribution if the applicant is not a State or State agency. Applicants
who are a State or State agencies should leave this column blank.

**Column (d)** - Enter the amount of cash and in-kind contributions to
be made from all other sources.

**Column (e)** - Enter totals of Columns (b), (c), and (d).

**Line 12** - Enter the total for each of Columns (b)-(e). The amount in
Column (e) should be equal to the amount on Line 5, Column (f) Section
A.

**Section D. Forecasted Cash Needs**

**Line 13** - Enter the amount of cash needed by quarter from the
grantor agency during the first year.

**Line 14** - Enter the amount of cash from all other sources needed by
quarter during the first year.

**Line 15** - Enter the totals of amounts on Lines 13 and 14.

**Section E. Budget Estimates of Federal Funds Needed for Balance of the
Project**

**Lines 16-19** - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity is
not necessary. For new applications and continuation grant applications,
enter in the proper columns amounts of Federal funds which will be
needed to complete the program or project over the succeeding funding
periods (usually in years). This section need not be completed for
revisions (amendments, changes, or supplements) to funds for the current
year of existing grants.

If more than four lines are needed to list the program titles, submit
additional schedules as necessary.

**Line 20** - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate accordingly
and show the overall totals on this line.

**Section F. Other Budget Information**

**Line 21** - Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the ordinary
or to explain the details as required by Federal grantor agency.

**Line 22** - Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the funding
period, the estimated amount of the base to which the rate is applied,
and the total indirect expense.

**Line 23** - Provide any other explanations or comments deemed
necessary.

**SF 424A (Rev. 4-92)** Page 4

**The following object class categories are those required on USAID Form
424A (Section B - Budget Categories):**

a\. **[Personnel]{.underline}**

The category includes the salary of each long-term and short-term, paid
position for the total estimated life-of-project, except consultants,
and the projected cost-of-living or bonus/merit increase for each
position.

b\. **[Fringe Benefits]{.underline}**

This category includes the amount and percentage of fringe benefits for
each headquarters and field personnel identified above. Include here all
allowances such as housing, schooling, leave benefits, and other items.

c\. **[Travel]{.underline}**

This category includes all projected travel, per diem and other related
costs for personnel **except** consultants. Include the method by which
airfare costs were determined; i.e. quotes for coach and if per-diems
are based on established policies.

d\. **[Equipment]{.underline}**

In accordance with 22 CFR 226, \'equipment\' means tangible
non-expendable personal property, including exempt property charged
directly to the award having a useful life of more than one year and an
acquisition cost of \$5,000 or more per unit. Information should be
included in the application on how pricing was determined for each piece
of the equipment.

There are statutory constraints relating to the purchase of agricultural
commodities, motor vehicles, pharmaceuticals, pesticides, rubber
compounding chemicals and plasticizers, used equipment and fertilizer
with USAID project funds. PVOs may obtain specific information on these
regulations on USAID Web Site at http://www.usaid.gov/pubs/ads.

e\. **[Supplies]{.underline}**

In accordance with 22 CFR 226, \'supplies\' means all personal property
excluding equipment, intangible property, debt instruments and
interventions.

There are statutory constraints relating to the purchase of agricultural
commodities, motor vehicles, pharmaceuticals, pesticides, rubber
compounding chemicals and plasticizers, used equipment and fertilizer
with USAID project funds. PVOs can obtain specific information on these
regulations on USAID Web Site at
http://www.usaid.gov/pubs/ads/300/312/htm.

f\. **[Contractual Services]{.underline}**

This category is for all subcontracts with organizations, which will
provide services to the project and any short- or long-term consultant
cost including fees, travel and perdiem. This category is not to be used
for sub-grants, which should be included in other.

g\. **[Construction]{.underline}**

N/A

h\. **[Other]{.underline}**

PVOs are to identify all costs associated with training of project
personnel.

PVOs planning to use USAID funds to send project staff or local
counterparts for training in the U.S. or a country other than the host
country, will be required to follow the guidance on USAID Participant
Training Regulations, which may be found on the USAID Web Site
http://www.usaid.gov/pubs/ads.

The PVO should provide information on any costs attributed to the
project not associated above; i.e. communications, facilities, fuel
vehicles, repair, maintenance and insurance.

Include in this budget class category all sub-grants.

i\. **[Indirect Charges]{.underline}**

Include a copy of the PVO\'s most recent negotiated indirect cost rate
agreement (NICRA) from the cognizant audit agency showing the overhead
and/or general administrative rate.

USAID Form 424A, Section C should reflect the PVO's and other sources'
cash contribution to this program. A cash match means that funds are
used to support the budget elements discussed above. This does not
include volunteer labor from U.S. or host country sources. The cash
value of donated equipment or supplies must be documented.

**A narrative that justifies the costs as appropriate and necessary for
the successful completion of the program should be attached to USAID
Form 424.**

The Cooperative Agreement Budget generally has four (4) different
categories called [Budget Cost Elements:]{.underline} Program, Training,
Procurement, and Indirect Costs. A sample Agreement Budget is included
below. On Standard Form 424A, Section B--Budget Categories, all eleven
[Object Class Categories]{.underline} have a footnote number next to
them. The footnote numbers next to the Object Class Categories
correspond to one of the four Cost Elements of the Cooperative Agreement
Budget. The 11 Object Class Categories fit within the four Cost Elements
of the Cooperative Agreement Budget. For this application, submit only
the Standard Form 424 and 424A, with the corresponding eleven (11)
Object Class Categories, supported by a detailed narrative. Do
**[NOT]{.underline}** use the four **Cost Elements of the**
**Cooperative Agreement Budget shown below**.

##### SAMPLE COOPERATIVE AGREEMENT BUDGET

SF 424, sec.B, Item 6

[Budget Cost Element]{.underline} [Object Class Category]{.underline}
[Budget Amount]{.underline}

Program Line a, b, c, and h \$\_\_\_\_\_

Training Line h \$\_\_\_\_

Procurement Line d, e and f \$\_\_\_\_\_

Indirect Costs Line j \$\_\_\_\_\_

Program's Total Budget \$\_\_\_\_\_

Funding arrangement:

Total USAID Amount \$\_\_\_\_\_

Recipient's Cost Share \$\_\_\_\_\_

Total Program Funding \$\_\_\_\_\_

[^1]: Water and sanitation activities contributing directly to health
    objectives are allowable in accordance with 2003 CSH Program Fund
    Guidance. While it is unlikely that grant applications focused
    entirely on infrastructure would receive competitive scores, the
    previous restrictions on water and sanitation programs have been
    removed. The rationale for GH investments in water and sanitation is
    based on a hygiene approach (e.g., good hand-washing) to complement
    and optimize the impact of water and sanitation infrastructure
    improvements (See ANNEX D).

[^2]: Family Planning and Reproductive Health (FP/RH) Funds through the
    Flexible Fund Initiative and Infectious Disease (TB) funds will be
    made available to support successful applications. Technical
    guidance is provided in the Technical Reference Materials (ANNEX C)
    and the 2003 CSH Program Fund Guidance (ANNEX D).