U.S. Department of Health and Human Services

Office of Population Affairs

Notice of Funding Opportunity Title X Family Planning Services Grants

Opportunity Number

PA-FPH-27-001

Application Due Date January 11, 2027

Technical Assistance Webinar Date November 9, 2026

Table of Contents

SUMMARY

A. ELIGIBILITY INFORMATION

B. AGENCY PRIORITIES

C. PROGRAM DESCRIPTION

1. Background

2. Expectations for Recipients

3. Federal Involvement in the Project

4. Eligibility criteria for project participants

D. AWARD INFORMATION

E. APPLICATION CONTENTS AND FORMAT

1. Format of the Application

2. Content

F. SUBMISSION REQUIREMENTS AND DATES

G. APPLICATION REVIEW INFORMATION

1. Responsiveness Review

2. Merit Review Criteria

3. Merit Review and Selection Process

4. Review of Risk Posed by Applicant

H. AWARD NOTICES

I. AWARD REQUIREMENTS AND ADMINISTRATION

1. Administrative and National Policy Requirements

2. Program Specific Terms and Conditions

3. Award Closeout

4. Lobbying Prohibitions

5. Non-Discrimination Requirements

6. Smoke- and Tobacco-free Workplace

7. Acknowledgement of Funding

8. HHS Rights to Materials and Data

9. Trafficking in Persons

10. Efficient Spending

11. Whistleblower Protection

12. Health Information Technology (IT) Interoperability

13. Certain telecommunications and video surveillance services or equipment

14. Human Subjects Protection

15. Research Integrity

16. Reporting

J. CONTACTS

K. OTHER INFORMATION

1. Application Checklist

2. Acronyms

3. Glossary

4. Object Class Descriptions and Required Justifications

5. Considerations in Recipient Plans for Oversight of Federal Funds

6. Financial Assistance General Certifications and Representations

7. Protections for Healthcare Entities under Weldon and Other Conscience Protection Statutes

BASIC INFORMATION

Opportunity Title Title X Family Planning Services

Program Office Office of Population

Affairs

Application Submission and Format Electronic application submitted via Grants.gov ONLY.

Opportunity Number

PA-FPH-27-001

Award Type Grant

Application Deadline January 11, 2027

Announcement Type Initial

Technical Assistance Webinar Date November 9, 2026

Assistance Listing

93.217 (Family Planning)

Technical Assistance Webinar Details visit the OPA website at https://opa.hhs.gov/grant-programs/funding-opportunities for details

Eligible Applicants (see Section A.1 for full details)

Executive Order 12372 does apply to this NOFO (see section F.3.D)

Estimated Total Funding Available Up to $ 257,000,000

Estimated Period of Performance (months)

Estimated Number of Awards up to 90

Anticipated Award Date April 1, 2027

Anticipated Award Funding Range $200,000 - $22M

Anticipated Project Start Date April 1, 2027

QUESTIONS?

Additional contact information in Section J https://opa.hhs.gov/grant-programs/funding-opportunities https://opa.hhs.gov/grant-programs/funding-opportunities

SUMMARY

The Office of Population Affairs (OPA) announces the anticipated availability of funds for Fiscal Year (FY) 2027 grants under the authority of Title X of the Public Health Service Act, Section 1001 (42 U.S.C. §300).

This notice solicits applications for projects to provide Title X services throughout the 50 United States, District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the U.S. Virgin Islands, American Samoa, the U.S. Outlaying Islands (Midway, Wake, et al.), the Republic of the Marshall Islands, the Federated State of Micronesia, and the Republic of Palau (hereafter, States). OPA intends to make available approximately up to $257 million for up to 90 grant awards for a period of up to five (5) years. The actual amount available will not be determined until enactment of the FY 2027 federal budget.

OPA’s Title X Family Planning Program funds “voluntary family planning projects [that] offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents).” (Title X of the Public Health Service Act, 42 U.S.C. 300 et seq., available at https://opa.hhs.gov/sites/default/files/2020-07/title-x-statute-attachment-a_0.pdf). The Title X Program is implemented through competitively awarded grants to a diverse network of public and private nonprofit entities. The program helps millions of low-income and uninsured Americans develop health literacy and access family planning and related health services, empowering individuals and families to make informed decisions and navigate chronic health conditions and pregnancy with confidence. By offering counseling and education to improve individuals’ optimal health outcomes, Title X promotes the level of health literacy necessary to support informed consent across the reproductive lifespan. For example, endometriosis often goes undiagnosed for years because symptoms such as severe menstrual pain or irregular bleeding are frequently normalized or minimized. Body literacy counseling helps patients recognize that these experiences are not “normal” features of womanhood, but potential indicators of an underlying condition, prompting earlier discussion with providers, timely diagnosis, appropriate treatment, and improved long-term reproductive and overall health outcomes.

Likewise, foundational knowledge of reproductive physiology enables patients and couples to recognize early signs of dysfunction, seek timely evaluation, and participate meaningfully in care decisions. Persistent gaps in reproductive knowledge highlight the need for such education. For example, a survey conducted for OPA in 2020 found that only 50% of women and 38% of men know that a woman’s ovaries do not keep producing new eggs until menopause (https://opa.hhs.gov/sites/default/files/2021- 01/fertility-knowledge-survey-findings-exec-summary-2020.pdf). By supporting body https://opa.hhs.gov/sites/default/files/2020-07/title-x-statute-attachment-a_0.pdf https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf literacy education alongside evidence-based evaluation and treatment of chronic disease, Title X services can help patients move beyond symptom-focused care toward informed, preventive, and restorative approaches to reproductive health.

These efforts align with HHS’s focus on addressing the root causes of chronic illnesses by targeting conditions that affect reproductive health and fertility. By promoting strategies that support education and counseling on reproductive health goals, reduce chronic disease, and assist individuals seeking to achieve healthy pregnancies, the Title X Program strengthens American families, individuals, and communities.

This notice solicits applications from public and private nonprofit entities to establish and operate voluntary Title X projects. These projects include a broad range of effective and acceptable services, including pregnancy testing and counseling, basic infertility services, sexually transmitted infection (STI) services (such as HIV prevention education, counseling, testing, and referral), health literacy, reproductive goals counseling to increase optimal health outcomes, and other preconception health services. Title X services also help address and provide referrals for health conditions that affect fertility, including endometriosis, polycystic ovary syndrome (PCOS), and uterine fibroids in women, as well as low sperm count, low sperm motility, low testosterone, and erectile dysfunction in men. OPA seeks a broad competition for Title X grant awards and are interested in innovative strategies to address chronic disease; reduce overmedicalization by strengthening approaches focused on underlying behavioral and lifestyle factors of health and evidence-based practices such as fertility-awareness based methods; promote health and body literacy; advance reproductive goals counseling for all clients; and support family formation.

All activities funded under this announcement must be in compliance with the requirements of the Title X statute, legislative mandates, and regulations. Copies of the Title X statute, regulations, and legislative mandates may be downloaded from the OPA website at https://opa.hhs.gov/grant-programs/title- x-service-grants/title-x-statutes-regulations-and-legislative-mandates.

While there is not a fixed cost-sharing percentage or amount, projects must include financial support from sources other than Title X. The proposed project budget must reflect non-federal financial support in addition to Title X funds on both the Standard Form (SF) 424A, Budget Information for Non-Construction Programs, and in the budget narrative. Recipients will provide family planning services that are in compliance with the Title X statute, regulations, and legislative mandates and that are guided by OPA’s key priorities.

OPA encourages applicants to review all program requirements, eligibility information, application format and submission information, evaluation criteria, and other information in this funding announcement to ensure that their application complies with all requirements and instructions.

https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates

The Office of the Assistant Secretary for Health (OASH) Grants and Acquisitions Management Division (GAM) will administer this competition.

We encourage you to review all program requirements, eligibility information, application format and submission instructions, and other content of this notice to ensure your application complies with all requirements.

A. ELIGIBILITY INFORMATION

1. Eligible Applicants Any public or private nonprofit entity is eligible to apply.

You must meet all of the eligibility requirements in order for us to review your application.

Eligible Entities Additional examples of eligible organizations include:

Any public or private nonprofit entity located in a State (which includes one of the 50 United States, District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the U.S. Virgin Islands, American Samoa, the U.S. Outlaying Islands (Midway, Wake, et al.), the Republic of the Marshall Islands, the Federated State of Micronesia, and the Republic of Palau (hereafter, States) is eligible to apply for a grant under this announcement. Faith-based organizations and American Indian/Alaska Native/Native American (AI/AN/NA) organizations are eligible to apply for Title X family planning services grants. Examples of eligible Organizations include:

• State Governments

• U.S. territories

• County Governments

• City or township governments

• Special district governments

• Independent school districts

• Public and State controlled institutions of higher education

• Native American tribal governments (Federally recognized)

• Public Housing authorities/Indian housing authorities

• Native American tribal organizations (other than federally recognized tribal governments)

• Nonprofits having 501(c)(3) status with the IRS, other than institutions of higher education

• Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education

• Non-profit private institutions of higher education

PDPI Eligibility There is no restriction on an individual’s eligibility to be Project Director (PD)/Principal Investigator (PI) on an application. However, we will not make an award with a PD/PI who has an active government-wide exclusion, suspension, or debarment recorded in SAM.gov.

We expect that throughout the period of performance the PD/PI will be involved in, and have substantial knowledge about, all aspects of the project. Although your organization may recognize co-PD/PIs on team-managed projects, we recognize only a single PD/PI who will be responsible for the programmatic aspects of the project.

Other Considerations

Submitting Multiple Applications

You may submit more than one application, but each application must be for a distinctly different project.

If you submit multiple applications for the same project, we will accept only the last application submitted a Grants.gov timestamp that is before the due date and time. We will disqualify all other versions of the application. See Section G.1.b for all disqualification factors.

Submitting an Application as a Group or Consortium

For any given project, we will only make an award to a single eligible entity. More than one entity may choose to work together on a project under this opportunity, but only one entity may submit the application. If awarded, that entity will be the award recipient and will be responsible for conducting the project.

The other entities may participate in the project, if awarded, and would be responsible to the recipient for their respective roles, typically as subrecipients.

Groups may form a consortium, partnership, or other legally recognized entity for the purpose of applying for this opportunity and carrying out any awarded project. The resulting entity must exist and be legally recognized when it applies and must have an active registration in SAM.gov.

We will conduct a risk assessment on the applying entity (Section F.4) prior to making any award.

Eligibility Documentation

Entity eligibility documentation (e.g., proof of 501(c)(3) status as determined by the Internal Revenue Service or an authorizing Tribal Resolution) must be included in the submitted application. For additional information, see Section 4.a. It is important that your organization is correctly classified in your SAM registration (Section F.2.a).

During our review of your application, we might request additional documentation to support your eligibility. This request means only that your application is under review and not that you will receive an award.

More specific information on the type of documentation that we might request specific to this opportunity appears in Section F.4.b.

Application Disqualification

We will disqualify applications that fail to meet the eligibility, responsiveness, formatting, and submission requirements (Sections G.1.b) prior to conducting merit review. Disqualified applications will not undergo further review.

We will notify disqualified applicants at the end of the competition when we announce the award recipients.

2. Application Responsiveness Criteria

We will review your application to determine whether it meets the responsiveness criteria below.

If your application does not meet the responsiveness criteria, we will disqualify it from the competition; we will not review it beyond the initial screening.

The responsiveness criteria are as follows:

• Family Participation Certification. Applicants must include a written statement in the appendix of the application certifying that:

“if funded, this Title X Family Planning Services project will encourage family participation in the decision of minors to seek family planning services and will provide counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities.”

3. Cost Sharing or Matching

Program regulations at 42 C.F.R. § 59.7(c) stipulate that ``No grant may be made for an amount equal to 100 percent of the project's estimated costs.'' Also, 42 C.F.R. § 59.7(b) states that “No grant may be made for less than 90 percent of the project's costs, as so estimated, unless the grant is to be made for a project that was supported, under section 1001, for less than 90 percent of its costs in fiscal year 1975. In that case, the grant shall not be for less than the percentage of costs covered by the grant in fiscal year 1975.''

While there is not a fixed cost-sharing percentage or amount, projects must include financial support from sources other than Title X. The proposed project budget should reflect financial support in addition to Title X funds on both the Standard Form (SF) 424A, Budget Information, and in the budget narrative and justification. The amount and source(s) of these funds must be clearly identified separately from the requested Title X support as indicated on the SF 424A, as well as on the SF 424, Application for Federal Assistance. The OASH Grants and Acquisition Management (GAM) Division will review applications to ensure that the requested amount of Title X funding is in compliance with this business requirement.

The cost sharing requirements outlined above are waived for any grant made to the U.S. Virgin Islands, Commonwealth of the Northern Mariana Islands, American Samoa, Guam, Republic of Palau, Federated States of Micronesia, and the Republic of the Marshall Islands. Although projects are expected to identify additional sources of funding and not solely rely on Title X funds, there is no specific amount of level of financial match requirement for this program.

B. AGENCY PRIORITIES

Required Alignment with OASH Mission and Agency Priorities

Consistent with OASH’s mission, in carrying out any project that is funded under this NOFO, recipients must align program design and activities with agency priorities where consistent with program authority and the scope of the award (Priorities of the Office of the Assistant Secretary for Health,” available online at: https://health.gov/priorities), and when authorized by law according to the Title X statute, regulations, legislative mandates, and additional program guidance. Funded activities must advance and support OASH’s mission to improve the health and well-being of Americans.

In addition, the recipient is required to administer any project that is awarded under this NOFO in accordance with the following objectives in Title X that are authorized to advance them:

1) Promote body and health literacy

2) Advance reproductive goals counseling

3) Implement a Quality Improvement and Quality Assurance (QI/QA) Plan with the goal to achieve optimal health outcomes

The recipients must demonstrate ongoing compliance with these priorities, in all programs that are authorized to advance them, through program design, implementation, reporting, and evaluation.

Failure to meaningfully align funded activities with the applicable requirements may result in corrective action, additional reporting requirements, or other actions consistent with federal grant regulations found at 2 C.F.R. Part 200 and the terms and conditions of this award (including termination pursuant to 2 C.F.R. 200.340(a)(4) for no longer effectuating program goals or agency priorities).

C. PROGRAM DESCRIPTION

The Office of the Assistant Secretary for Health (OASH), Office of Population Affairs (OPA) announces the anticipated availability of funds for Fiscal Year (FY) 2027 grants under the authority of Title X of the Public Health Service Act, Section 1001 (42 U.S.C.

§300).

The primary focus of OASH is to lead Americans toward healthier lives by promoting health and well-being across the lifespan. This includes the reproductive lifespan, supported through innovative, evidence-based programs, services, partnerships, and research that strengthen family formation and assist clients in achieving healthy pregnancies. Grants funded through this NOFO will expand access to Title X family services for millions of Americans, helping them build body literacy, address infertility, https://health.gov/priorities plan and space pregnancies, and navigate reproductive health conditions such as endometriosis, polycystic ovary syndrome (PCOS), and uterine fibroids in women, as well as low sperm count, low sperm motility, low testosterone levels, and erectile dysfunction in men.

Background

Title X clinics provide services to clients of both sexes and all ages, including adolescent clients, with priority given to persons from low-income families. Title X services are voluntary, confidential, and provided regardless of one’s ability to pay or a client's religion, race, color, national origin, disability, age, sex, number of pregnancies, or marital status. For many clients, Title X clinics are their only ongoing source of health care and health education.

The majority of the clients served by Title X providers are low-income, female, and under 30 years old. In order to ensure that all prospective low-income clients are able to access services, there is no charge for services to people with family incomes below 100% of the most recent federal poverty level (FPL) guidelines, and services are discounted on a sliding scale for people with family incomes between 101-250% of the FPL. In 2023, 60% of clients had family incomes at or below 100% FPL, while 83% had family incomes below 250% of the FPL. Detailed information about current and past clients served by Title X recipients and the broad range of services provided to clients by Title X recipients is available in the Family Planning Annual Report (FPAR) available on the OPA website at https://opa.hhs.gov/research-evaluation/title-x-services- research/family-planning-annual-report.

The Title X statute specifies that local and regional public or private nonprofit entities may apply directly to the Secretary for a Title X family planning services grant under this announcement. For applicants that will not provide all services directly, you must document, in your application, the process and selection criteria you will use to identify qualified subrecipients to fulfill Title X activities. You should also show how your subrecipients will provide the required services and best serve individuals in need throughout the anticipated service area. Applicants must additionally outline how all subrecipients, through their activities and services, will comply with Title X statutory and regulatory requirements and OPA program guidance.

Expectations for Recipients

a. Comply with Title X Statute, Regulations, Legislative Mandates, and Additional Program Guidance

All activities funded under this announcement must be in compliance with the requirements of the Title X statute, legislative mandates, and applicable regulations.

We also expect all activities funded under this announcement to be in compliance with additional program guidance issued by OPA.

https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report

1. Title X Statute

Requirements regarding the provision of family planning services under Title X are in the statute (Title X of the Public Health Service Act, 42 U.S.C. 300 et seq., available at https://opa.hhs.gov/sites/default/files/2020-07/title-x-statute-attachment-a_0.pdf) and in the implementing regulations which govern project grants for family planning services (42 C.F.R. part 59, subpart A). In addition, sterilization of clients as part of the Title X program must be consistent with 42 C.F.R. part 50, subpart B (“Sterilization of Persons in Federally Assisted Family Planning Projects”).

Title X of the Public Health Service Act authorizes the Secretary of HHS to award grants for projects to provide family planning services to any person desiring such services, with priority given to individuals from low-income families. Section 1001 of the Act, as amended, authorizes grants “to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents).”

In addition, Section 1001 of the statute requires that, to the extent practicable, Title X service providers shall encourage family participation in family planning services projects. Finally, Section 1001(b) assures the right of local and regional entities to apply directly to the Secretary for Title X grant funds.

Section 1008 of the Act, as amended, stipulates, “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.”

2. Title X Regulations

On October 4, 2021, OPA issued a final rule, (42 C.F.R. Part 59), to revise the regulations that govern the Title X family planning program by readopting the 2000 regulations (65 F.R. 41270), with several revisions to ensure access to quality family planning services for clients, especially low-income clients.

The 2021 final rule includes a description of what programs the regulations apply to (§ 59.1), definitions (§ 59.2), who is eligible to apply for a family planning services grant (§ 59.3), how one applies for a family planning services grant (§ 59.4), requirements that must be met by a family planning project (§ 59.5), procedures to assure the suitability of informational and educational material (print and electronic) (§ 59.6), criteria HHS will use to decide which family planning services projects to fund and in what amount (§ 59.7), how grants are awarded (§ 59.8), for what purposes the grant funds may be used (§ 59.9), confidentiality (§ 59.10), and additional conditions (§ 59.11). A copy of the 2021 final rule is available at https://www.govinfo.gov/content/pkg/FR-2021-10-07/pdf/2021-21542.pdf.

3. Legislative Mandates

The following legislative mandates have been part of the Title X appropriations language https://opa.hhs.gov/sites/default/files/2020-07/title-x-statute-attachment-a_0.pdf https://www.govinfo.gov/content/pkg/FR-2021-10-07/pdf/2021-21542.pdf for the last several years. This NOFO assumes these provisions will be carried forward in FY 2027, please review all applicable Title X appropriations when completing your application. Title X family planning services projects should include administrative, clinical, counseling, and referral services, as well as training of staff necessary to ensure adherence to these requirements.

“None of the funds appropriated in this Act may be made available to any entity under Title X of the PHS Act unless the applicant for the award certifies to the Secretary of Health and Human Services that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities;” and “Notwithstanding any other provision of law, no provider of services under Title X of the PHS Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.”

4. Additional Program Guidance

We also expect recipients to follow additional program guidance issued by OPA.

Additional program guidance includes, but is not limited to, occasional Program Policy Notices issued by OPA to provide clarity and guidance on policy issues relevant to Title X recipients.

i. Address OPA Program Priorities

In addition to the statute, regulations, legislative mandates, and additional program guidance that apply to Title X, Title X grantees should align their programs with OPA priorities to the extent authorized by law and within the scope of the program, OPA expects recipients to develop and implement plans to address the program priorities and provide evidence of the project’s capacity to address program priorities. OPA’s program priorities for recipients funded under this NOFO are in part informed by the Office of the Assistant Secretary for Health’s Statement of Priorities (available at https://health.gov/priorities), and are as follows:

1. Addressing the chronic disease epidemic through the delivery of Title X services

Chronic disease prevention and management are essential to improving public health and promoting healthy pregnancies and family formation. HHS is leading a science-driven response to the nation’s chronic disease epidemic, with a focus on identifying and addressing root causes that contribute to poor health outcomes, including those affecting fertility and reproductive health. OASH’s health programs and offices play a central role in developing solutions to reduce the burden of chronic disease through efforts that address nutrition, physical activity, sleep, and exposure to harmful chemical and environmental toxins. Integrating these priorities within the Title X program helps strengthen reproductive health outcomes by addressing conditions that affect women, such as hormonal imbalances, polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids, as well as conditions that affect men, including low sperm count, low sperm motility, low testosterone levels, and erectile dysfunction. Title X services may also address lifestyle and behavioral factors—such as sleep quality, nutrition, physical activity, and pornography use—that influence hormonal function and health in males and females.

We expect recipients to demonstrate how their Title X projects will contribute to broader HHS efforts to reduce chronic disease risks across the reproductive lifespan, improve health outcomes, and support individuals seeking to achieve healthy pregnancy. Key strategies for addressing chronic disease through Title X services include, but are not limited to, providing education and counseling on nutrition, sleep, stress, and physical activity; incorporating screening and referral pathways for health conditions linked to chronic disease and infertility in both women and men; collaborating with community health partners to reduce environmental exposures; and integrating health literacy education to help clients better understand and manage their reproductive and overall health. Additional information on HHS priorities and strategies related to addressing chronic disease is available at https://health.gov/priorities, https://www.whitehouse.gov/wp-content/uploads/2025/05/MAHA-Report-The-White- House.pdf, and https://www.whitehouse.gov/wp-content/uploads/2025/09/The-MAHA- Strategy-WH.pdf.

2. Reducing overmedicalization in health care and increasing focus on optimal health through the delivery of Title X services

Promoting better health outcomes requires a balanced approach to care that emphasizes optimal health (defined as physical, mental, and social wellbeing), not just medical intervention. OPA recognizes the overreliance on pharmaceutical and surgical treatments. Over the years, the Center for Disease Control and Prevention’s National Survey of Family Growth reports have shown a decrease in females’ current use of any contraception (approximately 65% of females of reproductive age in both 2015-2017 and 2017-2019 data, then 54% in the most recent 2022-2023 report).1 According to the 2023 National Health Statistics Report, the most common reason women reported discontinuing use related to dissatisfaction was side effects.2 This approach has failed to adequately address the root causes of the nation’s chronic disease burden, resulting in

1 Centers for Disease Control and Prevention. Current Contraceptive Status Among Women Aged 15–49: United States, 2015-2017. December 2018. https://www.cdc.gov/nchs/products/databriefs/db327.htm; Centers for Disease Control and Prevention. Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019.

https://www.cdc.gov/nchs/products/databriefs/db388.htm; Centers for Disease Control and Prevention. Current Contraceptive Status Among Females Ages 15–49: United States, 2022–2023. August 2025.

https://www.cdc.gov/nchs/products/databriefs/db539.htm.

2 Daniels K, Abma JC. Contraceptive methods women have ever used: United States, 2015–2019. National Health Statistics Reports; no 195. Hyattsville, MD: National Center for Health Statistics. 2023. DOI:

https://doi.org/10.15620/cdc:134502.

https://www.whitehouse.gov/wp-content/uploads/2025/05/MAHA-Report-The-White-House.pdf https://www.whitehouse.gov/wp-content/uploads/2025/05/MAHA-Report-The-White-House.pdf https://www.whitehouse.gov/wp-content/uploads/2025/05/MAHA-Report-The-White-House.pdf https://www.whitehouse.gov/wp-content/uploads/2025/09/The-MAHA-Strategy-WH.pdf https://www.whitehouse.gov/wp-content/uploads/2025/09/The-MAHA-Strategy-WH.pdf https://www.whitehouse.gov/wp-content/uploads/2025/09/The-MAHA-Strategy-WH.pdf https://www.cdc.gov/nchs/products/databriefs/db327.htm https://www.cdc.gov/nchs/products/databriefs/db388.htm https://www.cdc.gov/nchs/products/databriefs/db539.htm ongoing health challenges that affect fertility, pregnancy outcomes, and long-term health outcomes. Through the delivery of Title X services, OPA seeks to strengthen approaches that focus on the underlying behavioral and lifestyle factors of health—such as nutrition, sleep, physical activity, stress management, and environmental factors—that impact overall health and are shown to be effective in improving optimal health.

We expect applicants to demonstrate how their Title X projects will integrate noninvasive, evidence-based practices that promote health literacy, fertility awareness, and reproductive health without unnecessary medicalization or symptom suppression.

Key strategies for advancing optimal health through Title X services include, but are not limited to, expanding access to fertility-awareness–based methods (often referred to as natural family planning); providing education and counseling that encourage lifestyle practices supporting reproductive health and healthy pregnancies; fostering collaboration with community-based programs that address wellness and environmental health; and incorporating approaches that empower individuals to understand and manage their own health.

3. Promoting body and health literacy through the delivery of Title X services

Body literacy is foundational to informed decision-making, reproductive health, and lifelong health. OPA recognizes that gaps in biological understanding contribute to delayed diagnosis of health conditions and to the nation’s growing infertility crisis, which now affects approximately one in five married women of reproductive age with no prior births, according to the CDC.3 As part of this priority, Title X family planning clinics will be required to incorporate foundational body and health literacy into reproductive health counseling. This includes education on menstrual cycle physiology, hormonal health, male and female fertility awareness, and early indicators of reproductive disorders such as endometriosis, polycystic ovary syndrome (PCOS), thyroid dysfunction, metabolic disorders, and other conditions that often first emerge in adolescence. Body literacy counseling should equip individuals to recognize when symptoms such as pain, irregular cycles, hormonal disruption, or changes in sexual health warrant further medical evaluation rather than symptom suppression. By integrating body literacy into Title X services, OPA seeks to ensure that women and men understand the health significance of ovulation, endocrine function, and lifestyle factors that influence fertility, reproductive health, and future family formation, as well as pregnancy planning and risk reduction.

4. Advancing reproductive goals counseling through the delivery of Title X services

Reproductive goals counseling supports individuals in making informed, intentional

3 Centers for Disease Control and Prevention. National Survey of Family Growth (2015-2019), May 2024.

https://www.cdc.gov/nchs/nsfg/key_statistics/i-keystat.htm#infertility https://www.cdc.gov/nchs/nsfg/key_statistics/i-keystat.htm#infertility decisions about education, work, relationships, marriage, and childbearing across the lifespan, while advancing optimal health and wellbeing. OPA’s Fertility Knowledge Survey, conducted in 2020, found that over 65% of both women and men want or intend to have (more) children, but only 32% of women and 9% of men have discussed their plans to have children with a medical provider.

(https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf). OPA recognizes that many individuals lack access to resources that integrate family goals into broader life planning, often due to longstanding omissions in educational and counseling environments. As part of this priority, Title X clinics will be expected to offer reproductive goals counseling that presents evidence-informed pathways associated with improved economic stability and family stability, including completion of education, participation in the workforce, and marriage prior to childbearing. Research demonstrates that individuals who follow this sequence experience substantially lower risks of poverty across socioeconomic groups. Program counseling should affirm marriage and parenthood as meaningful and valued components of adult life, particularly in counseling adolescents on longterm reproductive goals, and support informed decision-making by helping individuals understand how life choices, reproductive health, and fertility intersect to shape long-term stability, health, and wellbeing. As part of these efforts to support family planning, Title X clinics are expected to provide services that support individuals and families seeking to have children.

5. Promoting evidence-based care through the delivery of Title X services

Protecting children and adolescents and ensuring that federally supported programs reflect the best available scientific evidence are central to promoting lifelong physical and reproductive health. HHS will prioritize funding for grantees who maintain a science-driven approach to healthcare, including by protecting children, respecting biological reality, and upholding scientific integrity across its programs. Integrating these priorities within the Title X program ensures that program activities reflect evidence-based practices and biological and reproductive health. To the extent permitted by applicable law, including any applicable court orders, we expect recipients to demonstrate how their Title X projects promote physical and reproductive health priorities established by HHS.

Key strategies include, but are not limited to, providing developmentally appropriate counseling rooted in biological science; ensuring referral pathways align with evidence-based care; and collaborating with community partners to promote practices that support healthy adolescent development.

6. Enforcing the Hyde Amendment through the delivery of Title X services

Protecting the integrity of taxpayer funding and advancing programs that respect the dignity of human life are core HHS responsibilities. The Hyde Amendment expressly prohibits the use of federal funds administered by HHS to pay for elective abortion.

OASH’s programs and offices play an essential role in implementing this statutory https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf https://opa.hhs.gov/sites/default/files/2021-01/fertility-knowledge-survey-findings-exec-summary-2020.pdf requirement across the Department’s activities. Integrating Hyde compliance within the Title X program strengthens its capacity to support women, families, and communities while ensuring adherence to federal law. To the extent permitted by applicable law, OASH will prioritize programs and funding that uphold Hyde protections and do not use taxpayer resources to promote or support elective abortion. As referenced above in the “Expectations for Recipients,” Section 1008 of the Public Health Service Act, as amended, stipulates, “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” We expect recipients to demonstrate how their Title X projects maintain strict separation from prohibited activities and contribute to broader HHS efforts to safeguard life-affirming, lawful, and ethical program delivery. Key strategies include, but are not limited to, implementing robust financial and programmatic safeguards; providing clear guidance to staff and subrecipients on Hyde requirements; and establishing monitoring processes that ensure ongoing compliance among staff and subrecipients.

7. Ensuring OASH funds benefit eligible individuals and not illegal aliens through the delivery of Title X services

Federal law requires that taxpayer-funded public benefits be administered in a manner that serves eligible individuals and does not encourage or support illegal immigration. To the extent allowed under Federal law and regulations, including the preliminary injunction issued in New York, et

al. v. DOJ, et al. (DRI), 1:25-cv-00345, OASH is committed to ensuring that Title X funds are used exclusively to benefit individuals who are lawfully eligible to receive federally funded services. Pursuant to Executive Order 14218 (available at https://www.govinfo.gov/content/pkg/DCPD-202500283/pdf/DCPD-202500283.pdf) and in alignment with OASH’s priorities (available at https://health.gov/priorities), OASH will prioritize programs, partnerships, and funding mechanisms that further the agency’s priority to ensure that federal resources are not used to facilitate or incentivize illegal immigration.

8. Implement a Quality Improvement and Quality Assurance (QI/QA) Plan

We expect recipients to implement a quality improvement and quality assurance (QI/QA) plan that involves collecting and using data to monitor the delivery of quality family planning services, inform modifications to the provision of services, inform oversight and decision-making regarding the provision of services, and assess patient satisfaction. We expect recipients to address oversight and service provision at the recipient level, the subrecipient level, and the service site level within their QI/QA plan.

As a part of the QI/QA plan, all recipients must collect and report FPAR 2.0 data to OPA on an annual basis and are expected to use their FPAR data to inform their QI/QA activities.

Additional information about FPAR 2.0, including the data elements and response options, is available on the OPA website at https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report/fpar2.

3. Federal Involvement in the Project

If you receive an award, we will encourage you to seek the advice and opinion of federal staff https://www.govinfo.gov/content/pkg/DCPD-202500283/pdf/DCPD-202500283.pdf https://health.gov/priorities https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report/fpar2 https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report/fpar2 https://opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report/fpar2 when problems arise. However, you would be responsible for making sound programmatic and administrative judgments. The responsibility for operating decisions will be yours and does not shift to HHS, OASH, or OPA.

Under a grant, the program office’s involvement may include routine monitoring and technical assistance such as monthly conference calls, occasional site visits, ongoing review of plans and progress, participation in relevant meetings, provision of training and technical assistance.

4. Eligibility criteria for project participants You must not restrict participation in the project on the basis of race, color, national origin, religion, sex, disability, age, or another protected characteristic (See Section I.5).

D. AWARD INFORMATION

Budget period(s)

We expect to fund awards in 12-month budget periods for a total period of performance up to 60 month(s). However, we may approve shorter periods of performance. Budget periods may vary from the estimated 12 months because of the timing of award issuance or other administrative factors.

For multi-year projects, recipients must submit a non-competing continuation (NCC) application for each budget period after the first. We will provide guidance generally 3 months prior to the end of the active budget period. Continuation funding is contingent upon the availability of funds, satisfactory progress of the project, appropriate stewardship of federal funds, and the best interests of the government. Funding for all approved budget periods after the first is generally the same as the initial award amount and may be subject to any offset with funds unused in a previous budget period.

E. APPLICATION CONTENTS AND FORMAT

1. Format of the Application You must prepare your application using the forms and information described in this NOFO.

The official online application package on Grants.gov contains all necessary forms and guidance for preparing an application. This package includes but is not limited to:

• Full Text of the NOFO

• Standard forms (required) and their instructions o SF-424 Application for Federal Assistance o SF-424A Budget Information for Non-Construction Programs o SF-LLL Disclosure of Lobbying Activities o Project Abstract Summary

• Sample templates, if available.

In addition to the four standard forms in the application package, your application will consist of 3 sections of materials you prepare:

1. Project Narrative

2. Appendices to the Project Narrative

3. Budget Package We strongly encourage you to read all instructions for the application format and content to avoid disqualification of your application. An application checklist is available in Section J.1.

a. Project Narrative - Formatting Following the formatting instructions below will help ensure that your application is readable for review process. Acceptable electronic file formats are in Section E.3.a.

Names of Individuals

We encourage you to use individuals’ full names (first, middle, last) on the standard forms and any other documents such as résumés/curricula vitae/biographical sketches to distinguish them for verification in the SAM exclusion records. Delays may result in award processing if full names are not provided.

You should avoid submitting personally identifiable information such as personal contact information (e.g., home address and telephone number) on résumés/curricula vitae/biographical sketches. Do not submit social security numbers.

If you receive an award, only one Project Director/Principal Investigator (PD/PI) will be named on the award documents. (Section A.1.b) Avoid using a placeholder or honorary PD/PI. If you have not hired an individual to be the PD/PI, you should name an interim PD/PI, and your application should clearly identify that person as such.

We typically expect the PD/PI to be named on the SF-424 in box 8.f. Avoid naming grant writers in box 8.f unless they have the expertise to respond to technical questions about the proposed project in a timely manner.

Identify other personnel who are essential or key to the execution of the proposed project clearly in your project narrative.

If you receive an award, a request for a change in PD/PI or key personnel under any circumstance requires prior approval of the grants management officer before becoming effective. We may disallow any costs incurred as a result of that change prior to our approval.

See Section I.1.c.

Page Formatting

If you submit documents that do not conform to the following instructions, GAM will disqualify your application during the review process (SectionF.1.b).

Use an easily readable typeface, such as Times New Roman or Arial.

Use a 12-point font.

Use an 8.5” X 11” page size. Any other size page (e.g., A4, legal) will disqualify your Application.

You must double-space the Project Narrative pages or we will disqualify your application. You may single-space tables or use alternate fonts, but you must ensure the tables are easy to read.

Do not number pages or include a table of contents. Our grants management system will generate page numbers once your application is complete.

You must submit your application in the English language and in terms of U.S. dollars (2 C.F.R.

§ 200.111(a)).

Page Limits

Your project narrative and appendices must adhere to these page limits.

The page limits do not include the budget package (Section D.2.c)

The page limits do not include the required forms (SF-424, SF-424A, SF-LLL, and the Project Abstract Summary)

If your application exceeds the specified page limits when printed on 8.5” X 11” page, we will not review your application further.

We encourage you to print out your application before submitting it to ensure that it is within the page limits and is easy to read. Do not reduce pages to fit multiple pages on a single sheet to avoid exceeding the page limitation.

Do not hyperlink to documents or sites outside of your application to augment your application.

Reviewers will not be permitted to follow links to external content during their assessment of your application. The one exception to this is a link to your internal controls as part of your budget package (Section D.2.c.3).

Page Limit

Project Narrative 50

Project Narrative plus Appendices

Labeling Proprietary Information

Proprietary information includes patentable ideas, trade secrets, privileged or confidential commercial or financial information, the disclosure of which may harm the applicant. You should include proprietary information in your application only to the extent that it is essential to the reviewers’ understanding of the project. Proprietary information should not appear in your Project Abstract Summary.

If your application contains proprietary information, you should clearly label the top of the first page of the project narrative. For example, https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-B/section-200.111 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-B/section-200.111

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