Barriers to 

American Indian, Alaska Native, and Native American 

Access to HHS Programs 

 FINAL REPORT 

Contract No. 233-02-087

Prepared for: 

U.S. Department of Health and Human Services 

Office of the Assistant Secretary for Planning and Evaluation 

Office of Human Services Policy 

200 Independence Avenue, S.W. 

Washington, D.C. 20201 

Prepared by: 

Westat 

1650 Research Boulevard 

Rockville, MD 20850 

April 2006 

This report was produced under the direction of Alana Landey 

and Peggy Halpern, Task Order Officers, Office of the 

Assistant Secretary for Planning and Evaluation, Office of 

Human Services Policy, Jerry Regier, Deputy Assistant 

Secretary. This report is available online at 

http://aspe.hhs.gov/hsp/06/barriers2access/

. 
Acknowledgments 

The authors would like to thank the following people for their contributions to this 

study: 

• The HHS work group whose guidance in the planning of the study and 

review of our work products were invaluable (Tom Hertz, Shannon Kelly, 

Diane Osterhus, Hal Greenberg, Kimberly Romine, Sheila Cooper, Neal 

Davis, Carmelia Strickland, Denise Beauvais, Floyd Godfrey, Jerome 

Wilson, Pelagie (Mike) Snesrud, Bill Robinson, Jill Erickson, Leo Nolan, 

Eugenia Tyner-Dawson, Eric Broderick, Valerie Jordan, and Tim Martin 

from the Tribal Self Governance Organization and Christina Morrow from 

the National Congress of American Indians); 

• The HHS staff from ACF/ANA, AHRQ, ASTBF, CDC, HRSA, IHS, NIH, 

and SAMHSA who participated in the various focus groups; 

• The project consultants, Carole Anne Heart, Gordon Belcourt, Ralph 

Forquera, and Frank Ryan, who provided insight into the American 

Indian/Alaska Native/Native American perspective on the HHS grant 

process and on the project; 

• The tribal representatives who participated in the many conference 

sessions; 

• HHS staff who provided us with information about other department 

initiatives including Walter Leginski, Lisa Gale, Deanna Carlson, and 

Marsha Brand; and 

• The HHS staff that talked with us in a series of initial interviews about the 

grants process and HHS. 

We also would like to extend special thanks to Dr. Norka Ruiz Bravo, Deputy 

Director for Extramural Research at NIH, who made a special effort to help us get 

the focus group participants from NIH. Finally, we would like to thank our co-task 

order officers, Alana Landey and Peggy Halpern, as well as Canta Pian, Barbara 

Broman, Don Winstead, and Jerry Regier from the Office of Human Services 

Policy in the Office of the Assistant Secretary of Planning and Evaluation, 

Department of Health and Human Services for their support and guidance 

throughout the study. 

i
TABLE OF CONTENTS

Page

EXECUTIVE SUMMARY ......................................................................................v

Purpose and Methods ................................................................................v

Findings..................................................................................................... vi

Discussion................................................................................................viii 

I. Overview and Purpose ....................................................................................1 

II. Background .....................................................................................................2

American Indians and Alaska Natives........................................................2

Native Hawaiians and Other Pacific Islanders............................................4

Level of AI/AN/NA Grant Awards and Funding, 2004.................................5

Review of Other Initiatives..........................................................................6

HHS Operating Divisions and Grant Programs Examined .........................8 

III. Findings...........................................................................................................9

Sources of Information on HHS Grant Opportunities .................................9

Factors that Affect the Decision to Apply for Specific Grant 

Opportunities............................................................................................12

Preparing Grant Applications ...................................................................17

Grant Review Processes..........................................................................20

Grants Management Issues and Processes.............................................21

Other Suggestions and Issues .................................................................22 

IV. Discussion .....................................................................................................24

Similarities and Differences in Perspectives of HHS Program Staff and 

AI/AN/NA Representatives.......................................................................24

Initiatives Underway Within HHS to Reduce Barriers and Increase 

AI/AN/NA Access to HHS Grant Programs ..............................................26

Practical Considerations for Implementing Suggested Strategies............27

Strategies Requiring HHS Action................................................28

 Strategies Requiring Lower Costs for Most HHS Agencies...28

 Strategies Involving More Significant Costs/Efforts for Most 

 HHS Agencies....................................................................29

Strategies Requiring Action by AI/AN/NA Tribes/Organizations .31

Suggested Strategies Requiring Congressional Action ..............32

Discussion .....................................................................................................33

ii
APPENDIX A: METHODS ..........................................................................35

APPENDIX B: LIST OF IDENTIFIED BARRIERS AND ASSOCIATED 

SUGGESTIONS FROM HHS PROGRAM STAFF AND 

AI/AN/NA REPRESENTATIVES.........................................41

APPENDIX C: HHS STAFF SURVEY ON BARRIERS TO AMERICAN 

INDIAN, ALASKA NATIVE AND NATIVE AMERICAN 

COMMUNITIES’ ACCESS TO HHS PROGRAMS .............48

Tables

Table 1: HHS Operating Divisions and Programs Included in Study ..................8

Table 2: Respondent Suggestions for Increasing AI/AN/NA Awareness of Grant 

 Opportunities .....................................................................................11

Table 3: Respondent Suggestions for Increasing AI/AN/NA Decisions to Apply 

 for Grant Opportunities ......................................................................16

Table 4: Respondent Suggestions for Assisting AI/AN/NA Tribes and 

 Organizations to Prepare Grant Applications.....................................19

Table 5: Respondent Suggestions for Grant Review Process .........................21

Table 6: Respondent Suggestions for Grants Management Processes ..........22

Table 7: Other Overarching Suggestions from Respondents to Increase 

 AI/AN/NA Access to HHS Grant Programs........................................24

Table B.1: Barriers to Obtaining Information About HHS Grant Opportunities 

 Identified by Respondents and Respondents’ Suggestions to 

 Address Identified Barriers................................................................41

Table B.2: Barriers to the Decision to Apply for Specific Grant Opportunities 

 Identified by Respondents and Respondents’ Suggestions to Address 

 Identified Barriers..............................................................................42

Table B.3: Barriers to Preparing Grant Applications Identified by Respondents 

 and Respondents’ Suggestions to Address Identified Barriers .........45

Table B.4: Barriers Related to HHS Grant Review Processes Identified by 

 Respondents and Respondents’ Suggestions to Address Identified 

 Barriers .............................................................................................46

Table B.5: Barriers Related to Grants Management Issues and Processes 

 Identified by Respondents and Respondents’ Suggestions for 

 Addressing Identified Barriers ...........................................................47

Table B.6: Other Respondent Overarching Suggestions for Increasing AI/AN/NA 

 Access to HHS Grant Programs ......................................................47

iii
iv
EXECUTIVE SUMMARY 

Purpose and Methods 

The purpose of this study was to gather information from both HHS 

program officials and tribal representatives on their perspectives on various 

program and regulatory barriers to American Indian, Alaska Native, and other 

Native American (AI/AN/NA) tribes and communities accessing HHS 

discretionary grants, identify for HHS the most significant barriers to grants 

access for American Indians, Alaska Natives and Native Americans (AI/AN/NA), 

and consider strategies for improving access. Lessons learned about reducing 

barriers to funding in other recent HHS initiatives targeting special populations 

were also reviewed to inform the study. The main components of the project 

included: 

• Developing, administering, and analyzing the results of a survey of 

officials of HHS programs for which AI/AN/NAs and entities that serve 

them are eligible, to ascertain their perspectives on possible barriers 

and remedies; 

• Conducting focus groups with staff from a subset of these programs to 

explore relevant issues in more detail; 

• Holding discussions with representatives of AI/AN/NA groups to obtain 

their input on perceived and actual barriers and how they can be 

lessened; and 

• Consulting with a workgroup of HHS and tribal representatives at major 

junctures in the project. 

In addition, a draft of this report was circulated to HHS staff from all of the 

Operating Divisions that participated in the study and to members of the HHS 

workgroup. Comments received during this review process clarified and 

provided additional information that was important to ensure accuracy of 

information included in the report and, particularly, to identify some of the 

initiatives that are underway within HHS and/or individual Operating Divisions 

that are similar to some of the strategies that emerged from this study. 

This report summarizes the findings of the study, with emphasis on 

possible strategies for reducing identified barriers to access HHS grant 

programs. The report also discusses and categorizes the suggested strategies 

in terms of those that would require different amounts of resources and time for 

implementation within HHS, those strategies that could be implemented by 

AI/AN/NA tribes and organizations, and those that may require congressional 

action to implement. In addition, issues of feasibility and practicality of specific 

suggestions are discussed. 

v
Findings 

Information on barriers to access to HHS discretionary grant programs 

and suggestions for strategies to reduce barriers were obtained from HHS staff 

and AI/AN/NA representatives and focused on several key areas of grant 

processes: 1) sources of information about grant opportunities; 2) factors 

affecting decisions to apply for specific grants; 3) preparing grant applications; 4) 

experiences with grant review processes; and 5) experiences with grants 

management processes. In addition, participants provided several broad 

suggestions for changes that would increase access to HHS grant programs. 

Limited resources of AI/AN/NA tribes and organizations were identified by 

both AI/AN/NA representatives and by HHS program staff as a major barrier to 

access of many tribes and organizations to HHS grants. The limited resources 

available make it difficult to: 1) learn about grant opportunities; 2) apply for grants 

that have matching requirements or limits on indirect costs; 3) prepare a 

successful grant application; and 4) develop and implement the infrastructure 

necessary to meet all grants management requirements. 

Possible strategies to reduce barriers to access were suggested by the 

study respondents. The feasibility of implementing these strategies is discussed 

separately in Section IV, Practical Considerations for Implementing Suggested 

Strategies. 

These strategies identified through the study process are organized by 

topic areas. They include: 

Strategies Related to Obtaining Information About Grant Opportunities, Deciding 

to Apply, and Preparing Grant Applications

• Announce grant opportunities through multiple methods, with targeted 

outreach and communications with AI/AN/NA organizations. 

• Increase time between grant announcements and due dates. 

• Increase use of annual or multi-year program announcements, with 

multiple due dates. 

• Increase use of planning grants by HHS agencies that may provide 

opportunities to build capacity and infrastructure. 

• Establish a pre-proposal letter of inquiry process to screen and select a 

limited number of invited proposals. 

• Include explicit statements about eligibility of AI/AN/NA tribes and 

organizations in all grant announcements. 

• Include explicit statements about minimum population base 

requirements in grant announcements, if applicable. 

vi
• Include explicit statements in grant announcement that experience 

may substitute for academic credentials of key staff 

• Increase accessibility of HHS grant program contacts. 

• Re-examine type and extent of requirements for data on “need” for 

grant program services for rural AI/AN/NA applicants and/or work with 

potential applicants to determine data required to establish need. 

• Increase training and technical assistance on grants processes and 

grants preparation skills, provided by HHS and/or national and regional 

AI/AN/NA organizations, including possible knowledge transfer 

between successful AI/AN/NA grantees and less experienced tribes 

and organizations. 

• Provide training and technical assistance in more locations that are 

more accessible to AI/AN/NA tribes and communities. 

• Greater participation by staff of AI/AN/NA tribes and organizations in 

available training and technical assistance opportunities. 

• Consider waiving or modifying indirect cost limits and matching funds 

requirements, particularly for those tribes and communities that have 

limited resources. 

• Consider waiving or modifying requirements for collaboration or 

coordination with states or local governments. 

• Consider waiving or modifying requirements to demonstrate that the 

program would be fully sustainable after the end of grant funding. 

• Develop a standardized HHS-wide grant application format and 

requirements. 

• Continue acceptance of hard copy grant applications, as an option, 

rather than moving to required electronic submission. 

• Design grant programs to better fit AI/AN/NA needs and make RFAs 

more culturally appropriate. 

Strategies for Grant Review Processes

• Consider reducing reliance on academic reviewers who place 

disproportionate emphasis on academic credentials of grant applicant 

staff, where such credentials are not necessary for successful 

performance and where alternative forms of expertise are 

demonstrated. 

• Increase use of AI/AN/NA grant reviewers and those familiar with 

AI/AN/NA subjects, when AI/AN/NA grant applications are to be 

considered. 

vii
• Provide orientation for grant reviewers to help them understand unique 

AI/AN/NA issues and circumstances. 

• If agency has not established a minimum population base for the grant 

program, provide reviewers with clear guidance on this issue. 

• Provide clear information on reasons for rejection of application. 

• Follow-up contact with HHS program staff by AI/AN/NA organizations 

to clarify reasons for rejection or to obtain summary statements, if not 

provided by agency. 

Strategies for Grants Management Processes

• Develop standardized HHS-wide grants management requirements. 

• Provide training and technical assistance on grants management 

requirements, particularly for new grantees. 

Other Strategies Suggested

• Consider AI/AN/NA “set-asides” or special grant initiatives within grant 

programs, including ways to address the needs of smaller/poorer tribes 

and organizations. 

• Improve capacity for HHS to track grant submissions and awards by 

AI/AN/NA tribes and communities. 

• Increase the number of grants targeted specifically to AI/AN/NA 

tribes/organizations. 

• Require evidence that states and academic institutions have support 

and participation of AI/AN/NA tribes and organizations, if they are 

included in grant application. 

• Provide opportunities for HHS program staff to visit AI/AN/NA tribes 

and communities and become knowledgeable of unique issues and 

circumstances. 

• Increase interagency collaboration to expand grant opportunities and 

assist AI/AN/NA groups to build capacity. 

Discussion 

There was considerable agreement among study respondents on barriers 

and on strategies to reduce those barriers. Within HHS, there are currently 

initiatives underway at the department level or within specific agencies that are 

viii
similar to several of the suggested strategies. These initiatives, some of which 

were identified by HHS staff reviewing a draft version of this report, are 

discussed in Section IV. 

The feasibility of implementing specific strategies for increasing AI/AN/NA 

access to HHS grant programs and the time that might be needed to implement 

changes depends on a number of factors, including: 

• The cost in HHS staff time and additional resources required for 

planning and implementation of new policies and procedures. 

• The cost to AI/AN/NA tribes and organizations to implement strategies 

requiring action on their part. 

• Whether congressional action is required. (Such changes are included 

in this report because they were identified by study respondents; their 

inclusion is not meant to imply that HHS has made any commitment to 

pursue such legislative changes.) 

This report provides an initial starting point for discussion of ways to 

potentially increase AI/AN/NA access to and participation in HHS grant 

programs. A summary of the key findings in this report was presented to the 

HHS Intradepartmental Council on Native American Affairs, and the Department 

is considering how best to utilize this information. 

ix
I. Overview and Purpose 

Increasing AI/AN/NA access to HHS programs is a priority of both the 

Secretary of the Department of Health and Human Services (HHS) and of the 

HHS’ Intradepartmental Council on Native American Affairs (ICNAA). In order to 

address this issue, the HHS’ Office of the Assistant Secretary for Planning and 

Evaluation (ASPE) and the Administration for Native Americans, the ICNAA, and 

the Assistant Secretary for Budget, Technology and Finance funded a research 

project to help increase understanding of the programmatic and administrative 

barriers preventing American Indian, Alaska Native and Native American 

(AI/AN/NA) communities from more fully participating in those HHS discretionary 

grants programs for which they are eligible. Past work has shown that, for most 

of the HHS programs available to AI/AN/NA individuals, tribes, or organizations, 

very few are funding more than one or two tribes or organizations and many are 

not reaching such entities at all. The purpose of this study was to gather 

information from both HHS program officials and tribal representatives on 

perspectives of various program and regulatory barriers, identify for HHS the 

most significant barriers to grants access for AI/AN/NAs, and consider strategies 

for improving access. Lessons learned about reducing barriers to funding in 

other recent HHS initiatives targeting special populations were also reviewed to 

inform the study. 

The main components of this project included: 

• Developing, administering and analyzing the results of a survey of 

officials of HHS programs for which AI/AN/NA tribes, communities, and 

organizations are eligible, to ascertain their perspectives on possible 

barriers and remedies; 

• Conducting focus groups with staff from a subset of these programs to 

explore relevant issues in more detail; 

• Holding discussions with representatives of AI/AN/NA groups to obtain 

their input on perceived and actual barriers and how they can be 

lessened; and 

• Consulting with a workgroup of HHS and tribal representatives at major 

junctures in the project. 

The survey of HHS staff members was sent to 261 individuals from HHS 

programs that have grant funds for which AI/AN/NA tribes and organizations 

were eligible to apply. These programs represent all ten operating divisions of 

HHS. A response rate of 56.7 percent was achieved, with responses received 

from 148 program and grants management staff representing 93 unique HHS 

programs. Although at least one response was received from each operating 

division, this sample should not be considered representative of all HHS program 

and grants staff with knowledge of grants for which AI/AN communities are 

eligible. After the survey results were analyzed and key findings had been 

identified, focus groups were held with HHS staff to obtain additional input and 

feedback on the survey findings. Separate focus groups were held with 

1
representatives from the National Institutes of Health, Centers for Disease 

Control and Prevention, Substance Abuse and Mental Health Services 

Administration, and Health Resources and Services Administration. A combined 

focus group was held with representatives from the Indian Health Service, 

Administration on Aging, and the Administration for Children and Families. A 

final focus group was held with senior staff from several agencies. 

Input from representatives of AI/AN/NA tribes and organizations was 

obtained through scheduled sessions at five national AI/AN conferences, 

conference calls with members of the National Institute of Drug Abuse (NIDA) 

Native American Researchers and Scholars Workgroup, and individual telephone 

interviews with representatives of Native Hawaiian (NH) and other Pacific 

Islander organizations. Approximately 150 AI/AN/NA representatives 

participated in these sessions and interviews. Appendix A to this report contains 

a detailed description of the methodologies that were used to collect information 

from HHS program staff and from representatives of AI/AN/NA communities and 

organizations. 

The study, was initiated in September 2004, was conducted by Westat. 

An interim progress report was prepared and presented at the April 2005 ICNAA 

meeting. This final report synthesizes the information obtained from the separate 

data collection activities and examines the differences and areas of agreement 

between the HHS and the AI/AN/NA perspectives on barriers and their reduction. 

The report summarizes suggested strategies to increase AI/AN/NA access to 

discretionary grant programs that HHS could consider for future implementation. 

II. Background 

The success of this study depended on a strong understanding of the 

issues and characteristics of AI/AN/NA tribes and communities that affect their 

ability to apply for HHS discretionary grants. Some of these issues and 

characteristics are not unique to the AI/AN/NA population and may affect the 

ability of other groups to obtain HHS grant funding. In this section, we provide an 

overview of the AI/AN/NA population and a brief summary of findings from other 

HHS initiatives to increase access to HHS grant programs for other populations. 

The section also discusses the level of grant awards and funding to AI/AN/NA 

groups in recent years, and the specific operating divisions that provide grant 

funding within HHS. 

American Indians and Alaska Natives

American Indians (AI) and Alaska Natives (AN) are defined by the U.S. 

Census Bureau as “people having origins in any of the original peoples of North 

and South America (including Central America), and who maintain tribal affiliation 

or community attachment.”1 American Indians and Alaska Natives who are 

 

1

 U.S. Census Bureau, “The American Indian and Alaska Native Population: 2000.” Census 2000 Brief, Feb. 2002, p. 2. 

2
members of federally-recognized tribes are a subgroup of all who report AI/AN 

race on the U.S. Census; they have a unique relationship with the federal 

government. The federal government may provide health care, housing, and 

other services to members of federally-recognized tribes, although these services 

are generally provided to those tribal members who reside on or near 

reservations; however, other types of tribal members/communities are 

sometimes eligible for HHS programs. Some grant programs are available to 

state-recognized tribes and, in addition, other AI/AN/NA groups may apply for 

HHS grants as eligible nonprofit or community-based organizations. Thus, it is 

important to distinguish among four groups who report American Indian or Alaska 

Native race: 

• AI/ANs who are members of federally-recognized tribes, regardless of 

residence. 

• AI/ANs who are members of federally-recognized tribes and who 

reside on or near reservations (also reported on Bureau of Indian 

Affairs data files). 

• AI/ANs who meet the definition of “Indian” in Section 4 of the Indian 

Health Care Improvement Act, the primary legislative authority of the 

Indian Health Service. This definition is sometimes used by other HHS 

programs. 

• AI/ANs who self-identify race as AI/AN, either alone or in combination 

with other races. This definition includes members of federallyrecognized tribes, members of non-federally-recognized tribes, and 

others who report AI/AN race but are not enrolled as members of a 

tribe. 

The Census Bureau reports that 2.5 million people reported AI/AN race 

only on the 2000 Census, and over 4 million reported AI/AN race only or in 

combination with another race. Those reporting AI/AN race only or in 

combination with another race are 1.5 percent of the U.S. population; those 

reporting AI/AN race only are 0.9 percent of the U.S. population. Forty-three 

percent of the AI/AN population resides in the Western region of the U.S.; 31 

percent in the South; 17 percent in the Midwest; and 9 percent reside in the 

Northeast.2

American Indians and Alaska Natives, on average, are younger, have 

larger households, and are poorer than other Americans. American Indians who 

reside on reservations have real per capita income and median household 

income that is only half the U.S. level. Poverty rates of Indian people are three 

times the national average and unemployment rates are more than twice the U.S. 

average.3

 

2 Ibid. 

3

 Taylor, J.B. and Kali, J.P., “American Indians on Reservations: A Databook of Socioeconomic Change 

Between the 1990 and 2000 Censuses.” The Harvard Project on American Indian Economic Development, 

Harvard University, Cambridge, MA. January 2005. 

3
The American Indian/Alaska Native (AI/AN) population has long 

experienced a disproportionately high rate of various health problems. Over 

time, the Indian Health Service (IHS) and the tribal and urban Indian health 

programs have demonstrated the ability to utilize limited resources to improve 

AI/AN health status, primarily by focusing on preventive and primary care 

services. This resulted in significant improvements between 1972-74 and 1997-

99 for a number of health problems including large decreases in mortality rates 

due to tuberculosis, gastrointestinal disease, infant mortality, unintentional 

injuries, and maternal mortality.4 

However, a recent IHS report notes that while the IHS public health model 

has been effective as noted above, the problems facing AI/AN communities 

today are very different from those that existed historically. Today, the health 

problems in AI/AN communities tend to mirror the health problems confronting all 

races in the country, such as obesity, substance abuse, and lack of exercise, 

tobacco dependence, and violence. The impact of these conditions is reflected 

in continuing health disparities between AI/ANs and the white non-Hispanic 

population involving increased disease burden and decreased life expectancy, 

often leading to the development of chronic diseases such as cardiovascular 

disease, diabetes, liver disease, cancer, and injuries that require costly long-term 

treatment. 5 In addition to unemployment and poverty, high population growth, 

poor living conditions and sanitation, and residence in rural areas with scarce 

health providers and facilities present continuing challenges for the Indian 

communities and the Indian health system that serves them. 

Native Hawaiians and Other Pacific Islanders

The Native Hawaiian (NH) and other Pacific Islander (PI) population 

includes those who are members of any of the native peoples of Hawaii, Guam, 

Samoa, or other Pacific Islands. Those who identified their race, alone or in 

combination with another race, as Hawaiian/Pacific Islander on the 2000 Census 

constituted 0.3 percent of the U.S. population.6

 Only one-third of the 874,414 

Native Hawaiians/Pacific Islanders identified in the 2000 Census reported that 

their race was Hawaiian/Pacific Islander alone, while two-thirds reported their 

race as Hawaiian/Pacific Islander in combination with another race. 

Nearly three-fourths of Native Hawaiians and other Pacific Islanders 

resided in the West in 2000; over half resided in Hawaii and California. Native 

 

4

 Indian Health Service FY 2005 Performance Plan, FY 2004 Revised Final Performance Plan and FY 2003 

Performance Report, January 28, 2004: U.S. HHS/PHS/IHS: Rockville, Maryland. 

http://www.ihs.gov/NonMedicalPrograms/PlanningEvaluation/pe-gpra.asp 5 Promises to Keep: Public Health Policy for American Indians & Alaska Natives in the 21st Century, M. 

Dixon and Y. Roubideaux (eds.). The American Public Health Association, 2002; T. Kue Young, The Health 

of Native Americans: Towards a Biocultural Epidemiology, Oxford University Press, 1994; American Indian 

Health: Innovations in Health Care, Promotion, and Policy, E.R. Rhoades, M.D. (ed.). The Johns Hopkins 

University Press, 2000. 

6

 U.S. Bureau of the Census, “The Native Hawaiian and Other Pacific Islander Population: 2000.” Census 

2000 Brief, December 2001. 

4
Hawaiians and other Pacific Islanders are nearly 25 percent of the population of 

Hawaii. 

Within the Native Hawaiian/Pacific Islander population, there are several 

ethnically distinct categories. Polynesians, including Native Hawaiians, 

Samoans, Tongans, Tahitians, Tuvaluans, and Maoris, are the largest subgroup, 

accounting for 65 percent of all NH/PIs. Micronesians, including Guamanians, 

Marshallese, Palauans, residents of the Northern Mariana Islands and of the 

Federated States of Micronesia, are 13 percent of all NH/PIs. Melanesians, 

including Fijians, New Caledonians, Solomon Islanders, Vanuatuans, and Papua 

New Guineans, are two percent of this population.7

 

There is less information available on health and socioeconomic status of 

Native Hawaiians and other Pacific Islanders than for American Indians and 

Alaska Natives. Until recently, race identification on the U.S. Census and other 

national surveys combined Asians and Native Hawaiians/Pacific Islanders into 

one category. There has been increasing evidence, however, that there is great 

diversity within this combined racial category. As a result, the Office of 

Management and Budget established a new racial category, Native Hawaiian 

and Pacific Islander, and required that federal agencies collect information on 

this new race category by 2003. The 2000 Census included the NH/PI race 

category and, as a result, provides an initial baseline for assessing 

socioeconomic status and some limited health measures.8

The limited information available indicates that the NH/PI population is 

younger, household size is larger, and household income is lower than the U.S. 

average. Available data also indicate that the NH/PI population experiences 

poorer health than the U.S. average. Infant mortality rates for Native Hawaiians 

in 2002 were 37 percent higher than the rate for all races in the U.S.; the 

tuberculosis rate in the U.S. Pacific Islands was 8.4 times the mainland U.S. 

average; and Native Hawaiians in Hawaii were more than twice as likely to be 

diagnosed with diabetes as non-Hispanic white residents of Hawaii.9 

Level of AI/AN/NA Grant Awards and Funding, 2004

The underlying rationale for this study is based on the perception that 

AI/AN/NA tribes and organizations receive a disproportionately low number of 

HHS grant awards. Information from the HHS Tracking Accountability in 

Government Grants System (TAGGS) database for FY 2004 provides evidence 

that the AI/AN/NA population is under-represented as a proportion of total grant 

funding across all HHS agencies. AI/AN/NAs are approximately 1.5 percent of 

the U.S. population, but AI/AN/NA entities serving them receive only 0.51 percent 

 

7

 Panapassa, S.V. “The Health of U.S. Pacific Islander Populations: Emerging Directions.” Presentation, 

May 2005. 

8 Ibid.

9

 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of 

Minority Health, “Highlights in Minority Health, Asian American and Pacific Islander Heritage Month.” May 

2005. (Accessed 9-16-05 at http://www.cdc.gov/omh/Highlights/2005/HMary05.htm). 

5
of total grant funds awarded by HHS agencies.10 HHS currently does not have 

the data capability to determine whether this under-representation in grant 

awards is due to disproportionately fewer applications from AI/AN/NA groups or 

to disproportionately low rates of awards to AI/AN/NA groups that submit 

applications. 

The proportion of funds awarded to AI/AN/NA tribes and organizations 

varies widely across agencies. The Indian Health Service awarded 72 percent of 

its total grant funding to tribes and tribal organizations in 2004 and the 

Administration on Aging awarded 2 percent of its total funding to AI/AN groups 

that year. The National Institutes of Health awarded only 0.01 percent of total 

available grant funds to AI/AN/NA groups – and made only eight awards to these 

groups out of a total of 55,822 grants awarded. However, the NIH does fund 

grants to non-AI/AN/NA groups that support research in AI/AN/NA communities 

and it also provides some of its extramural research dollars to a small number of 

academic institutions that are run by tribes. With the exception of the three 

agencies that manage grant programs that are specific to AI/AN/NAs (IHS, AoA, 

and ACF/ANA), no HHS agency awarded more than 0.63 percent of total grant 

funding to AI/AN/NA tribes or organizations. 

Agencies vary in the types of grant programs they support and, to some 

extent, under-representation of AI/AN/NA groups in grant awards and funding 

may reflect the types of grants available from specific agencies. NIH and the 

Agency for Health Care Research and Quality (AHRQ) focus heavily on 

academic research grants, and AI/AN/NA tribes and organizations may have 

limited experience and lack staff with appropriate technical expertise to conduct 

research. Other agencies – Health Resources and Services Administration 

(HRSA), Centers for Disease Control (CDC), and Substance Abuse and Mental 

Health Services Administration (SAMHSA) – support some research-focused 

grants and others that fund program development and provision of services. 

AI/AN/NA groups may be more likely to apply and be funded for non-researchfocused grant programs. Despite this, HRSA, CDC, and SAMHSA also fund 

disproportionately few grants to this population. 

Review of Other Initiatives

Through other projects, HHS has examined barriers to access to 

departmental grant programs by other special population groups, including 

people experiencing homelessness, rural Americans and those served by faithbased and community organizations. Knowing that these past efforts could 

provide valuable context for the current study, Westat staff reviewed the earlier 

studies’ methodologies and findings and talked to key federal contacts 

 

10 U.S. Bureau of the Census, “We the People: American Indians and Alaska Natives in the United States.” 

Census 2000 Special Reports, February 2006. Grant receipt data are based on a search of the TAGGS 

data specifying that the recipient of the awards be a “Tribal Council.” Awards to AI/AN/NA applicants can be 

to tribes, tribal councils, community organizations, communities, and many other types of applicants. These 

applicants are not generally identified as AI/AN/NA organizations in the data. Obtaining an exhaustive count 

of these recipients was beyond the scope of this project. 

6
associated with the projects to better understand the issues they confronted. 

Information on how these studies solicited information on barriers informed our 

approach, and not surprisingly, many of the suggestions we heard in this current 

study parallel those identified in previous studies. 

The barriers identified in these earlier reports and the strategies presented 

to address these barriers are generally related to statutory, regulatory, 

administrative, or policy issues and to resources of the population groups 

examined. Statutory barriers are legislative requirements that may define 

program parameters that direct funding and payment policies (e.g., requirements 

for matching funds, population-based formulas that determine the level of 

funding, and eligibility rules). Regulatory barriers include program rules, 

definitions, and procedures. Administrative barriers may include management 

requirements and standards for routine program functions. Resource barriers 

generally are those that involve limited infrastructure or capacity of the population 

groups studied that affect their ability to learn about, respond to, and manage 

HHS grants. 

Statutory barriers to access to HHS grant funds for these populations 

included: 1) distribution of HHS funds through state block grants that may not be 

distributed by recipient states to organizations serving under-represented 

population groups; 2) requirements for matching funds that may be prohibitive for 

under-served groups that lack resources for the match; and 3) programs with 

allocation formulas based on numbers of clients or anticipated costs that may be 

biased against small or rural communities with small numbers of participants and 

the inability to spread costs across a larger client base. It should be noted, 

however, that statutory requirements are often necessary to design programs 

that meet the need identified by Congress. 

Two regulatory barriers identified were: 1) inconsistent definitions of the 

terms “community” and/or “rural”; and 2) data required to establish eligibility and 

meet reporting requirements are often not available at the rural and small 

community level. Several cross-cutting administrative, policy and resource 

barriers were also identified: 1) lack of resources to track and identify grant 

opportunities; 2) each HHS program requires unique grant application formats 

and have different grants management requirements; 3) program funding is 

inadequate for small community-based organizations to administer and provide 

services to special populations and to those in remote areas; 4) the inherent 

advantage previous HHS grantees have in the award process; and 5) lack of 

explicit statements about eligibility in grant announcements. 

A number of barriers related to the limited resources and capacity of these 

special population groups were also identified, including: 1) potential applicants 

may not have resources or experience to track and identify grant opportunities, 

prepare grants, or gain access to experienced grants writers; and 2) many 

community-based programs for people who are homeless, rural populations, and 

faith-based organizations do not have administrative or service capacity to meet 

program requirements or to successfully apply and compete for grants, due to 

7
limited workforce numbers, lack of computer and internet technology and 

experience, and transportation barriers. 

HHS Operating Divisions and Grant Programs Examined 

Discretionary grant opportunities that may be of interest and relevant to 

AI/AN/NA tribes and organizations originate from each of the HHS operating 

divisions. The survey of HHS staff and program officials and the focus groups 

conducted to obtain more detailed input on perceived barriers encompassed all 

ten HHS operating divisions and 129 specific grant programs for which AI/AN/NA 

organizations were eligible to apply. The majority of the 129 grant programs 

studied were identified from a study done by HHS using FY 2003 data that 

examined characteristics of grant programs for which tribes were eligible to 

apply. Table 1 summarizes the operating divisions and programs surveyed. 

Table 1: HHS Operating Divisions and Programs Included in Study 

OPDIV Acronym 

Number of 

Programs 

Surveyed 

Number of 

Staff 

Surveyed 

Administration for Children and 

Families ACF 20 39 

Agency for Health Care 

Research and Quality AHRQ 1 2 

Administration on Aging AoA 2 3 

Centers for Disease Control CDC 22 37 

Centers for Medicare and 

Medicaid Services CMS 1 1 

Office of the Secretary HHS/OS 3 6 

Health Resources and Services 

Administration HRSA 35 44 

Indian Health Service IHS 10 20 

National Institutes of Health NIH 16 57 

Substance Abuse and Mental 

Health Services Administration SAMHSA 19 52 

Total 129 261 

 Three of the agencies listed above – IHS, AoA, ACF/ANA − award 

AI/AN/NA-specific grants. In addition to the survey of operating division staff, 

focus groups were subsequently conducted with staff from ACF, AoA, CDC, 

HRSA, IHS, NIH, and SAMHSA and with senior staff from ANA, IHS, 

ASBTF/Division of Grants Oversight and Review and Division of Discretionary 

Grants, SAMHSA, and AHRQ. 

8
III. Findings 

The perspectives of HHS program staff and AI/AN/NA representatives on 

barriers to access and strategies to increase access to HHS grant programs are 

summarized in this section. Areas of concurrence, differences in perspectives, 

and suggestions for changes are highlighted and discussed. In addition, we 

present a set of strategies for change that are drawn from these sources. The 

discussion in this section is organized by the broad topic areas that were 

explored with HHS program staff and AI/AN/NA representatives, including: 

• Sources of information on HHS grant opportunities; 

• Factors that affect the decision to apply (or not apply) for a specific 

grant opportunity; 

• Experiences with developing grant applications; 

• Experiences with the HHS grant review process; 

• Experiences with grants management requirements and processes; 

and 

• Other issues that affect access to HHS grant programs. 

 Some suggested strategies to address barriers are repeated in more 

than one topic area, as the interviewees indicated that the strategy would be 

appropriate to accomplish several objectives. Appendix B includes tables 

organized by each of the above topic areas that list key barriers along with 

suggestions to address each of the identified barriers. Finally, during the review 

of this report by staff from HHS Operating Divisions, information was provided 

that a number of the suggested strategies are currently in place in some 

Operating Divisions or HHS-wide. These are discussed in Section IV, Initiatives 

Underway. 

Sources of Information on HHS Grant Opportunities 

Learning about HHS grant opportunities in a timely way that permits 

preparation and submission of a well-developed grant application is a critical 

issue for AI/AN/NA access to HHS grant programs. A number of barriers to 

obtaining information about HHS grant opportunities were identified by both HHS 

program staff and by AI/AN/NA representatives. 

AI/AN/NA representatives focused on limited resources to track and 

identify HHS grant opportunities as the major barrier to learning about HHS grant 

opportunities. Smaller AI/AN/NA organizations often do not have staff with 

experience or available time to devote to tracking opportunities on an ongoing 

basis. In addition, many of the AI/AN/NA representatives expressed concern 

about the increasing reliance of HHS and other federal agencies on Internet 

announcements. Many AI/AN/NA tribes and organizations are located in rural 

areas and have limited Internet access to track and identify grant opportunities. 

9
In addition, grant announcements may be sent to tribal chairs or other high-level 

managers who are very busy and do not forward the announcement to the 

appropriate person in the tribe in a timely way. These factors often result in 

AI/AN/NA organizations learning about grant opportunities at a point when there 

is little time left to prepare a grant application. The usual short time period 

between grant announcements and their due dates was identified as a significant 

barrier for those who do not have resources to learn about grant opportunities on 

a timely basis. A short time span does not allow adequate time for coordination 

with any potential partners including the state, obtaining tribal approvals, and 

writing the grant proposal. 

Some HHS program staff indicated that they perceived that some 

AI/AN/NA tribes and organizations were unaware of grant opportunities and 

generally indicated that lack of resources and knowledge about sources where 

grant announcements were published were the primary causes. Grant 

opportunities are announced in multiple ways and these were mentioned by most 

of the HHS program staff and by many of the AI/AN/NA representatives. Both 

HHS program staff and some AI/AN/NA representatives mentioned that national 

or regional AI/AN/NA organizations provide information to their members about 

grant opportunities and suggested that these organizations could take a larger 

role in dissemination, perhaps in partnership with HHS. HHS staff also 

suggested that increased coordination among the OPDIVs such as sharing lists 

of tribal contacts, may increase access. However, HHS program staff also 

expressed concern that the costs of extensive and targeted outreach to assist 

AI/AN/NA tribes and organizations to learn about the grant application tracking 

process and grant opportunities could be high; thus, cost-effective approaches 

would need to be utilized. 

Specific suggestions for increasing awareness of HHS grant opportunities 

were made by both HHS program staff and by AI/AN/NA representatives. These 

are presented in Table 2. 

10
Table 2: Respondent Suggestions for Increasing AI/AN/NA Awareness of 

Grant Opportunities 

Suggestions 

HHS 

Respondents 

AI/AN/NA 

Participants 

Publish a compilation of potential grant 

opportunities for the fiscal year at the 

beginning of the year in hard copy format and 

distribute widely. 

X X 

Increase use of annual or multiple year 

program announcements with multiple 

deadlines 

X 

Use multiple forms of communication on 

grant opportunities (e.g., fax, telephone, 

email). 

X 

Provide targeted training by HHS on 

Grants.Gov to AI/AN/NA tribes and 

organizations. 

X X 

Assign responsibility to HHS Regional Offices 

to notify AI/AN/NA tribes and organizations in 

their region about grant opportunities. 

X 

Provide targeted outreach and 

training/technical assistance in advance of 

grant announcements. 

X 

National and regional AI/AN/NA 

organizations take a greater role in 

dissemination of information on grant 

opportunities, perhaps in partnership with 

HHS. 

X X 

Coordinate among OPDIVs by sharing lists of 

tribal contacts. X 

AI/AN/NA tribes/organizations designate a 

“point of contact” to receive grant 

announcements from HHS. 

X X 

Although AI/AN/NA representatives were more likely to identify specific 

changes that HHS could make to increase awareness of grant opportunities, 

HHS program staff were also aware of the need for more targeted outreach and 

for training and technical assistance that would assist AI/AN/NA tribes and 

organizations to learn about and prepare for specific grant opportunities. 

Targeted outreach was discussed in a variety of ways; for example, identification 

by HHS staff of tribes that have specific needs in a substantive area or that are 

interested in certain types of grants and then sending electronic and hard copies 

of the RFA to these tribes; HHS staff attendance at national and other tribal 

11
meetings in order to increase awareness of grant opportunities; and providing 

specialized assistance to tribes interested in a specific grant opportunity. 

Factors that Affect the Decision to Apply for Specific Grant Opportunities

The decision to apply for a specific grant opportunity involves many 

factors, including the relevance of the grant program to AI/AN/NA needs and 

priorities. Many of the issues raised by AI/AN/NA representatives and by HHS 

staff as barriers to a decision to pursue grant opportunities were related to limited 

resources and capacity in AI/AN/NA communities, including: 

• Short time frame between the announcement and the due date for the 

application; and 

• Lack of staff with experience in or the time to prepare technical and 

financial proposals. 

Other issues raised were related to HHS procedures and requirements, 

including: 

• Uncertainty about whether AI/AN/NA tribes and organizations were 

eligible to apply for the specific opportunity as a result of inexplicit 

language; for example, the RFA may say that public and private 

nonprofit agencies are eligible, and although this term may include 

tribes, tribes are not specifically mentioned in the announcement. Also, 

it may not be clear if certain tribal organizations such as tribal colleges 

and universities, non-federally recognized tribes or Urban Indian 

Health Centers are eligible. 

• Difficulty reaching identified HHS contact persons to obtain 

clarifications and additional information; 

• Lack of required data for small areas and groups to establish “need”; 

• Requirements for collaboration or coordination with states or other 

local entities, with which AI/AN/NA groups may have poor or limited

relationships; 

• Limitations on indirect costs; 

• Requirements for matching funds; 

• Recommendations or requirements in some grant announcements that 

the applicant provide a plan to demonstrate that the program will be 

sustained after the end of grant funding; 

• Explicit or implicit requirements that the proposed program director or 

principal investigator have specific academic degrees or credentials, 

which are often not available in AI/AN/NA tribes and organizations; and 

• Skepticism of AI/AN/NA leaders about the ability of HHS agencies and 

reviewers to understand and make allowances for the unique issues 

and circumstances of AI/AN/NA tribes and organizations. 

12
Both AI/AN/NA representatives and HHS program staff suggested that 

one way to address the lack of resources and experienced staff that are major 

factors affecting the decision to apply for a grant opportunity was for HHS to 

provide more training and technical assistance (T/TA) on grant writing to these 

tribes and organizations. This T/TA could be provided either directly by HHS or 

through contractors who would have regional responsibilities for providing these 

services. It was also suggested that more planning grants might be made 

available to AI/AN/NA organizations to assist them to build capacity and 

infrastructure. Some strategies suggested by respondents addressed barriers 

associated with HHS procedures (e.g., identifying multiple HHS contacts for 

additional information, including specific language about AI/AN/NA tribes and 

organizations in the eligibility criteria). Other suggestions (e.g., waiving or 

modifying requirements for matching funds, limits on indirect costs, or 

requirements for collaboration or coordination with states) are likely to require 

congressional action to address. However, it should be noted that waiving or 

modifying any type of requirements is easier to accommodate in programs where 

these requirements are not specified in statute. 

There was considerable discussion by AI/AN/NA representatives of the 

effect of limitations on indirect costs and requirements for matching funds on 

decisions to apply for specific grants. AI/AN/NA representatives stated that limits 

on indirect costs and requirements for matching funds were often reasons for 

deciding not to apply for a specific grant. Many tribes and organizations have 

very limited resources and, as a result, are unable to administer a program that is 

not fully funded by HHS with respect to indirect costs. 

HHS staff indicated that indirect rates are negotiated on a case-by-case 

basis with each organization applying for grant funding so recovery of indirect 

costs should be handled in those negotiations. They did note that if tribes or 

other organizations cannot fully recover their indirect costs, the organizations will 

either not apply for the grant or will have to take those funds away from the 

program itself. Some HHS staff indicated that waiver of limits on indirect costs 

could be considered in some situations if a request is made that documents 

inability to meet these costs. They also commented on the fact that the indirect 

costs are treated differently in some IHS and non-IHS HHS funding streams. 

These staff members suggested that this difference may cause confusion in the 

grant application process. When contracts are issued from IHS for tribes or other 

organizations to provide health care, the tribe or organization receives funds to 

operate the program plus additional administrative costs beyond the projected 

actual cost of the health care, whereas non-IHS HHS grant fund applications 

must build indirect costs into the proposal budget. 

Similarly, few AI/AN/NA tribes and organizations have access to funds that 

could be used to provide even a relatively low level of matching funds. A related 

issue was the recommendation or requirement of some grant programs that grant 

applicants provide a plan to demonstrate the sustainability of the program after 

grant funding ended, which would be helpful to the AI/AN/NA community that has 

come to rely on it during the grant period. Sustainability of some components of 

13
the program may be possible, but some grant announcements require a plan for 

sustainability of the full program. Several AI/AN/NA representatives stated that, 

if they had the necessary resources to sustain a program, they would already 

have the program in place. HHS staff suggested that AI/AN/NA-specific grant 

options within broader grant programs could include flexibility in grant 

announcements by encouraging creative proposals for achieving a degree of 

sustainability in grant proposals. 

Both HHS staff and AI/AN/NA representatives recognized that the 

requirements in some grant announcements for specific detailed data on 

prevalence of disease conditions or “need” for services are a barrier for some 

tribes/organizations, particularly those in rural areas and in the Pacific Islands. 

Both baseline data to measure progress as well as data to monitor and report on 

outcomes are important. Modifying the requirements for rural and other 

applicants in areas for which data on need are not available could be considered, 

as well as increased flexibility in the type and level of detailed data that are 

acceptable. 

HHS staff indicated that grant reviewers must follow the requirements set 

in the RFA in scoring proposals and making award decisions, but recognized that 

some grant announcements may be written in a way that is culturally insensitive 

and pose an undue burden. For example, some grant announcements require 

that only evidence-based practices be used in a grant program; however, 

traditional tribal practices may not be evidence-based or not yet researched as 

such. Thus, language in the announcement needs to recognize these traditional 

practices and/or set up alternative standards of proof for evidence-based 

practice. Language such as “tribal/ethnic/culturally-specific approaches are 

acceptable” could be incorporated into the grant announcement to encourage 

culturally appropriate responses. 

Some HHS staff and AI/AN/NA representatives also noted that grant 

programs may not be designed to “fit” tribal structure and needs. For example, 

grant programs that indicate that only health provider groups are eligible do not 

recognize that many tribes receive services through the IHS and IHS cannot 

apply for grant funding from other federal agencies. A related issue is the 

requirement, in some grant announcements, that the proposed program director 

and/or staff have specific academic credentials. In most rural areas and on 

reservations there may not be a supply of people with these credentials. As a 

result, many AI/AN/NA staff learn “on the job” and build extensive experience in 

other ways, but do not meet the specific academic or credential requirements for 

the grant program. 

AI/AN/NA representatives also emphasized the significant barrier posed 

by the short time frame between grant announcements and due dates and nearly 

uniformly suggested that HHS increase that time frame in order to encourage 

more tribes and organizations to pursue grant opportunities. HHS program staff, 

however, were much less likely to suggest that this time extension was needed. 

However, a suggestion by HHS staff was offered involving an increased use of 

program announcements as a solution. This mechanism specifies a program 

14
area and has a shelf-life of three to five years, providing multiple receipt dates 

spread out over time; for example, there could be six opportunities to submit an 

application over the three to five years. Although there is no guarantee that the 

program would be refunded every year, often it is. Suggestions for facilitating the 

decision to apply for grants are presented in Table 3. 

See Page 16 for Table 3. 

15
Table 3: Respondent Suggestions for Increasing AI/AN/NA Decisions to 

Apply for Grant Opportunities 

Suggestions 

HHS Respondents AI/AN/NA 

Participants 

Increase the time between grant announcements 

and due dates for submission. X 

Increase use of annual or multiple year program 

announcements with multiple deadlines. X 

Establish a pre-proposal letter of inquiry (LOI) 

process with invited proposals based on review of 

LOI. 

X 

Include specific language in announcement about 

AI/AN/NA eligibility. X X 

Consider specific language in grant announcement 

that experience can be substituted for academic 

credentials. 

X 

Increase accessibility of HHS grant program 

contacts. X X 

Establish multiple HHS contacts to answer 

questions about the announcement. X X 

Consider waiving or modifying limits on indirect 

costs and requirements for matching funds for 

organizations that can demonstrate that they do 

not have sufficient resources to conduct the 

program or match the funding. 

X 

Re-examine type and extent of requirements for 

data on “need” for AI/AN/NA applicants in rural 

areas and/or work with potential applicants to 

determine data required to establish need. 

X X 

AI/AN/NA tribes /organizations contact program 

office to reach agreement on acceptable data on 

need. 

X 

Consider waiving or modifying requirements for 

collaboration/coordination with state and local 

agencies in appropriate circumstances. 

X X 

Consider waiving or modifying requirements to 

demonstrate that grant program can be fully 

sustained. 

X 

Provide more training and technical assistance to 

AI/AN/NA tribes and organizations on grant writing. X X 

Increase the number and types of planning grants 

for which AI/AN/NA organizations may apply. X 

Design programs to better fit AI/AN/NA tribes’ and 

communities’ needs. X X 

Make RFA more culturally adaptive (e.g., accept 

traditional practices as well as evidence-based 

practices). 

X X 

16
Preparing Grant Applications

Limited resources and experience in AI/AN/NA tribes and organizations 

were also the most frequently cited barriers to preparing a grant application, for 

both HHS program staff and AI/AN/NA representatives. AI/AN/NA respondents 

expressed concern about limited computer/internet access and experience of 

some tribes and urged that HHS not move to requiring electronic submission of 

grants and continue to permit hard copy submission as an option. 

The short time frame between the announcement and due date for 

submissions was also mentioned by AI/AN/NA representatives who stressed that 

tribal council or board approval often required at least a month, leaving grant 

writers only a short time to actually prepare the grant application. AI/AN/NA 

representatives also mentioned that, in some cases, they have had trouble 

reaching the designated agency contact to obtain information and clarifications of 

requirements. 

Both HHS program staff and AI/AN/NA representatives identified 

inadequate training and technical assistance to assist tribes and other 

organizations to develop skills and experience in grant writing. Some HHS staff 

and AI/AN/NA representatives suggested that national and regional AI/AN/NA 

organizations could take a greater role in providing outreach, training, and 

technical assistance on grant preparation, perhaps in partnership with HHS. In 

addition, some HHS staff indicated that perhaps AI/AN/NA tribes and 

organizations that have experience and success in obtaining HHS grants could 

serve as “peer” advisors to other tribes and organizations. Native 

Hawaiian/Pacific Islander representatives stated that “peer” organizations could 

be most effective in providing this type of knowledge transfer. 

While both AI/AN/NA and HHS participants agreed on the need for more 

technical assistance and training, at the same time HHS officials recognized that 

resource limitations required this technical assistance to be targeted as 

discussed in the above section on Sources of Information on HHS Grant 

Opportunities. One suggestion for those who may not be able to attend off-site 

training sessions was the use of a compact disc, Webcasting or videoteleconference as basic training tools that could be used to tell potential 

applicants what reviewers will look for, the importance of completing all sections 

of the application, and other key tips. 

Some HHS program staff also suggested that AI/AN/NA tribes and 

organizations make greater efforts to send staff to training and technical 

assistance sessions in order to increase the likelihood that their grant 

applications would be responsive to requirements and have a greater probability 

of success. AI/AN/NA representatives indicated that the cost of sending staff to 

these trainings was often more than they could afford, particularly when they 

were only held in a few locations. It was suggested that HHS hold more trainings 

and technical assistance workshops regionally and in locations that were more 

17
accessible to AI/AN/NA groups. In addition, it was suggested that T/TA sessions 

might be held in locations where national/regional AI/AN/NA conferences are 

held, during or just before or after the conference. Along these lines, HHS staff 

suggested that HHS, perhaps through the ICNAA, coordinate training efforts 

among those OPDIVs attempting to do outreach to AI/AN/NA organizations. As 

a result, tribes may only have to send their staff members to one training instead 

of multiple meetings. 

A major issue raised by many AI/AN/NA representatives, and some HHS 

program officials, was that different agencies and specific grant programs appear 

to use different formats and requirements for grant applications. This was 

perceived to be a significant issue that made it difficult for AI/AN/NA staff to 

become proficient at preparing grant applications, since formats and rules 

differed so much among grant programs. AI/AN/NA representatives emphasized 

the need for a standardized grant application format to assist them to develop 

expertise in grant writing that could be used across multiple agencies and 

programs. Some HHS staff noted that grant application formats are standardized, 

particularly with respect to budget forms and certifications required. However, 

AI/AN/NA respondents indicated that unique aspects of the program narrative 

requirements across agencies and grant programs posed the greatest difficulties 

for interpretation and response to announcements. 

Some AI/AN/NA representatives also expressed concern about the trend 

toward requiring electronic submission of grant applications, stating that this 

requirement would make it impossible for organizations in rural areas and with 

limited computer expertise to prepare and submit grants. 

Some HHS program staff also emphasized that one strategy for AI/AN/NA 

organizations to develop capacity and a foundation for successful grants 

applications was for these organizations to apply for planning grants that provide 

funds to develop program capacity that would enable them to apply for larger 

implementation grants. These program staff suggested that HHS could increase 

the use of planning grants in order to provide AI/AN/NA organizations with 

funding that would assist them in preparing successful grant applications. HHS 

staff also suggested that increased use of program announcements with multiple 

due dates could be helpful to tribes/organizations. 

These and other suggestions for changes that would provide support and 

assistance to AI/AN/NA tribes and organizations in preparing grant applications 

are presented in Table 4 on the next page. 

18
Table 4: Respondent Suggestions for Assisting AI/AN/NA Tribes and 

Organizations to Prepare Grant Applications 

Suggestions 

HHS 

Respondents 

AI/AN/NA 

Participants

Standardize grant application format and 

requirements across all HHS agencies. X X 

Increase time between announcement and due 

dates. X 

Increase use of annual or multiple year program 

announcements with multiple deadlines. X 

Increase the number and types of planning 

grants for which AI/AN/NA organizations may 

apply. 

X 

Establish a pre-proposal letter of inquiry (LOI) 

process with invited proposals based on review 

of LOI. 

X 

Increase accessibility of agency contacts for 

information and clarifications. X 

Establish multiple HHS contacts to answer 

questions about the announcement. X X 

National and regional AI/AN/NA organizations 

take a greater role in providing training and 

technical assistance, perhaps in partnership 

with HHS. 

X 

Successful AI/AN/NA grantees provide “peer” 

training to other AI/AN/NA tribes/organizations. X X 

AI/AN/NA tribes/organizations send staff to 

HHS and other grant training workshops. X 

Continue to permit hard copy submission of 

applications as an option, in addition to use of 

electronic submissions. 

X X 

19
Grant Review Processes

AI/AN/NA representatives had numerous personal experiences with HHS 

grant review processes that were shared during the conference sessions and 

interviews. These experiences strongly suggested to them that some grant 

reviewers had very limited or no understanding of AI/AN/NA history, culture, 

geography, and resource limitations. In addition, AI/AN/NA representatives 

related experiences that suggested that, even when no minimum population base 

was specified in the eligibility criteria, some reviewers ranked AI/AN/NA 

applications lower because of the small number of people that would be reached 

by the grant program. Those AI/AN/NA representatives that had applied for 

grants that were primarily research-oriented or had a significant evaluation 

component also stated that HHS agencies relied heavily on academic reviewers 

who placed disproportionate emphasis on academic credentials and degrees and 

discounted extensive experience of proposed staff because they did not have 

academic experience. Finally, some AI/AN/NA representatives stated that HHS 

agencies sometimes do not provide adequate information on the reasons their 

application was rejected, and this was seen as a barrier to learning how to 

improve their future applications. 

HHS program staff generally believed that the review processes in place 

were designed to be fair and informative. Some did note that there might be 

reviewers who had limited knowledge and understanding of AI/AN/NA issues that 

could be important to appropriately evaluate grant applications. Most HHS 

program staff believed that the current process provided feedback to applicants 

to help them understand the reasons for acceptance or rejection. 

Suggestions for changes in the grant review process that would increase 

AI/AN/NA access to HHS grant programs are provided in Table 5. AI/AN/NA 

representatives provided most of these suggestions, although some HHS 

program staff also suggested that it might be helpful to either include AI/AN/NA 

reviewers on grant panels considering AI/AN/NA applications or to provide some 

background to the reviewers on unique issues that might be considered in 

reviewing applications from AI/AN/NA tribes and organizations. HHS staff also 

noted that program announcements and scoring criteria can make clear that 

experience can substitute for academic credentials, as appropriate. Finally, 

some HHS program staff encouraged AI/AN/NA applicants to contact the agency 

for more information, if summary statements are not provided or if the reasons for 

rejection were not clear. 

20
Table 5: Respondent Suggestions for Grant Review Process 

Suggestions 

HHS 

Respondents 

AI/AN/NA 

Participants 

Include AI/AN/NA reviewers on grant review 

panels when AI/AN/NA applications are being 

reviewed.

X X 

Provide information to reviewers about unique 

AI/AN/NA issues prior to review of 

applications submitted by AI/AN/NA groups.

X X 

Consider reducing reliance on academic 

reviewers. X 

Provide academic reviewers with 

information/guidelines to reduce their 

emphasis on degrees and credentials.

X 

If agency has minimum population base 

requirements, state that in announcement or, 

if not, provide reviewers with clear guidance. 

X 

Provide clear information on reasons for 

rejection of application. X 

AI/AN/NA applicants seek information on 

reasons for rejection, if agency does not 

provide summary statements or if reason is 

unclear. 

X 

Grants Management Issues and Processes

Grants management processes and requirements did not stimulate as 

much discussion in AI/AN/NA sessions and interviews as did other topics, nor did 

many HHS program staff identify grants management issues as significant 

barriers to AI/AN/NA access to HHS grants programs. Several AI/AN/NA 

representatives who had received HHS grants mentioned that grants 

management was difficult when the organization had multiple grants because 

each HHS agency appeared to have different reporting and financial 

documentation requirements. As a result, staff had to learn new procedures with 

each new grant and this required additional time and resources. 

AI/AN/NA representatives suggested that HHS consider standardizing 

grants management requirements and formats across agencies to reduce burden 

of grantees. HHS staff indicated that lack of administrative and financial 

infrastructures to support awards and successfully implement programs were a 

particular barrier for small tribes and organizations, resulting in an uneven 

playing field among these groups. Both AI/AN/NA representatives and HHS 

program staff suggested that additional training and technical assistance to new 

21
grantees on grants management requirements and financial documentation 

would be beneficial (Table 6). 

Table 6: Respondent Suggestions for Grants Management Processes 

Suggestions 

HHS 

Respondents 

AI/AN/NA 

Participants 

Standardize grants management financial 

and reporting requirements across HHS 

agencies. 

X 

Provide grants management training and 

technical assistance to new grantees. X X 

Other Suggestions and Issues

AI/AN/NA representatives had additional suggestions to HHS on 

strategies for increasing AI/AN/NA access to HHS grant programs (Table 7). 

Many AI/AN/NA representatives indicated that they believed that, due to limited 

resources and capacity, their organizations did not have the ability to compete 

successfully against large urban organizations and universities. Given this 

disparity in resources, “set-asides” for AI/AN/NA organizations within grant 

programs were perceived to be a possible strategy for increasing the number of 

grant awards to this group. A related suggestion was that more grants be offered 

that are targeted to only AI/AN/NA tribes and organizations. However, 

representatives of smaller, rural, and poorer tribes and organizations also noted 

that set-asides and targeted grant programs would likely result in more grants 

being awarded to larger, more affluent tribes and organizations and would not 

benefit those that currently are less likely to receive grant funding. These 

representatives suggested that there be “small, rural, poor set-asides” within any 

AI/AN/NA set-aside program to ensure that grants were awarded to the diverse 

range of AI/AN/NA organizations. 

AI/AN/NA representatives also suggested that HHS establish a data base 

that could be used to monitor applications and awards from individual AI/AN/NA 

tribes and organizations. This monitoring process could identify tribes and 

organizations that were submitting applications but not being awarded grants. 

This information could be used to develop and provide targeted training and 

technical assistance to tribes and organizations that were unsuccessful and 

needed additional T/TA to be successful on future applications. 

Another suggestion by AI/AN/NA representatives was to change HHS 

grant application procedures to a two-phased process. An initial solicitation 

would be in the form of short letters of inquiry/proposal abstracts that briefly 

describe the methodology/approach that would be developed and the applicant’s 

capacity to conduct a particular grant program. Then, HHS could screen those 

22
brief letters/abstracts and select a limited number of potential applicants to 

submit full grant applications that would have a much higher probability of 

success. This two-stage approach is used by some foundations and imposes 

much less burden on limited resources of AI/AN/NA organizations. HHS program 

staff acknowledged that this change would reduce the burden on grant 

applicants, but noted that it would increase the burden on HHS staff that would 

have to conduct two rounds of review. 

A number of AI/AN/NA representatives were concerned about and cited 

examples of states and universities applying for and being awarded grants that 

focused on AI/AN/NA populations without ever obtaining tribal or other leadership 

agreement. Subsequently, these grantees might seek to obtain approval and 

involvement of the AI/AN/NA population or, in some cases, conduct the program 

with other groups or without approval. The suggestion was made that HHS 

agencies should be cautious about grant applicants who are non-Native but 

planning to conduct research or programs with AI/AN/NA populations and should 

require that the applicant submit letters of support and memoranda of agreement 

from the tribal population prior to HHS making an award. 

Both AI/AN/NA representatives and some HHS program staff indicated 

that greater communication between HHS staff and AI/AN/NA tribes and 

organizations would be beneficial and would increase access to HHS grant 

programs for this population. Training and technical assistance could be 

provided where AI/AN/NA tribes and organizations are located and would provide 

HHS T/TA staff with more knowledge and information on AI/AN/NA culture, 

history, and circumstances. Similarly, HHS program staff could visit AI/AN/NA 

grantees and observe first-hand the issues that affect tribes and other 

organizations. This increased knowledge on the part of HHS staff could be 

helpful at all stages of the grant process, from methods for advertising grant 

announcements through review processes and to ensuring effective grants 

management after award. 

Collaboration among HHS agencies and organizations involved in grant 

implementation was also discussed as a possible way to build the infrastructure 

necessary to successfully administer programs and manage grant funds. For 

example, the Native American Research Center for Health (NARCH) is a 

cooperative program using funds from IHS and various research agencies such 

as NIH and AHRQ to fund research activities and training at tribal organizations. 

The principal research investigator must be associated with a tribe, but need not 

be American Indian. The tribe then partners with an academic institution. Also, 

there can be partnerships between OPDIVs; for example, if a tribe has received a 

SAMHSA grant, they would then be eligible to apply for an NIH research 

grant/clinical trial that focused on the purpose of the SAMHSA grant. SAMHSA 

and NIDA currently have this type of an arrangement. 

23
Table 7: Other Overarching Suggestions from Respondents to Increase 

AI/AN/NA Access to HHS Grant Programs 

Suggestions 

HHS 

Respondents 

AI/AN/NA 

Participants 

Consider AI/AN/NA “set-asides” within grant 

programs. 

X X 

Consider targeting “set-asides” to 

smaller/poorer AI/AN/NA tribes and 

organizations. 

X 

Increase number of grants targeted 

specifically to AI/AN/NA organizations. X 

Monitor AI/AN/NA grant applications and 

awards within HHS to track award trends and 

to target technical assistance, including to 

unsuccessful applicants. 

X 

Require states and academic institutions that 

submit applications involving AI/AN/NA tribes 

and organizations to provide evidence of 

AI/AN/NA support and participation prior to 

award. 

X 

HHS staff within each agency should visit 

AI/AN/NA tribes and communities to become 

knowledgeable about unique issues and 

circumstances. 

X 

Increase interagency collaboration to expand 

grant opportunities and assist AI/AN/NA 

groups to build capacity. 

X 

As noted, HHS Operating Division staff identified a number of strategies 

currently in place in some Operating Divisions or HHS-wide that address some of 

the identified barriers. These are discussed below in Section IV, Initiatives 

Underway. 

IV. Discussion 

Similarities and Differences in Perspectives of HHS Program Staff and AI/AN/NA 

Representatives

HHS program staff and AI/AN/NA representatives who participated in this 

study were generally in agreement that the major barrier to AI/AN/NA access to 

HHS grants is the limited resources, capacity, and experience of these groups to 

engage successfully in the grant process. Both groups also identified and 

recognized that the lack of resources and capacity for electronic communication, 

24
combined with the increasing emphasis on use of the internet by HHS grant 

programs, had the potential to further disadvantage those organizations that had 

limited access to the internet. AI/AN/NA representatives were particularly 

cognizant of the diversity of AI/AN/NA tribes and communities with respect to 

resources and capacity and emphasized that tribes and communities that were 

rural, geographically isolated, and poor faced more barriers and needed more 

assistance than others. 

AI/AN/NA representatives also were more likely to identify specific 

regulatory and procedural issues within HHS than did HHS program staff. Many 

of the discussions of these specific issues were illustrated by AI/AN/NA 

representatives by their own experiences, e.g., difficulties in contacting HHS 

grant program staff to obtain clarifications about grant requirements, and 

difficulties in obtaining cooperation from state and local agencies that some 

grants require. AI/AN/NA representatives also cited a wide range of examples of 

grant reviewers’ comments that they felt documented the lack of knowledge and 

understanding of Native culture and circumstances (e.g., one individual said that 

a grant reviewer commented that the proposed inclusion of traditional medicine 

men in the project was the equivalent of the grant supporting “witch doctors”; 

another individual volunteered that grant reviewers criticized the proposed high 

costs of travel, not recognizing that travel between islands in the Pacific is very 

expensive). 

Many HHS program staff, however, did recognize that their own and grant 

reviewers’ lack of knowledge of and experience with AI/AN/NA culture and 

circumstances could disadvantage tribes and organizations that apply for grant 

funds. Program staff from agencies that work extensively with AI/AN/NA groups 

(i.e., IHS, ANA, AoA) were likely to be more knowledgeable and to have 

developed program procedures that were designed to address some of the 

issues identified. For example, the ANA grant review process begins with 

orientation for grant reviewers on AI/AN/NA culture and circumstances that may 

be important to understanding grant applications. Other HHS program staff, from 

agencies that fund very few AI/AN/NA organizations, may have little exposure to 

or knowledge of history, culture, geographic and other issues that affect their 

AI/AN/NA grantees. Most AI/AN/NA representatives at conference sessions and 

in interviews suggested that it would be beneficial to them and to HHS to have 

program staff visit and learn about AI/AN/NA communities. Some HHS program 

staff also suggested this would be helpful. 

A major theme that emerged throughout the discussions with both HHS 

program staff and AI/AN/NA representatives was the need for additional targeted 

technical assistance and training to assist tribes and organizations to better 

understand the grants process, increase skills in grant writing and budget 

preparation, and strengthen grants management capacity. Training and 

technical assistance needs were raised in every session with AI/AN/NA 

representatives and by HHS program staff that participated in the survey and in 

focus groups. While other specific strategies were identified by study participants 

to address specific barriers to AI/AN/NA access to HHS grant programs, training 

25
and technical assistance were identified across nearly all areas of the study, and 

by the majority of study participants, as an important strategy to improve access 

for this population. 

Initiatives Underway Within HHS to Reduce Barriers and Increase AI/AN/NA 

Access to HHS Grant Programs

This report was circulated, in draft form, to the staff of HHS Operating and 

Staff Divisions (OPDIVs/STAFFDIVs) who were asked to provide information on 

current procedures and initiatives to reduce barriers to access for AI/AN/NA 

groups. While not all Divisions responded, those that did indicated that a number 

of policies, procedures and initiatives are underway across HHS that are 

intended to reduce some of the identified barriers to AI/AN/NA access to grant 

programs. Some of these initiatives are similar to the strategies that have been 

identified in this study. Some are limited to specific Operating Divisions and not 

implemented HHS-wide; other HHS-wide initiatives under development would 

address some of the issues raised by respondents to this study. The list below is 

not comprehensive, since there was not a systematic effort to review every 

OPDIV’s policies and procedures, but it presents examples of those initiatives, 

policies and procedures that were identified by HHS staff: 

• An initiative is underway to standardize the grant application format 

HHS-wide. 

• A government-wide template is used by the Office of Management and 

Budget to standardize the format for grant announcements. 

• HHS and government-wide initiatives are currently in process to 

develop standardized grants management requirements. 

• A HHS-wide policy is in place to explicitly state in grant 

announcements that AI/AN/NA tribes, organizations, communities, 

tribal colleges, etc. are eligible to apply, when this is the case. 

• Waivers pertaining to matching requirements and limits on indirect cost 

rates are available by request, in some circumstances unless 

prohibited by the authorizing legislation.

• Some OPDIVs have put in place policies that ensure that tribes have 

the opportunity to compete for all grants that are open to state and/or 

local governments, unless there is a clear statutory or regulatory 

restriction from doing so.

• Some OPDIVs publish hard copy compilations of anticipated grant 

opportunities for the coming fiscal year. 

• One OPDIV reported that a new timeline for the grants announcement 

process is in place that increases the amount of time between the 

announcement and due dates. 

• One OPDIV reported providing orientation for reviewers about unique 

26
issues of AI/AN/NA tribes and communities prior to the grant review 

process. 

• Several OPDIVs offer tribal-specific grant programs. 

• One OPDIV reported that it is pilot-testing a Letter of Intent (LOI) 

process requiring applicants to provide sufficient but streamlined 

information about their proposed program prior to the grant application 

submission and that OPDIV staff respond to every LOI regarding the 

appropriateness of the proposed program or better matches with 

alternative funding. 

• Some OPDIVs provide pre-application technical assistance by 

videotaping training sessions and making them available as webcasts 

or recording pre-application conference calls and making them 

available to potential applicants. 

• Several OPDIVs reported that while the electronic application is the 

preferred method for accepting applications, grants policy staff have 

provided exceptions, as needed. 

In addition to these specific initiatives, ongoing activities undertaken by the 

HHS also may provide a mechanism for identifying and addressing barriers to 

AI/AN/NA access to grant programs. These include annual budget consultations 

with federally-recognized AI/AN tribes and communities, regional consultations 

with tribes, Office of Intergovernmental Affairs (IGA) meetings with AI/AN/NA 

groups with an interest in departmental grant programs, other communication 

efforts and notifications to tribal and other Native American groups to provide 

information and education about Department programs and initiatives (e.g., 

daily/weekly meetings held during the Department’s response to Hurricane 

Katrina which included dissemination of information about government-wide 

resources available to address emergency and other needs). Finally, HHS policy 

requires that federally recognized tribes and HHS engage in consultation that 

ensures meaningful and timely input by tribal officials in the development of 

policies that have tribal implications; each HHS Operating and Staff Division has 

an accountability process to ensure such consultation. 

Practical Considerations for Implementing Suggested Strategies

The feasibility of implementing specific strategies for increasing AI/AN/NA 

access to HHS grant programs and the time that might be needed to implement 

changes depends on a number of factors, including: 

• The cost in HHS staff time and additional resources required for 

planning and implementation of new policies and procedures. 

• The costs to AI/AN/NA tribes and organizations to implement 

strategies requiring action on their part. 

27
• The extent to which strategies are specific to AI/AN/NA tribes and 

communities or would affect and be applicable to all potential grantees. 

• Whether congressional action is required. 

Each of these factors and their implications for the feasibility of specific 

strategies is discussed in this section. 

Strategies Requiring HHS Action

HHS agencies may be able to directly address a number of the 

suggestions for changes that have emerged from this study through regulatory or 

policy changes. The feasibility of the strategies that would require HHS actions, 

however, may vary depending on the potential staff time required to make the 

change and the additional costs that implementation of the change might impose 

on HHS and/or on the individual agency. Some suggested strategies might 

require little staff time and minimal additional costs for implementation, while 

others might involve extensive staff time and implementation costs. 

It is also important to recognize that there are substantial differences 

among HHS agencies that administer grant programs in their current procedures 

and approaches to grant programs. Some agencies’ procedures may already 

incorporate some of the suggested strategies; other agencies may require 

extensive changes in order to implement some of them. Therefore, it is not 

possible to draw conclusions, across all HHS agencies, about the feasibility of 

many of the suggested changes based on a uniform estimate of the staff time 

and implementation costs that might be involved. Below, the suggested 

strategies that are likely to involve less staff time and lower implementation costs 

for most HHS programs are listed and then those that would likely require greater 

effort and costs are presented. 

Strategies Requiring Lower Costs for Most HHS Agencies

• Include explicit language about eligibility of AI/AN/NA tribes and tribal 

organizations (e.g., tribal colleges and universities, Urban Indian 

Health Centers) in all grant announcements for which they are eligible. 

• Include explicit statements about minimum population base required in 

grant announcements, if award is dependent on the size of population 

that would be served under the grant. 

• Ensure that the language in future grant announcements is written in a 

culturally sensitive manner. 

• Increase time between grant announcements and the due date for 

applications. 

28
• Adopt the use of annual or multi-year program announcements, with 

multiple due dates for applications. 

• Consider waiving or modifying requirements to demonstrate 

sustainability of program for AI/AN/NA applicants in more flexible ways. 

• Increase accessibility and/or the number of HHS grant program 

contacts to answer questions about the grant announcement. 

• Consider waiving or modifying requirements for collaboration or 

coordination with states or local government agencies for AI/AN/NA 

applicants. 

• Consider waiving or modifying the requirement for data on “need” for 

grant program services for AI/AN/NA applicants in rural areas. 

• Continue to permit hard copy submission of applications rather than 

moving to required electronic submission. 

• Prior to receiving applications, provide targeted outreach to tribes that 

have specific needs addressed by particular grants or are interested in 

the area that is the grant focus. 

• Recruit and include AI/AN/NA grant reviewers and individuals familiar 

with AI/AN/NA circumstances on panels when AI/AN/NA grant 

applications are to be reviewed. 

• Provide orientation for grant reviewers that would assist them to 

understand unique AI/AN/NA issues and circumstances and take them 

into consideration in the grant review process. 

• Provide clear and detailed information to applicants on the reasons for 

rejection of applications. 

Strategies Involving More Significant Costs/Efforts for Most HHS Agencies

• Announce grant opportunities through multiple methods, both Internet 

and hard copies, including targeted outreach and communications with 

AI/AN/NA tribes and organizations. 

• Consider waiving or modifying nonstatutory matching fund 

requirements for AI/AN/NA tribes and organizations. 

• Consider waiving or modifying nonstatutory indirect cost limits for 

AI/AN/NA tribes and organizations. 

• Provide more training and technical assistance on identifying grant 

opportunities, preparing grant applications, and grants management 

requirements to AI/AN/NA tribes and organizations; provide this 

training and technical assistance regionally and in geographic locations 

that are easily accessible to AI/AN/NA organizations (e.g., at national 

29
and regional conferences attended by AI/AN/NA representatives). 

• Provide targeted training and technical assistance to AI/AN/NA 

organizations that have submitted unsuccessful applications. 

• Develop a single HHS-wide standardized grant application format and 

requirements. 

• Develop standardized HHS-wide grants management requirements 

and reporting formats. 

• Establish a pre-proposal letter of inquiry process to screen and select a 

limited number of invited proposals. 

• Consider AI/AN/NA “set-asides” within grant programs, including 

specific “set-asides” for small/poorer tribes and organizations, or 

design AI/AN/NA-specific grant initiatives and/or capacity-building 

initiatives for smaller/poorer tribes and organizations within broader 

grant authorities. 

• Increase the use of planning grants for capacity and infrastructure 

building to assist AI/AN/NA groups to develop capacity and 

infrastructure. 

• Provide HHS program staff with opportunities to visit AI/AN/NA tribes 

and communities in order to become knowledgeable about unique 

issues and circumstances. 

The time required to develop and implement new procedures within HHS 

and within specific agencies may be lengthy, even when the specific strategy 

may involve minimal costs and staff effort for most agencies. In addition, an 

overall approach to reducing barriers to AI/AN/NA access to HHS grant programs 

may necessarily involve formal tribal consultation with federally recognized tribes 

and/or involvement of AI/AN/NA representatives in the process. If such 

consultation is necessary, the timeframe for development and implementation of 

specific strategies and/or an overall approach may increase. 

There also may be concerns that some of the suggested changes would 

potentially benefit AI/AN/NA tribes and organizations by giving them an 

advantage over other racial/ethnic groups that are similarly under-represented in 

receiving HHS grants. Attention would need to be given to the implications of 

these types of changes. In addition, some strategies that have been suggested 

may be more or less feasible depending on the nature of the specific grant 

program. For example, in some programs, some strategies (e.g. 

waiving/modifying requirements to coordinate with local or state governments or 

for sustainability) may be inconsistent with program intent or objectives. 

Furthermore, research-focused grants, for instance, may require more academic 

and technical expertise to conduct than grants that are intended to provide 

services or to develop and implement new programs. Consequently, 

30
implementation of specific strategies and their practicality may vary by the 

objectives of individual agencies and grant programs. 

Strategies Requiring Action by AI/AN/NA Tribes/Organizations

A number of suggested strategies would require AI/AN/NA tribes and 

organizations to implement changes. These strategies include: 

• National and regional AI/AN/NA organizations, alone or in collaboration 

with HHS, could take a stronger role in disseminating information about 

grant opportunities and in providing outreach, training, and technical 

assistance on grant preparation and grants management. 

• AI/AN/NA tribes and organizations that have experience and success 

in obtaining HHS grants could serve as “peer” advisors to assist other 

tribes and organizations to develop the skills and knowledge necessary 

to obtain grants. 

• AI/AN/NA tribes and organizations could designate a specific “point of 

contact” to receive grant announcements to avoid delays in learning 

about opportunities and inform HHS agencies to send the 

announcement to this individual. 

• AI/AN/NA tribes and organizations that are interested in applying for 

grants could send program staff to grant training workshops and 

technical assistance meetings regularly to increase the likelihood that 

grant applications would be responsive to requirements. 

• AI/AN/NA tribes and organizations that submit grant applications could 

initiate requests for information and explanation of reasons that 

applications were unsuccessful, if the grant program does not send out 

summary statements or if the reasons for rejection are unclear. 

National and regional AI/AN/NA organizations could feasibly take a 

greater role in assisting AI/AN/NA tribes and organizations to learn about grant 

opportunities and to develop skills in “grantsmanship.” However, these 

organizations have limited funding for such outreach, training, and technical 

assistance to their members and might not be able to undertake a significant 

additional effort. In addition, some AI/AN/NA tribes and organizations that are 

poorer and located in remote areas with limited internet access might not be able 

to take advantage of the increased services that could be made available by 

national and regional organizations. 

Knowledge transfer from AI/AN/NA tribes/organizations that are 

experienced and successful in obtaining HHS grants to organizations that have 

been less successful or have less experience could be feasible, and was strongly 

advocated by some Native representatives as well as by some HHS staff 

interviewed in this study. However, AI/AN/NA tribes and organizations that are 

31
successful in obtaining grants are also aware that there is a limited amount of 

grant funding available. They may be reluctant to provide training and technical 

assistance to other AI/AN/NA groups that will then be competing for the same 

grant awards that they are seeking. Additionally, because the costs of 

knowledge transfer between tribes/organizations could be significant, these types 

of efforts would likely need to be subsidized by national or regional AI/AN/NA 

organizations, HHS, or some other federal or private agency. One strategy that 

could be utilized would be to design organized federal efforts for the purpose of 

facilitating knowledge and skills transfer between AI/AN/NA tribes/organizations. 

The extent to which these suggested strategies are feasible also varies 

with the characteristics of the AI/AN/NA tribe or organization. Poorer, 

geographically remote tribes often have few staff and limited resources to commit 

a staff person to be the “point of contact” for grant announcements, to send staff 

to grant workshops and technical assistance meetings, or to conduct follow-up 

with HHS agencies on the reasons that their grant applications are unsuccessful. 

However, these strategies may be workable for some tribes/organizations that 

have an interest in pursuing grant opportunities and some resources that could 

be committed to developing capacity. 

Suggested Strategies Requiring Congressional Action 

Some HHS grant programs are established by Congress through 

legislation that specifies many aspects of the grant process. Changes in these 

programs would necessitate congressional action to modify the authorizing 

language for the program to eliminate or change the program elements identified 

as barriers to AI/AN/NA access to HHS grant programs. Such changes are 

included in this report because study respondents identified them as possible 

ways to improve access to HHS grants programs; their inclusion is not meant to 

imply that HHS has made any commitment to pursue such legislative changes. 

Examples of changes suggested by respondents that would require 

congressional action include: 

• State explicitly that AI/AN/NA tribes and organizations are eligible for 

the grant program. 

• Consider waiving or providing Secretarial authority to waive or modify 

requirements for matching funds for AI/AN/NA applicants in 

appropriate circumstances; 

• Consider waiving or providing Secretarial authority to waive or modify 

limits on indirect costs that may be recovered for AI/AN/NA applicants 

in appropriate circumstances; 

• Consider waiving or providing Secretarial authority to waive or modify 

requirements for sustainability of programs after the end of the grant 

period. 

32
• Consider waiving or providing Secretarial authority to waive or modify 

requirements for collaboration or coordination with states or local 

government agencies for AI/AN/NA applicants in appropriate 

circumstances; and 

• Consider AI/AN/NA “set-asides” and/or targeted grants within 

congressionally mandated grant programs, including ways to address 

the needs of small/poorer tribes and organizations. 

Discussion

While the AI/AN/NA population was the focus of this study, previous HHS 

initiatives have examined strategies for increasing access to HHS grant 

programs for other subpopulatons. Many of the barriers identified in this study 

were also identified as barriers to access to HHS grant programs by 

organizations serving people who are experiencing homelessness, rural 

communities and organizations, and faith-based organizations. These common 

barriers include: 

• Inadequate infrastructure, resources, and capacity to identify grant 

opportunities, prepare grant applications, and meet grants 

management requirements; 

• Uncertainty about eligibility for individual grant programs because the 

announcement does not contain explicit definitions of eligible entities; 

• Requirements for matching funds; 

• Preference for larger population base for grant funding; 

• Unavailability of data required to establish “need” or eligibility for the 

grant program; 

• Complexity of grant application requirements and unique requirements 

and formats for each agency or grant program; 

• Lack of understanding by grant reviewers of unique issues that may 

impact the target population or require higher costs to meet the grant 

objectives. 

Because of these commonalities, the suggested strategies to reduce 

barriers that affect AI/AN/NA access to HHS grant programs, if implemented, 

could produce benefits for other groups as well as to the AI/AN/NA tribes and 

organizations that are the focus of this study. 

This report on barriers to AI/AN/NA access to HHS grant programs and 

suggested strategies for reducing those barriers provides an initial starting point 

for discussion of ways to potentially increase AI/AN/NA access to and 

participation in HHS grant programs. A summary of the key findings in this report 

was presented to the HHS Intradepartmental Council on Native American Affairs, 

and the Department is considering how best to utilize this information. Possible 

33
future research could focus on the process for determining AI/AN/NA eligibility for 

new and/or ongoing grants programs, and documenting existing outreach and 

technical assistance efforts to Native groups that could serve as models for other 

programs within the Department. 

34
APPENDIX A: METHODS 

Survey of HHS Staff 

The Barriers survey instruments were developed collaboratively by 

Westat, the HHS Co-Task Order Officers (Co-TOOs) for this project, and HHS 

Workgroup members. There were three separate survey instruments: the base 

survey instrument for all OPDIVs with the exception of the Health Resources and 

Services Administration (HRSA), a HRSA base survey for technical program 

staff, and a HRSA grants management survey for a representative of the grants 

management office. 

Each of the Barriers survey instruments contained questions covering the 

following topics: respondent and program characteristics, the degree to which the 

programs received applications from and awarded grant funds to AI/AN/NA 

communities and organizations, the mechanisms used to publicize grant 

announcements and provide technical assistance to applicants, the grant review 

process, respondent perceptions of barriers that limited AI/AN/NA communities 

from applying for and receiving grant funds, and suggestions for increasing 

AI/AN/NA communities/organizations’ access to funding. Copies of the survey 

instruments are available from the Office of the Assistant Secretary for Planning 

and Evaluation. 

Westat, with guidance from the Co-TOOs and Workgroup members, 

identified a total of 129 unique programs (that tribes are eligible to receive 

awards from) to be surveyed from among the ten OPDIVs. The primary basis for 

the selection of these 129 programs was an internal HHS report developed in 

2004 by Master Key that identified the total and AI/AN/NA community-specific 

numbers of grants and award amounts during FY 2002. For each program, the 

study team also identified the most appropriate person(s) in each specific OPDIV 

to be contacted for the Barriers survey. Usually two or more staff members were 

identified, all of whom were employed in either the technical program or grants 

management office. Because this survey involved federal employees, Office of 

Management and Budget approval was not required to conduct the survey. A 

total of 261 individuals were contacted for the survey. At the end of data 

collection, a total of 148 responses from 93 unique programs were received for 

an overall survey response rate of 56.7 percent. At least one response was 

received from each OPDIV. 

Data collection for this component of the Barriers study started on March 

18, 2005 and ended on June 7, 2005. Respondents were first sent an email 

about the Barriers study that contained background information about the study, 

a letter from a senior official at HHS explaining the purpose and importance of 

the study, and one or more survey instrument attachments. Two weeks after the 

initial email, a followup email was sent to survey non-responders to remind them 

35
about the survey and emphasize the due date. One week after the reminder 

email, a follow-up telephone call was made to each nonrespondent to remind him 

or her about the survey and/or assist with survey completion. 

There were a number of survey methodology issues that guided the 

development of the approach adopted to analyze these survey data. These 

issues included the following: the design of the survey instrument included some 

questions that were directed to technical program officers and some questions 

that were directed to grants management staff; there was wide variation across 

OPDIVs in the number of people surveyed and considerable variation in 

response rates across OPDIVs; and there were differences among respondents 

in their background and experience with grants and, as a result, some OPDIVs 

had more respondents who reported that they did not know the answer to 

specific questions than did other OPDIVs. 

These issues meant that review of overall frequencies had to be 

undertaken with great care. A single OPDIV with a large number of respondents 

could unduly influence the results. Moreover, results could not be crosstabulated and compared by OPDIV. For these and other reasons, analysis of the 

survey data required a more qualitative analytical approach that involved 

comparison across grant types and categories of staff responsibility to better 

understand the survey responses. The analyses of these data consisted of four 

primary steps: (1) initial review of overall frequencies; (2) review of survey data 

cross-tabulated by grant type; (3) review of survey data cross-tabulated by 

number and funding amount of awards made to AI/AN/NA communities and 

organizations by the OPDIV; and (4) review of survey data by primary 

responsibility of respondent. 

Analyses were used to prepare an interim report on the findings from the 

survey component of the project. 

AI/AN/NA Perspectives and Input 

The project team used two approaches to gather AI/AN/NA perspectives 

and input: holding informal discussions at national AI/AN/NA conferences and 

conducting informal telephone discussions with additional representatives of 

AI/AN/NA communities. The project team, with the assistance of the HHS 

Working Group and the project consultants, was successful in arranging sessions 

at five national conferences: 

• National Conference of American Indians (NCAI), February 28, 2005 (2 

sessions); 

• National Council on Urban Indian Health (NCUIH), March 14, 2005; 

• American Indian Higher Education Consortium (AIHEC), March 31, 

2005; 

• Annual Meeting of the Direct Service Tribes (DST), April 26, 2005; and 

36
• Annual Meeting of the Self-Governance Tribes (SGT), May 4, 2005 (2 

sessions). 

In addition, at the suggestion of the IHS representative to the HHS 

Working Group, two telephone conference calls were scheduled with members of 

the NIDA Native American Researchers and Scholars Workgroup. 

The process through which sessions at national conferences were 

scheduled, advertised, and conducted was similar for each conference. 

Arrangements were made with sufficient lead time to permit the sessions to be 

included in the conference agenda. In addition, project consultants and members 

of the HHS Working Group made efforts to mention the sessions to individuals 

who planned to attend the conferences and to encourage their participation. The 

sessions at each conference were facilitated by a Westat staff person. Carole 

Anne Heart, Executive Director of the Aberdeen Area Tribal Chairmen’s Health 

Board and a project consultant, co-facilitated the sessions at the NCAI, DST, and 

SGT annual meetings. The topic areas that were discussed at each conference 

session included: identification of grant opportunities; factors that affect decisions 

to submit applications; experiences in preparing grant applications; experiences 

with grant review processes; and experiences with grants management 

processes. A separate presentation was prepared for each session and 

handouts of the presentations were distributed to all attendees. 

In order to obtain information on the representativeness of attendees at 

these sessions, a sign-in sheet was circulated that requested the attendee’s 

name, tribe or tribal organization, and state of residence. These attendee lists 

were used to determine whether the input received, across all the sessions, was 

from a geographically varied sample of AI/AN/NA tribes and organizations. 

Detailed notes were taken of comments and discussion that occurred at each 

session. These notes were then used to prepare a summary for each of the 

sessions held. 

Westat then developed a participation matrix, based on the conference 

sessions attendance lists, which included information on attendees’ tribal 

affiliation or organization represented and geographic location. This participation 

matrix was reviewed, relative to geographic distribution of the AI/AN/NA 

population and population size of tribe, to identify potential under-represented 

groups. This review identified several under-represented groups: Native 

Hawaiians, Other Pacific Islanders, and tribes from the southern and eastern 

region of the U.S. In addition, there was concern that tribes that are less likely to 

apply for HHS grants or be funded were under-represented. 

Individual telephone interviews were then conducted with six 

representatives of Native Hawaiian (NH) and Pacific Islander (PI) groups. These 

interviewees provided information on experiences of these groups on the five 

topics that were explored in the conference sessions. Despite extensive efforts to 

contact and arrange interviews with representatives from southern and eastern 

tribes and with tribes with few HHS grant awards, over a two-month period, the 

project team was unable to interview representatives of these tribes. 

37
The session summaries and interview notes were used to prepare an 

interim report concerning AI/AN/NA perspectives and input on barriers to access 

to HHS grant funds. 

In-Depth Study of Programs 

The focal point for the in-depth study of programs was Operating Divisions 

(OPDIVs) rather than programs as originally planned because of the limited 

number of staff assigned to each program. Five focus groups were held with 

program and grants management staff. One focus group was held with senior 

level staff from a mix of the OPDIVs and StaffDivs. 

The OPDIVs were identified using the Master Key report (described in the 

Survey of HHS section of Appendix A) and up-to-date information from the 

Tracking Accountability in Government Grants System (TAGGS) data files. 

Ultimately, OPDIVs were selected that represented those OPDIVs that make 

many awards to AI/AN/NA tribes and communities (ACF, AoA, IHS), those 

OPDIVs that make a moderate number of awards to AI/AN/NA tribes and 

communities (HRSA, SAMHSA, and CDC), and OPDIVs that make few awards 

(NIH). The decision was made to group ACF, AoA, and IHS into a single focus 

group because each of these OPDIVs makes a significant number of awards to 

tribes and other AI/AN/NA organizations. We expected that their experiences 

would be very similar. All or nearly all awards made by IHS and ANA 

(Administration for Native Americans) within ACF go to tribes or other AI/AN/NA 

organizations. AoA also makes a significant number of awards to tribes and 

organizations each year. According to the Master Key report, in 2004, AoA made 

more than 50% of their awards (representing about 9% of their funds) to tribal 

groups. 

Representatives from all OPDIVs and Staff Divisions (Barriers Work 

Group members or other designated contacts) were asked to make suggestions 

for participants in the senior-level focus group. Ultimately, this group consisted of 

representatives from the following OPDIVs: ACF/ANA, IHS, ASBTF, SAMHSA, 

CDC, and AHRQ. 

There were a total of 57 participants across the 6 focus group sessions. 

Each focus group, including the senior staff focus group, was composed of a mix 

of program administration and grants management staff. In the program-level 

focus groups, the majority of staff was involved in program administration. There 

was a nearly even mix for the senior staff focus group. 

Focus groups were moderated by a Westat senior staff member. There 

were at least two note takers (Westat staff and/or HHS staff) at each session. At 

the focus group sessions, the moderators provided an overview of the project 

and its objectives. Each participant was given an opportunity to introduce 

him/herself, describe his/her role in terms of program or grant responsibilities, 

describe the programs that he/she currently and/or previously worked with, and 

discuss their experiences, both positive and negative, with AI/AN/NA 

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39

communities and organizations that applied for those programs. After brief 

introductions, participants were then asked to identify the following: 

• Barriers that affect AI/AN/NA communities and organizations when 

applying for grant funds; 

• Barriers that affect AI/AN/NA communities and organizations during 

the pre-award phase of the grant process; and 

• Strategies to increase AI/AN/NA applications and grant funding 

awards. 

Detailed notes were prepared for each focus group. These notes then 

were used to prepare a memorandum summarizing findings from this component 

of the project. 
40
APPENDIX B: LIST OF IDENTIFIED BARRIERS AND ASSOCIATED SUGG

FROM HHS PROGRAM STAFF AND AI/AN/NA REPRESEN

Table B.1: Barriers to Obtaining Information About HHS Grant Opportunities Identified by RespRespondents’ Suggestions to Address Identified Barriers 

Barriers Identified by Respondents: Learning 

about HHS Grant Opportunities 

Respondents’ Suggestions to Address 

Lack of knowledgeable staff who can track or search for grant opportunities on a regular basis. 

1. Provide training and technical assistance on grants

organizations. 

Limited computer availability and internet access, particularity for rural and small AI/AN/NA organizations. 

1. Publish compilation of potential grant opportunities 

beginning of the year in hard copy and distribute w

2. Use multiple forms of communication about grant o

telephone, mail, email). 

3. Assign responsibility to HHS Regional Offices to no

in their region about grant opportunities. 

4. National and regional AI/AN/NA organizations take 

dissemination of information on grant opportunitieswith HHS. 

5. Coordinate among the OPDIVs by sharing lists of tr

Reliance on “word of mouth” results in learning too late to submit. 

1. Publish compilation of potential grant opportunities 

beginning of the year in hard copy and distribute w

2. Make greater use of annual or multiple year progra3. AI/AN/NA tribes/organizations designate a “point of announcements from HHS. 

Lack of targeted outreach and training on accessing grant announcements. 

1. Provide targeted outreach and training/technical as

announcements. 

41
Table B.2: Barriers to the Decision to Apply for Specific Grant Opportunities Identified by Resp

Respondents’ Suggestions to Address Identified Barriers 

Barriers Identified by Respondents: 

Decision to Apply for Grant Opportunities 

Respondents’ Suggestions to Address Id

Short timeframe between announcement and due date of application. 

1. Increase the timeframe between grant announcement

submission. 

2. Increase the use of annual or multiple-year program a

multiple deadlines. 

Uncertainty about AI/AN/NA eligibility. 1. Include specific language in announcement about AI/A

organizations’ eligibility. 

Inadequate resources and experienced staff to prepare application. 

1. Provide more training and technical assistance to AI/A

organizations on grant writing process and elements. 

2. Increase the number and types of planning grants for 

organizations may apply. 

Lack of data to establish “need”. 1. Re-examine type and extent of requirements for data 

applicants in rural areas and/or work with potential apprequired to establish need. 

2. AI/AN/NA tribe/organization contact program office to 

on “need”. 

Requirements for collaboration or coordination with States an/or other entities. 

1. Consider waiving or modifying nonstatutory requiremen

collaboration/coordination with state and local agencies in appropriate circumstances. 

Limitations on indirect costs or matching funds requirements. 

1. Consider waiving or modifying nonstatutory limits on ind

requirements for matching funds for organizations that do not have sufficient resources to conduct the program 

Requirements that grant application must indicate that the program is sustainable after end of grant period. 

1. Consider waiving or modifying nonstatutory requiremen

Difficulty reaching HHS contact person for grant program to obtain additional information. 

1. Increase accessibility of agency contacts for informatio2. Establish multiple HHS contacts to answer questions a

Requirements that principal investigator or program director have specific academic or other credentials. 

1. Consider specific language in grant announcement tha

substituted for academic credentials. 

42
Table B.2 (Continued) 

Barriers Identified by Respondents: 

Decision to Apply for Grant Opportunities 

Respondents’ Suggestions to Address Id

RFP does not reflect unique aspects of Indian Country resulting in skepticism about HHS agencies‘ and reviewers knowledge of unique AI/AN/NA issues 

1. Design programs to better fit needs of AI/AN/NA tribes a

2. Include language in grant announcements to make it cle

culturally adaptive (e.g., accept traditional practices as wpractices). 

43
44
Table B.3: Barriers to Preparing Grant Applications Identified by Respondents and Responden

Address Identified Barriers 

Barriers Identified by Respondents: 

Preparing Grant Applications 

Respondents’ Suggestions to Address Ide

Lack of staff with experience/expertise in grant writing and grant application preparation and/or capacity. 

1. Coordinate training and technical assistance on grant 

AI/AN/NA tribes/organizations and provide it in more loaccessible to AI/AN/NA groups (e.g. during national co

2. National and regional AI/AN/NA organizations take a g

training and technical assistance, perhaps in partnersh

3. Successful AI/AN/NA grants provide “peer” training to 

tribes/organizations. 

4. AI/AN/NA tribes/organizations send staff to HHS and o

workshops. 

5. Increase number and types of planning grants availab

tribes/organizations. 

6. Increase use of pre-proposal letter of inquiry (LOI) with 

proposals based on review of LOIs. 

Short timeframe between announcement and due date to obtain Tribal Council approval and letters of commitment. 

1. Increase time between grant announcement and due d2. Increase use of annual or multiple year program anno

due dates. 

Inability to reach HHS contact(s) and obtain needed information and clarifications. 

1. Increase accessibility of agency contacts for informatio2. Establish multiple HHS contacts to answer questions a

Need to meet different application requirements for each agency/application 

1. Standardize grant application format and requirements 

agencies. 

Limited computer/internet access 1. Continue to permit hard copy submission of applicatio

addition to use of electronic submissions. 

45
Table B.4: Barriers Related to HHS Grant Review Processes Identified by Respondents and Re

Suggestions to Address Identified Barriers 

Barriers Identified by Respondents: Grant Review 

Processes 

Respondents’ Suggestions to Address Id

Reviewers have limited knowledge and understanding of AI/AN/NA unique issues and governmental structure. 

1. Include AI/AN/NA reviewers on grant review p

applications are being reviewed. 

2. Provide information to reviewers about unique 

prior to review of applications submitted by AI/

Some agencies rely too heavily on academic reviewers who put disproportionate emphasis on academic degrees and credentials. 

1. Consider reducing reliance on academic revie2. Provide academic reviewers with information/g

their emphasis on degrees and academic cred

Small population base of many AI/AN/NA tribes and communities is viewed as too limited for grant objectives. 

1. If agency has minimum population base requir

announcement or, if not, provide reviewers wi

Some HHS agencies do not explain adequately the reasons for rejection; thus AI/AN/NA applicants can’t learn from process. 

1. Provide applicant with clear information on rea

application. 

2. AI/AN/NA applicants contact agency for inform

rejection, if agency does not provide summary reason is unclear. 

46
Respondent Suggestions 

Consider AI/AN/NA “set-asides” within grant programs. Consider targeting “set-asides” to smaller/poorer AI/AN/NA tribes and organizations. Increase number of grants targeted specifically to AI/AN/NA organizations. Monitor grant applications and awards within HHS to track award trends and to target technical assistance, incluapplicants. Require states and academic institutions that submit applications involving AI/AN/NA tribes and organizations to 

AI/AN/NA support and participation prior to award. 

HHS staff within each agency should visit AI/AN/NA tribes and communities to become knowledgeable about uncircumstances. Increase interagency collaboration to expand grant opportunities and assist AI/AN/NA groups to build capacity. 

Barriers Identified by Respondents: Grants 

Management 

Issues and Processes 

Respondents’ Suggestions to Address I

Every HHS agency has different grants management and reporting requirements. 

1. Standardize grants management financial an

requirements across HHS agencies. 

2. Provide grants management training and tech

new grantees. 

47

Table B.5: Barriers Related to Grants Management Issues and Processes Identified by ResponRespondents’ Suggestions for Addressing Identified Barriers Table B.6: Other Respondent Overarching Suggestions for Increasing AI/AN/NA Access to HHS Grant Programs 
APPENDIX C: HHS STAFF SURVEY ON BARRIERS TO 

AMERICAN INDIAN, ALASKA NATIVE AND 

NATIVE AMERICAN COMMUNITIES’ ACCESS 

TO HHS PROGRAMS 

THANK YOU FOR PARTICIPATING IN THIS STUDY. PLEASE ANSWER ALL 

QUESTIONS BASED ON FY 2004 INFORMATION ABOUT THE GRANT PROGRAM 

ENTITLED {PROGRAM TITLE}. PLEASE FEEL FREE TO USE ANY INFORMATION 

SOURCE YOU DEEM APPROPRIATE IN ORDER TO COMPLETE THESE QUESTIONS 

AS ACCURATELY AS POSSIBLE. 

IN THIS SURVEY, THE TERM “AMERICAN INDIAN, ALASKA NATIVE, AND NATIVE 

AMERICAN COMMUNITIES” IS USED TO REFER TO BOTH FEDERALLY RECOGNIZED 

AND NON-FEDERALLY RECOGNIZED AMERICAN INDIAN TRIBES AND ANY TYPE OF 

NON-PROFIT ORGANIZATIONS FORMED BY AMERICAN INDIAN TRIBES, ALASKA 

NATIVE COMMUNITIES, OR OTHER NATIVE AMERICAN COMMUNITIES (INCLUDING 

PACIFIC ISLANDERS AND NATIVE HAWAIIANS). SOME EXAMPLES OF TRIBAL 

ORGANIZATIONS INCLUDE TRIBAL EPIDEMIOLOGY CENTERS, REGIONAL INDIAN 

HEALTH BOARDS, URBAN INDIAN CENTERS, AND TRIBAL HEAD START PROGRAMS. 

TRIBAL COLLEGES ARE ALSO INCLUDED IN THE BROAD CATEGORY OF AI/AN/NA 

COMMUNITIES/ ORGANIZATIONS. 

SECTION A: WHO YOU ARE

1. How long have you worked with HHS grant programs? 

 LESS THAN 1 YEAR 

1 TO 5 YEARS 

6 TO 10 YEARS 

11 TO 15 YEARS 

16 YEARS OR MORE 

2. What are your current responsibilities in the grants process? (Please select all that 

apply) 

 PREPARE PROGRAM ANNOUNCEMENTS 

 PUBLICIZE GRANT OPPORTUNITIES 

 PROVIDE TECHNICAL ASSISTANCE 

 CONDUCT TECHNICAL REVIEW OF APPLICATIONS 

 CONDUCT BUDGET REVIEW OF APPLICATIONS 

 ADMINISTER PROGRAM COMPONENT—PROVIDE TECHNICAL OVERSIGHT 

 ADMINISTER FINANCIAL COMPONENT—PROVIDE FINANCIAL/ADMINISTRATIVE 

OVERSIGHT 

 OTHER, SPECIFY 

3. Are American Indian Tribes or organizations (including Tribal colleges), Alaska 

Native villages or corporations, or other Native American communities/organizations 

48
(e.g., Native Hawaiians, Pacific Islanders) specifically listed as eligible to apply for 

your grant program? 

 YES 

 NO 

4. For your grant program, have you received grant applications from and/or awarded 

grants to American Indian, Alaska Native or other Native American (AI/AN/NA) 

communities/organizations? 

 YES 

 NO (PLEASE GO TO QUESTION 12) 

 DON’T KNOW (GO TO QUESTION 12) 

SECTION B: AI/AN/NA APPLICATIONS AND AWARDS IN YOUR PROGRAM

In this section, we are interested in finding out about applications submitted by and awards 

made to AI/AN/NA communities and organizations. Please do not include applications and 

awards in which AI/AN/NA communities or organizations receive services or research 

benefits from non-AI/AN/NA grantees BUT DO NOT RECEIVE ANY DIRECT FUNDING 

EITHER AS THE GRANTEE OR AS A SUBCONTRACTOR TO THE GRANTEE. 

5. Do you have data available to report on the number of applications your grant 

program receives from AI/AN/NA communities/organizations and awards made to 

AI/AN/NA communities/organizations? (Please check all that apply.) 

 DATA ARE AVAILABLE ON THE NUMBER OF APPLICATIONS RECEIVED 

 DATA ARE AVAILABLE ON THE NUMBER OF AWARDS MADE 

 NO (GO TO QUESTION 8) 

 DON’T KNOW (GO TO QUESTION 8) 

6. In FY 2004, about how many applications did your grant program receive from 

AI/AN/NA communities/organizations? 

7. In FY 2004, how many grant applications from AI/AN/NA communities/organizations 

were funded? 

 

8. Do you have data available to report on the number of applications your grant 

program received that included AI/AN/NA communities/organizations as 

subcontractors as well as the number of grant awards made that included AI/AN/NA 

subcontractors? (Please check all that apply.) 

 DATA ARE AVAILABLE ON THE NUMBER OF APPLICATIONS RECEIVED 

 DATA ARE AVAILABLE ON THE NUMBER OF AWARDS MADE 

 NO DATA ARE AVAILABLE (GO TO QUESTION 12) 

 DON’T KNOW (GO TO QUESTION 12) 

49
9. Was an AI/AN/NA community/organization a subcontractor on any applications within 

your program in the past year? 

 YES 

 NO (GO TO QUESTION 12) 

 DON’T KNOW (GO TO QUESTION 12) 

10. How many applications did you receive in which an AI/AN/NA 

community/organization was a subcontractor? 

11. How many of the applications in which an AI/AN/NA community/organization was a 

subcontractor were funded? 

SECTION C: PROGRAM ANNOUNCEMENTS AND TECHNICAL ASSISTANCE

Please describe activities that have occurred in the last year. You are free to use any 

information source you deem appropriate in order to complete these questions as accurately 

as possible. 

12. How were grant opportunities made public in your program? (Please select all that 

apply) 

 WEBSITE, PLEASE SPECIFY 

 FEDERAL REGISTER NOTICE 

 REGIONAL OFFICE OUTREACH 

 FEDERAL PUBLICATIONS SUCH AS THE NIH GUIDE OR HRSA PREVIEW 

 NEWSLETTERS OR OTHER PUBLICATIONS FROM NON-FEDERAL 

ORGANIZATIONS 

 DIRECT MAILINGS FROM HHS 

 CONFERENCE PRESENTATIONS 

 OTHER, SPECIFY 

13. Did your program provide pre-application technical assistance to grant applicants? 

 YES 

 NO (GO TO QUESTION 22) 

14. What topics for pre-application technical assistance have been most frequently 

requested by potential AI/AN/NA applicants? (Please select all that apply) 

 NONE REQUESTED 

 ELIGIBILITY DETERMINATION 

 BUDGET PREPARATION 

 CLARIFICATION OF STATEMENT OF WORK 

 CLARIFICATION OF APPLICATION FORMAT REQUIREMENTS 

 PARTNERING OPPORTUNITIES 

 OTHER, SPECIFY 

15. What types of pre-application technical assistance did you provide to potential 

applicants? 

 (Please select all that apply) 

50
 PHONE ASSISTANCE 

 WORKSHOPS 

 WEB-BASED MATERIALS 

 EMAIL/FAX OF INFORMATION 

 COPIES OF PREVIOUS SUCCESSFUL APPLICATIONS 

 OTHER, SPECIFY 

16. In FY 2004, have you conducted any pre-application technical assistance (TA) 

activities directed specifically at AI/AN/NA communities/organizations? 

 YES, PLEASE SPECIFY 

 NO (GO TO QUESTION 22) 

17. In FY 2004, how many different AI/AN/NA organizations/communities received this 

TA? 

18. Who provided the technical assistance directed at AI/AN/NA 

communities/organizations? 

 

19. Please estimate the following about AI/AN/NA communities/organizations who 

received pre-application TA from your program: 

Number of completed applications 

Number approved for funding 

Number funded 

20. How helpful do you believe these technical assistance activities were to potential 

AI/AN/NA applicants? 

 VERY HELPFUL 

 SOMEWHAT HELPFUL 

 NOT AT ALL HELPFUL 

21. Please tell us more about your answer to question 20. We would like to know how 

pre-application TA activities were helpful or why you think they were not helpful. 

 

22. How do you think TA efforts could be more effective in obtaining applications from 

AI/AN/NA communities, making applications more competitive, and/or assisting 

these communities to implement a grant that has been awarded? 

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SECTION D: THE REVIEW PROCESS

Please describe activities that have occurred in the last year in your program. 

23. Please describe the type of grant review process your program used. Please include 

information about the degree to which your program uses internal (i.e., Federal 

employees) and/or external reviewers. 

 

24. If applicable, how were your internal technical grant reviewers selected? 

 

25. If applicable, how were your external technical grant reviewers selected? 

 

26. Do regulations require AI/AN/NA reviewers for grant applications to your program? 

 YES (GO TO QUESTION 28) 

 NO 

27. If not required by regulations, when you received applications from AI/AN/NA 

communities/organizations, did you attempt to include AI/AN/NA reviewers in your 

internal and/or external review process? 

 YES 

 NO 

28. Did AI/AN/NA reviewers participate in the internal and/or external review process for 

your program? 

 YES 

 NO (GO TO QUESTION 32) 

52
29. How did your program select or identify AI/AN/NA reviewers? 

 

30. If applicable, how often did you have AI/AN/NA reviewers as part of your internal 

review committees? 

 ALWAYS 

 OFTEN 

 OCCASIONALLY 

 NEVER 

 DON’T HAVE AN INTERNAL REVIEW COMMITTEE

 DON’T KNOW 

31. If applicable, how often did you have AI/AN/NA reviewers as part of your external 

review committees? 

 ALWAYS 

 OFTEN 

 OCCASIONALLY 

 NEVER 

 DON’T HAVE AN EXTERNAL REVIEW COMMITTEE

 DON’T KNOW 

32. How were funding decisions made after the review process? 

 BY REVIEW PANEL SCORING ONLY 

 A COMBINATION OF SCORING AND SET-ASIDES AND OTHER FACTORS, 

 PLEASE SPECIFY 

 OTHER, SPECIFY 

53
SECTION E: FACTORS INFLUENCING AI/AN/NA APPLICATIONS AND AWARDS

33. Please select any of the following factors that you believe may decrease the 

likelihood that AI/AN/NA communities/organizations will apply for grant funding 

through your program. (Please select all that apply) 

 AI/AN/NA COMMUNITIES/ORGANIZATIONS ARE UNAWARE OF FUNDING 

OPPORTUNITIES 

 PERCEPTION THAT THEY ARE INELIGIBLE 

 AI/AN/NA COMMUNITIES/ORGANIZATIONS LACK INFORMATION ON HOW TO 

ACCESS FUNDING OPPORTUNITIES 

 CATEGORICAL FUNDING DOES NOT MATCH TRIBAL NEEDS 

 LACK OF AI/AN/NA COMMUNITY/ORGANIZATION STAFF TRAINED IN 

GRANTSMANSHIP (e.g., GRANT APPLICATION WRITING, GRANT 

ADMINISTRATION) 

 FEDERAL REGULATIONS PERTAINING TO TRIBES RESTRICT PARTICIPATION 

 PROGRAM FINANCIAL MANAGEMENT/ADMINISTRATIVE REPORTING 

REQUIREMENTS 

 REQUIREMENTS FOR MATCHING FUNDS 

 REQUIREMENT THAT APPLICANT HAVE AN APPROVED HHS INDIRECT COST 

RATE TO RECEIVE ADMINISTRATIVE/OVERHEAD COSTS 

 COSTS AND REPORTING REQUIREMENTS TO OBTAIN/MAINTAIN APPROVED 

INDIRECT COST RATE 

 LIMITATION OF ALLOWED INDIRECT COSTS 

 OTHER, SPECIFY 

 DON’T KNOW 

34. In your program, what factors distinguish a funded AI/AN/NA proposal from all 

unfunded proposals (from any source)? (Please select all that apply) 

 TECHNICAL/SCIENTIFIC MERIT OF PROPOSAL 

 RESPONSIVENESS TO ALL APPLICATION REQUIREMENTS 

 SIZE OF BUDGET OVERALL AND RELATIVE TO POPULATION 

 PRIOR EXPERIENCE OF APPLICANT 

 QUALIFICATIONS OF PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR 

PROPOSED 

 ADHERENCE TO GRANT APPLICATION FORMATS AND REQUIREMENTS 

 EVIDENCE THAT PROGRAM CAN BE EFFECTIVELY IMPLEMENTED 

 FINANCIAL ACCOUNTABILITY/BUDGET PREPARATION 

 OTHER, SPECIFY 

 DON’T KNOW 

35. In your program, do you think that the small population base of most AI/AN/NA 

communities/organizations is a negative factor in program funding decisions? 

 YES 

 NO 

 DON’T KNOW 

54
36. Do you think that any of the following factors related to implementing a grant affect 

the likelihood that AI/AN/NA communities/organizations will receive grant funding 

from your program? (Please select all that apply) 

 LACK OF RESEARCH INFRASTRUCTURE 

 LACK OF ADMINISTRATIVE/FINANCIAL MANAGEMENT INFRASTRUCTURE 

 DIFFICULTIES IMPLEMENTING GRANT ACTIVITIES OR MANAGING GRANT 

FUNDING 

 LIMITED TECHNOLOGICAL CAPABILITIES (e.g., INTERNET ACCESS, ELECTRONIC 

DATA COLLECTION AND MANAGEMENT) 

 REMOTENESS OF POPULATIONS CREATE BARRIERS FOR HHS MONITORING 

 LIMITED STAFF 

 OTHER, SPECIFY 

 DON’T KNOW 

SECTION F: SUGGESTIONS FOR INCREASING AI/AN/NA 

COMMUNITIES/ORGANIZATIONS’ ACCESS TO HHS FUNDING

37. What steps could your program, or higher level organization(s) of which the program 

is a part, take to increase the number of applications received from AI/AN/NA 

communities/organizations? 

 

38. What steps could your program take to increase the likelihood that AI/AN/NA 

applications will be funded? 

 

39. Do you think that HHS departmental grant policies could be changed in ways that 

would reduce the grants access barriers faced by AI/AN/NA 

communities/organizations? If yes, please tell us how. 

 

40. What steps could your program take to facilitate successful implementation of grants 

by AI/AN/NA awardees? 

 

41. What other factors do you believe affect AI/AN/NA communities/organizations’ 

access to HHS funding? 

 

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SECTION G: ADDITIONAL INFORMATION

42. We appreciate any other observations you may have about your experiences with 

working with ANY grant opportunities. Do you have any experiences that you would 

like to share concerning barriers to AI/AN/NA access to funding and/or changes that 

may be made to increase access? 

 

Thank you for completing this questionnaire. 

Please submit the completed questionnaire using any of the following methods: 

EMAIL: BarriersProject@Westat.com 

MAIL: TERITA JACKSON 

 WESTAT 

1650 RESEARCH BOULEVARD 

RM RA 1259 

ROCKVILLE, MD 20850 

FAX: 301-315-5912

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