**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

*HIV/AIDS Bureau*

*Division of Community Based Programs*

> ***HIV Early Intervention Services (EIS) Program***
>
> *Competing Continuation and New Proposals for Existing Geographic
> Service Areas (EISEGA)*
>
> ***Announcement \# HRSA-09-099***
>
> **Catalog of Federal Domestic Assistance (CFDA) No. 93.918**

**PROGRAM GUIDANCE**

Fiscal Year *2009*

**Application Due Date: *July 1, 2008***

**Release Date: *May 1, 2008 ***

**Date of Issuance*: May 1, 2008***

*Contact:*

*Kathleen Treat, MSW, MS*

*Division of Community Based Programs*

*HRSA, HIV/AIDS Bureau*

*5600 Fishers Lane #7A-30*

*Rockville, Maryland 20857*

*Tel. 301 443-7602*

*Fax 301 443-1839*

Authority: Sections 2651 and 2693 of the Public Health Service Act, as
amended (2 USC 300ff -51)

**Guidance Table of Contents**

[I. Funding Opportunity Description 4](#__RefHeading___Toc197395130)

[Purpose 4](#Funding_purpose)

[Background 4](#__RefHeading___Toc197395133)

[II. Award Information 8](#__RefHeading___Toc197395134)

[1. Type of Award 8](#__RefHeading___Toc197395135)

[2. Summary of Funding 9](#__RefHeading___Toc197395136)

[III. Eligibility Information 9](#__RefHeading___Toc197395137)

[1. Eligible Applicants 9](#__RefHeading___Toc197395138)

[2. Cost Sharing/Matching 10](#__RefHeading___Toc197395139)

[3. Other 10](#__RefHeading___Toc197395140)

[IV. Application and Submission Information
10](#__RefHeading___Toc197395142)

[1. ADdress to Request Application Package 10](#Application_materials)

[Application Materials 10](#__RefHeading___Toc197395144)

[2. Content and Form of Application Submission
11](#__RefHeading___Toc197395145)

[Application Format Requirements 11](#Application_formatrequirements)

[i. Application Face Page 15](#__RefHeading___Toc197395149)

[ii. Table of Contents 16](#__RefHeading___Toc197395150)

[iii. Application Checklist (Grants.gov)
16](#__RefHeading___Toc197395151)

[iv. Budget 16](#__RefHeading___Toc197395152)

[v. Budget Justification 21](#__RefHeading___Toc197395154)

[vi. Staffing Plan and Personnel Requirements
22](#__RefHeading___Toc197395155)

VII\. ASSURANCES AND CERTIFICATIONS 23

[viii. Project Abstract 24](#__RefHeading___Toc197395157)

ix[. Program narrative 24](#__RefHeading___Toc197395157)

[x. Attachments 36](#Format_ProgramNarrative)

[3. Submission Dates and Times 37](#Format_Appendices)

[4. Intergovernmental Review 38](#Application_materials)

[5. Funding Restrictions 38](#__RefHeading___Toc197395162)

[6. Other Submission Requirements 38](#__RefHeading___Toc197395163)

[V. Application Review Information 40](#__RefHeading___Toc197395164)

> *1. REVIEW
> CRITERIA................................................................................................................40*
>
> *2. REVIEW AND SELECTION
> PROCESS......................................................................................44*
>
> *3. FUNDING
> PREFERENCES...................................................................................................\...45*

[VI. Award Administration Information 45](#Review_ReviewCriteria)

> *1. AWARD
> NOTICES..................................................................................................................45*
>
> *2. ADMINISTRATICE AND NATIONAL POLICY
> REQUIREMENTS................................................\...46*
>
> *3.
> REPORTING.........................................................................................................................47*

[VII. Agency Contacts 48](#__RefHeading___Toc197395172)

[viii. Tips for Writing a Strong Application
49](#__RefHeading___Toc197395173)

**APPENDIX A -- ELECTRONIC SUBMISSION
GUIDE............................................................................51**

**APPENDIX B -- REGISTERING AND APPLYING THROUGH
GRANTS.GOV............................................66**

**APPENDIX C- ADDITIONAL AGREEMENTS AND
ASSURANCES.........................................................71**

**APPENDIX D -- PROGRAM REQUIREMENTS AND
EXPECTATIONS....................................................74**

**APPENDIX E- SERVICE
AREAS......................................................................................................
85**

[]{#__RefHeading___Toc197395130 .anchor}**I. Funding Opportunity
Description**

[]{#Funding_purpose .anchor}

**Purpose**

The Department of Health and Human Services (DHHS), Health Resources and
Services Administration (HRSA), HIV/AIDS Bureau (HAB) announces this
funding opportunity for competing Part C (formerly known as Title III)
Early Intervention Services (EIS) to support outpatient HIV early
intervention and primary care services. These services target
low-income, medically underserved people in existing primary care
systems. The authority for this grant program is Sections 2651 and 2693
of the Public Health Service Act, as amended (42 USC 300ff -51).

Title XXVI of the PHS Act, as amended by the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 (Ryan White HIV/AIDS Program) was
signed into law on December 19, 2006. The purpose of the Ryan White
Program Part C is to provide HIV primary care in the outpatient setting.
Applicants must propose to provide a comprehensive continuum of
outpatient HIV primary care services in the targeted area including: 1)
HIV counseling, testing, and referral; 2) medical evaluation and
clinical care; 3) other primary care services; and 4) referrals to other
health services. Primary care for persons with HIV disease should start
as early in the course of the infection as possible. However, entry into
a Part C EIS program may take place at any point in the spectrum of the
disease or the patient's lifespan.

**Minority AIDS Initiative (MAI)**

The Minority AIDS Initiative (MAI) is intended to address the
disproportionate impact that HIV/AIDS has on racial and ethnic
minorities and to address the disparities in access, treatment, care and
outcomes for racial and ethnic minorities, including African Americans,
Alaska Natives, Latinos, American Indians, Asian Americans, Native
Hawaiians, and Pacific Islanders. The goal of the MAI is to help reduce
this burden by:

-   Increasing the number of persons from racial and ethnic populations
    receiving HIV care, and

-   Increasing the number of persons from racial and ethnic populations
    who stay in care.

MAI funds are granted to health care providers who have a history of
providing culturally and linguistically appropriate care and services to
racial and ethnic minorities. Funded Part C EIS programs either have
applied for (elected) MAI funds or have been assigned funds under the
MAI. Elected MAI funds are awarded for a program, budget and work plan
that the grantee presented as part of its competing application.
Assigned MAI funds are those designated to grantees by the HRSA/HAB
Division of Community Based Programs (DCBP), which administers the Part
C EIS program. This assignment is based on the percentage of the
population served or proposed to be served from racial/ethnic minority
communities.

The amount of MAI funds awarded is noted on the Notice of Grant Award
(NGA).

[]{#__RefHeading___Toc197395133 .anchor}**Background**

DHHS, HRSA and HAB are committed to meeting the national goals and
principles described below. As you complete your application, consider
how your program supports and helps to implement these goals and
principles.

[National Goal]{.underline}

Healthy People 2010 is a DHHS-led national activity for setting health
priorities. Grants funded under this guidance will meet Healthy People
2010 objectives by expanding counseling and testing and increasing the
number of primary care programs that provide comprehensive HIV services.

[HRSA Goal]{.underline}

The goal for all HRSA programs is to assure access to high quality
health care and reduce disparities in health outcomes for recipients of
services in HRSA funded programs. The result is that all persons who
need care have equal access to high quality health care, regardless of
the payment source.

HRSA is committed to ensuring access to quality health care for all.
Quality care means

access to services, information, materials delivered by competent
providers in a manner

that factor in the language needs, cultural richness, and diversity of
populations served.

Quality also means that, where appropriate, data collection instruments
used should

adhere to culturally competent and linguistically appropriate norms. For
additional

information and guidance, refer to the National Standards for Culturally
and Linguistically

Appropriate Services in Health Care published by the U.S. Department of
Health and

Human Services. This document is available online at
<http://www.omhrc.gov/CLAS>.

[HAB Guiding Principles]{.underline}

HAB has identified four factors that have significant implications for
HIV/AIDS care services and treatment, which should be considered as the
application and program are developed and refined:

-   Revise care systems to meet emerging needs,

-   Ensure access to quality HIV/AIDS care,

-   Coordinate Ryan White Program services with other health care
    delivery systems, and

-   Evaluate the impact of Ryan White Program funds and make needed
    improvements.

HRSA evaluates its programs through use of the Government Performance
and Results Act (GPRA), the Performance Assessment Rating Tool (PART)
and the Grantee Performance Review Protocol (GPRP). HAB has identified
specific measures under GPRA and PART to evaluate performance of
grantees. PART measures look at performance of Ryan White HIV/AIDS
Program grantees across all programs.

GPRA measures relevant to Part C EIS programs are:

**Strategy II. Improve Health Outcomes**

A. Expand the availability of health care, particularly to underserved,
vulnerable, and special needs populations

-   Increase the number of people receiving primary care services under
    Early Intervention Services Programs

The PART measures relevant to Part C are:

**Strategy I. Improve Access to Health Care**

*Performance Goal*: Expand the Capacity of the Health Care Safety Net

*Long-Term Goal*

By 2010, increase the national proportion of people living with HIV
receiving primary medical care and treatment to 50 percent (includes all
persons who know and those who do not know their serostatus).

*Short-Term Goals*

1\. Increase by 2 percent every second year the number of persons
provided services through the Ryan White HIV/AIDS Program.

2\. Increase by 2 percent annually the number of persons who learn their
serostatus from Ryan White HIV/AIDS Programs

**Strategy II. Improve Health Outcomes**

*Performance Goal*: Expand the Availability of Health Care, Particularly
to Underserved, Vulnerable, and Special Needs Populations

*Long-Term Goal*

By 2010, increase by 10 percent the number of racial/ethnic minorities
and by 2.5 percent the number of women served by Ryan White HIV/AIDS
Program -funded programs.

*Short-Term Goals*

1\. Serve a proportion of racial/ethnic minorities in Ryan White
HIV/AIDS Program -funded programs that exceeds their representation in
national AIDS prevalence data, as reported by the CDC, by a minimum of 5
percentage points annually (e.g., if 15 percent of overall AIDS cases
are among racial/ethnic minorities, 20 percent of Ryan White HIV/AIDS
Program -funded clients will be racial/ethnic minorities).

2\. Serve a proportion of women in Ryan White HIV/AIDS Program-funded
programs that exceeds their representation in national AIDS prevalence
data reported by the CDC, by a minimum of 5 percentage points (e.g., if
15 percent of overall AIDS cases are among women, 20 percent of Ryan
White HIV/AIDS Program-funded clients will be women).

**Strategy III. Improve the Quality of Health Care**

*Performance Goal*: Promote Effectiveness of Health Care Services

*Long-Term Goal*

By 2010, all Ryan White HIV/AIDS Program -funded HIV primary medical
care providers will have implemented a quality management program and
will meet two "core" standards included in the *HHS Clinical Practices
Guidelines for Treatment of Adults, Adolescents, and Pregnant Women*.

*Short-Term Goals*

1\. Increase by 5 percentage points annually the number of Ryan White
HIV/AIDS Program-funded primary medical care providers that will have
implemented a quality management program.

2\. Increase the proportion of new Ryan White HIV/AIDS Program
HIV-infected clients who are tested for CD4 count and viral load.

-   GPRA and PART measures can be included in the GPRP, as are
    additional performance measures that are used to determine grantee
    performance. The GPRP will be used to conduct objective grantee
    performance reviews, State-level reviews, and community-level
    reviews HRSA-wide. These GPRP site visit reviews are designed to
    analyze the key factors associated with successful performance of
    HRSA programs as follows:

    -   Results and Outcomes;

    -   Organizational Structure and Capacity;

    -   Outreach and Consumer Satisfaction;

    -   Business and Financial Management;

    -   Leadership and Strategic Planning; and

    -   Partnerships.

The protocol for performance reviews is available on HRSA's Web site at
http://www.hrsa.gov/performancereview/. Performance reviews are
coordinated through HRSA's 10 Regional Divisions located in Boston, New
York, Philadelphia, Atlanta, Chicago, Kansas City, Dallas, Denver, San
Francisco, and Seattle as well as a sub-regional office in Puerto Rico.

**Improving Quality**

Title XXVI of the PHS Act, as amended, requires all funded programs to
establish clinical quality management programs to:

-   Assess the extent to which HIV health services are consistent with
    the most recent HHS (formerly referred to as Public Health Service)
    guidelines for the treatment of HIV disease and related
    opportunistic infections, and

-   Develop strategies for ensuring that such services are consistent
    with the guidelines for improvement in the access to and quality of
    HIV services.

A study by the Institute of Medicine (IOM) examined allocation, planning
and quality assessment for the Ryan White Program. The findings were
released in a report titled "Measuring What Matters" in 2003. The report
recognized HRSA/HAB\'s efforts in the area of quality management (QM),
which had been underway for several years at the time of the report\'s
release. However, it went on to state that more needed to be done to
measure and improve the quality of care provided by Ryan White HIV/AIDS
Program grantees.

(For additional information, go to
<http://hab.hrsa.gov/special/aboutquality.htm>

and <http://hab.hrsa.gov/reports/report_08_04.htm>

> HRSA/HAB has developed a definition of quality consistent with the
> definitions of the IOM report that fulfills the quality goals of the
> legislation. For HAB, "Quality is the degree to which a health or
> social service meets or exceeds established professional standards and
> user expectations. Evaluations of the quality of care must consider
> (1) the quality of inputs, (2) the quality of the service delivery
> process, and (3) the quality of outcomes, in order to continuously
> improve systems of care for individuals and populations." The HAB
> HIV/AIDS Core Clinical Performance Measures for Adults & Adolescents: 
> Group 1 were released on December 21, 2007. These are a set of core
> quality measures which Ryan White HIV/AIDS Program grantees will be
> encouraged to use in their quality management plan. Additional
> measures will be released in 2008.

Every grantee is required to have or establish a quality management
program to assess and improve the quality of the services delivered
under the Ryan White HIV/AIDS Program. It should systematically measure
achievement of program objectives and impact of the program and track
work plan activities and accomplishments. Current QM practices note
improved outcomes where a senior leader is involved in QM. HRSA/HAB
expects grantees to demonstrate real involvement from senior leadership.

For all subcontractors and vendors a mechanism must be in place to
ensure care and services meet HHS guidelines (available at
[http://www.aidsinfo.nih.gov/](http://www.aidsinfo.nih.gov/ )[)]{.underline},
standards of care or best practices, as applicable, based on services
funded.

As part of an internal quality management program, a Continuous Quality
Improvement (CQI) Program could also be established that incorporates
continuous review of internally selected performance indicators of
administrative and training related processes and activities. Applicants
may wish to expand their knowledge of QM and CQI programs. The following
sites can provide entry points:

**HRSA/HAB Quality Manual:**

> http://hab.hrsa.gov/tools/QM/index.htm

**HRSA/HAB Quality Tools:**

> http://hab.hrsa.gov/special/qualitycare.htm

**The National Quality Center:**
http://www.ihi.org/IHI/Topics/HIVAIDS/TheNationalQualityCenterNQC.htm

**HIVQUAL Project:**

> www.hivqual.org

Any effective QM program will be able to document five key
characteristics:

1.  **Use a systematic process.** The process should include clearly
    identified leadership and accountability, and allocate sufficient
    dedicated resources to support the activities.

2.  **Establish benchmarks.** Data and measurable outcomes should be
    used to determine progress toward relevant, evidence-based
    benchmarks.

3.  **Be focused.** Linkages, efficiencies, and provider and client
    expectations should be a primary focus for addressing outcome
    improvement.

4.  **Be adaptable**. The process should be continuous, adaptive to
    change and able to fit within the framework of other programmatic
    quality assurance and quality improvement activities, (i.e. JCAHO,
    Medicaid and other HRSA programs).

5.  **Result in improved outcomes.** Data collected should be fed back
    into the quality management process to assure that goals are
    accomplished and improved outcomes are realized.

    []{#__RefHeading___Toc197395134 .anchor}**II. Award Information**

    []{#__RefHeading___Toc197395135 .anchor}**1. Type of Award**

Funding will be provided in the form of a grant.

[]{.mark}

[]{#__RefHeading___Toc197395136 .anchor}**2. Summary of Funding**

[]{.mark}

Approximately **\$2,935,220** is expected to be available to fund
**seven** grantees. Successful applicants will receive a grant for up to
five years, beginning January 1, 2009 or April 1, 2009**.** Applicants
should apply for a five-year project period. The budget requested is not
to exceed your award from Fiscal Year 2008 before any carry-over and/or
offset adjustments. The funding level can also be verified by contacting
the Grants Management Specialist identified in your Notice of Grant
Award. Funding beyond the first year is dependent on the availability of
appropriated funds for Part C EIS, satisfactory grantee performance, and
a determination that continued funding is in the best interest of the
Federal government. Ryan White HIV/AIDS Program funds are intended to be
the payer of last resort, and cannot be used to supplement payments for
covered services from other sources such as Medicaid, Medicare, private
insurance, or other grant programs, except for the Indian Health
Service.

[]{#__RefHeading___Toc197395137 .anchor}**III. Eligibility Information**

[]{#__RefHeading___Toc197395138 .anchor}**1. Eligible Applicants**

This competition is open to Part C EIS grantees with project periods
ending December 31, 2008 or March 31, 2009 and new organizations
proposing to replace the current grantee. New organizations must
demonstrate that they will serve the existing patients, populations,
scope of services and service areas currently served by the grantee they
intend to replace. Applicants must identify the grantee they intend to
replace. For information about the current grantees, new organizations
should contact Kathleen Treat, Health Resources and Services
Administration, HIV AIDS Bureau, Division of Community Based Programs,
5600 Fishers Lane, Suite 7A-30, Rockville, MD, 20857, phone (301)
443-7602, email
[kathleen.treat@hrsa.hhs.gov](mailto:jose.morales@hrsa.hhs.gov). A list
of service areas for current EIS grantees with project periods ending
December 31, 2008 and March 31, 2009 is included in Appendix E.

Eligible applicants must be public or private non-profit entities. These
include, but are not limited to:

-   Federally qualified health centers as described in Title XIX,
    Section 1905 of the Social Security Act

-   Family planning agencies under Section 1001 of the PHS Act, other
    than States

-   Comprehensive Hemophilia Diagnostic and Treatment Centers

-   Rural Health Clinics

-   Health facilities operated by or under contract with the Indian
    Health Service

-   Community-based organizations, clinics, hospitals, and other health
    facilities that provide early intervention services to those persons
    infected with HIV/AIDS through intravenous drug use

-   Nonprofit private entities that currently provide comprehensive
    primary care services to populations at risk of HIV/AIDS, including
    faith-based and community-based organizations

Faith-based and community-based organizations are eligible to apply. All
applicants, including current grantees, must document Medicaid provider
status. Applicants may document formal agreements with Medicaid
providers for provision of all services covered under the Medicaid State
plan. This requirement may be waived for free clinics that do not impose
a charge for health services and do not accept reimbursement from
Medicaid, Medicare or private insurance. All applicants, including
current grantees, must document that they are fully licensed to provide
clinical services as required by their State and/or local jurisdiction.
Medicaid provider status and licensure must be in place prior to
submitting an application. Applicants must make reasonable efforts to
participate in the Part B consortium if one exists for their geographic
service area.

[]{#__RefHeading___Toc197395139 .anchor}**2. Cost Sharing/Matching**

No cost sharing or matching funds are required for this Grant.

[]{#__RefHeading___Toc197395140 .anchor}**3. Other**

Any application that fails to satisfy the deadline requirements
referenced in *Section IV.3* will be considered non-responsive and will
not be considered for funding under this announcement.

## Maintenance of Effort

Grant funds shall not be used to take the place of current funding for
activities described in the application. Grantee must agree to maintain
non-Federal funding for grant activities at a level that is not less
than expenditures for such activities during the fiscal year prior to
receiving this grant. This means that you must spend at least as much of
your own funds on HIV care as you did last year.

[]{#__RefHeading___Toc197395142 .anchor}**IV. Application and Submission
Information**

[]{#Application_materials .anchor}

1.  **Address to Request Application Package**

    []{#__RefHeading___Toc197395144 .anchor}**Application Materials**

> The application and submission process has changed significantly. HRSA
> is ***requiring*** applicants for this funding opportunity to apply
> electronically through Grants.gov. All applicants ***must*** submit in
> this manner unless the applicant is granted a written exemption from
> this requirement in advance by the Director of HRSA's Division of
> Grants Policy. Grantees must request an exemption in writing from
> <DGPWaivers@hrsa.gov>, and provide details as to why they are
> technologically unable to submit electronically though the Grants.gov
> portal. Make sure you specify the announcement number for which you
> are seeking relief. As indicated in this guidance, **HRSA and its
> Grants Application Center (GAC) will only accept paper applications
> from applicants that received prior written approval.**
>
> Refer to Appendix A for detailed application and submission
> instructions. Pay particular attention to Section 3, which provides
> detailed information on the competitive application and submission
> process.
>
> Applicants must submit proposals according to the instructions in
> Appendix A, using this guidance in conjunction with Public Health
> Service (PHS) Application Form 5161-1. These forms contain additional
> general information and instructions for grant applications, proposal
> narratives, and budgets. These forms may be obtained from the
> following sites by:

[]{.mark}

(1) Downloading from <http://www.hrsa.gov/grants/forms.htm>

> Or

\(2\) Contacting the HRSA Grants Application Center at:

> The Legin Group, Inc.
>
> 910 Clopper Road
>
> Suite 155 South
>
> Gaithersburg, MD 20878
>
> Telephone: 877-477-2123
>
> <HRSAGAC@hrsa.gov>
>
> []{.mark}
>
> Instructions for preparing portions of the application that must
> accompany Application Form 5161-1 appear in the "Application Format"
> section below.

[]{#__RefHeading___Toc197395145 .anchor}**2. Content and Form of
Application Submission**

[]{#Application_formatrequirements .anchor}**Application Format
Requirements**

> See Appendix A, Section 4 for detailed application submission
> instructions. These instructions must be followed.
>
> The total size of all uploaded files **may not exceed the equivalent
> of 80 pages when printed by HRSA, approximately 10 MB.** **This
> 80-page limit includes the abstract, project and budget narratives,
> attachments, and letters of commitment and support.** Standard forms
> are NOT included in the page limit.
>
> **Applications that exceed the specified limits (approximately 10 MB,
> or that exceed 80 pages when printed by HRSA) will be deemed
> non-compliant. All non-compliant applications will be returned to the
> applicant without further consideration.**
>
> **Application Format**
>
> Applications for funding must consist of the following documents in
> the following order:
>
> []{.mark}

# SF 424 Non Construction -- Table of Contents

-   It is mandatory to follow the instructions provided in this section
    to ensure that your application can be printed efficiently and
    consistently for review.

-   Failure to follow the instructions may make your application
    non-compliant. Non-compliant applications will not be given any
    consideration and those particular applicants will be notified.

-   For electronic submissions, applicants only have to number the
    electronic attachment pages sequentially, resetting the numbering
    for each attachment, i.e., start at page 1 for each attachment. Do
    not attempt to number standard OMB approved form pages.

-   For electronic submissions no table of contents is required for the
    entire application. HRSA will construct an electronic table of
    contents in the order specified.

-   When providing any electronic attachment with several pages, add
    table of content page specific to the attachment. Such page will not
    be counted towards the page limit.

-   For paper submissions (when allowed), number each section
    sequentially, resetting the page number for each section. i.e.,
    start at page 1 for each section. Do not attempt to number standard
    OMB approved form pages.

-   For paper submissions ensure that the order of the forms and
    attachments is as specified below.

  ------------------------------------------------------------------------------
  **Application       **Form       **Instruction**          **HRSA/Program
  Section**           Type**                                Guidelines**
  ------------------- ------------ ------------------------ --------------------
  Application for     Form         Pages 1, 2 & 3 of the    Not counted in the
  Federal Assistance               SF-424 face page.        page limit
  (SF-424)                                                  

  Project             Attachment   Can be uploaded on page  Required attachment.
  Summary/Abstract                 2 of SF-424 - Box 15     Counted in the page
                                                            limit. Refer
                                                            guidance for
                                                            detailed
                                                            instructions.
                                                            Provide table of
                                                            contents specific to
                                                            this document only
                                                            as the first page

  Additional          Attachment   Can be uploaded on page  As applicable to
  Congressional                    2 of SF 424 - Box 16     HRSA; not counted in
  District                                                  the page limit

  HHS Checklist Form  Form         Pages 1 & 2 of the HHS   Not counted in the
  PHS-5161                         checklist.               page limit

  Project Narrative   Form         Supports the upload of   Not counted in the
  Attachment Form                  Project Narrative        page limit
                                   document                 

  Project Narrative   Attachment   Can be uploaded in       Required attachment.
                                   Project Narrative        Counted in the page
                                   Attachment form.         limit. Refer
                                                            guidance for
                                                            detailed
                                                            instructions.
                                                            Provide table of
                                                            contents specific to
                                                            this document only
                                                            as the first page

  SF-424A Budget      Form         Page 1 & 2 to supports   Not counted in the
  Information -                    structured budget for    page limit
  Non-Construction                 the request of Non       
  Programs                         construction related     
                                   funds                    

  SF-424B             Form         Supports assurances for  Not counted in the
  Assurances -                     non construction         page limit
  Non-Construction                 programs                 
  Programs                                                  

  Disclosure of       Form         Supports structured data Not counted in the
  Lobbying Activities              for lobbying activities. page limit
  (SF-LLL)                                                  

  Other Attachments   Form         Supports up to 15        Not counted in the
  Form                             numbered attachments.    page limit
                                   This form only contains  
                                   the attachment list      

  Attachment 1-15     Attachment   Can be uploaded in Other Refer to the
                                   Attachments form 1-15    attachment table
                                                            provided below for
                                                            **specific**
                                                            sequence. Counted in
                                                            the page limit
  ------------------------------------------------------------------------------

-   To ensure that attachments are organized and printed in a consistent
    manner, follow the order provided below. Note that these
    instructions may vary across programs.

-   Evidence of Non Profit status and invention related documents, if
    applicable, must be provided in the other attachment form.

-   Additional supporting documents, if applicable, can be provided
    using the available rows. Do not use the rows assigned to a specific
    purpose in the program guidance.

-   Merge similar documents into a single document. Where several pages
    are expected in the attachment, ensure that you place a table of
    content cover page specific to the attachment. Table of content page
    will not be counted in the page limit.

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Position Descriptions for Key Personnel/Positions.
                      .

  Attachment 2        Biographical Sketches of Key Personnel

  Attachment 3        Documentation of Medicaid provider status and
                      Licensure

  Attachment 4        Map of Service Area

  Attachment 5        Letter from Part A and/or Part B

  Attachment 6        If applicable, Letter from Part B

  Attachment 7        List of signed Contracts and Memoranda of
                      Agreement/Understanding

  Attachment 8        Progress Report on Work Plan

  Attachment 9        Project Organizational Chart

  Attachment 10       If applicable, latest negotiated indirect cost
                      agreement

  Attachment 11       If applicable, funding preference request.

  Attachment 12       Optional

  Attachment 13       Optional

  Attachment 14       Optional

  Attachment 15       Optional
  -----------------------------------------------------------------------

> Note the following specific information related to your submission.

**Application Format**

i.  []{#__RefHeading___Toc197395149 .anchor}***Application Face Page***

> Use Public Health Service (PHS) Application Form 5161-1, provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance, the Catalog of Federal Domestic
> Assistance Number is 93.*918*.
>
> **Item 2 Type of Application**
>
> Current grantees should check "Continuation." New applicants for
> existing service areas should check "New."
>
> **Item 4 Applicant Identifier**
>
> Enter Not Applicable.
>
> **Item 5a Federal Entity Identifier**
>
> Enter Not Applicable.
>
> **Item 5b Federal Award Identifier**
>
> If you are a current grantee, enter your most recent 10-digit grant
> number from item 4a of your most recent Notice of Grant Award. If you
> are not the current grantee of record, please leave this item blank.
>
> **Item 8c DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm> or call 1-866-705-5711.
> Please include the DUNS number in item 8c on the application face
> page. Applications ***will not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization is required to register with
> the Federal Government's Central Contractor Registry (CCR) in order to
> do electronic business with the Federal Government. Information about
> registering with the CCR can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm>.
>
> **Item 14 Areas Affected by Project**
>
> **Important:** Enter all counties in your service area.
>
> **Item 19** Some states require that you submit a copy of your Federal
> grant applications to a Single Point of Contact (SPOC) at the state
> government level. If your state participates in the SPOC review
> process, enter the date you sent the copy of your Ryan White HIV/AIDS
> Program grant application to the SPOC office. A list of states and
> territories that currently participate in the SPOC review process can
> be downloaded from the internet at:
> <http://www.whitehouse.gov/omb/grants/spoc.html>.

ii. []{#__RefHeading___Toc197395150 .anchor}***Table of Contents***

> The application should be presented in the order of the Table of
> Contents provided earlier. Again, for electronic applications no table
> of contents is necessary as it will be generated by the system. (Note:
> the Table of Contents will not be counted in the page limit).

iii. []{#__RefHeading___Toc197395151 .anchor}***Application Checklist
     (Grants.gov)***

> Use PHS Application Form 5161-1, provided with the application
> package.

iv. []{#__RefHeading___Toc197395152 .anchor}***Budget***

> For current grantees, the budget requested is not to exceed your award
> from FY 2008 before any carry-over and/or offset adjustments. The Ryan
> White HIV/AIDS Program has established specific legislative criteria
> for the expenditure of funds for Part C. After reserving funds for
> administration and clinical quality management, **at least 75
> percent** of the remaining funds must be spent on Core Medical
> Services, which includes the Early Intervention Services (EIS). At
> least 50 percent of the total funds awarded must be spent on Early
> Intervention Services. No more than 10 percent of the funds awarded
> may be spent on administrative costs, including indirect costs. It is
> a program expectation that no more than 5 percent of the grant will be
> spent on clinical quality management, consistent with Parts A and B.
> The remainder of the funds may be spent on support services, defined
> as those services needed for individuals with HIV/AIDS to achieve
> their medical outcomes. Please note that HAB is seeking approval from
> OMB for allocation reports and expenditure reports for all Parts of
> the Ryan White HIV/AIDS Program. All grant funds must be accounted for
> in these reports, should these reports be approved. For further
> information, please see the reports section later in this guidance.
>
> Core Medical Services are defined as:
>
> A. Outpatient and ambulatory health services
>
> B. AIDS Drug Assistance Program treatments (ADAP) under Part B
>
> C. AIDS pharmaceutical assistance
>
> D. Oral Health Care
>
> E. Early intervention services
>
> F. Health insurance premium and cost sharing assistance for low-income
> individuals in accordance with Part B
>
> G. Home health care
>
> H. Medical nutrition therapy
>
> I. Hospice Services
>
> J. Home and community-based health services as defined under Part B
>
> K. Mental Health Services
>
> L. Substance abuse outpatient care
>
> M. Medical case management, including treatment adherence services
>
> Applicants may apply for a **waiver of the Core Medical Services
> requirement** in accordance with the information published by HRSA in
> the Federal Register Notice, Vol. 72, No. 126, dated July 2, 2007. The
> OMB number for a Core Medical Services waiver request under the
> emergency process is 0915-0307.
>
> The Part C Program now divides the allowable costs among five Part C
> Cost Categories. These categories are **Early Intervention Services
> Costs, Core Medical Services Costs, Support Services Costs, Quality
> Management Costs, and Administrative Costs**. The Early Intervention
> Services Costs are repeated in the Core Medical Services Costs column
> because all Early Intervention Services are part of the Core Medical
> Services. The Total Column should include only Core Medical Services,
> Support Services, Clinical Quality Management, and Administration.
> ***Please note: if you use a spreadsheet for your line item budget,
> use only the top worksheet.***
>
> **[Early Intervention Services Costs]{.underline}** are those costs
> associated with the direct provision of medical care. In accordance
> with current legislation, early intervention services costs must be at
> least 50 percent of your entire Federal Part C EIS budget. You are
> encouraged to propose a percentage greater than 50 percent. Early
> intervention services costs include:

-   Salaried personnel, contracted personnel or visit fees associated
    with the provision of primary medical care, laboratory testing, oral
    health care, outpatient mental health and substance abuse treatment,
    specialty and subspecialty care, referrals for health and support
    services and adherence monitoring/ education services. Types of
    providers typically included under early intervention services are
    physicians, mid-level providers, nurses, pharmacists, dentists,
    dental hygienists, lab technicians, medical assistants, intake
    receptionists, nutritionists, mental health/substance abuse service
    professionals, referral coordinators, medical case managers,
    specialists and sub-specialists.

-   Lab, x-ray, and other diagnostic tests

-   Medical/dental equipment and supplies

-   Medical Case Management, to assist people to access care and remain
    in care, including eligibility assistance for Medicaid and
    pharmaceutical assistance programs

-   Electronic Medical Records

-   Patient education, in conjunction with medical care

-   Transportation for clinical care provider staff to provide care

-   Other clinical and diagnostic services regarding HIV/AIDS and
    periodic medical evaluations of individuals with HIV/AIDS

    **[Core Medical Services Costs]{.underline}** include those listed
    above plus the following:

-   HIV Counseling

-   The following core medical services have historically been paid by
    Parts A or B (Titles I or II) but not Part C (Title III), and should
    only be provided by Part C with justification.

-   AIDS Drug Assistance Program treatments

-   Health Insurance Premium and cost sharing assistance for low income
    individuals

-   Home health care

-   Hospice Services

-   Home and community-based health services as defined under Part B

    **[Clinical Quality Management Costs]{.underline}** are those costs
    required to maintain a clinical quality management program.
    Consistent with Parts A and B, it is a program expectation that no
    more than 5 percent of the grant be spent on Clinical Quality
    Management- additional expenditures must be justified. Examples
    include:

-   Continuous Quality Improvement (CQI) activities

-   Clinical Quality management coordination

-   Data collection for clinical quality management purposes

-   Consumer involvement to improve services

-   Staff training/technical assistance (including travel and
    registration) to improve services- this includes the annual clinical
    update and the biennial All Grantee Meeting

-   Participation in Statewide Coordinated Statement of Need process and
    local planning bodies and other local meetings

    **[Support Services Costs]{.underline}** are those costs for
    services that are needed for individuals with HIV/AIDS to achieve
    their medical outcomes. Support Services Costs include:

-   Patient transportation to medical appointments

-   Outreach to identify people with HIV, or at-risk of contracting HIV,
    to educate them about the benefits of early intervention and link
    them into primary care

-   Local travel by staff to provide support services

-   Translation services, including interpretation services for deaf
    persons

-   Patient education materials for general use

-   Patient advocates to maintain access to care

-   Respite Care (historically paid by Parts A or B (Titles I or II) but
    not Part C (Title III), and should only be provided by Part C with
    justification)

    **[Administrative Costs]{.underline}** are those not directly
    associated with service provision. By law, no more than 10 percent
    of your Federal Part C EIS budget can be allocated to administrative
    costs. Staff activities that are administrative in nature should be
    allocated to administrative costs. Examples of administrative costs
    include:

-   Indirect Costs, which are allowed only if the applicant has a
    negotiated indirect cost rate approved by a recognized Federal
    agency. A copy of the latest negotiated cost agreement that covers
    the period for which funds are requested must be submitted as
    Attachment 5 of the application. Indirect costs are those costs
    incurred by the organization that are not readily identifiable with
    a particular project or program, but are considered necessary to the
    operation of the organization and performance of its programs. All
    indirect costs are considered administrative for the Part C EIS
    program and therefore are subject to the 10 percent limitation on
    administrative expense

-   Rent, utilities, and other facility support costs

-   Personnel costs and fringe benefits of staff members responsible for
    the management of the project (such as the Project Director and
    program coordinator), non-CQI program evaluation, non-CQI data
    collection/reporting, supervision, and other administrative, fiscal,
    or clerical duties

-   Telecommunications, including telephone, fax, pager and internet
    access

-   Postage

-   Liability insurance

-   Office supplies

-   Audits

-   Payroll/Accounting services

-   Computer hardware/software not directly related to patient care

-   Program evaluation, including data collection for evaluation

    ***Part C EIS funds [cannot]{.underline} be used to pay for
    inpatient services, residential treatment, clinical research,
    nursing home care, needle exchange services, cash payments to
    clients, or purchasing or improving real property.***

    The budget period is for ONE year, from January 1, 2009- December
    31, 2009 or April 1, 2009- March 31, 2010.

> The Part C EIS Budget is composed of the following: (1) Standard Form
> 424A for Non-Construction Programs, (2) the Line-Item Budget, (3) the
> Budget Narrative (also called the Budget Justification), and (4) the
> Staffing Plan. These items should include your requested Federal Part
> C EIS funds only. Other funding sources for your HIV program (such as
> in-kind resources, private donations, other grant funds, etc.) should
> be described in the section titled "Current and Projected Sources of
> Funding." You will use the SF424A from the PHS Application form 5161-1
> and submit it with the line item budget, budget narrative, and
> staffing plan documents through the EHBs.

(1) **Standard Form 424A** - Use PHS Application Form 5161-1, provided
    with the application package. On the Standard Form 424A for
    Non-Construction Programs, please complete Sections A, B, E and F.
    The CFDA Number should read 93.918. Only Part C EIS Federal
    resources proposed to support the Part C EIS program should be
    included on this form. Selected portions of the instructions are
    highlighted below to help you complete the form.

-   SF 424A, Section A, Budget Summary, Line 1: title Line 1 "Core
    Medical Services" in column (a) and include the CFDA number 93.918
    in column (b). In columns (e) and (g) include the Part C EIS project
    costs for core medical services, including the EIS costs. This must
    represent at least 75 percent of the budget after reserving funds
    for CQM and administration; applicants are encouraged to propose a
    higher level than the minimum requirement. Do not include CQM,
    support services, or administrative costs. Columns c, d and f should
    be left blank.

-   SF 424 A, Section A, Budget Summary, Line 2: title Line 2 "Support
    Services." In columns (e) and (g) include the Part C EIS support
    services costs for the project.

-   SF 424 A, Section A, Budget Summary, Line 3: title Line 3 "Clinical
    Quality Management." In columns (e) and (g) include the Part C EIS
    clinical quality management costs for the project.

-   SF 424 A, Section A, Budget Summary, Line 4: title Line 4
    "Administrative." In columns (e) and (g) include the Part C EIS
    administrative costs. This must include all indirect costs. Not more
    than 10 percent, including planning and evaluation of the approved
    Federal grant funds, may be used for administrative costs. This
    limitation is statutorily imposed per Section 2664 (g)(3). Cell 3e
    must not exceed 10 percent of the total Part C EIS funds requested.

-   SF 424A, Section B, Budget Categories, Column 1: title Column 1
    "Core Medical Services." Represent all costs associated with the
    provision of core medical services by the identified object class
    categories. The total amount should equal that listed in Section A,
    Cell 1g.

-   SF 424A, Section B, Budget Categories, Column 2: title Column 2
    "Support Services." Present the total of support services costs by
    the identified object class categories. The total amount should
    equal that listed in Section A, Cell 2g.

-   SF 424A, Section B, Budget Categories, Column 3: title Column 3
    "Clinical Quality Management." Present the total clinical quality
    management by the identified object class categories. The total
    amount should equal that listed in Section A, Cell 3g.

-   SF 424A, Section B, Budget Categories, Column 4: title Column 4
    "Administrative." Present the total administrative costs by the
    identified object class categories. The total amount should equal
    that listed in Section A, Cell 3g

-   SF 424A, Section B, Budget Categories, Column 5: present the total
    Part C EIS costs of the project. The total amount, Cell 5k, should
    equal that listed in Section A, Cell 5g.

-   SF 424A, Section B, Budget Categories, Line 7: for the purposes of
    this budget, leave this section blank.

-   SF 424A, Section C, Non-Federal Resources: leave blank.

-   SF 424A, Section D, Forecasted Cash Needs: leave blank.

-   SF 424A, Section E, Budget Estimates of Federal Funds: project the
    budget estimates for project years 2 through 5 in cells 16(b)
    through 16(e), respectively.

-   SF 424A, Section F, Other Budget Information, Line 21: a separate
    line item budget is required to further delineate the Object Class
    Categories, therefore, Line 21 does not need to be completed.

-   SF 424A, Section F, Other Budget Information, Line 22: leave blank

-   **Line-Item Budget** -- The line-item budget should list costs
    separately for each line item. Personnel should be listed separately
    and include names. Include in the personnel section staff who manage
    the grant and monitor contractors' use of funds, provision of
    services, quality and data submission, whether or not the staff are
    paid for by grant funds. It is recommended that you present your
    line item budget in table format, listing the program category costs
    (Early Intervention Services, Core Medical Services, Support
    Services, Clinical Quality Management, and Administration Costs)
    across the top and object class categories (Personnel, Fringe
    Benefits, etc) in a column down the left hand side. Since EIS must
    be 50% of the award, but is also part of core medical services, the
    EIS costs must be repeated in the Core Medical Services Column. The
    amount requested on the SF424A and the amount listed on the
    line-item budget should match. Reminder- for current grantees, the
    budget requested is not to exceed your award from FY 2008 before any
    carry-over and/or offset adjustments.

Your [budget period is for one year]{.underline} while your project
period may be up to five years. Your budget should be realistic, well
justified and relate to the needs identified throughout your
application. Awards, on a competitive basis, will be for a one-year
budget period, although project periods may be granted for up to five
years. Applications for continuation grants funded under these awards
beyond the one-year budget period but within the project period will be
considered in subsequent years on a noncompetitive basis, subject to
availability of funds, satisfactory progress of the grantee and a
determination that continued funding would be in the best interest of
the Federal Government.

v.  []{#__RefHeading___Toc197395154 .anchor}***Budget Justification***

Provide a justification that explains the amounts requested for each
item in the line-item budget according to appropriate Part C EIS budget
categories, Early Intervention Services, Core Medical Services Costs,
Support Services Costs, Clinical Quality Management Costs, and
Administrative Costs. **The budget narrative should clearly describe
each cost element, describe how each item will support achievement of
proposed objectives, and detail why each item is critical to the mission
of your program**. Be very careful about showing how each item in the
"other" category is justified. The budget narrative MUST be concise. Do
NOT use this section to expand the project narrative.

Explain how you estimate or calculate each proposed line-item amount by
providing a calculation that contains the estimated cost per unit and
the estimated number of units. For example, if your budget includes a
\$30,000 line-item for lab tests, justify the expense with an
explanation in your Budget Justification as follows: "25 viral load
tests at \$100.00 each per month x 12 months = \$30,000."

Include the following in the Budget Justification narrative:

-   **Personnel:** For each position, provide the total annual salary,
    the Part C EIS full time employee (FTE) allocation, and briefly
    describe the major job responsibilities. Provide the names of each
    person or indicate if the position is vacant. All Personnel should
    be allocated based on primary care, other program or administrative
    costs. Contracted personnel should be listed under the appropriate
    contractual budget object class category below. Be sure to include
    staff who manage the grant and monitor contractors' use of funds,
    provision of services, quality and data submission, whether or not
    the staff are paid for by grant funds.

-   **Fringe Benefits:** Itemize the components that comprise the fringe
    benefit rate, e.g., health insurance, FICA, SUTA, life insurance,
    retirement plan, and tuition reimbursement. The fringe benefits
    should be directly proportional to that portion of personnel costs
    that are primary care, other program, or administrative costs.
    Provide a clear justification if the expenses are not proportionally
    allocated.

-   **Equipment:** Itemize equipment costs and provide justification for
    the need of the equipment to carry out the program's goals. All
    equipment should be allocated based on primary care, other program,
    or administrative costs.

-   **Travel:** Itemize travel costs according to local and long
    distance travel. International travel (including Canada and Mexico)
    is not an allowable expense. For local travel, the mileage rate,
    number of miles, reason for travel and staff member completing the
    travel should be outlined. For long distance travel, the number of
    trips, number of travelers, costs and staff members completing the
    travel should be outlined. **Grantees are expected to include in
    their budgets travel expenses for up to three (3) persons to attend
    the Ryan White HIV/AIDS Program All-Grantee Meeting. Grantees also
    are expected to send one clinical care provider to the Annual HIV
    Clinical Update Meeting. As described above, clinical staff travel
    to provide care is included in EIS, while patient transportation is
    included in support services. All other travel is included in CQM.**

-   **Supplies:** Categorize supplies according to type: medical or
    office. Explain how the amounts were developed. For example,
    "Medical supplies are based on 3,600 encounters at \$2.50 per
    encounter for a total of \$9,000." Supplies should be allocated
    based on EIS, core medical services, support services, CQM or
    administrative costs.

-   **Contractual:** Categorize all contract costs according to type,
    e.g., medical referral, lab referral, translation services,
    management consultant. In the budget narrative, clearly explain the
    purpose of the contract, itemize each subcontract and demonstrate
    how the amounts were developed. All contractual items should be
    allocated based on primary care, other program, or administrative
    costs.

-   **Other:** Itemize all costs in this category and explain in
    sufficient detail to enable HAB to determine if each cost is
    allowable. In most cases, pharmaceuticals, legal fees, insurance,
    membership dues, continuing education/conference fees and audit
    related costs would fall under this category.

> **Indirect Costs:** **You may include indirect costs in this
> application if you have an approved indirect cost rate for costs other
> than research or instruction. The maximum indirect cost rate allowable
> under this program is 10% due to the legislative limitation on
> administrative costs**. Indirect costs are those costs incurred for
> common or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. For institutions subject to Office of Management and Budget
> (OMB) Circular A-21, the term "facilities and administration" is used
> to denote indirect costs. *If an organization applying for an
> assistance award does not have an indirect cost rate, the applicant
> may wish to obtain one through HHS's Division of Cost Allocation
> (DCA).  Visit DCA's website at: 
> [http://rates.psc.gov](http://rates.psc.gov/)/ to learn more about
> rate agreements, the process for applying for them, and the regional
> offices which negotiate them.*

vi. []{#__RefHeading___Toc197395155 .anchor}***Staffing Plan and
    Personnel Requirements***

> *This section is submitted with the budget documents and counts toward
> the page limit. This section is scored in Criterion 5:
> Resources/Capabilities* Applicants must present a staffing plan for
> the entire program. Provide a justification for the plan that includes
> education and experience qualifications and rationale for the amount
> of time being requested under the grant for each staff position. Note
> the source of funding for positions not funded under the grant. You
> may find it helpful to supply this information in a table.
> Specifically describe the experience and expertise of your clinical
> care staff. Include a description of the staff's knowledge of the
> community and the clients, their commitment to clinical outcomes,
> cultural competence, and evaluation capabilities. Position
> descriptions that include the roles, responsibilities, and
> qualifications of proposed **key** project staff must be included in
> **Attachment 1**. Copies of brief biographical sketches for any key
> employed personnel that will be assigned to work on the proposed
> project must be included in **Attachment 2***.* The biographical
> sketches are brief narratives of each **key** employee including their
> background and role in the proposed project, regardless of payment
> through this grant. Key staff include at a minimum the program
> coordinator and medical director for your program. The program
> coordinator is responsible for the oversight and day to day management
> of the proposed Part C EIS Program and the medical director assumes
> responsibility for all clinical aspects of the grant.

-   Specifically identify the person in your staffing plan who will lead
    the QM activities for this grant. This person may or may not be
    supported by the grant funds.

-   Specifically identify staff who manage the grant and monitor
    contractors' use of funds, provision of services, quality and data
    submission, whether or not the staff are paid for by grant funds.

vii\. **Assurances and Certifications**

Review the assurances listed and select "I Agree" to certify that the
assurances and certifications have been read and that the applicant
agrees to comply with the requirements of form SF 424B and the
Additional Assurances listed in Appendix C upon award of funds. If you
have received prior written approval to submit a paper application, you
will need to sign the Additional Agreements, Assurances and
Certifications and include it in your application. It will not count
toward the page limit.

**Disclosure of Lobbying Activities**

If "Yes" for lobbying activities was selected in the certifications
section, then the Disclosure of Lobbying Activities must be completed.

***Medicaid and Licensure***

> In **Attachment 3**, include documentation of your Medicaid provider
> number and clinic licensure (where applicable). If the grantee of
> record does not provide primary care, please include the Medicaid
> provider number for sub-contractor(s)/primary care provider(s). If
> clinic licensure is not required in your jurisdiction, describe how
> that can be confirmed in State regulation or other information. This
> information is required each year. **Documentation of this information
> should be in the form of a table that identifies all providers'
> Medicaid number and clinic licensure status, if applicable. Official
> documentation may be required prior to an award being made or in the
> post-award period.**

[]{#__RefHeading___Toc197395157 .anchor}***viii. Project Abstract***

Your project abstract should be attached to item 15 of the SF 424
submitted through Grants.gov. Provide a 1-2 page summary of the
application. Because the abstract is often distributed to provide
information to the public and Congress, please prepare this so that it
is clear, accurate, concise, and without reference to other parts of the
application. It may be helpful to prepare your abstract after the rest
of the application has been written because most of the information
required in this section can be taken from other sections of the
completed application.

> **Please place the following at the top of the abstract:**

-   Project Title (FY 2009 Part C EIS)

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-mail Address

-   Web Site Address, if applicable.

The Project Abstract must have the following five subheadings:

> **1. Summary of Request:** A short statement briefly describing the
> requested services and specific sites where they will be provided. If
> you are new applicant, identify the grantee listed in Appendix F that
> you intend to replace. Indicate whether you are applying for part or
> all of your funding to be considered under the MAI. Indicate whether
> you are requesting funding preferences and/or funding special
> considerations as described in the Review and Selection Process
> Section of this guidance.
>
> **2. Target Population(s):** A brief description of the geographic
> area to be served by the proposed project, including demographic
> characteristics of the target population(s) affected by HIV in that
> specific area.
>
> **3. Current HIV Service Activities:** A description of the HIV
> services currently available in your service area. Also list those HIV
> services that are provided specifically by your organization. Include
> the number of clients who received primary medical care from your
> program in each of the last three calendar years. For current
> grantees, this information should come from Section 6.1 of your Annual
> Data Reports.
>
> **4. Problem:** A summary of the principal problems and unmet needs of
> people living with HIV in your service area that will be addressed if
> the proposed project is funded.
>
> **5. Goals and Objectives:** A presentation of the major goals and
> objectives for the project period as described in your Work Plan.

[]{#Format_ProgramNarrative .anchor}***ix. Narrative***

> The "Program Narrative" provides a comprehensive framework and
> description of all aspects of the proposed program. It should be
> succinct, self-explanatory and well organized so reviewers can
> understand the proposed project.
>
> Use the following section headers for the Narrative:

-   INTRODUCTION

-   NEEDS ASSESSMENT

-   METHODOLOGY

-   WORK PLAN

-   RESOLUTION OF CHALLENGES

-   EVALUATION AND TECHNICAL SUPPORT

-   ORGANIZATIONAL INFORMATION

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-   ***Introduction***

> This section should briefly describe the problem and the associated
> factors contributing to it. You may wish to expand on information
> presented in the "Problem" section of the abstract. If you are new
> applicant, identify the grantee listed in Appendix F that you intend
> to replace. Indicate whether you are requesting funding preference
> and/or funding special consideration as described in the Review and
> Selection Process Section of this guidance.

[]{.mark}

-   ***NEEDS ASSESSMENT***

> *This section is scored under Criterion 1: Need.* This section
> outlines the needs of your community. The four (4) required components
> of this section are:

(1) HIV Seroprevalence and Surrogate Markers.

(2) Target Populations.

(3) The Social Context of HIV/AIDS.

(4) The Local HIV Service Delivery System and describe changes to that
    system.

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1.  **HIV Seroprevalence and Surrogate Markers:** The Ryan White
    HIV/AIDS Program gives preference to applicants that make services
    available in geographic areas that have experienced an increase in
    the burden of providing services for people living with HIV for the
    past two years. Use this section to provide and discuss data on the
    incidence and prevalence of HIV and AIDS in your area. Request
    information on AIDS incidence, AIDS prevalence and HIV prevalence,
    and unmet need from your State grantee of record for Part B, and
    from your Eligible Metropolitan Area (EMA) or Transitional Grant
    Area (TGA) grantee of record for Part A, if applicable.

> In this section, you should discuss the epidemic in your service area
> as compared to State or EMA data. Discuss the similarities,
> differences and trends noted in such areas as race, ethnicity, gender,
> and exposure category. Discuss whether Part A or B estimates of unmet
> need of people who know they are HIV positive but are not in care
> apply to your service area. You may also discuss the rates of diseases
> such as syphilis, gonorrhea, tuberculosis, Hepatitis C, and substance
> abuse that indicate a prevalence of high risk behaviors associated
> with HIV transmission. Show the impact of the HIV epidemic in your
> area by answering these questions:

-   How many people are newly reported with AIDS and how many are living
    with HIV and AIDS for each of the past three years? Include
    **2004,** **2005 and 2006** if that information is available in your
    area. You may also use **2007** data if available.

-   What is the estimated rate of increase or decrease in the number of
    reported HIV or AIDS cases for this period? Highlight any new groups
    that show a rapid growth in HIV or AIDS cases.

    You may find other measures that show the impact on your community.
    Use data from a reliable source in this section of the application
    and clearly identify the source(s) for that data (e.g., the State
    Department of Health or the Centers for Disease Control and
    Prevention).

    **2. Target Populations:** Clearly identify the populations that
    your organization will serve. It is important that you compare the
    populations you serve or propose to serve to the general population
    in your area. Specifically address the communities of color you
    serve or propose to target. Include statistics on persons most
    affected by the epidemic in your area, such as persons of color,
    women, and adolescents, as well as characteristics such as the
    general and adolescent pregnancy rate in the area. To the extent
    possible, your presentation of the target population(s) should
    include the distribution by race/ethnicity, gender, age, and mode of
    HIV transmission for both your organization and for the proposed
    service area. Be sure to indicate the date and source for the data
    you provide. Identify trends that have occurred over the last three
    years as your organization has confronted increases or decreases
    among specific groups (e.g., a 10 percent increase in the number of
    women seeking services.)

    **3. The Social Context of HIV/AIDS:** Describe and discuss the
    social and economic characteristics of the community you propose to
    serve. Discuss the community infrastructure for primary health care
    services in general; including community health centers and other
    publicly funded entities. Focus your discussion on how these
    conditions have an impact on the provision of HIV services in your
    geographical area. If the information is available, you may compare
    characteristics of the general population with the characteristics
    of HIV+ persons in the community. Examples of questions you may
    address include:

-   What percentage of the population is African American, Hispanic,
    Native American, and/or Asian American/Pacific Islander?

-   What percentage of the population is homeless?

-   What percentage of the population use drugs?

-   What percentage of the population is single head-of-household?

-   What percentage of the population is unemployed?

-   What percentage of the population is adolescent (ages 13-24)?

-   What percentage of the population is uninsured?

-   What percentage of the population live below the FPL?

    The statistics that you include must be specific to the area from
    which the majority of the proposed clients will be drawn. Statistics
    from your State or larger area within your State may be cited for
    purposes of comparison or contrast. You also may include a
    description of other relevant characteristics of the target
    populations that affect their access to primary care. These factors
    may include primary language, citizenship status, education (e.g.,
    high school graduation rate for the area), and access to
    transportation.

    **4. The Local HIV Service Delivery System and recent changes:** In
    this section you must show what HIV primary care services are
    currently available in your service area. Refer to a map of your
    service area that shows the locations of local providers of primary
    health care in your area, and include this map as **Attachment 5**
    of your application.

    Your presentation of the local HIV service delivery system should
    cover three broad areas:

    1\) the HIV service providers in your area, including your own
    organization, and the specific services they provide; 2) public
    funding for those services; and 3) the gaps in services in your
    area, particularly those that affect the populations that you have
    targeted.

    -   HIV service providers in your area, including your program: List
        the public and private organizations that provide HIV services
        in your area, the specific services each one provides, and, if
        possible, the number of unduplicated clients/patients each one
        serves annually. You may be able to find specific information
        through the HHS web site Tracking Accountability in Government
        Grants System, <http://taggs.hhs.gov/> and the HAB Web site at
        <http://hab.hrsa.gov/>.

    -   Public funding in support of HIV services in your area: Identify
        all Federal, State, and local funding sources for HIV prevention
        and care in the proposed service area. Include providers funded
        by the CDC, NIH, and SAMHSA. A flow chart can be very helpful in
        showing how these entities work together, but is not required.

    -   Gaps in local services and barriers to care: Describe current
        gaps in HIV early intervention services in the area. Identify
        those populations that are not being served, and describe the
        barriers that prevent them from receiving the services they
        need. If cultural/linguistic or gender gaps in services exist in
        your community, describe how you plan to address these gaps.

    -   Describe the need for HIV-related health services by individuals
        with HIV disease who are aware of their HIV status, but are not
        receiving primary medical care in your service area.

    -   Describe changes in the health care delivery system that affect
        your delivery of HIV primary care services, e.g., managed care,
        Medicaid, Medicare, availability of ADAP funding.

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-   ***Methodology***

    *Sections 1-6 and the Work Plan are scored under Criterion 2:
    Response. Section 7 is scored under Criterion 4: Impact.* Use this
    section to describe your organization's scope of work for each of
    the services as described. The minimal information you should
    provide in each of these sections is described below. A complete
    description of Program Requirements and Expectations is included in
    Appendix D. You may provide additional information that will help
    reviewers to understand how your services are delivered and the
    policies and procedures that ensure that your program maintains
    professional standards of care.

1.  **HIV Counseling, Testing, Referral, Partner Counseling, and Linking
    to Care**

-   Describe the counseling, testing and referral services that are or
    will be available through the proposed program and through other
    organizations in the community.

-   Describe the steps taken to ensure the confidentiality or anonymity
    of clients and test results.

-   Describe protocols for routine testing of women according to CDC
    guidelines and for counseling HIV infected pregnant women and women
    of childbearing age about the use of antiretroviral therapy to
    reduce perinatal HIV transmission.

-   Describe how clients who test HIV-positive receive facilitated and
    timely referrals to primary care and other services.

-   Describe policies and procedures for partner counseling services.

-   Describe special efforts over the most recent project period to
    increase enrollment in your services by persons most affected by the
    epidemic such as persons/communities of color, women and
    adolescents. For new applicants, describe your efforts over the past
    three years.

2.  **Medical Evaluation and Clinical Care**

-   Describe the proposed diagnostic and therapeutic measures that are
    available for preventing and treating the deterioration of the
    immune system and related conditions. Include periodic medical
    evaluations, appropriate treatment of HIV infection, prophylactic
    and treatment interventions for complications of HIV infection,
    including opportunistic infections, opportunistic malignancies and
    other AIDS defining conditions.

-   Describe plans for handling referrals to and enrollment in clinical
    trials offered through biomedical research facilities or community
    based organizations that conduct experimental treatments for HIV
    disease.

-   Describe the on-site or contract laboratory that you plan to use to
    support CD4, viral load, and other tests. Discuss the availability
    of State laboratory reimbursement (Part B) programs.

-   Discuss the availability of your State(s) AIDS Drug Assistance
    Program or other locally available pharmacy assistance programs.

-   Describe plans for staff training related to HIV primary care.
    Describe training available through your area's AIDS Education and
    Training Centers (AETC) and the training received by your staff.

-   Describe how consumers are or will be involved in decisions
    regarding their personal health care regimens.

-   Describe the policy/procedure for after-hours and weekend coverage
    for urgent or emergency medical and dental care needs.

-   If you are a new organization applying to replace an existing
    grantee, describe in detail how your organization will improve
    services to the existing patients, population and service area of
    the existing grantee. In addition, describe how you will transition
    services from the existing grantee to your organization. Describe
    the activities, time frames, and efforts to coordinate the
    transition of services in a way that does not disrupt or impede the
    delivery of Part C EIS services to the existing patient population.

3.  **Other Core Medical Services**

-   Describe how oral health care (diagnostic, preventive, and
    therapeutic services) will be provided to patients with HIV
    infection.

-   Describe how adherence education will be provided.

-   Describe how outpatient mental health treatment services will be
    provided.

-   Describe how substance abuse treatment services will be provided.

-   Describe how nutritional services will be provided.

-   Describe how palliative care and other end of life support will be
    provided.

-   Describe how you incorporate HIV prevention into medical care for
    persons living with HIV, including screening patients for behavioral
    risk, offering behavioral interventions, and providing partner
    counseling and referral services.

4.  **Referral System**

-   Describe how referrals to specialty and subspecialty medical care
    and other health and social services will be provided.

-   Discuss formal mechanisms for facilitating and tracking referrals.

-   Describe how coordination with admission/emergency room staff and
    discharge planners will occur during inpatient hospital visits.

5.  **Other Services**

-   Describe specific outreach efforts for targeted communities of color
    you serve or propose to serve.

-   Describe how your clients will have access to case management
    services.

-   Describe how your program will assist clients in determining their
    eligibility for financial support and services under Federal, State
    or local programs providing health services, mental health services,
    social services or other appropriate services.

6.  **MAI**

[]{.mark}

If you are an existing grantee, note how much MAI funding your program
received on the FY 2008 NGA. All applicants should note the racial and
ethnic minority groups specifically served by its organization. If your
program serves one particular minority population because of geography,
you must still answer the questions below. Please do not use this
section for any additional demographic information about the communities
your program serves. Provide that in the need assessment.

If your award for FY 2008 lists MAI funds, or if you target minority
populations, your application must include a description of the MAI
population(s) served by your program. For each target population, you
must describe briefly these items:

-   The specific ethnic or minority group your program serves.

-   Outreach efforts of your program to recruit infected members of that
    group.

-   How you identify infected persons who are members of that group.

-   How you enroll these persons in care after you have identified them
    as infected.

-   How you retain these persons in care after they are enrolled.

Also, provide the following data for each ethnic or minority group:

-   Number enrolled in care at the beginning of the budget year.

-   Number newly identified during the budget year.

-   Number newly enrolled during the budget year.

-   Number enrolled at the end of the budget year.

7.  **Coordination and Linkages with Other HIV Programs**

    *This section is scored in Criterion 4: Impact.* Describe your
    participation, coordination and/or linkage(s) with other publicly
    funded HIV care and prevention programs in your proposed service
    area. Address the following questions.

    **Part A:** If your program is in a Part A EMA or TGA, describe the
    level of Part A funds utilized in your community for core medical
    services and support services that are proposed in this application.
    If your organization receives Part A funding:

-   Identify the amount of funding you receive for each Part A service
    category.

-   Describe how the services proposed in this application are
    consistent with, but not duplicative of services supported by Part
    A.

-   Include in **Attachment 6** of your application a letter from the
    Part A Grantee of Record that documents your organization's
    involvement with Part A and in the Ryan White HIV/AIDS Program HIV
    Planning Council, if applicable. The letter must also address why
    Part C EIS funds are necessary to address the needs described in
    your application. If you cannot obtain this letter, explain why.
    Information about Part A is found at
    <http://hab.hrsa.gov/treatmentmodernization/parta.htm>[.]{.underline}

    **Part B:** Identify the amount of funding you receive for each Part
    B service category. If your program is located in a State/territory
    that has created a Part B HIV Care Consortium, use this section to:

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-   Describe the Part B consortium's service plan.

-   Include in **Attachment 6 or 7** a letter from the Part B Grantee of
    Record documenting your organization's involvement in Consortium
    activities. This letter must also explain why Part C EIS funds are
    needed to address the needs described in your application. If you
    cannot obtain a letter, explain why. Information about Part B is
    found at
    [**http://hab.hrsa.gov/treatmentmodernization/partb.htm**](http://hab.hrsa.gov/treatmentmodernization/partb.htm)

    **Part C EIS:** If your program is located near other Part C EIS
    funded programs, explain how your program does not duplicate
    services provided in your proposed service area and target
    population. If there are other Part C EIS supported programs in your
    area, including capacity building grants, identify those
    organizations, and describe the mechanisms in place for
    collaborating with them, sharing resources, and ensuring against
    duplication of services.

    **Other Ryan White HIV/AIDS Program funded providers in your area:**
    Describe your organization's participation, coordination and/or
    linkage with Part D; Part F Dental Reimbursement Program, Community
    Based Dental Partnership, or Special Projects of National
    Significance, if any exist in your area; and the nearest AIDS
    Education and Training Center.

    **HIV prevention activities in your area:** Describe your
    organization's collaboration with ongoing HIV prevention activities
    in your area and how HIV-positive individuals are referred to HIV
    primary care services. Describe the availability, accessibility, and
    your program's coordination/linkage with the CDC-funded HIV
    counseling, testing, referral, and prevention programs. Please
    include information on TB and STI control programs. Describe your
    program's collaboration with other organizations involved in
    prevention for those already HIV positive.

    **Other federally funded services in your area:** Describe your
    organization's collaboration with primary health care services, if
    any exist in your area, including publicly-funded Community Health
    Centers, mental health and substance abuse treatment programs
    including those funded by SAMHSA, and research programs including
    those funded by NIH.

    Because of space limitations, it is not necessary to include
    memoranda of agreement or understanding or contracts with other
    organizations in the application. Instead in **Attachment 8**,
    include a list of those organizations with which you have signed
    agreements with a brief description of what activities are covered.
    HAB may request copies of those agreements and/or contracts as part
    of post-award administration.

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-   ***Work Plan***

The Work Plan delineates your steps to implement and evaluate your HIV
primary care program. The Work Plan should address any needs previously
identified in your needs assessment. If you do not address a certain
need, explain why in the relevant section of your application. ***Please
note: if you use a spreadsheet for your work plan, use only the top
worksheet. Additional worksheets may not print, and may not be seen by
the reviewers.***

The Work Plan must be written for your [entire]{.underline} outpatient
HIV Primary Care Program (regardless of funding stream) and must include
goals for your entire proposed project period. Work Plan **objectives**
should be written for one year. Your Work Plan should be a tool that
will help you actively manage your program by measuring progress,
identifying necessary changes, and quantifying your accomplishments. It
will also be used by HRSA/HAB to monitor your progress.

The Work Plan must be written to include problem statements, goals,
objectives, action steps, person responsible for each step, and
evaluation methods. Grantees will revise and update the Work Plan in
their non-competing continuation applications, which are due before the
end of each budget period. Information in the Work Plan may be used as
part of the Office of Performance Review site visit reviews as
performance measures.

Note the funding source for activities in the work plan that are not
funded under the Part C budget.

**Work Plan Objectives:**

The Work Plan should cover four major areas, as well as any other goals
and objectives that will guide you in implementing your HIV Primary Care
Program. These areas are:

-   Access To Care, which should include Counseling and Testing
    activities; linkage and referral with other programs which do
    Counseling and Testing; Outreach to bring people into care; and the
    number of new patients to be provided primary HIV medical care
    services for each year of the grant. Applicants serving or targeting
    communities of color should include one or more goals and objectives
    relating to reaching and serving these communities.

-   Comprehensive, Coordinated Primary HIV Medical Care, which shall
    include the total number of patients to be provided primary HIV
    medical care services for each year of the grant. It should address
    the full range of services which should be provided under the
    program expectations, including frequency of visits, laboratory
    testing, adherence education, oral health care, nutrition services,
    outpatient substance abuse treatment and outpatient mental health
    treatment, Hepatitis B and C screening, treatment, and education.

-   Implementation of a Quality Management Program, such as a Continuous
    Quality Improvement Program. It should include specifics on what
    indicators you will be looking at and what improvement you expect.
    You are encouraged to use indicators of health outcomes as well as
    process indicators.

-   The planning and implementation of Consumer Involvement Activities,
    as described in the program expectations.

**Making Your Work Plan Specific, Time-Framed, and Measurable:**

Your Work Plan objectives must be specific, time-framed and measurable.
Information is provided below about how to write a Problem Statement,
Goal, Objective, Action Step, Person Responsible, and Evaluation Method
that may assist you in writing your Work Plan.

a)  **The Problem Statement (also called the Statement of Need)** helps
    you design your Goals and Objectives. Relate these to the mission of
    your organization and to the goals of the Part C EIS Program.

b)  **Goals** are generally broad statements, which describe the
    long-term benefits you seek.

c)  **Objectives** should identify your target population(s), state what
    will change, how much change will occur and by when. The objective
    should lead to measurable outcomes that will make it easy for you to
    report on progress made. If you use either numbers or percentages in
    your objectives, be clear about where you are starting from (the
    baseline number).

> Are your Objectives realistic? Give yourself a target you can reach.
> Do not commit to an objective that is out of reach. For example, can
> you really achieve 100 percent compliance with TB testing? Remember
> that objectives should contain "action verbs" such as the following
> phrases: "to enroll..."; "to provide..."; and "to reduce." Keep your
> objectives simple and obtainable, in accordance with the program
> expectations.

d)  **Action Steps** describe the specific activities undertaken to
    accomplish your Objectives. Action Steps should flow logically from
    your Problem Statement, Goal and Objectives. They should clearly
    describe your program activities as well as the sequence of
    activities, and they should be reasonable. Remember to build in
    start-up time for new initiatives. How long does it really take to
    recruit and hire someone in your system?

e)  **Person Responsible:** Specify the individual(s) responsible for
    accomplishing each action step by what date.

f)  **Evaluation Method:** The purpose of evaluation is to measure the
    results of your program. Evaluation is also a tool that provides
    information and feedback so that you can make appropriate
    adjustments to your program during the project period. Effective
    evaluation methods will help your organization determine the extent
    to which your objectives have been accomplished as well as the
    extent to which this is attributable to your program or
    intervention. Your Evaluation Method is how you will measure whether
    or not a particular Objective has been achieved.

> []{.mark}

-   ***Resolution of Challenges***

    *This section is scored in Criterion 5: Resources/Capabilities.*
    Discuss challenges that are likely to be encountered in designing
    and implementing the activities described in the Work Plan, and
    approaches that will be used to resolve such challenges. New
    applicants should describe total number and number of new clients
    receiving primary medical care each year for the past three years,
    including demographics such as gender, race/ethnicity, age and
    exposure category.

> **Progress Report (Current Grantees Only):** Any information included
> in the progress report which is vital to the proposed program for the
> next project period should be repeated in the appropriate section. The
> progress report should highlight the major accomplishments achieved
> during the prior project period. It should include narrative
> information as well as progress toward meeting work plan goals and
> objectives (which may be included as a chart as Attachment 8). Address
> each of the following:

-   Indicate the level of Part C EIS funding received in each year of
    the most recent project period. If the project was approved for less
    than three years, explain why.

-   Provide the total number, number of new, and demographics (e.g.,
    race/ethnicity, age, gender, exposure category, and insurance
    status) of clients served in each year of the most recent project
    period, and the current year to date. Use information from the
    Program Data Report and other program data to describe the number
    and type of clients served by each type of service (i.e.,
    counseling/testing/referral, primary medical care, dental care,
    outreach, case management). The total number testing positive and
    overall seroprevalence for counseling/testing should be included.
    These numbers are usually more clearly presented in a chart or
    table.

-   Describe the average cost of care per patient for each service
    category: outpatient medical care, oral health, outpatient mental
    health treatment, outpatient substance abuse treatment, nutritional
    services and specialty care.

-   Summarize the major accomplishments for the project period,
    including program expansion activities, and describe the degree to
    which the objectives were achieved. List the service objectives from
    the most recent work plan and indicate progress made on each
    objective over each year of the last project period, including the
    current year to date. Use numbers of clients and services as well as
    percentages. (Progress toward meeting the work plan may be submitted
    as a chart).

-   Describe the factors that facilitated and hindered implementation of
    any of your project's goals, objectives and activities. Describe
    specific actions taken to overcome any barriers.

-   Indicate whether one or more Part C EIS-specific site visits
    occurred during the most recent project period. Indicate whether a
    site visit through the Office of Performance Review occurred during
    the most recent project period. For ALL site visits list the major
    program deficiencies cited and performance areas cited and describe
    actions taken to correct deficiencies.

-   Indicate whether you have received separate technical assistance
    from HAB. Describe the focus of the technical assistance. What has
    changed as a result of the technical assistance?

> []{.mark}

-   ***Evaluation and Technical Support Capacity***

    This section is scored in Criterion 3: Evaluative Measures and
    Criterion 4: Impact. In this section, you will describe your
    evaluation activities including quality management, as well as the
    information systems that support those activities.

**Quality Management**

-   Describe the composition of the staff who participate in quality
    improvement/management activities.

-   Describe the formalized mechanisms used by your program to implement
    quality improvement (e.g., QM committee, how often they meet,
    meeting minutes).

-   Describe the indicators established, or tracked or to be established
    in measuring the success of your program.

-   Describe the strategy used to collect data, including how data are
    collected, what data are collected, and results. This is focused on
    your currently identified needs. HRSA/HAB will identify measures in
    the near future that will be required.

-   Describe the process and time frames used to provide feedback,
    implement changes within your program.

-   Describe the specific activities implemented among Service/Provider
    Organizations to assess the existence and outcomes of their quality
    management programs.

-   Describe the role of consumers in the Quality Management program,

-   Describe the impact of your program (i.e. populations served,
    community) in terms of how successful you have been.

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-   Discuss how your Quality Management program has worked to improve
    the care or services your program provides:

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-   Discuss how an item or measure was identified as needing
    improvement.

-   What process did you use to analyze the cause of this situation?

-   What process did you use to design an intervention?

-   How did you test the intervention?

-   What did you measure to demonstrate change? Was there a change? Do
    you consider this an improvement?

-   What were your next steps?

-   Did you re-measure this? If you did, what did it show?

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-   Outline the program's evaluation strategy that is used to measure
    achievement of program objectives and impact of the program.

**Information Systems**

Discuss your current information system and its capacity to manage and
report the required administrative and clinical data noted below:

-   The number of individuals provided early intervention
    services/primary care, counseling and testing, outreach, and case
    management services.

-   Demographic data on the clients receiving services, in total and for
    special funding initiatives.

-   Epidemiologic data on the population receiving services, including
    the extent of new TB infections, active cases, and MDR-TB.

-   Exposure and diagnostic categories on the population receiving
    services.

-   The number of HIV infected individuals and the CDC classification of
    their disease.

-   The extent to which the costs of HIV‑related health care are paid by
    third party payers.

-   The average costs of providing each category of early intervention
    service/primary care as described above.

[]{.mark}

-   ***Organizational Information***

    *This section is scored in Criterion 5: Resources/Capabilities* In
    this section, describe your organization's capacity and expertise to
    provide primary care by describing your administrative, fiscal, and
    clinical operations. At minimum, you should provide the following
    information:

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-   The mission of your organization. How does a Part C EIS project fit
    within the scope of this mission?

-   The structure of your organization. Include in **Attachment 10** an
    Organizational Chart that clearly shows how your program is divided
    into departments, the professional staff positions that administer
    those departments, and the reporting relationships.

-   Your organization's experience providing HIV primary care services.
    Include primary medical and specialty care, mental health care,
    substance abuse services, and psychosocial support services. Also
    describe your organization's ability to respond to emerging
    populations with HIV.

-   What systems are in place to ensure that the most recent HHS
    Guidelines, HIV/AIDS clinical standards and protocols are being
    followed?

-   Your organization's experience with the fiscal management of grants
    and contracts. What kind of accounting system is in place? What
    internal systems are used to monitor grant expenditures? How will
    your organization manage and monitor subcontractor performance and
    compliance with Part C EIS requirements?

-   Consumer involvement. Describe how consumers have been involved in
    the planning, implementation and evaluation activities of your
    program over the most recent project period and indicate the number
    of consumers involved. How will consumers be meaningfully and
    routinely involved in the future in your HIV primary care program?

-   Your knowledge of and ability to implement culturally and
    linguistically appropriate services.

-   The status of the implementation of managed care contracts for
    persons with HIV.

-   The discounted fee schedule that is being used, and how it is
    implemented.

-   The annual cap on patient charges related to HIV services and how it
    is monitored.

-   How program income is collected, tracked and used to support your
    HIV program.

-   In-kind, private donations, or other grant funds that will be used
    to support your HIV program.

-   Your organization's participation or intent to participate in the
    340B Drug Pricing Program. If your organization purchases or
    reimburses for outpatient drugs, an assessment must be made to
    determine whether the organization's drug acquisition practices meet
    Federal requirements regarding cost-effectiveness and reasonableness
    (see 42 CFR Part 50, Subpart E, and OMB Circulars A-Section 340B of
    the Public Health Service Act and the assessment shows that
    participating in the 340B Drug Pricing Program and its Prime Vendor
    Program is the most economical and reasonable manner of purchasing
    or reimbursing for covered outpatient drugs (as defined in section
    340B), failure to participate may result in a negative audit
    finding, cost disallowance or grant funding offset.

-   If you are a new organization proposing to replace a current
    grantee, describe your plan to provide services to the existing
    patients, population, scope of services, and service area that that
    grantee currently serves. Provide a detailed plan for transition of
    services from the existing grantee to your organization. This plan
    should outline specific activities, timelines, and coordination
    strategies to minimize any potential disruption of service
    provision.

[]{.mark}

[]{.mark}

***x. Attachments***

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative. Be
> sure each attachment is clearly labeled. **Attachments must include**:

[]{.mark}

1)  **Attachment1**: Job Descriptions for Key Personnel

> Keep each to one page in length as much as is possible. Item 6 in the
> Program Narrative section of the PHS 5161-1 Form provides some
> guidance on items to include in a job description.

[]{.mark}

2)  **Attachment 2**: Biographical Sketches of Key Personnel

> Include biographical sketches for persons occupying the key positions
> described in Attachment 1, not to exceed two pages in length. In the
> event that a biographical sketch is included for an identified
> individual who is not yet hired, please include a letter of commitment
> from that person with the biographical sketch.

[]{.mark}

3)  **Attachment 3**: Documentation of Medicaid provider status and
    applicable facility licensure to provide clinical services.
    Documentation for this application should be in the form of a table
    that identifies all providers' Medicaid number and clinic licensure
    status, if applicable. Official documentation may be required prior
    to an award being made or in the post-award period.

4)  **Attachment4**: Map of Service Area, showing location of other HIV
    service providers

5)  **Attachments 5/6**: Letters from Part A and/or Part B.

6)  **Attachment 7**: List all provider organizations who have signed
    major contracts and/or memoranda of agreement, with a brief
    description of the covered activities.

7)  **Attachment 8**: Progress report on work plan goals and objectives,
    if applicable.

8)  **Attachment 9**: An organizational chart

9)  **Attachment 10**: If applicable, copy of negotiated indirect cost
    rate agreement.

10) **Attachment 11**: If applicable, funding preference request. (Refer
    to section V.2 for further information.)

11) **Attachments 12-15**: Optional attachments submitted by applicant.
    Please note that they count toward the page limit.

> **If you wish to include additional letters of support, include only
> those which specifically indicate a commitment to the project/program
> (e.g., in-kind services, dollars, staff, space, equipment). Letters of
> agreements and support must be dated. List all other support letters
> on one page.**

[]{#Format_Appendices .anchor}**3. Submission Dates and Times**

**Application Due Date**

> The due date for applications under this grant announcement is ***July
> 1, 2008 at 8:00 P.M. ET***. Applications will be considered as meeting
> the deadline if they are E-marked on or before the due date. Please
> consult Appendix A, Section 3 for detailed instructions on submission
> requirements.
>
> The Chief Grants Management Officer (CGMO) or a higher level designee
> may authorize an extension of published deadlines when justified by
> circumstances such as acts of God (e.g. floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> Applications must be submitted by 8:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you register immediately in Grants.gov (see
> Appendix B) and complete the forms as soon as possible, as this is a
> new process and may take some time.**
>
> **Please refer to Appendix B for important specific information on
> registering, and Appendix A, Section 3 for important information on
> applying through Grants.gov.**
>
> **Late applications:**
>
> Applications which do not meet the criteria above are considered late
> applications. HRSA shall notify each late applicant that its
> application will not be considered in the current competition.

**4. Intergovernmental Review**

> The EIS Program is a program subject to the provisions of Executive
> Order 12372, as implemented by 45 CFR 100. Executive Order 12372
> allows States the option of setting up a system for reviewing
> applications from within their States for assistance under certain
> Federal programs. Application packages made available under this
> guidance will contain a listing of States which have chosen to set up
> such a review system, and will provide a State Single Point of Contact
> (SPOC) for the review. Information on States affected by this program
> and State Points of Contact may also be obtained from the Grants
> Management Officer listed in the Agency Contact(s) section, as well as
> from the following Web site:
> <http://www.whitehouse.gov/omb/grants/spoc.html>.
>
> All applicants other than federally recognized Native American Tribal
> Groups should contact their SPOC as early as possible to alert them to
> the prospective applications and receive any necessary instructions on
> the State process used under this Executive Order.
>
> Letters from the State Single Point of Contact (SPOC) in response to
> Executive Order 12372 are due sixty days after the application due
> date.

[]{#__RefHeading___Toc197395162 .anchor}**5. Funding Restrictions**

Awards to support projects are always contingent upon Congressional
appropriation, satisfactory progress in meeting the project's
objectives, and a determination that continued funding would be in the
best interest of the government.

-   Part C EIS funds [cannot]{.underline} be used to pay for inpatient
    services, hospice, residential treatment, clinical research, nursing
    home care, needle exchange services, cash payments to clients, or
    purchasing or improving real property. Funds awarded under this
    announcement may not be used for the following purposes: research,
    fundraising expenses, lobbying activities and expenses, pre-award
    costs, foreign travel, or construction, unless it is minor
    alterations to an existing facility, to make it more suitable for
    the purposes of the grant program. In such case, prior authorization
    must be sought. Other non-allowable costs can be found in the Cost
    Principles located at
    <http://www.hhs.gov/grantsnet/lawsregs/index.htm>.

-   No more than 10%, including planning and evaluation of the grant,
    may be expended for administrative expenses.

-   At least 50% of the grant must be expended for EIS Services

-   At least 75% of the grant, after reserving funds for clinical
    quality management and administration, must be expended for Core
    Medical Services.

-   It is a program expectation that no more than 5 % of the grant will
    be spent on clinical quality management, consistent with Parts A and
    B.

[]{.mark}

[]{.mark}

[]{#__RefHeading___Toc197395163 .anchor}**6. Other Submission
Requirements**

> As stated in Section IV.1, except in rare cases HRSA will no longer
> accept applications for grant opportunities in paper form. Applicants
> submitting for this funding opportunity are ***required*** to submit
> ***electronically*** through Grants.gov. To submit an application
> electronically, please use the
> [http://www.Grants.gov](http://www.Grants.gov/) Web site. When using
> Grants.gov you will be able to download a copy of the application
> package, complete it off-line, and then upload and submit the
> application via Grants.gov.
>
> As soon as you read this, whether you plan on applying for a HRSA
> grant later this month or later this year, it is incumbent that your
> organization ***immediately register*** in Grants.gov and become
> familiar with the Grants.gov site application process. If you do not
> complete the registration process you will be unable to submit an
> application. The registration process can take up to one month, so you
> need to begin immediately.
>
> To be able to successfully register in Grants.gov, it is necessary
> that you complete all of the following required actions:
>
> • Obtain an organizational Data Universal Number System (DUNS) number.
>
> • Register the organization with Central Contractor Registry (CCR).
>
> • Identify the organization's E-Business POC (Point of Contact).
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password.
>
> • Register an Authorized Organization Representative (AOR).
>
> • Obtain a username and password from the Grants.gov Credential
> Provider.
>
> Instructions on how to register, tutorials and FAQs are available on
> the Grants.gov Web site at www.grants.gov. Assistance is also
> available from the Grants.gov help desk at support@grants.gov or by
> phone at 1-800-518-4726.
>
> More specific information, including step-by-step instructions on
> registering and applying, can be found in Appendix B of this guidance.
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA
> through Grants.gov.
>
> Applications will be considered as having met the deadline if the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time.
>
> **It is incumbent on applicants to ensure that the Authorizing
> Official (AO) is available to submit the application to HRSA by the
> application due date. We will [not]{.underline} accept submission or
> re-submission of incomplete, rejected, or otherwise delayed
> applications after the deadline.**
>
> **Again, please understand that we will not consider additional
> information and/or materials submitted after your initial application.
> You must therefore ensure that all materials are submitted together.
> Further information on the HRSA electronic submission policy can be
> obtained at <http://www.hrsa.gov/grants/electronicsubmission.htm>.**
>
> []{#__RefHeading___Toc197395164 .anchor}**V. Application Review
> Information**

[]{#Review_ReviewCriteria .anchor}

**1. Review Criteria**

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation. Review criteria are outlined
below with specific detail and scoring points. Funding levels will be
reviewed in reference to level of effort, progress and performance
described in this application. For current Part C EIS grantees, past
performance in meeting legislative requirements and program expectations
will be taken into account regarding continuation of funding and the
level of funding awarded. Omission or misrepresentation of critical
information will be grounds for considering your application ineligible.

Applications will be scored on the basis of 100 points. Points will be
allocated based on the extent to which the proposal addresses each of
the criteria listed below. The Part C Early Intervention Services
Program has six (6) review criteria:

**Criterion 1: Need**

*Weight- 10 points*

*This section corresponds to the Needs Assessment section of the
application.*

1.  Does the applicant document the impact of the HIV epidemic in the
    proposed service area by demonstrating growth in the number of HIV
    and/or AIDS cases and/or surrogate markers?

2.  Does the applicant clearly describe racial and ethnic minority
    communities that they propose to serve? Does the applicant document
    the effect of the HIV epidemic on the target population(s) in the
    most recent three (3) year period?

3.  Does the applicant provide a comprehensive description of, and
    changes in, the existing HIV service delivery system? Does the
    applicant document the public funding sources for HIV prevention and
    care in the proposed service area? Does the applicant identify gaps
    in service and barriers to care? Does the applicant describe the
    need for HIV-related health services by individuals with HIV disease
    who are aware of their HIV status, but are not receiving primary
    medical care in its service area?

    **Criterion 2: Response**

*Weight: 30 Points*

*This corresponds to the Methodology (Sections 1-6 and the Workplan)
section of the application.*

Overall, does the applicant document the ability of the organization to
provide, internally and/or by referral, the full comprehensive continuum
of HIV care?

1.  Does the applicant fully describe HIV Counseling, Testing, Referral,
    Partner Counseling, and Linking to care?

2.  Does the applicant fully describe the medical evaluation and
    clinical care systems,(such as CD4 monitoring, viral load testing,
    antiretroviral therapy, prophylaxis and treatment of opportunistic
    infections, and malignancies). Does the applicant describe the
    organization's formal arrangements to refer and enroll clients in
    clinical trials? Does the applicant describe other support for
    laboratory and pharmacy services, plans for staff education, and the
    involvement of consumers in decisions regarding their care? Does the
    applicant describe a policy for after-hours and weekend coverage for
    urgent or emergency medical and dental care needs? If a new
    organization applying to replace an existing grantee, does the
    applicant describe how it will improve services to the existing
    patients, population and service area of the existing grantee.

3.  Does the applicant document the availability of core medical
    services, including outpatient oral health, adherence, mental
    health/substance abuse, nutritional services and palliative care.
    Does the applicant describe how HIV prevention services are
    incorporated into medical care?

4.  Does the applicant demonstrate that there are formal systems in
    place that will facilitate referrals of individuals to health and
    support services that are not directly provided by the applicant?
    Does the applicant demonstrate that there are mechanisms in place
    for receiving feedback from the providers of health and support
    services to which patients are referred?

5.  Does the applicant explain how clients will be assisted in
    determining eligibility for financial support and services from
    other publicly funded programs?

6.  Does the applicant describe the racial and ethnic minority groups
    they serve? If the applicant indicates that MAI funding has been
    received, do they describe outreach, enrollment and retention in
    care for targeted groups? Do they describe the numbers enrolled.

7.  If applicant is applying as a new applicant proposing to replace an
    existing grantee, does the applicant describe how clinical services
    will be transitioned with minimal or no disruption of services?

Is the work plan realistic with specific, measurable, and time-framed
goals and objectives?

Does the work plan contain objectives that reflect the comprehensive
continuum of HIV care*?*

If applicable, does the work plan contain objectives specific to the
MAI?

Does the applicant document the ability of the organization to provide,
internally and/or by referral, the full comprehensive continuum of HIV
care? Does the applicant document that there is a staffing plan
appropriate for the provision of early intervention services/primary
care?

**Criterion 3: Evaluative Measures**

*Weight: 15 Points*

*This section corresponds primarily to the Evaluation and Technical
Support Capacity section of the application.*

Does the applicant identify the person who will lead the quality
management activities for the grant? (See section vi. Staffing Plan)

Does the applicant describe the staff who will participate in quality
management/improvement activities? Does it describe the role of
consumers in these activities?

Does the applicant describe the formal mechanisms to implement quality
improvement?

Does the applicant identify what indicators are being measured and the
strategy for collection of data?

Does the applicant describe the process to provide feedback and
implement changes?

Does the applicant describe specific activities to assess the existence
and outcomes of the quality management program?

Does the applicant provide an example of the quality management
program's functioning, from item identification through intervention
design to measurement of outcomes?

Does the applicant describe how the applicant organization will
determine the effectiveness of the quality management activities?

Does the evaluation plan describe the evaluation model that will be used
to assess attainment of program's objectives and to assess the impact of
the program on the communities served?

Does the applicant demonstrate the ability to comply with reporting
requirements of the program?

**Criterion 4: Impact**

*Weight: 5 Points*

*This section corresponds to the overall application, Evaluation and
Technical Support Capacity section (Quality Management) the Methodology
(Section 7) and Attachments sections of the application.*

Overall, what has been the impact of this program on the community and
on people living with HIV in the target area? How successful it has
been? What outcomes do they describe? How has quality management
improved care for people living with HIV?

Does the applicant document linkages, coordination and collaboration
with other programs and providers, such as Part A, Part B, CDC funded
counseling and testing programs, prevention programs, TB and STI control
programs, other Ryan White HIV/AIDS Program funded programs, as well as
Community Health Centers and programs funded by the NIH and SAMHSA

Are letters from Part A and/or Part B included in the attachments (if
applicable) and is a map of the service area included?

**Criterion 5: Resources/Capabilities**

*Weight: 20 Points*

*This section corresponds to the vi. Staffing Plan, Resolution of
Challenges, Organizational Information and Attachments sections of the
application.*

Does the applicant document that there is a staffing plan appropriate
for the provision of early intervention services/primary care? Does the
staffing plan show a reasonable level of time allocated in relation to
the number of patients receiving primary medical care? Does the
applicant fully describe organizational and staff expertise in providing
HIV primary care services? Does the applicant include job descriptions
and biographical sketches of key staff in Attachments 1 and 2?

If a new applicant for an existing service area, does the applicant
demonstrate that a new proposal for an existing service area will serve
the existing patients, populations, scope of services and service areas
currently served by the grantee they intend to replace? Does the
applicant describe challenges anticipated and a plan to meet those
challenges?

If a current grantee, does the applicant demonstrate satisfactory
progress in meeting prior goals and objectives? Has the applicant
successfully implemented a Part C EIS program that meets program
expectations?

If a current grantee, is progress on the most recent work plan
described, either in narrative or in an attached chart?

If a current grantee, does the applicant indicate the level of funding
in each year of the project period?

Does the applicant, whether current or new, describe the total number
and number of new clients receiving primary medical care in each of the
last three years? Are service and demographic information included? Is
the average cost of care for each service category included?

If a current grantee, does the applicant describe any Part C
EIS-specific or OPR site visits during the project period? Are major
program deficiencies, performance areas and corrective actions
described?

Overall, does the applicant demonstrate the organization's ability to
implement the proposed project? Does the applicant describe the mission,
structure and experience which supports the provision of HIV Primary
care services? Does the applicant include an organizational chart in the
attachments?

Does the applicant have systems in place to ensure that the most recent
HIV/AIDS clinical standards and protocols will be followed?

Overall, does the applicant document the organization's fiscal and MIS
capacity to manage this grant, and meet program requirements including a
discounted fee schedule, annual cap on patient charges, collecting,
tracking and using program income to support the HIV program? Are
Medicaid provider numbers included in the attachments? If applicable,
does the applicant demonstrate the ability to manage and monitor
subcontractor performance and compliance with Part C EIS requirements?

Does the applicant describe the level of involvement of consumers in the
development, implementation, and evaluation of the Part C EIS program?

Does the applicant demonstrate knowledge of and ability to implement
culturally and linguistically appropriate services?

**Criterion 6: Support Requested**

*Weight: 20 Points*

*This section corresponds to the budget documents, Progress Report and
the Attachment sections of the application.*

Does the applicant present a budget that is appropriate to the proposed
program plan? If services are included in the program plan but not
included in the budget, does the Work Plan indicate a funding source for
those services?

Does the budget allocate resources to ensure that at least 50 percent of
funds are for the provision of early intervention services as described
in this guidance?

Does the budget allocate resources to ensure that at least 75 percent of
funds are for the provision of core medical services, after funds are
reserved for clinical quality management and administration?

Does the budget adhere to the **10 percent** limit on administrative
costs?

Does the applicant provide a clearly presented budget justification that
fully explains each line item?

**2. Review and Selection Process**

The Division of Independent Review is responsible for managing objective
reviews within HRSA. Applications competing for federal funds receive an
objective and independent review performed by a committee of experts
qualified by training and experience in particular fields or disciplines
related to the program being reviewed. In selecting review committee
members, other factors in addition to training and experience may be
considered to improve the balance of the committee, e.g., geographic
distribution. Each reviewer is screened to avoid conflicts of interest
and is responsible for providing an objective, unbiased evaluation based
on the review criteria noted above. The committee provides expert advice
on the merits of each application to program officials responsible for
final selections for award.

Applications that pass the initial HRSA eligibility screening will be
reviewed and rated by a panel based on the program elements and review
criteria presented in relevant sections of this program announcement.
The review criteria are designed to enable the review panel to assess
the quality of a proposed project and determine the likelihood of its
success.  The criteria are closely related to each other and are
considered as a whole in judging the overall quality of an application.

[]{.mark}

**Funding Preferences**

The Ryan White HIV/AIDS Program provides a funding preference for some
applicants. Applicants receiving the preference will be placed in a more
competitive position among applications that can be funded. Applications
that do not receive a funding preference will be given full and
equitable consideration during the review process. The law provides that
a funding preference be granted to any qualified applicant that
specifically requests the preference and meets the criteria for the
preference as follows:

*Qualification 1: Increased Burden*

An applicant can request a funding preference if they demonstrate an
increase in the burden over the past two years of providing services
regarding HIV disease, as described by AIDS cases, sexually transmitted
diseases, tuberculosis, drug abuse, co-infection with HIV/AIDS and
hepatitis B or C, lack of availability of early intervention services,
lack of primary health providers other than the applicant, and the
distance patients have to travel for care.

*Qualification 2: Rural Areas*

An applicant can request a funding preference if they provide services
in rural areas (outside urbanized areas and urban clusters as described
by the U.S. Census Bureau).

*Qualification 3: Underserved*

An applicant can request a funding preference if they serve areas that
are underserved with respect to early intervention services.

[]{.mark}

[]{.mark}

**VI. Award Administration Information**

**1. Award Notices**

> Each applicant will receive written notification of the outcome of the
> objective review process, including a summary of the expert
> committee's assessment of the application's merits and weaknesses, and
> whether the application was selected for funding. Applicants who are
> selected for funding may be required to respond in a satisfactory
> manner to Conditions placed on their application before funding can
> proceed. Letters of notification do not provide authorization to begin
> performance.
>
> The Notice of Grant Award sets forth the amount of funds granted, the
> terms and conditions of the grant, the effective date of the grant,
> the budget period for which initial support will be given, the
> non-Federal share to be provided (if applicable), and the total
> project period for which support is contemplated. Signed by the Grants
> Management Officer, it is sent to the applicant agency's Authorized
> Representative, and reflects the only authorizing document. It will be
> sent prior to the start date of January 1, 2009 and April 1, 2009.

**2. Administrative and National Policy Requirements**

> Successful applicants must comply with the administrative requirements
> outlined in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92
> (governmental), as appropriate.
>
> HRSA grant awards are subject to the requirements of the HHS Grants
> Policy Statement (HHS GPS) that are applicable to you based on your
> recipient type and the purpose of this award. This includes, as
> applicable, any requirements in Parts I and II of the HHS GPS that
> apply to the award, as well as any requirements of Part IV. The HHS
> GPS is available at <http://www.hrsa.gov/grants/default.htm>. The
> general terms and conditions in the HHS GPS will apply as indicated
> unless there are statutory, regulatory, or award-specific requirements
> to the contrary (as specified in the Notice of Award).
>
> Awards issued under this guidance are subject to the requirements of
> Section 106 (g) of the Trafficking Victims Protection Act of 2000, as
> amended (22 U.S.C. 7104). For the full text of the award term, go to
> <http://www.hrsa.gov/grants/trafficking.htm>. If you are unable to
> access this link, please contact the Grants Management Specialist
> identified in this guidance to obtain a copy of the Term.

**PUBLIC POLICY ISSUANCE**

[]{.mark}

**HEALTHY PEOPLE 2010**

> **Healthy People 2010** is a national initiative led by HHS that sets
> priorities for all HRSA programs. The initiative is designed to
> achieve two overarching goals: (1) Increase Quality and Years of
> Healthy Life; and (2) Eliminate Health Disparities. The program
> consists of 28 focus areas and 467 objectives. HRSA has actively
> participated in the work groups of all the focus areas, and is
> committed to the achievement of the Healthy People 2010 goals.
>
> Applicants must summarize the relationship of their projects and
> identify which of their programs objectives and/or sub-objectives
> relate to the goals of the Healthy People 2010 initiative.
>
> Copies of the Healthy People 2010 may be obtained from the
> Superintendent of Documents or downloaded at the Healthy People 2010
> website: [http://www.health.gov/healthypeople/document]{.underline}/.

[]{.mark}

> The Public Health Service strongly encourages all award recipients to
> provide a smoke-free workplace and to promote the non-use of all
> tobacco products. Further, Public Law 103-227, the Pro-Children Act of
> 1994, prohibits smoking in certain facilities (or in some cases, any
> portion of a facility) in which regular or routine education, library,
> day care, health care or early childhood development services are
> provided to children.

[]{.mark}

**3. Reporting**

> The successful applicant under this guidance must comply with the
> following reporting and review activities:

a.  **Audit Requirements**

> Comply with audit requirements of Office of Management and Budget
> (OMB) Circular A-133. Information on the scope, frequency, and other
> aspects of the audits can be found on the Internet at
> [www.whitehouse.gov/omb/circulars](http://www.whitehouse.gov/omb/circulars).
> Note that Section 501 - General Provisions, requires every grantee to
> submit an audit to its State (or, in the case of a State, to the
> Secretary) every other year; with audits posted on the internet.

b.  **Payment Management Requirements**

> Submit a quarterly electronic PSC-272 via the Payment Management
> System. The report identifies cash expenditures against the authorized
> funds for the grant. Failure to submit the report may result in the
> inability to access grant funds. The PSC-272 Certification page should
> be faxed to the PMS contact at the fax number listed on the 272 form,
> or it may be submitted to the:
>
> Division of Payment Management
>
> HHS/ASAM/PSC/FMS/DPM
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (877) 614-5533;

c.  **Status Reports**

> 1\. Submit a **Financial Status Report**. A financial status report is
> required within 90 days of the end of each grant year. The report is
> an accounting of expenditures under the project that year. More
> specific information will be included in your award notice;
>
> 2\. Submit an aggregate Ryan White HIV/AIDS Program Data Report (RDR)
> via the HRSA Electronic Handbook for each direct service provider
> annually. The RDR is due in March and should report on services
> provided during the previous calendar year.
>
> 3\. Starting in Calendar Year 2009, submit grantee, service provider,
> and client level data on a semi-annual basis (January to June and July
> through December) via the HRSA Electronic Handbook. HAB is seeking OMB
> approval for this process, and information will be published in the
> Federal Register in late Spring, 2008.
>
> 4\. Submit a **noncompeting continuation application** on specified
> dates prior to the end of each budget period prior to the end of the
> project period. The noncompeting continuation application will include
> a progress report, budget for the upcoming budget period, and revised
> work plan.
>
> 5\. HAB is seeking OMB approval for an Allocation Report, to be due 90
> days after the start of the budget period, and an Expenditure Report,
> to be due 90 days after the end of the budget period. These reports
> account for the allocation and then expenditure of all grant funds
> according to the specific core medical services, support services,
> clinical quality management, and administration. Data for these
> reports would be uploaded to a secure HRSA server via the HRSA
> Electronic Handbook. A Federal Register Notice was published on
> October 5, 2007 requesting comment. Further information about these
> reports will be published in the Federal Register.
>
> **d. Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. As part of this agency-wide
> effort , HRSA grantees will be required to participate in an on-site
> performance review of their HRSA funded program(s) by a review team
> from one of the ten OPR regional divisions. Grantees should expect to
> participate in a performance review at some point during their project
> period. When a grantee receives more than one HRSA grant, each of the
> grantee's HRSA funded programs will be reviewed during the same
> performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees will
> be expected to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. In addition, performance reviews also
> provide an opportunity for grantees to offer direct feedback to the
> agency about the impact of HRSA policies on program implementation and
> performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

[]{#__RefHeading___Toc197395172 .anchor}**VII. Agency Contacts**

> Applicants may obtain additional information regarding business,
> administrative, or fiscal issues related to this grant announcement by
> contacting:

Shelia Burks

Grants Management Specialist

Division of Grants Management Operations, HRSA/OFAM

Parklawn Building, Room 11A-02

5600 Fishers Lane

Rockville, Maryland 20857

Telephone: (301) 443-6452

E-mail: Shelia.Burks@hrsa.hhs.gov

Additional information related to overall program issues and technical
assistance may be obtained by contacting your current Part C EIS Project
Officer or:

Kathleen Treat, MSW, MS

Chief, Southern Regional Branch

Division of Community Based Programs

HRSA, HIV/AIDS Bureau

5600 Fishers Lane #7A-30

Rockville, Maryland 20857

Tel. 301 443-7602

Fax 301 443-1839

Email: kathleen.treat@hrsa.hhs.gov

[]{#__RefHeading___Toc197395173 .anchor}**viii. Tips for Writing a
Strong Application**

[]{.mark}

> **Include DUNS Number.** You must include a DUNS Number to have your
> application reviewed. Applications ***will not*** be reviewed without
> a DUNS number. To obtain a DUNS number, access
> [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
> 1-866-705-5711. Please include the DUNS number in item 8c on the
> application face page.
>
> **Keep your audience in mind.** Reviewers will use only the
> information contained in the application to assess the application. Be
> sure the application and responses to the program requirements and
> expectations are complete and clearly written. Do not assume that
> reviewers are familiar with the applicant organization, service area,
> barriers to health care, or health care needs in your community. Keep
> the review criteria in mind when writing the application.
>
> **Start preparing the application early.** Allow plenty of time to
> gather required information from various sources.
>
> **Follow the instructions in this guidance carefully.** Place all
> information in the order requested in the guidance. Avoid the risk of
> having reviewers hunt through your application for information.
>
> **Be brief, concise, and clear.** Make your points understandable.
> Provide accurate and honest information, including candid accounts of
> problems and realistic plans to address them. If any required
> information or data is omitted, explain why. Make sure the information
> provided in each table, chart, attachment, etc., is consistent with
> the proposal narrative and information in other tables. Your budget
> should reflect back to the proposed activities, and all forms should
> be filled in accurately and completely.
>
> **Be organized and logical.** Many applications fail to receive a high
> score because the reviewers cannot follow the thought process of the
> applicant or because parts of the application do not fit together.
>
> **Be careful in the use of attachments.** Do not use the attachments
> for information that is required in the body of the application. Be
> sure to cross-reference all tables and attachments to the appropriate
> text in the application. Be sure to upload the attachments in the
> order indicated in the forms.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> that page limits are followed. Limit the use of abbreviations and
> acronyms, and define each one at its first use and periodically
> throughout application. Make sure you submit your application in final
> form, without markups.
>
> **Print out and carefully review an electronic application to ensure
> accuracy and completion.** When submitting electronically, print out
> the application before submitting it to ensure appropriate formatting
> and adherence to page limit requirements. **Check to ensure that all
> attachments are included before sending the application forward.**
>
> **Ensure that all information is submitted at the same time.** We will
> not consider additional information and/or materials submitted after
> your initial submission, nor will we accept e-mailed applications or
> supplemental materials once your application has been received.

APPENDIX A: HRSA's Electronic Submission User Guide

User Guide Table of Contents

> 1\. INTRODUCTION
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 1.1. DOCUMENT PURPOSE AND
> SCOPE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 1.2. DOCUMENT ORGANIZATION AND VERSION
> CONTROL\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2\. NONCOMPETING CONTINUATION
> APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.1. PROCESS
> OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) (IF NOT ALREADY
> REGISTERED)...................................................................................................\...\...\...\...\...
>
> 2.3. PROJECT DIRECTOR AND AUTHORIZING OFFICIAL NEED TO REGISTER WITH
> HRSA EHBS
>
> (IF NOT ALREADY REGISTERED)
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4. APPLY THROUGH [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4.1 Find Funding
> Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4.2 Download Application Package
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2.4.3 Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.4.4 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.4.5 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.5. VERIFY IN HRSA ELECTRONIC HANDBOOKS
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.5.1 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.5.2 Manage Access to Your Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.5.3 Check Validation
> Errors\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.5.4 Fix Errors and Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.5.5 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 3\. COMPETING
> APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.1. PROCESS
> OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) NOT ALREADY
> REGISTERED)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3. APPLY THROUGH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.1 Find Funding
> Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.2 Download Application
> Package\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.3 Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.4 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.3.5 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4\. GENERAL INSTRUCTIONS FOR APPLICATION
> SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1. NARRATIVE ATTACHMENT
> GUIDELINES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1.1
> Font\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1.2 Paper Size and
> Margins\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.3
> Names\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.4 Section Headings
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.5 Page
> Numbering\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 4.1.6 Allowable Attachment or Document
> Types\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 4.2. APPLICATION CONTENT ORDER (TABLE OF
> CONTENTS)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.3. PAGE
> LIMIT\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.0 CUSTOMER SUPPORT INFORMATION
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.1.1 Grants.gov Customer
> Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.1.2 HRSA Call
> Center\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 5.1.3 HRSA Program
> Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.0
> FAQs\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.1.
> SOFTWARE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.1.1 What are the software requirements for using
> Grants.gov?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.1.2 Why can\'t I download PureEdge Viewer onto my
> machine?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.1.3 I have heard that Grants.gov is not Macintosh compatible. What
> do I do if I use only a
> Macintosh?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> \...\...\...\...\...\...\.....
>
> 6.1.4 What are the software requirements for HRSA
> EHBs?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.1.5 What are the system requirements for using HRSA EHBs on a
> Macintosh computer?\...\...\...\...\...\...\....
>
> 6.2. APPLICATION RECEIPT
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

6.2.1 What will be the receipt date\--the date the application is
stamped as received by Grants.gov

> or the date the data is received by HRSA?
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.2.2 When do I need to submit my application?
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.2.3 What emails can I expect once I submit my application? Is email
> reliable? \...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.2.4 If a resubmission is required because of Grants.gov system
> problems, will these be
>
> considered
> \"late\"?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.3. APPLICATION
> SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....

6.3.1 How can I make sure that my electronic application is presented in
the right order for

> objective
> review?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.4 GRANT.GOV
> HELP\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....

# 

# 1. Introduction

## 1.1 Document Purpose and Scope {#document-purpose-and-scope .unnumbered}

Major changes are coming to HRSA's Grant Application Process. For
guidances released/posted on or after January 1, 2006, HRSA will no
longer accept applications for grant opportunities on paper. Applicants
submitting new and competing continuations and a selected number of
noncompeting continuation applications will be required to submit
electronically through Grants.gov. All applicants must submit in this
manner unless the applicant is granted a written exemption from this
requirement in advance by the Director of HRSA's Division of Grants
Policy.

The purpose of this document is to provide detailed instructions to help
applicants and grantees submit applications electronically to HRSA
through Grants.gov. The document is intended to be the comprehensive
source of all information related to the new processes that HRSA and its
customers have to adopt and will be updated periodically. This document
is not meant to replace program guidance documents for funding
announcements.

## 1.2 Document Organization and Version Control {#document-organization-and-version-control .unnumbered}

This document contains 5 sections apart from the Introduction. Following
is the summary:

  ------------------------------ ----------------------------------------
  **Section**                    **Description**

  Noncompeting Continuation      Provides detailed instructions to
  Application                    existing HRSA grantees for applying
                                 electronically using Grants.gov for all
                                 noncompeting announcements

  Competing Application          Provides detailed instructions to
                                 applicant organizations for applying
                                 electronically using Grants.gov for all
                                 competing announcements

  General Instructions for       Provides instructions and important
  Application Submission         policy guidance on application format
                                 requirements

  Customer Support Information   Provides contact information to address
                                 technical and programmatic questions

  Frequently Asked Questions     Provides answers to frequently asked
  (FAQs)                         questions by various categories
  ------------------------------ ----------------------------------------

This document is under version control. Please visit
<http://www.hrsa.gov/grants> to retrieve the latest published version.

# 2. Noncompeting Continuation Application

## 2.1 Process Overview {#process-overview .unnumbered}

Following is the process for submitting a noncompeting continuation
application through Grants.gov:

1.  HRSA will communicate noncompeting announcement number to the
    project director (PD) and authorizing official (AO) via email. The
    announcement number will be required to search for the announcement
    in Grants.gov.

2.  Search for the announcement in Grants.gov Apply
    (<http://www.grants.gov/Apply>).

3.  Download the application package and instructions from Grants.gov.
    The program guidance is also part of the instructions that must be
    downloaded.

4.  Save a local copy of the application package on your computer and
    complete all the forms based on the

5.  Submit the application package through Grants.gov. (Requires
    registration)

6.  Track the status of your submitted application at Grants.gov until
    you receive a notification from Grants.gov that your application has
    been received by HRSA.

7.  HRSA Electronic Handbooks (EHBs) software pulls the application
    information into EHBs and validates the data against HRSA's business
    rules.

8.  HRSA notifies the project director, authorizing official, business
    official (BO) and application point of contact (POC) by email to
    check HRSA EHBs for results of HRSA validations and enter additional
    information, including in some cases performance measures, necessary
    to process the noncompeting continuation.

9.  AO verifies the application in HRSA EHBs, fixes any validation
    errors, makes necessary corrections and submits the application to
    HRSA. (Requires registration)

## 2.2 Grantee Organization Needs to Register With Grants.gov (if not already registered) -- See Appendix B {#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b .unnumbered}

Grants.gov requires a **one-time** registration by the applicant
organization. This is a three step process and should be completed by
any organization wishing to apply for grant. If you do not complete this
registration process you will not be able to submit an application. The
registration process will require some time (anywhere from 5 business
days to a month). Therefore, applicants or those considering applying at
some point in the future should register immediately. Registration with
Grants.gov provides the individuals from the organization the required
credentials in order to apply.

If an applicant organization has already completed Grants.gov
registration for another Federal agency, this section can be skipped.

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). To be able to
successfully register in Grants.gov, it is necessary that you complete
all of the following required actions:

-   Obtain an organizational Data Universal Number System (DUNS) number

-   Register the organization with Central Contractor Registry (CCR)

-   Identify the organization's E-Business POC (Point of Contact)

-   Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
    password

-   Register an Authorized Organization Representative (AOR)

```{=html}
<!-- -->
```
-   Obtain a username and password from the Grants.gov Credential
    Provider

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

In addition, if an applicant does not have a Taxpayer Identification
Number (TIN) or Employer Identification Number (EIN), allow for extra
time. Beginning Oct. 30, 2005, the CCR also validates the EIN against
Internal Revenue Service records, a step that will take one to two
business days.

Please direct questions regarding Grants.gov registration to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   It is recommended that this registration process be completed at
    least two weeks prior to the submittal date of your organization's
    first Grants.gov submission.

## 2.3 Project Director and Authorizing Official Need to Register with HRSA EHBs (if not already registered) {#project-director-and-authorizing-official-need-to-register-with-hrsa-ehbs-if-not-already-registered .unnumbered}

In order to access your noncompeting continuation application in HRSA
EHBs, existing grantee organizations must register within the EHBs. The
purpose of the registration process is to collect consistent information
from all users, avoid collection of redundant information and allow for
the unique identification of each system user. Note that registration
within HRSA EHBs is required only **once for each user for each
organization they represent.**

Registration within HRSA EHBs is a two-step process. In the first step,
individual users from an organization who participate in the grants
process such as applying for noncompeting continuations must create
**individual** system accounts. In the second step, the users must
associate themselves with the appropriate grantee organization. **To
find your organization record use the 10-digit grant number from the
Notice of Grant Award (NGA) belonging to your grant.** Note that since
all existing grantee organization records already exist within EHBs,
there is no need to create a new one.

To complete the registration quickly and efficiently we recommend that
you have the following information handy:

1.  Identify your role in the grants management process. HRSA EHBs offer
    the following three functional roles for individuals from
    applicant/grantee organizations:

-   Authorizing Official (AO),

-   Business Official (BO), and

-   Other Employee (for project directors, assistant staff, AO designees
    and others).

For more information on functional responsibilities refer to the HRSA
EHBs online help.

2.  10-digit grant number from the latest NGA belonging to your grant
    (Box 4b on NGA). You must use the grant number to find your
    organization during registration. All individuals from the
    organization working on the grant must use the same grant number to
    ensure correct registration.

In order to access the noncompeting application, the project director
and other participants have to register the specific grant and add it to
their respective portfolios. This step is required to ensure that only
the authorized individuals from the organization have access to grant
data. **Project directors will need the last released NGA in order to
complete this additional step**. Again, note that this is a one time
requirement.

The project director must give the necessary privileges to the
authorizing official and other individuals who will assist in the
noncompeting continuation application submission using the administer
feature in the grant handbook. The project director should also delegate
the "Administer Grant Users" privilege to the authorizing official.

Once you have access to your grant handbook, use the "Noncompeting
Continuations" link under the deliverables section to access your
noncompeting application.

Note that registration with HRSA EHBs is independent of Grants.gov
registration.

For assistance in registering with HRSA EHBs, call 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>.

-   You must use your 10-digit grant number (box 4b from NGA) to
    identify your organization.

## 2.4 Apply through Grants.gov {#apply-through-grants.gov .unnumbered}

### 2.4.1 Find Funding Opportunity {#find-funding-opportunity .unnumbered}

Search for the announcement in Grants.gov **Apply**
(<http://www.grants.gov/Apply>).

Enter the announcement number communicated to you in the field *Funding
Opportunity Number*. (Example announcement number: 5-S45-06-001)

-   Noncompeting announcements are not available in Grants.gov FIND!

### 2.4.2 Download Application Package {#download-application-package .unnumbered}

Download the application package and instructions. In order to view
application package and instructions, you will also need to download and
install the PureEdge Viewer (<http://www.grants.gov/DownloadViewer>).
This small, free program will allow you to access, complete, and submit
applications electronically and securely.

-   Please review the system requirements for PureEdge Viewer on the
    Grants.gov website.

### 2.4.3 Complete Application {#complete-application .unnumbered}

Complete the application using both the built-in instructions and the
instructions provided in the program guidance. Ensure that you save a
copy of the application on your local computer.

-   Ensure that you provide your 10-digit grant number (box 4b from NGA)
    in the Federal Award Identifier field (box 5b in SF424 or box 4 in
    SF424 R&R)

Please direct questions regarding PureEdge to Grants.gov. Contact the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance.

-   You can complete the application offline -- you do not have to be
    connected to the Internet.

### 2.4.4 Submit Application {#submit-application .unnumbered}

The \"Submit\" button on the application package cover page will become
active after you have downloaded the application package, completed all
required forms, attached all required documents, and saved your
application package. Click on the \"Submit\" button once you have done
all these things and you are ready to send your completed application to
Grants.gov.

Review the provided application summary to confirm that the application
will be submitted to the program you wish to apply for. To submit, you
will be asked to Log into Grants.gov. Once you have logged in, your
application package will automatically be uploaded to Grants.gov. A
confirmation screen will appear once the upload is complete. Note that a
Grants.gov Tracking number will be provided on this screen. Please
record this number so that you may refer to it for all subsequent help.

Please direct questions regarding application submission to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   You must be connected to the Internet and must have a Grants.gov
    username and password to submit the application package.

### 2.4.5 Verify Status of Application {#verify-status-of-application .unnumbered}

Once Grants.gov has received your submission, Grants.gov will send email
messages to advise you of the progress of your application through the
system. Over the next 24 to 48 hours, you should receive two emails. The
first will confirm receipt of your application by the Grants.gov system
("Received"), and the second will indicate that the application has
either been successfully validated ("Validated") by the system prior to
transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

In case of any errors, you must correct the application and resubmit it
to Grants.gov. If you are unable to resubmit because the opportunity has
since closed, **contact the HRSA Call Center** at 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>. You may be asked to provide a copy of the
"Rejected with Errors" notification you received from Grants.gov.

You can check the status of your application(s) anytime after
submission, by logging into Grants.gov using the black \'Applicants\'
link at the top of any page, and clicking on the \'Check Application
Status\' link.

If there are no errors, the application will be downloaded by HRSA. On
successful download at HRSA, the status of the application will change
to "Received by Agency" and you will receive an additional email from
Grants.gov. Subsequently within two to three business days the status
will change to "Agency Tracking Number Assigned."

-   It is recommended that you check the status of your application in
    Grants.gov until the status is changed to "Agency Tracking Number
    Assigned".

## 2.5 Verify in HRSA Electronic Handbooks {#verify-in-hrsa-electronic-handbooks .unnumbered}

For assistance in registering with or using HRSA EHBs, call 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>.

-   Grant Project Director must be registered in HRSA EHBs and have
    access to the specific grant for which the noncompeting application
    is being submitted for further actions.

### 2.5.1 Verify Status of Application {#verify-status-of-application-1 .unnumbered}

Once your application is received by HRSA, it will be processed to
ensure that the application is submitted for the correct funding
announcement, with the correct grant number and grantee organization.
Upon this processing, which is expected to take up to two to three
business days, HRSA will assign a unique tracking number to your
application. This tracking number will be posted to Grants.gov and the
status of your application will be changed to "Agency Tracking Number
Assigned". Note the HRSA tracking number and use it for all
correspondence with HRSA. At this point, your application is ready for
review and submission in HRSA EHBs.

You should also receive an email from HRSA EHBs confirming the
successful receipt of your application at HRSA. The email is sent to the
project director, authorizing official, point of contact for the
application and the business official -- all from the submitted
application. The email is also sent to the current project director
listed on the NGA. Because email is not always reliable, please check
the HRSA EHBs or Grants.gov to see if the application is available for
review in HRSA EHBs.

-   Because email is not reliable, check HRSA EHBs within two to three
    business days from submission within Grants.gov for availability of
    your application.

### 2.5.2 Manage Access to Your Application {#manage-access-to-your-application .unnumbered}

You must be registered in HRSA EHBs to get access to your application.
To ensure that only the right individuals from the organization get
access to the application, you must follow the process described
earlier.

The project director, using the Administer feature in the grant
handbook, must give the necessary privileges to the authorizing official
and other individuals who will assist in the submission of the
noncompeting continuation application. Project directors must also
delegate the "Administer Grant Users" privilege to the authorizing
official so that future administration can be managed by the authorizing
official.

Once you have access to your grant handbook, use the "Noncompeting
Continuations" link under the deliverables section to access your
noncompeting application.

### 2.5.3 Check Validation Errors {#check-validation-errors .unnumbered}

HRSA EHBs will apply HRSA's business rules to the application received
through Grants.gov. All validation errors are recorded and displayed to
the applicant. To view the validation errors use the 'Grants.gov Data
Validation Comments' link on the application status page in HRSA EHBs.

### 2.5.4 Fix Errors and Complete Application {#fix-errors-and-complete-application .unnumbered}

Applicants must review the errors in HRSA EHBs and make necessary
changes. Applicants must also complete the detailed budget and other
required forms in HRSA EHBs and assign an AO registered in HRSA EHBs to
the application. HRSA EHBs will show the status of each form in the
application package and all forms must be complete before submission.

### 2.5.5 Submit Application {#submit-application-1 .unnumbered}

To submit an application, you must have the 'Submit Noncompeting
Continuation' privilege. This privilege must be given by the project
director to the authorizing official or a designee. Once all forms are
complete, the application can be submitted to HRSA.

-   You will have two weeks from the date the application was due in
    Grants.gov for submission of the remaining information in HRSA EHBs.
    The new due date will be listed in HRSA EHBs.

# 3. Competing Application

## 3.1 Process Overview {#process-overview-1 .unnumbered}

Following is the process for submitting a competing application through
Grants.gov:

1\. HRSA will post all competing announcements on Grants.gov FIND
(<http://grants.gov/search/>). Announcements are typically posted at the
beginning of the fiscal year when HRSA releases its annual Preview,
although program guidances are generally not available until later. For
more information visit <http://www.hrsa.gov/grants>.

2\. When program guidance is available, search for the announcement in
Grants.gov Apply (<http://www.grants.gov/Apply>).

3\. Download the application package and instructions from Grants.gov.
The program guidance is also part of the instructions that must be
downloaded.

4\. Save a local copy of the application package on your computer and
complete all the forms based on the instructions provided in the program
guidance.

5\. Submit the application package through Grants.gov. (Requires
registration)

6\. Track the status of your submitted application at Grants.gov until
you receive a notification from Grants.gov that your application has
been received by HRSA.

## 3.2 Grantee Organization Needs to Register With Grants.gov (if not already registered) -- See Appendix B {#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b-1 .unnumbered}

Grants.gov requires a **one-time** registration by the applicant
organization. This is a three step process and should be completed by
any organization wishing to apply for grant. If you do not complete this
registration process you will not be able to submit an application. The
registration process will require some time (anywhere from 5 business
days to a month). Therefore, applicants or those considering applying at
some point in the future should register immediately. Registration with
Grants.gov provides the individuals from the organization the required
credentials in order to apply.

If an applicant organization has already completed Grants.gov
registration for another Federal agency, this section can be skipped.

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). To be able to
successfully register in Grants.gov, it is necessary that you complete
all of the following required actions:

-   Obtain an organizational Data Universal Number System (DUNS) number

-   Register the organization with Central Contractor Registry (CCR)

-   Identify the organization's E-Business POC (Point of Contact)

-   Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
    password

-   Register an Authorized Organization Representative (AOR)

```{=html}
<!-- -->
```
-   Obtain a username and password from the Grants.gov Credential
    Provider

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

In addition, if an applicant does not have a Taxpayer Identification
Number (TIN) or Employer Identification Number (EIN), allow for extra
time. Beginning Oct. 30, 2005, the CCR also validates the EIN against
Internal Revenue Service records, a step that will take one to two
business days.

Please direct questions regarding Grants.gov registration to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   It is recommended that this registration process be completed at
    least two weeks prior to the submittal date of your organization's
    first Grants.gov submission.

## 3.3 Apply through Grants.gov {#apply-through-grants.gov-1 .unnumbered}

### 3.3.1 Find Funding Opportunity {#find-funding-opportunity-1 .unnumbered}

Search for announcements in Grants.gov **FIND**
(<http://grants.gov/search/>) and select the announcement that you wish
to apply for. Refer to the program guidance for eligibility criteria.

Please visit <http://www.hrsa.gov/grants> to read annual HRSA Preview.

-   All competing announcements should be available in Grants.gov FIND!
    When program guidance is release, announcements are made available
    in Grants.gov APPLY.

### 3.3.2 Download Application Package {#download-application-package-1 .unnumbered}

Download the application package and instructions. In order to view
application package and instructions, you will also need to download and
install the PureEdge Viewer (<http://www.grants.gov/DownloadViewer>).
This small, free program will allow you to access, complete, and submit
applications electronically and securely.

-   Please review the system requirements for PureEdge Viewer on the
    Grants.gov website.

### 3.3.3 Complete Application {#complete-application-1 .unnumbered}

Complete the application using both the built-in instructions and the
instructions provided in the program guidance. Ensure that you save a
copy of the application on your local computer.

-   If you are applying for a competing continuation or a supplemental
    grant, ensure that you provide your 10-digit grant number (box 4b
    from NGA) in the Federal Award Identifier field (box 5b in SF424 or
    box 4 in SF424 R&R)

Please direct questions regarding PureEdge to Grants.gov. Contact the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance.

-   You can complete the application offline -- you do not have to be
    connected to the Internet.

### 3.3.4 Submit Application {#submit-application-2 .unnumbered}

The \"Submit\" button on the application package cover page will become
active after you have downloaded the application package, completed all
required forms, attached all required documents, and saved your
application package. Click on the \"Submit\" button once you have done
all these things and you are ready to send your completed application to
Grants.gov.

Review the provided application summary to confirm that the application
will be submitted to the program you wish to apply for. To submit, you
will be asked to Log into Grants.gov. Once you have logged in, your
application package will automatically be uploaded to Grants.gov. A
confirmation screen will appear once the upload is complete. Note that a
Grants.gov Tracking number will be provided on this screen. Please
record this number so that you may refer to it for all subsequent help.

Please direct questions regarding application submission to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   You must be connected to the Internet and must have a Grants.gov
    username and password to submit the application package.

### 3.3.5 Verify Status of Application {#verify-status-of-application-2 .unnumbered}

Once Grants.gov has received your submission, Grants.gov will send email
messages to advise you of the progress of your application through the
system. Over the next 24 to 48 hours, you should receive two emails. The
first will confirm receipt of your application by the Grants.gov system
("Received"), and the second will indicate that the application has
either been successfully validated ("Validated") by the system prior to
transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

In case of any errors, you must correct the application and resubmit it
to Grants.gov. If you are unable to resubmit because the opportunity has
since closed, **contact the Director of the Division of Grants Policy**
via email at <DGPWaivers@hrsa.gov> and thoroughly explain the situation;
include a copy of the "Rejected with Errors" notification.

You can check the status of your application(s) anytime after
submission, by logging into Grants.gov using the black \'Applicants\'
link at the top of any page, and clicking on the \'Check Application
Status\' link.

If there are no errors, the application will be downloaded by HRSA. On
successful download at HRSA, the status of the application will change
to "Received by Agency" and you will receive an additional email from
Grants.gov.

Once your application is received by HRSA, it will be processed to
ensure that the application is submitted for the correct funding
announcement, with the correct grant number (if applicable), and
applicant/grantee organization. Upon this processing, which is expected
to take up to two to three business days, HRSA will assign a unique
tracking number to your application. This tracking number will be posted
to the Grants.gov and the status of your application will be changed to
"Agency Tracking Number Assigned". Note the HRSA tracking number and use
it for all correspondence with HRSA.

-   It is recommended that you check the status of your application in
    Grants.gov until the status is changed to "Agency Tracking Number
    Assigned".

# 4. General Instructions for Application Submission

-   It is mandatory to follow the instructions provided in this section
    to ensure that your application can be printed efficiently and
    consistently for review.

-   

-   Failure to follow the instructions may make your application
    non-compliant. Non-compliant applications will not be given any
    consideration and the particular applicants will be notified.

## 4.1 Narrative Attachment Guidelines {#narrative-attachment-guidelines .unnumbered}

-   The following guidelines are applicable to both electronic and paper
    submissions (when allowed) unless otherwise noted.

### 4.1.1 Font  {#font .unnumbered}

Please use an easily readable serif typeface, such as Times Roman,
Courier, or CG Times. The text and table portions of the application
must be submitted in not less than 12 point and 1.0 line spacing.
Applications not adhering to 12 point font requirements may be returned.
Do not use colored, oversized or folded materials. For charts, graphs,
footnotes, and budget tables, applicants may use a different pitch or
size font, not less than 10 pitch or size font. However, it is vital
that when scanned and/or reproduced, the charts are still clear and
readable.

Please do not include organizational brochures or other promotional
materials, slides, films, clips, etc. 

### 4.1.2 Paper Size and Margins {#paper-size-and-margins .unnumbered}

For duplication and scanning purposes, please ensure that the
application can be printed on 8 ½" x 11" white paper. Margins must be at
least one (1) inch at the top, bottom, left and right of the paper.
Please left-align text.

### 4.1.3 Names {#names .unnumbered}

Please include the name of the applicant and 10-digit grant number (if
competing continuation, supplemental or noncompeting continuation) on
each page.

### 4.1.4 Section Headings {#section-headings .unnumbered}

Please put all section headings flush left in bold type.

### 4.1.5 Page Numbering {#page-numbering .unnumbered}

**Electronic Submissions**

For electronic submissions, applicants only have to number the
electronic attachment pages sequentially, resetting the numbering for
each attachment, i.e., start at page 1 for each attachment.

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

Do not number the standard OMB approved forms. Please number each
attachment page sequentially. Reset the numbering for each attachment.
(Treat each attachment/document as a separate section.)

### 4.1.6 Allowable Attachment or Document Types {#allowable-attachment-or-document-types .unnumbered}

**Electronic Submissions**

The following attachment types are supported in HRSA EHBs. Even though
grants.gov may allow you to upload any type of attachment, it is
important to note that HRSA only accepts the following types of
attachments:

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

## 4.2 Application Content Order (Table of Contents) {#application-content-order-table-of-contents .unnumbered}

When applications were submitted in paper, it was easy to direct the
applicants to prepare a table of contents and make it as a part of the
application. Applicants did not have any problem in preparing the
package that included standard forms as well as attachments. All the
pages were numbered sequentially. Preparation instructions were given in
the program guidance. With the transition to electronic application
receipt, this process has changed significantly. HRSA is using an
approach that will ensure that regardless of the mode of submission
(electronic or paper when exemptions are granted), all applications will
look the same when printed for objective review.

HRSA uses two standard packages from Grants.gov.

SF 424 (otherwise known as 5161) -- For service delivery programs

SF 424 R&R -- For research and training programs (programs previously
using the 398 or the 6025 and 2590 application packages)

For each package HRSA has defined a standard order of forms and that
order is available within the program guidance. The program guidance may
also provide applicants with explicit instructions on where to upload
specific documents.

If you are applying on paper (when allowed), you must use the program
guidance for the order of the forms and all other applicable guidelines.

## 4.3 Page Limit {#page-limit .unnumbered}

HRSA prints your application for review regardless of whether it is
submitted electronically or by paper (when allowed).

When your application is printed, the narrative documents may not exceed
80 pages in length unless otherwise stated in the program guidance.
These narrative documents include the abstract, project and budget
narratives, and any other attachments such as appendices, letters of
support required as a part of the guidance. This 80 page limit does not
include the OMB approved forms. Note that some program guidances may
require submission of OMB approved program specific forms as
attachments. These attachments will not be included in the 80 page
limit.

Applicants must follow the instructions provided in this section and
ensure that they print out all attachments on paper and count the number
of pages before submission.

-   Applications, whether submitted electronically or on paper, that
    exceed the specified limits will be deemed non-compliant.
    Non-compliant competing applications will not be given any
    consideration and the particular applicants will be notified.
    Non-compliant noncompeting applications will have to be resubmitted
    to comply with the page limits.

# 5. Customer Support Information

### 5.1.1 Grants.gov Customer Support {#grants.gov-customer-support .unnumbered}

Please direct ALL questions regarding Grants.gov to Grants.gov Contact
Center at Tel.: 1-800-518-4726. Contact Center hours of operation are
Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time, excluding
Federal holidays.

Please visit the following support URL for additional material on
Grants.gov website.

<http://www.grants.gov/CustomerSupport>

### 5.1.2 HRSA Call Center {#hrsa-call-center .unnumbered}

For assistance with or using HRSA EHBs, call 877-GO4-HRSA (877-464-4772)
between 9:00 am to 5:30 pm ET or email <callcenter@hrsa.gov>.

Please visit HRSA EHBs for online help. Go to:

<https://grants.hrsa.gov/webexternal/home.asp> and click on 'Help'

### 5.1.3 HRSA Program Support {#hrsa-program-support .unnumbered}

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance. Do not call the
program contact for technical questions related to either Grants.gov or
HRSA EHBs.

# 6. FAQs

## 6.1 Software {#software .unnumbered}

### 6.1.1 What are the software requirements for using Grants.gov? {#what-are-the-software-requirements-for-using-grants.gov .unnumbered}

Applicants will need to download the PureEdge viewer. Grants.gov website
provides the following information:

**System Requirements:**

For PureEdge Viewer to function properly, your computer must meet the
following system requirements:

Windows 98, ME, NT 4.0, 2000, XP\
500 MHz processor\
128 MB of RAM\
40 MB disk space\
Web browser: Internet Explorer 5.01 or higher, Netscape Communicator
4.5 - 4.8, Netscape 6.1, 6.2, or 7

If you do not have a Windows operating system, you will need to use a
Windows Emulation program.

Please visit <http://www.grants.gov/DownloadViewer> for all details and
any updates.

### 6.1.2 Why can't I download PureEdge Viewer onto my machine? {#why-cant-i-download-pureedge-viewer-onto-my-machine .unnumbered}

Depending on your organization's computer network and security protocols
you may not have the necessary permissions to download software onto
your workstation. Contact your IT department or system administrator to
download the software for you or give you access to this function.

### 6.1.3 I have heard that Grants.gov is not Macintosh compatible. What do I do if I use only a Macintosh? {#i-have-heard-that-grants.gov-is-not-macintosh-compatible.-what-do-i-do-if-i-use-only-a-macintosh .unnumbered}

Grants.gov is aware of the issues facing Macintosh users who apply for
Federal grants electronically. Grants.gov has provided the following
response regarding this issue on its website at
<http://www.grants.gov/MacSupport>:

> *Grants.gov recognizes that support to users of Non-Windows operating
> systems and the PureEdge Viewer is often required across a distinct
> segment of the grant applicant community. Although at this time, the
> PureEdge Viewer is only available for Windows based installs,
> Grants.gov offers support for Non-Windows platforms.*
>
> *Grants.gov is working with PureEdge in the development of a
> Non-Windows compatible viewer. PureEdge has committed to providing a
> platform independent viewer by November 2006. Information related to
> the Non-Windows compatible viewer will be posted to this webpage
> (http://www.grants.gov/MacSupport). Please bookmark this page and
> return at your convenience for more details.*

Grants.gov and NIH have partnered to provide free access to Citrix
servers for Macintosh Users who are looking for an alternative to using
PC emulation software with the PureEdge forms. A Citrix server
connection allows Macintosh users to remotely launch a Windows session
on their own machines by using the free Citrix client application.
Applicants will need to download and install the free Citrix client
application in order to work. This service is now available for use.

Grants.gov website states:

> *Beginning December 20, 2005, non-Windows users will be able to
> download and complete the PureEdge forms by taking advantage of the
> free Citrix server. Non-Windows users are also able to submit
> completed grant applications via the Citrix environment.*

For details, please visit <http://www.grants.gov/MacSupport>

### 6.1.4 What are the software requirements for HRSA EHBs? {#what-are-the-software-requirements-for-hrsa-ehbs .unnumbered}

HRSA EHBs can be accessed over the Internet using Internet Explorer (IE)
v5.0 and above and Netscape 4.72 and above. HRSA EHBs are 508 compliant.

IE 6.0 and above is the recommended browser.

HRSA EHBs use pop-up screens to allow users to view or work on multiple
screens. Ensure that your browser settings allow for pop-ups.

In addition, to view attachments such as Word and PDF, you will need
appropriate viewers.

### 6.1.5 What are the system requirements for using HRSA EHBs on a Macintosh computer?  {#what-are-the-system-requirements-for-using-hrsa-ehbs-on-a-macintosh-computer .unnumbered}

Mac users are requested to download the latest version of Netscape for
their OS version. It is recommended that Safari v1.2.4 and above or
Netscape v7.2 and above be used.

Note that Internet Explorer (IE) for Mac has known issues with SSL and
Microsoft is no longer supporting IE for Mac. HRSA EHBs do not work on
IE for Mac.

In addition, to view attachments such as Word and PDF, you will need
appropriate viewers.

## 6.2 Application Receipt {#application-receipt .unnumbered}

### 6.2.1 What will be the receipt date\--the date the application is stamped as received by Grants.gov or the date the data is received by HRSA? {#what-will-be-the-receipt-date--the-date-the-application-is-stamped-as-received-by-grants.gov-or-the-date-the-data-is-received-by-hrsa .unnumbered}

**Competing Submissions:**

The submission/receipt date will be the date the application is received
by Grants.gov.

**Noncompeting Submissions:**

The submission/receipt date will be the date the application is
submitted in HRSA EHBs.

### 6.2.2 When do I need to submit my application? {#when-do-i-need-to-submit-my-application .unnumbered}

**Competing Submissions:**

Applications must be submitted to Grants.gov by 8 PM ET on the due date.

**Noncompeting Submissions:**

Applications must be submitted to Grants.gov by 8 PM ET on the due date.

Applications must be verified and submitted in HRSA EHBs by 5:00 PM ET
on the due date. (2 weeks after the due date in Grants.gov) Refer to the
program guidance for specific dates.

###  {#section-1 .unnumbered}

### 6.2.3 What emails can I expect once I submit my application? Is email reliable? {#what-emails-can-i-expect-once-i-submit-my-application-is-email-reliable .unnumbered}

**Competing Submissions:**

When you submit your noncompeting application in Grants.gov, it is first
received and validated by Grants.gov. Typically, this takes a few hours
but it may take up to 48 hours during peak volumes. You should receive
two emails from Grants.gov.

The first will confirm receipt of your application by the Grants.gov
system ("Received"), and the second will indicate that the application
has either been successfully validated ("Validated") by the system prior
to transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

Subsequently, the application will be downloaded by HRSA. This happens
within minutes of when your application is successfully validated by
Grants.gov and made available for HRSA to download. On successful
download at HRSA, the status of the application will change to "Received
by Agency" and you will receive another email from Grants.gov.

Because email is not reliable, you must check the respective systems if
you do not receive any emails within the specified timeframes.

**Noncompeting Submissions:**

When you submit your noncompeting application in Grants.gov, it is first
received and validated by Grants.gov. Typically, this takes a few hours
but it may take up to 48 hours during peak volumes. You should receive
two emails from Grants.gov.

Subsequently, the application will be downloaded by HRSA. This happens
within minutes of when your application is successfully validated by
Grants.gov and made available for HRSA to download. On successful
download at HRSA, the status of the application will change to "Received
by Agency" and you will receive another email from Grants.gov.

Subsequently, it is processed by HRSA to ensure that the application is
submitted for the correct funding announcement, with the correct grant
number and grantee organization. This may take up to 3 business days. At
this point you will receive an email from HRSA confirming the successful
receipt of your application and asking the PD and AO to review and
resubmit the application in HRSA EHBs.

Because email is not reliable, you must check the respective systems if
you do not receive any emails within the specified timeframes.

-   For more information refer to sections 2.4 and 2.5 in this guide

### 6.2.4 If a resubmission is required because of Grants.gov system problems, will these be considered \"late\"? {#if-a-resubmission-is-required-because-of-grants.gov-system-problems-will-these-be-considered-late .unnumbered}

**Competing Submissions:**

No. But you must **contact the Director of the Division of Grants
Policy** via email at <DGPWaivers@hrsa.gov> and thoroughly explain the
situation. Include a copy of the "Rejected with Errors" notification you
received from Grants.gov.

**Noncompeting Submissions:**

No. But you must **contact the HRSA Call Center** at 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>. You may be asked to provide a copy of the
"Rejected with Errors" notification you received from Grants.gov.

## 6.3 Application Submission {#application-submission .unnumbered}

### 6.3.1 How can I make sure that my electronic application is presented in the right order for objective review? {#how-can-i-make-sure-that-my-electronic-application-is-presented-in-the-right-order-for-objective-review .unnumbered}

Follow the instructions provided in section to ensure that your
application is presented in the right order and is compliant with all
the requirements.

## 6.4 Grants.gov {#grants.gov .unnumbered}

For a list of frequently asked questions and answers maintained by
Grants.gov please visit the following URL:

<http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/GrantsGov_UST_Grantee.htm#index.html>

**Appendix B -- Registering and Applying Through Grants.gov**

**Prepare to Apply through Grants.gov:**

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [not]{.underline}
e-mail an electronic copy of a grant application to us.

Please understand that we will not consider additional information
and/or materials submitted after your initial application. You must
therefore ensure that all materials are submitted together.

Note: Except in rare cases, paper applications will NOT be accepted for
this grant opportunity. If you believe you are technologically unable to
submit an on-line application you MUST contact the Director of the
Division of Grants Policy, at <DGPWaivers@hrsa.gov> and explain why you
are technologically unable to submit on-line. Make sure you specify the
announcement number you are requesting relief for. HRSA and its Grants
Application Center (GAC) will only accept paper applications from
applicants that received prior written approval.

In order to apply through Grants.gov the Applicant must register with
Grants.gov. This is a three step process that must be completed by any
organization wishing to apply for a grant opportunity. The registration
process will require some time. Therefore, applicants or those
considering applying at some point in the future should register
**[immediately]{.underline}**. Registration in Grants.gov does not
require the organization to apply for a grant; it simply provides the
organization the required credentials so that the organization may apply
for a grant in the future. Registration is required only once.

**[REGISTRATION:]{.underline}**

GET STARTED NOW AND COMPLETE THE ONE-TIME REGISTRATION PROCESS TO BEGIN
SUBMITTING GRANT APPLICATIONS AS SOON AS YOU READ THIS.

You don't need to be registered to search or to begin selecting,
downloading and completing grant applications. Registration is required
to submit applications. Therefore, it is essential that your
organization be registered prior to attempting to submit a grant
application or your organization will not be able to do so. **Be sure to
complete the process early as the registration process may take some
time (anywhere from 5 days to 1 month).**

**There are three steps to the registration process:**

Step 1: Register your organization

Step 2: Register yourself as an Authorized Organization Representative

Step 3: Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](../www.grants.gov). Individual assistance is available
at [http://www.grants.gov/Support](http://www.grants.gov/Support  ) or
1-800-518-4726. Grants.gov also provides a variety of support options
through online Help including Context-Sensitive Help, Online Tutorials,
FAQs, Training Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

\- Obtain your organization's Data Universal Number System (DUNS) number

\- Register your organization with Central Contractor Registry (CCR)

\- Identify your organization's E-Business POC (Point of Contact)

\- Confirm your organization's CCR "Marketing Partner ID Number (M-PIN)"
password

2\. Register Yourself as an Authorized Organization Representative (AOR)

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

\- Contact your E-Business POC to ensure your AOR status

\- Log in to Grants.gov to check your AOR status

The Grants.gov/Apply feature includes a simple, unified application
process to enable applicants to apply for grants online. The information
applicants need to understand and execute the steps is at
http://www.grants.gov/GetStarted. Applicants should read the Get Started
steps carefully. The site also contains registration checklists to help
you walk through the process. HRSA recommends that you download the
checklists and prepare the information requested before beginning the
registration process. Reviewing information required and assembling it
before beginning the registration process will save you time and make
the process faster and smoother.

**REGISTER YOUR ORGANIZATION**

Before you can apply for a grant via Grants.gov, your organization must
obtain a Data Universal Number System (DUNS) number and register early
with the Central Contractor Registry (CCR).

**Obtain your organization's DUNS number**

A DUNS number is a unique number that identifies an organization. It has
been adopted by the Federal government to help track how Federal grant
money is distributed. Ask your grant administrator or chief financial
officer to provide your organization's DUNS number.

\-**How do you do it**? If your organization does not have a DUNS
number, call the special Dun & Bradstreet hotline at 1-866-705-5711 to
receive one free of charge.

\- **How long will this take?** You will receive a DUNS number at the
conclusion of the phone call.

**Register your organization with CCR**

The CCR is the central government repository for organizations working
with the Federal government. Check to see if your organization is
already registered at the CCR website. If your organization is not
already registered, identify the primary contact who should register
your organization.

When your organization registers with CCR, it will be required to
designate an E-Business Point of Contact (E-Business POC). The designee
authorizes individuals to submit grant applications on behalf of the
organization and creates a special password called a Marketing Partner
ID Number (M-PIN) to verify individuals authorized to submit grant
applications for the organization.

\-**How do you do it?** Visit the CCR website at http://www.ccr.gov.
Check whether your organization is already registered or register your
organization right online. Be certain to enter an MPIN number during
this process as this is an optional field for the CCR registration but
mandatory for Grants.gov.

\- **How long will this take?** It may take a few days for you to
collect the information needed for your organization's registration, but
once you finish the registration process, you can move on to Step 2 the
very next business day. Note it will take up to a month for the total
registration- therefore this should be done as soon as possible.

**GET AUTHORIZED as an AOR by Your Organization**

The registration process is almost complete. All that remains is the
final step ---getting authorized. Even though you have registered, your
E-Business POC must authorize you so Grants.gov will know that you are
verified to submit applications.

\- **Obtain your E-Business POC authorization**

After your Authorized Organizational Representative (AOR) profile is
completed, your organization's E-Business POC will receive an email
regarding your requested AOR registration, with links and instructions
to authorize you as an AOR.

\- **How do you do it?** Instruct your E-Business POC to login to
Grants.gov at http://www.grants.gov/ForEbiz and enter your
organization's DUNS number and M-PIN. They will select you as an AOR
they wish to authorize and you will be verified to submit grant
applications.

\- **How long will this take?** It depends on how long it takes your
E-Business POC to log in and authorize your AOR status. You can check
your AOR status by logging in to Grants.gov at
http://www.grants.gov/ForApplicants.

**REGISTER YOURSELF as an Authorized Organization Representative (AOR)**

Once the CCR Registration is complete, your organization is finished
registering. You must now register yourself with Grants.gov and
establish yourself as an AOR, an individual authorized to submit grant
applications on behalf of your organization. There are two elements
required to complete this step --- both must be completed to move onto
Step 3.

1\. **Obtain your username and password**

In order to safeguard the security of your electronic information, and
to submit a Federal grant application via Grants.gov, you must first
obtain a username and password from the Grants.gov Credential Provider.

\- **How do you do it**? Just register with Grants.gov's Credential
Provider at http://www.grants.gov/Register1. You will need to enter your
organization's DUNS number to access the registration form. Once you
complete the registration form you will be given your username and you
will create your own password.

\- **How long will this take?** Same day. When you submit your
information you will receive your username and be able to create your
password.

**2. Register with Grants.gov**

Now that you have your username and password, allow about 30 minutes for
your data to transfer from the Credential Provider, then you must
register with Grants.gov to set up a short profile.

\> **How do you do it?** Simply visit http://www.grants.gov/Register2 to
register your username and password and set up your profile. Remember,
you will only be authorized for the DUNS number which you register in
your Grants.gov profile.

\> **How long will this take?** Same day. Your AOR profile will be
complete after you finish filling in the profile information and save
the information at Grants.gov.

You have now completed the registration process for Grants.gov. If you
are applying for a [new or competing continuation]{.underline} you may
find the application package through Grants.gov FIND. If you are filling
out a [non-competing continuation]{.underline} application you must
obtain the announcement number through your program office, and enter
this announcement number in the search field to pull up the application
form and related program guidance. Download the required forms and enter
your current grant number in the appropriate field to begin the
non-competing continuation application which you will then upload for
electronic submittal through Grants.gov. For continuation applications
which require submittal of performance measures electronically,
instructions are provided in the program guidance on how to enter the
HRSA electronic handbooks to provide this information.

**How to submit an electronic application to HRSA via Grants.gov/Apply**

a\. [Applying using Grants.gov.]{.underline} Grants.gov has a full set
of instructions on how to apply for funds on its website at
<http://www.grants.gov/CompleteApplication>. The following provides
simple guidance on what you will find on the Grants.gov/Apply site.
Applicants are encouraged to read through the page entitled, "Complete
Application Package" before getting started. See Appendix A for specific
information.

b\. [Customer Support]{.underline}. The grants.gov website provides
customer support via (800) 518-GRANTS (this is a toll-free number) or
through e-mail at support@grants.gov. The customer support center is
open from 7:00 a.m. to 9:00 p.m. Eastern time, Monday through Friday,
except federal holidays, to address grants.gov technology issues. For
technical assistance to program related questions, contact the number
listed in the Program Section of the program you are applying for.

**Timely Receipt Requirements and Proof of Timely Submission**

a\. Electronic Submission. All applications must be received by
www.grants.gov/Apply by 8:00 P.M. Eastern Time on the due date
established for each program.

Proof of timely submission is automatically recorded by Grants.gov. An
electronic time stamp is generated within the system when the
application is successfully received by Grants.gov. The applicant will
receive an acknowledgement of receipt and a tracking number from
Grants.gov with the successful transmission of their application.
Applicants should print this receipt and save it, along with facsimile
receipts for information provided by facsimile, as proof of timely
submission. When HRSA successfully retrieves the application from
Grants.gov, Grants.gov will provide an electronic acknowledgment of
receipt to the e-mail address of the AOR. Proof of timely submission
shall be the date and time that Grants.gov receives your application.

Applications received by grants.gov, after the established due date and
time for the program, will be considered late and will not be considered
for funding by HRSA. HRSA suggests that applicants submit their
applications during the operating hours of the Grants.gov Support Desk,
so that if there are questions concerning transmission, operators will
be available to walk you through the process. Submitting your
application during the Support Desk hours will also ensure that you have
sufficient time for the application to complete its transmission prior
to the application deadline. Applicants using dial-up connections should
be aware that transmission should take some time before Grants.gov
receives it. Grants.gov will provide either an error or a successfully
received transmission message. The Grants.gov Support desk reports that
some applicants abort the transmission because they think that nothing
is occurring during the transmission process. Please be patient and give
the system time to process the application. Uploading and transmitting
many files, particularly electronic forms with associated XML schemas,
will take some time to be processed.

Note the following additional information regarding submission of all
HRSA applications through Grants.gov:

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

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

• After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. HRSA will retrieve your application from Grants.gov.

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov

Competitive applications will be considered as having met the deadline
if: (1) the application has been successfully transmitted electronically
by your organization's Authorizing Official through Grants.gov on or
before the deadline date and time.

# Appendix C: Additional Agreements & Assurances

Ryan White HIV/AIDS Treatment Modernization Act of 2006, Part C
(formerly Title IIII) EIS

The authorized representative of the applicant must include a signed
original copy of the attached form with the grant application. This form
lists the program assurances which must be satisfied in order to qualify
for a Part C grant.

NOTE: The text of the assurances has been abbreviated on this form for
ease of understanding; however, grantees are required to comply with all
aspects of the assurances as they are stated in the Act.

I, the authorized representative of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in
applying for a grant under Part C of Title XXVI, Public Health Service
Act, as amended by the Ryan White Treatment Modernization Act of 2006,
P.L. 109-415, 42 U.S.C. 300ff-51 - 300ff-67, hereby certify that:

I. As required in section 2651:

> A. Grant funds will be expended only for providing core medical
> services as described in subsection (c), support services as described
> in subsection (d) and administrative expenses as described in section
> 2664(g)(3).
>
> B. Grant funds will be expended for the purposes of providing, on an
> outpatient basis, each of the following early intervention required
> services:
>
> 1\. Counseling individuals with respect to HIV disease in accordance
> with section 2662;
>
> 2\. Testing to confirm the presence of HIV infection; to diagnose the
> extent of immune deficiency; to provide clinical information on
> appropriate therapeutic measures for preventing and treating the
> deterioration of the immune system and for preventing and treating
> conditions arising from the disease;
>
> 3\. Other clinical preventive and diagnostic services regarding HIV
> disease, and periodic medical evaluations of individuals with the
> disease;
>
> 4\. Providing the therapeutic measures described in 2. above; and
>
> 5\. Referrals described in section 2651(e)(2);
>
> C. Grantee will expend not less than 50% of grant funds awarded for
> activities described in 2-5 above.
>
> D. After reserving funds for administration and clinical quality
> management, grantee will use not less than 75% of the remaining grant
> funds to provide core medical services that are needed in the area
> involved for individuals with HIV/AIDS who are identified and eligible
> under this title (including services regarding the co-occurring
> conditions of the individuals).
>
> E. Each of the early intervention services in A. will be available
> through the applicant entity, either directly or through public or
> nonprofit private entities, or through for-profit entities if such
> entities are the only available provider of quality HIV care in the
> area.
>
> F. A small proportion of grant funds may also be expended to provide
> the support services that are needed for individuals with HIV/AIDS to
> achieve their medical outcomes.

II\. As required under section 2652(b), all providers of services
available in the Medicaid State plan must have entered into a
participation agreement under the State plan and be qualified to receive
payments under such plan, or receive a waiver from this requirement.

III\. As required under section 2654(a): Provisions of services to
persons with hemophilia will be made and/or coordinated with the network
of comprehensive hemophilia diagnostic and treatment centers.

IV\. As required under section 2661(a) : The confidentiality of all
information relating to the person(s) receiving services will be
maintained in accordance with applicable law.

V. As required under section 2661(b): Informed consent for HIV testing
will be obtained.

VI\. As required under section 2662: The applicant agrees to provide
appropriate counseling services, under conditions appropriate to the
needs of individuals.

VII\. As required under section 2663: All testing that is conducted with
Ryan White CARE Act funds will be carried out in accordance with
sections 2661 and 2662.

VII\. As required under section 2664(a)(1)(C) Information regarding how
the expected expenditures under the grant are related to the planning
process for localities funded under part A (including the planning
process described in section 2602) and for States funded under part B
(including the planning process described in section 2617(b) will be
submitted.

IX\. As required under section 2664(a)(1)(D) A specification of the
expected expenditures and how those expenditures will improve overall
client outcomes, as described in the State plan under section 2517(b)
will be submitted.

X. As required under section 2664(a)(2): A report to the Secretary in
the form and on the schedule specified by the Secretary will be
submitted.

XI\. As required under section 2664(a)(3) Additional documentation to
the Secretary regarding the process used to obtain community input into
the design and implementation of activities related to the grant will be
submitted.

XII\. As required under section 2664(a)(4) Audits regarding funds
expended under Part C will be submitted every 2 years to the lead State
agency under section 2617(b)(4) and will include necessary client level
data to complete unmet need calculations and the Statewide Coordinated
Statements of Need process.

XII\. As required under section 2664(b): To the extent permitted under
State law, regulation or rule, opportunities for anonymous counseling
and testing will be provided.

XIV\. As required under section 2664(c): Individuals seeking services
will not have to undergo testing as a condition of receiving other
health services.

XV\. As required under section 2664(d): The level of pre-grant
expenditures for early intervention services will be maintained at the
level of the year prior to the grant year.

XVI\. As required under section 2664(e): A sliding fee schedule with
limits and conditions specified in section 2664 (e) will be utilized.

XVII\. As required under section 2664(f): Funds will not be expended for
services covered, or which could reasonably be expected to be covered,
under any State compensation program, insurance policy, or any Federal
or State health benefits program (except for a program administered by
or providing services of the Indian Health Service); or by an entity
that provides health services on a prepaid basis.

XVIII\. As required under section 2664(g): Funds will be expended only
for the purposes awarded, such procedures for fiscal control and fund
accounting as may be necessary will be established, and not more than 10
percent of the grant will be expended for administrative expenses,
including planning and evaluation, except that the costs of a clinical
quality management program may not be considered administrative expenses
for the purposes of such limitation.

XIX\. As required under section 2667: Agreement that counseling programs
shall not be designed to promote, or encourage directly, intravenous
drug abuse or sexual activity, homosexual or heterosexual; shall be
designed to reduce exposure to and transmission of HIV/AIDS by providing
accurate information; shall provide information on the health risks of
promiscuous sexual activity and intravenous drug abuse; and shall
provide information on the transmission and prevention of hepatitis A,
B, and C, including education about the availability of hepatitis A and
B vaccines and assisting patients in identifying vaccination sites.

XX\. As required under section 2681: Assure that services funded will be
integrated with other such services, coordinated with other available
programs (including Medicaid), and that the continuity of care and
prevention services of individuals with HIV is enhanced.

XXI\. As required under section 2684: No funds will be used to fund AIDS
programs, or to develop materials, designed to promote or encourage,
directly, intravenous drug use or sexual activity, whether homosexual or
heterosexual.

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

Title:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Appendix D Program Requirements and Expectations 

Funded EIS programs must provide the proposed services directly and/or
through formal agreements with public or private nonprofit entities.
Programs may contract with for-profit entities to provide some of the
services if these are the only available providers of quality HIV care
in the area.

The Part C program now has several requirements for allocation of grant
funds- these include early intervention services (EIS), core medical
services (CMS), clinical quality management (CQM) and administration. A
minimum of 50 percent of funds awarded must be spent on providing early
intervention services to HIV-positive individuals. After funds for CQM
and administration have been reserved, at least 75 percent of funds must
be spent on core medical services. HIV Counseling is not included in the
50 percent requirement, although it is included as a core medical
service. All the EIS services are included in CMS, as well as some
additional services. The HAB encourages applicants to exceed these
minimum requirements. No more than 10 percent of the grant may be spent
on administrative expenses. It is a program expectation that no more
than 5 percent will be spent on CQM. Allocation of additional funds must
be justified.

**Required Services**

The following primary care services must be provided to all persons
living with HIV/AIDS, whether on-site or at another facility:

1.  **HIV counseling, testing, referral, and partner counseling
    services.**

> HIV counseling, testing, referral, and partner counseling should be
> provided for all individuals in your targeted service population but
> should not be duplicative if these are available and accessible to
> your target population(s). Instead, linkages and formal referral
> mechanisms should be established with these programs to ensure
> follow-up and evaluation for those persons identified as HIV-positive.
>
> If HIV counseling, testing, referral and partner counseling are
> provided directly by your program, these services must comply with
> provisions stipulated by the Centers for Disease Control and
> Prevention (CDC) in accordance with Sections 2661, 2662 and 2663 of
> the Ryan White Program. The Revised Guidelines for Counseling,
> Testing, and Referral are available at: <http://aidsinfo.nih.gov/>.
> Your program also must agree to assure the confidentiality of patient
> information in compliance with applicable Federal, State and local
> law.

2.  **Medical evaluation and clinical care, such as CD4 cell monitoring,
    viral load testing, antiretroviral therapy, prophylaxis and
    treatment of opportunistic infections, malignancies and other
    related conditions, routine immunizations, prevention of perinatal
    transmission, and patient education including linkage to prevention
    services.**

> Individuals must be offered a comprehensive continuum of HIV care
> including primary medical care and, when applicable, perinatal care.
> At a minimum, your program, in accordance with the latest HHS
> guidelines, should provide periodic medical evaluations; appropriate
> treatment of HIV infection; and prophylactic and treatment
> interventions for complications of HIV infection, including
> opportunistic infections, opportunistic malignancies and other AIDS
> defining conditions. Your program also must provide for a system to
> confirm the presence of HIV infection, and must provide tests to
> diagnose the extent of deficiency in the immune system. Individuals
> must have access to ongoing prevention services while other treatment
> is being administered. The system of care must provide appropriate
> diagnostic and therapeutic measures for preventing and treating the
> deterioration of the immune system and related conditions, conforming
> to the most recent clinical care protocols. Your program must also
> have a system in place for after-hours and weekend clinical coverage
> for medical and dental services.
>
> Your program is required to have a plan for handling referrals to and
> enrollment in clinical trials offered by biomedical research
> facilities or community-based organizations that conduct HIV-related
> clinical trials. For information on these protocols call the AIDS
> Clinical Trials Information Service at 1-800-TRIALS-A or visit the
> AIDSinfo website at
> [http://www.aidsinfo.nih.gov](http://www.aidsinfo.nih.gov/).

-   Tuberculosis, Hepatitis B and C, and sexually transmitted infections
    (STI) evaluation and treatment are indispensable components of an
    HIV primary care program. To the extent that a service area or
    sub-population within the service area is experiencing accelerating
    case rates of tuberculosis, Hepatitis B and C, or STDs, HIV programs
    should develop diagnosis, prophylaxis and treatment services. For
    example, tuberculosis screening should be routine follow-up for all
    patients diagnosed as HIV-positive.

> To ensure consistency and continuity of care, your program's clinical
> staff should track and coordinate all inpatient care and referrals.
> Staff should develop plans for the resumption of the patient\'s care
> at your program once discharged from the hospital.
>
> Please note the following types of patient care, services and costs
> are not supported by Part C EIS:

-   inpatient hospitalization

-   residential treatment

-   clinical research

-   nursing home care

-   needle exchange services

-   cash payments to clients

-   purchasing or improving real property

    In the face of rapidly changing clinical management of HIV disease,
    continuing education opportunities must be provided to EIS program
    staff to ensure they remain abreast of clinical advances and adjust
    clinical protocols accordingly. In addition, your program must
    implement and practice recommendations as presented in the following
    HHS guidelines. These publications are available on-line at
    [http://www.aidsinfo.nih.gov/](http://www.aidsinfo.nih.gov/ ) or may
    be obtained by calling: 1-800-HIV-0440.

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-   Guidelines for the Use of Antiretroviral Agents in HIV-Infected
    Adults and Adolescents

-   Guidelines for the Prevention of Opportunistic Infections in Persons
    Infected with HIV

-   Guidelines for the Use of Antiretroviral Agents in Pediatric HIV
    Infection

-   Public Health Service Task Force Recommendations for the Use of
    Antiretroviral Drugs in Women Infected with HIV-1 for Maternal
    Health and Interventions to Reduce Perinatal HIV-1 Transmission in
    the U.S.

> Your program should ensure patients have the opportunity to actively
> participate in decision-making about their personal health care
> regimen. Patients should be involved and fully educated about their
> medical needs and treatment options within the standards of medical
> care. A document describing patient rights and responsibilities should
> be posted in a prominent place within the facility, and policies
> should be reviewed with each patient at intake. The policies and
> posted document should clearly describe the recourse a patient has if
> he/she is dissatisfied with the care provided.

3.  **Other primary care medical services provided either directly or
    through a formal referral mechanism, including oral health care,
    adherence counseling, outpatient mental health care, outpatient
    substance abuse treatment, nutritional services, and specialty
    medical care.**

> In addition to providing each patient with a thorough medical
> evaluation and related clinical care, your program should provide,
> directly or via referral, access to oral health care, adherence
> counseling, outpatient mental health care, outpatient substance abuse
> treatment, nutritional services and specialty medical care as
> described below. If you are unable to provide any of these services
> on-site, your program must establish and demonstrate formal
> arrangements such as contracts or memoranda of understanding with
> appropriate providers. It is recommended that all practitioners for
> these services have experience working with the target population and
> with HIV.

-   **Oral Health:** Grant funds may be used to support the provision of
    oral health services by general dental practitioners, dental
    specialists, dental hygienists and other trained dental providers in
    on-site facilities. You also may use these funds to secure or
    subsidize such services obtained off-site by referral. Funding may
    also be available through Part A, Part B and Part D-supported
    programs in your area. If a HRSA supported HIV/AIDS Dental
    Reimbursement Program or Community-Based Dental Partnership Program
    exists in your service area, document efforts to collaborate with
    that program. A list of HRSA supported HIV/AIDS Dental reimbursement
    programs is available on-line at:
    [http://www.hab.hrsa.gov/programs/dentallist.htm.]{.underline}

-   **Adherence:** Successful adherence programs are most effective when
    they use a multi-disciplinary approach. Your adherence program might
    include readiness assessments, patient education, adherence
    monitoring and counseling.

-   **Outpatient Mental Health:** Outpatient mental health services
    include assessment, diagnosis, and treatment. Optimal mental health
    treatment requires a multidisciplinary approach involving primary
    care or specialty physicians and mental health professionals who are
    trained, experienced, and/or certified in the field.

-   **Substance Abuse Services:** Outpatient substance abuse services
    include assessment, diagnosis, and treatment. Optimal substance
    abuse treatment requires a multidisciplinary approach involving
    primary care or specialty physicians and substance abuse
    professionals who are trained, experienced, and/or certified in the
    field.

-   **Nutritional Services:** Nutritional services include
    dietary/nutritional evaluation, nutritional supplements, and
    nutrition education or counseling, optimally provided by a licensed
    registered dietitian or nutritionist.

-   **Specialty Care:** Clients must have access to specialty and
    subspecialty care. Such services include oncology, dermatology,
    ophthalmology, gynecology and pulmonary.

> **Prevent new infections by working with persons diagnosed with HIV
> and their partners:**
>
> You are encouraged to incorporate the ***"Recommendations for
> Incorporating HIV Prevention into Medical Care of Persons Living with
> HIV"*** into your clinical program. These recommendations were
> developed jointly by the Centers for Disease Control and Prevention
> (CDC), the Health Resources and Services Administration (HRSA), the
> National Institutes of Health (NIH) and the HIV Medicine Association
> (HIVMA) of the Infections Diseases Society of America (IDSA)
> (Morbidity and Mortality Weekly Report July 18, 2003, Volume 52,
> Number RR-12).
>
>  
>
> *Recommendations for Incorporating HIV Prevention into Medical Care of
> Persons Living with HIV"*
> ([www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm)]{.underline} provide
> rationale and guidance for making risk screening, STD screening, and
> prevention messages part of the routine medical care you deliver to
> patients with HIV infection. As health care providers, you are in a
> unique position to help persons living with HIV/AIDS stop the spread
> of HIV. Because physicians, nurses, nurse's practitioners, and
> physician assistants have a strong influence on patients' behavior,
> you can positively impact health issues by screening for STDs,
> delivering brief prevention messages and asking patients about risk
> behaviors, in ways that are culturally and linguistically appropriate,
> during patient visits. Health care providers can help to reduce the
> number of new HIV infections and impact the HIV epidemic by:
>
>  

-   **Screening patients for behavioral risk** through interviews or
    questionnaires regarding sexual and needle-sharing behaviors and
    screening for STDs and pregnancy.

-   **Offering behavioral interventions** to change knowledge,
    attitudes, and behaviors to reduce personal risk of transmitting or
    acquiring other STDs. These might include posters and brochures in
    waiting and exam rooms; verbal discussions with patients
    supplemented by written materials; condoms readily accessible in the
    clinic; and referral to other persons or organizations providing
    services such as substance abuse treatment.

-   **Providing partner counseling and referral services (PCRS**),
    including partner notification, as described above. Such services
    can help the sex and needle-sharing partners of HIV-infected
    patients learn their HIV status and take steps to avoid becoming
    infected (or, if infected, to avoid infecting others) and gain
    earlier access to medical evaluation, treatment, and other services.

    Copies of the recommendations can be ordered by calling the National
    Prevention Information Network (NPIN) at (800) 458-5231 or visiting
    the NPIN Website at [www.cdcnpin.org.]{.underline}

    **Support Services**

    When funds are not available from other sources, EIS programs may
    use Part C EIS funds to provide support services necessary to ensure
    a comprehensive continuum of primary care services. To obtain
    funding for these services, justify why they cannot be purchased
    using other funding sources. Other program services include:

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-   **Outreach** to: a) those who may be at high risk of contracting the
    disease and need referral for counseling and testing; b) those who
    may have HIV disease in order to explain the benefits of early
    intervention and link them into care; and c) providers to make them
    aware of the availability and benefits of EIS services.

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-   **Non-medical case management to persons infected with HIV to access
    support services such as housing, food panty, transportation**

-   **Consumer transportation for medical care**

-   **Translation**

-   **General health education materials**

-   **Patient Advocates to maintain access to care**

-   **Respite Care**

    Outreach and case management services may not be duplicative of
    other existing and accessible community resources. They must be
    coordinated with the outreach and case management activities funded
    under Part A, Part B, or Part D of the Ryan White Program, or any
    other funding source. Outreach must be consistent with HAB Policy
    Notice 07-06: Use of Ryan White Program Funds for Outreach Services,
    available on the web at
    <http://hab.hrsa.gov/law/0706.htm>[.]{.underline}

    Although you are not required to provide outreach services, you must
    have a plan for identifying and linking people at high risk for HIV
    into counseling and testing and linking those living with HIV into
    care at your program.

**Required Policies and Procedures for Program Operations**

**Referral System**

Your program must have a system in place for referring patients to
health and social services. You may use Part C EIS funds to create and
implement a referral process, and for related evaluation, diagnostic,
and treatment services. Your system should include a referral mechanism
for specialty and subspecialty care. However, because the emphasis of
Part C EIS funding is for primary medical care, Part C EIS funds should
not be used for specialty consultations and treatment at the expense of
providing basic HIV primary care services.

Your referral system must include a process for tracking and monitoring
referrals. Your system also should have a mechanism in place for
documenting the results of the referral from the providers of health and
support services to which patients are referred.

**Coordination and Linkages to Other HIV Programs**

Optimum patient care results when grantees are knowledgeable about and
coordinate with all available and accessible community resources. These
resources may include federally-funded and non-federally-funded programs
such as homeless, housing, substance abuse treatment, mental health
treatment and other supportive services. Your proposed program must:

-   **Be consistent with the Statewide Coordinated Statement of Need
    (SCSN).**

-   **Agree to participate in the ongoing revisions of the SCSN.**

    A copy of the SCSN can be obtained from your State's Ryan White
    Program Part B Director. In addition, your program is required to
    coordinate services with other providers of health care services
    funded by the Ryan White Program including Part A, Part B, Part C
    EIS, Part D, Special Projects of National Significance, AIDS
    Education and Training Centers, the Dental Reimbursement Program,
    and the Community Based Dental Partnership Program. If your
    organization is located in an Eligible Metropolitan Area (EMA) or a
    Transitional Grant Area (TGA), you are encouraged to participate in
    the activities of the Ryan White Program Part A Planning Council.
    Applicants must demonstrate that they have coordinated with and not
    duplicated Part A services. If your program is located in a
    State/territory that has created a Part B HIV Care Consortium, you
    must make reasonable efforts to participate in that consortium. If
    your program is located near existing Part C EIS funded programs,
    you are expected to demonstrate that your program does not duplicate
    services provided in your service area and target population. You
    also are expected to coordinate and collaborate with other Part C
    EIS programs. If your program is located in the service area of an
    existing Part D program you are expected to collaborate and
    coordinate services for women, infants, children and youth. A
    listing of Ryan White Program grantee contact information can be
    found on
    [http://www.hab.hrsa.gov/programs/granteecontact.htm.]{.underline}

    You are expected to collaborate with ongoing HIV prevention
    activities and establish formal linkages for referrals of
    HIV-positive individuals for care. You are also expected to
    collaborate with Community Health Centers and other publicly funded
    primary care services, mental health and substance abuse treatment
    services including those funded by the Substance Abuse and Mental
    Health Services Administration (SAMHSA) and research programs
    including those funded by the National Institutes of Health (NIH).

**Clinical Quality Management (CQM)**

HAB has defined quality as follows:

"Quality is the degree to which a health or social service meets or
exceeds established professional standards and user expectations.
Evaluations of the quality of care should consider (1) the quality of
inputs, (2) the quality of the service delivery process, and (3) the
quality of outcomes, in order to continuously improve systems of care
for individuals and populations."

Your CQM program should ensure that systematic and continuous processes
are in place for planning, implementing, and evaluating improvement
strategies. If other organizations provide primary care for your
organization via subcontract, you are responsible for assuring that CQM
systems are in place at those organizations. Your subcontracts must
include provisions regarding monitoring and CQM, and you may require
regular reporting from your subcontractors on this issue. It is a
program expectation that, consistent with Part A and Part B of the Ryan
White Program, no more than 5 percent of the grant is spent on CQM,
unless justified with prior approval.

The three-fold purpose of CQM is to ensure:

-   Funded services adhere to established HIV clinical practice
    standards and Public Health Service (PHS) guidelines.

-   Strategies for improvements to quality medical care include vital
    health-related supportive services in achieving appropriate access
    and adherence with HIV medical care.

-   Available demographic, clinical, and health care utilization
    information is used when developing and adapting programs to address
    changing trends in the epidemic.

All Part C EIS CQM programs must include clinical goals and measures.
Copies of the proposed quality measures can be provided. Examples of
clinical measures you may choose to include, but are not limited to the
following:

-   Number of patients with CD4+ counts 2 or more times per year

-   Number of patients with CD4+ (cells/mm^3^) count under 350.

-   Number of patients with viral load (HIV-1 RNA copies/mL) under
    10,000.

-   Number of patients with CDC defined AIDS who are on HAART

-   Number of patients on highly active antiretroviral therapy (HAART)
    who received adherence counseling/intervention at their last visit.

-   Use of prophylaxis for *pneumocystis carinii* pneumonia (PCP) and/or
    *mycobacterium avuim complex* (MAC) at a prescribed point in time
    among active patient load.

-   Number of patients with CD4+ counts \<200 who are on PCP prophylaxis

-   Number of female patients receiving pap smears in the last six
    months.

-   Number of pregnant patients who are on ART

-   Change in the frequency or duration of hospitalizations.

-   Change in the average waiting time for first appointment.

-   Change in the percent of patients with visit(s) in the last three
    months.

    In addition to clinical outcomes, your CQM program also must have:

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-   Designated leaders and accountability.

-   Routine data collection and analyses of data on measurable outcomes.

-   A system for ensuring that data are fed back into your
    organization's quality improvement process to assure goals are
    accomplished.

-   Consistency, to the extent possible, with other programmatic quality
    improvement activities such as the Joint Commission on the
    Accreditation of Healthcare Organizations (JCAHO), Medicaid, and
    other HRSA funded programs.

    HAB also encourages grantees to conduct CQI for the administrative
    and fiscal components of their organization.

**Program Evaluation**

Your program is required to develop an evaluation strategy with outcome
measures that demonstrate achievement of your program goals and
objectives and the impact of the program. You are required to have an
information system that has the capacity to manage and report the
following administrative, fiscal, and clinical data:

-   The number of individuals provided early intervention
    services/primary care.

-   Demographic data on the clients receiving services.

-   Epidemiological data on the population receiving services, including
    the extent of new TB infections, active TB cases, and multi-drug
    resistant tuberculosis (MDR-TB).

-   Exposure and diagnostic categories on the population receiving
    services.

-   The number of HIV infected individuals and the CDC classification of
    their disease.

-   The extent to which the costs of HIV‑related health care are paid by
    third party payers.

-   The average costs of providing each category of early intervention
    service/primary care.

-   The aggregate totals for each category of data.

    Routinely analyzing these data will assist you in making
    programmatic or fiscal adjustments that will benefit your program
    and patients. In addition, you will utilize these data when you
    write the Progress Report of your annual non-competing grant
    application and the annual CARE Act Data Report that is due each
    March.

**Medicaid Participation**

Your program must be a participating Medicaid entity for all services
that are covered under your State plan, and must document that status.
If you subcontract with a public or private entity to provide Medicaid
reimbursable services, that entity must also be a participating Medicaid
provider. If you or a subcontractor does not impose a charge or accept
reimbursement for health services from any third party, HAB may grant a
waiver of this requirement. Submit the waiver request as part of your
grant application.

If your State or local government requires a license or certification
before clinical services can be provided, provide documentation that you
are licensed to provide such services.

**Patient Payment for Services**

Your program must develop consistent and equitable policies and
procedures related to verification of patients' financial status,
implementation of a sliding fee scale, and ensuring a cap on patient
charges for HIV-related services. In order to comply with these
requirements, your program may need to provide additional staff
training, develop patient education materials, and/or place notices in
patient waiting rooms and reception areas.

-   **Sliding Fee Scale** Clients cannot be denied primary care if they
    are not able to pay for services. Part C EIS programs must provide a
    system to discount patient payment for charges by developing and
    utilizing a sliding discounted fee schedule that is published and
    made readily available. The scale must be based on the patient's
    income. The law prohibits imposing a first-party charge on
    individuals whose income is at or below 100 percent of the Federal
    Poverty Level and requires that individuals with incomes above the
    official poverty level be charged for services. Each program is
    responsible for creating its own sliding fee scale in accordance
    with the most recent Federal Poverty Level guidelines. Federal
    Poverty Guidelines are updated each year in early spring, and are
    available on the web at
    [[http://aspe.hhs.gov/poverty/index.shtml#latest.]{.underline}](http://aspe.hhs.gov/poverty/index.shtml#latest.)

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-   **Patient Cap on Charges** The law limits the annual cumulative
    charges to an individual for HIV‑related services to:

+----------------------------+-----------------------------------------+
| **Family Income**          | > **Maximum Charge**                    |
+----------------------------+-----------------------------------------+
| At or below 100% of        | \$0                                     |
| Poverty                    |                                         |
+----------------------------+-----------------------------------------+
| 101% to 200% of Poverty    | No more than 5% of gross annual income  |
+----------------------------+-----------------------------------------+
| 201% to 300% of Poverty    | No more than 7% of gross annual income  |
+----------------------------+-----------------------------------------+
| Over 300% of Poverty       | No more than 10% of gross annual income |
+----------------------------+-----------------------------------------+

Your Part C EIS program must have a system in place to ensure that these
annual caps on charges to patients are not exceeded.

**Program Income** Programs are required to maximize the service
reimbursement available from private insurance, Medicaid, Medicare, and
other third-party sources. Programs are required to track and report all
sources of service reimbursement as program income on the annual
Financial Status Report and in annual data reports. All program income
earned must be used to further your HIV program objectives. The Ryan
White Program is the payer of last resort, except for programs
administered by or providing the services of the Indian Health Service.

**Limitation on Administrative Expenses** Not more than 10 percent of
the approved Part C EIS Federal grant funds may be used for
administrative costs. Indirect costs will be allowed only if the
applicant has a Federal negotiated indirect cost rate. All indirect
costs are considered administrative and subject to the 10 percent
limitation. Administrative costs include:

-   Program Coordination

-   Clerical, financial and management staff not directly related to
    patient care

-   Rent, utilities, facility costs

-   Program evaluation

-   Data collection for evaluation

-   Telecommunications

-   Postage

-   Liability insurance

-   Audits

-   Computer hardware/software not directly related to patient care

-   Indirect costs

**Other Financial Issues** Programs must have appropriate financial
systems in place that provide for internal controls, safeguarding
assets, ensuring stewardship of Federal funds, maintaining adequate cash
flow to meet daily operations, assuring access to care, and maximizing
revenue from non-Federal sources.

Because of the numerous financial requirements of the Ryan White Program
Part C, grantees must seek approval to deviate from their approved
budget. They must request a budget modification regardless of the amount
or percentage of the grant award to be changed.

There is no required match or other cost participation requirement for
these categorical grants. However, the level of non-Federal expenditures
for HIV early intervention services/primary care must be maintained at
the level for the year prior to the grant award. Grantees are expected
to maximize revenues from grant-supported services and other
government/private grants and not supplant existing services using Part
C EIS funds.

Clients who need medications and are eligible for State drug
reimbursement programs funded under Part B of the Ryan White Program or
other pharmaceutical programs should be assisted in accessing these
resources prior to the use of Part C EIS grant funds for such purposes.

**Additional Reporting Requirements**

1.  It is a legislative requirement that programs provide information on
    how expenditures relate to the Part A and Part B planning processes.

2.  It is a legislative requirement that programs provide specification
    on how expenditures will improve overall client outcomes, as
    described in the State plan.

3.  It is a legislative requirement that programs provide documentation
    regarding the process used to obtain community input into the design
    and implementation of the program.

4.  It is a legislative requirement that programs submit audits
    consistent with Office of Management and Budget circularA-133 every
    two years to the State, including client level data to complete the
    unmet need and Statewide Coordinated Statement of Need.

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1.  **Additional Policies and Procedures for Program Operations**

**Consumer Involvement**

It is a program expectation that EIS programs will actively involve
consumers in program development, implementation, and evaluation
activities. "Consumers" are defined as persons living with HIV/AIDS
(PLWH's) or their representatives (i.e., those who represent PLWH's who
are unable to speak for themselves such as HIV+ children and severely
ill individuals) who are served by your program.

There are many ways to involve consumers, and each program should design
consumer involvement that best suits its situation. To accomplish
effective consumer involvement, programs should provide necessary
training, mentoring, supervision, and reimbursement of expenses.
Examples of consumer involvement are:

-   HIV consumer representation on the organization's Board of
    Directors.

-   Establishment of an HIV specific Consumer Advisory Board.

-   HIV consumer representation on an existing consumer advisory board.

-   Involvement of HIV consumers on workgroups, committees and task
    forces, such as a Program Committee, an Outreach Task Force, or a
    Patient Education Committee.

-   Using HIV consumers as peer educators, outreach workers, or staff in
    the clinic, with fair and equitable pay for the job they are hired
    to perform.

-   Involving HIV consumers through surveys, consumer forums, and focus
    groups.

-   Using HIV peer trainers to work directly with patients to help them
    address issues. related to making healthy decisions, gaining access
    to clinical trials, managed care, etc.

2.  **Drug Pricing Program**

Programs funded under this grant are eligible for and should demonstrate
participation in HRSA's 340B Drug Pricing Program. This program enables
Part C EIS grantees to purchase medications at a reduced rate. Detailed
program information is available on-line at
http://www.hrsa.gov/odpp/default.htm

For more information, contact:

Office of Pharmacy Affairs

5600 Fishers Lane,

Parklawn Building, mail stop 10C-03

Rockville, MD 20857

1-800-628-6297

# Appendix E Service Areas 

These service areas have project periods ending December 31, 2008 and
are up for competition for January 1, 2009, as well as project periods
ending March 31, 2009 which are up for competition for April 1, 2009.
New proposals to replace existing grantees are expected to cover the
entire service area of the existing grantee. Each grantee's service area
is listed separately.

  --------------------- --------------- ---------------- ------------------------------------
  [Service areas of                                      
  Part C EIS grantees                                    
  up for competition                                     
  for January,                                           
  2009:]{.mark}                                          

  [Grantee]{.mark}      [City]{.mark}   [State]{.mark}   [Service Area (counties)]{.mark}

  Newark Community      Newark          NJ               Essex
  Health Centers, Inc.                                   

  Open service area,    Mound Bayou     MS               Bolivar, Sunflower, Washington
  formerly Delta Health                                  
  Center, Inc.                                           

  Premier Care And      Shreveport      LA               Bossier, Caddo
  Learning Ctr                                           

  Consejo De La Salud   Ponce           PR               Juana Diaz, Penuelas, Ponce
  De La                                                  

  Open service area,    Baltimore       MD               Baltimore City
  formerly Health                                        
  Education Resource                                     
  Organization,                                          
  services currently                                     
  provided by Chase                                      
  Brexton Health                                         
  Services                                               

  [Service areas of                                      
  Part C EIS grantees                                    
  up for competition                                     
  for April,                                             
  2009:]{.mark}                                          

  Carilion Medical      Roanoke         VA               Counties of Lee, Scott, Wise,
  Center                                                 Dickenson, Russell, Washington,
                                                         Buchanan, Tazewell, Smyth, Grayson,
                                                         Wythe, Bland, Pulaski, Giles,
                                                         Carroll, Floyd, Patrick, Henry,
                                                         Montgomery, Craig, Roanoke,
                                                         Franklin.  Cities of Galax,
                                                         Covington, Clifton Forge,
                                                         Martinsville, Norton, Radford,
                                                         Roanoke, and Salem

  Open service area,    Casper          WY               State of Wyoming
  formerly Community                                     
  Health Center of                                       
  Central Wyoming                                        
  --------------------- --------------- ---------------- ------------------------------------