§ 136.104 Application. ( a ) Forms for applying for grants are governed by 45 CFR 75.206.
( b ) In addition to such other pertinent information as the Secretary may require, the application for a grant under this subpart shall contain the following: ( 1 ) A description of the applicant including an indication whether the applicant is a Tribe or tribal organization, and if the latter: ( i ) The legal and organizational relationship of the applicant to the Indians in the Area to be served or effected by the project.
( ii ) A description of the current and proposed participation of Indians in the activities of applicant.
( iii ) Whether applicant is controlled, sanctioned or chartered by the governing body of the Indians to be served, and if so, evidence of such fact.
( iv ) If elected, a description of the election process, voting criteria, and extent of voter participation in the election designating the organization.
( 2 ) A narrative description of the project including its goals and objectives and the manner in which the proposed project is compatible with published Indian Health Service statements of availability of funds, the manner in which those goals and objectives are to be attained, and a work and time schedule which will be utilized to accomplish each goal and objective.
( 3 ) A description of applicant's staff, present or proposed, including their qualifications, academic training, responsibilities and functions.
( 4 ) A description of the manner in which the staff is or will be organized and supervised to carry out proposed activities.
( 5 ) A description of training to be provided as part of the proposed project.
( 6 ) A description of the administrative, managerial, and organizational arrangements and resources to be utilized to conduct the proposed project.
( 7 ) An itemized budget for the budget period (normally 12 months) for which support is sought and justification of the amount of grant funds requested.
( 8 ) The intended financial participation, if any, of the applicant, specifying the type of contributions such as cash or services, loans of full or part-time staff, equipment, space materials or facilities, or other contributions.
( 9 ) Where health services are to be provided, a description of the nature of the services to be provided and the population to be served.
( 10 ) A description of the Federal property, real and personal, equipment, facilities and personnel which applicant proposes to utilize and a description of the arrangements which applicant has made or will make to assume responsibility for the operation and management of those facilities.
( c ) The application shall contain assurances satisfactory to the Secretary that the applicant will: ( 1 ) Where applicant is providing services, provide such services at a level and range which is not less than that provided by the Indian Health Service or that identified by the Service after negotiation with the applicant, as an appropriate level, range and standard of care.
( 2 ) Where providing services, provide services in accordance with law and applicable Indian Health Service policies and regulations.
( 3 ) Where providing services, provide services in a fair and uniform manner, consistent with medical need, to all Indian people.
(Approved by the Office of Management and Budget under control number 0915-0045) [40 FR 53143, Nov. 14, 1975, as amended at 50 FR 1853, Jan. 14, 1985; 81 FR 3010, Jan. 20, 2016]