Notice of Funding Opportunity

Application due Friday, March 27, 2026

Nursing Home Staffing Campaign Opportunity number: CMS-2V2-26-001

Contents

Step 1: Review the Opportunity 4

Basic information 5

Summary 5

Funding details 6

Eligibility 9

Program description 12

Step 2: Get Ready to Apply 25

Get registered 26

Find the application package 27

Step 3: Build Your Application 28

Application checklist 29

Application contents and format 30

Step 4: Understand Review, Selection, and Award 48

Application review 49

Award notices 51

Step 5: Submit Your Application 52

Application submission and deadlines 53

Step 6: Learn What Happens After Award 55

Post-award requirements and administration 56

Contacts and Support 59

Before you begin 3

Appendix A: Estimated number of qualified nursing homes in each state 61

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on Friday, March 27, 2026.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Summary 5

Funding details 6

Eligibility 9

Program description 12

Basic information Centers for Medicaid & Medicare Services (CMS)

Center for Clinical Standards and Quality (CCSQ)

Recruiting nurses to work in nursing homes through financial incentives.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Nursing Home Staffing Campaign

Opportunity number:

CMS-2V2-26-001

Assistance listing:

93.693

NOFO version: Original

Key dates

Application submission deadline:

Friday, March 27, 2026

Optional letter of intent deadline:

February 20, 2026

Informational webinar:

February 25, 2026

Expected award date:

June 15, 2026

Expected earliest start date: July 1, 2026

See application submissions and deadline for other time frames that may apply to this NOFO.

Summary The Centers for Medicare & Medicaid Services (CMS) is committed to improving safety and quality of care in the nation’s nursing homes. Nursing home staffing is a critical factor for improving care for nursing home residents.

However, some nursing homes struggle to hire enough nursing staff to meet each resident’s needs. Additionally, state survey agencies, which are responsible for inspecting nursing homes for compliance with federal regulations, have also had challenges hiring nurses to conduct these inspections. The Nursing Home Staffing Campaign (NHSC) is aimed at increasing the availability of nurses to work in the nursing home environment, such as in qualifying nursing homes or in an oversight capacity for a state inspection agency.

This Notice of Funding Opportunity (NOFO) is focused on helping to recruit registered nurses (RNs) and licensed practical nurses or licensed vocational nurses (LPNs) to work in nursing homes by offering financial incentives.

Through this NOFO, CMS is accepting applications for cooperative agreements to entities that will administer financial incentives, such as loan repayment and stipends to RNs and LPNs, to work for three years in a qualifying nursing home or in an oversight role with a state agency.

Step 1: Review the Opportunity 5

Funding details Funding type: Cooperative agreement, which means that both you and CMS will have roles in the project. Throughout the life of your project, we will be there to help and work with you.

Expected total funding for the program: $80,000,000 subject to availability of funds

Expected total awards: 5 to10

Funding range per applicant for the period of performance: $1,760,000 to $20,000,000 per region per applicant

The awards will cover all costs associated with the program, including financial incentives to nurses and costs for administering the incentives (such as staff and technology).

CMS will evaluate applicants’ coverage of the entire country, but will award one or two applicants to serve each of the six regions. We will not award more than three applicants for any one region. We recommend that applicants review Appendix A (estimated number of qualifying nursing homes per state) to help determine the amount of funds needed for each region. However, these estimates are preliminary and will likely increase. Applicants should base their estimates on the amount of funds available and assume more nursing homes will qualify as eligible. For example, an applicant could estimate how many LPNs, two-year RNs, and four-year RNs they plan to recruit based on the funding available for each type of nurse (see Program requirements and expectations, Financial incentive administration), minus administrative costs. Of the total funding, CMS estimates administrative costs should be approximately 15% or lower.

We will provide funding in 5 budget periods of 12 months each over a 5-year period of performance. The continuity of funding for an award will depend on availability of funds, project evaluation, and any other factors determined as necessary by CMS.

Step 1: Review the Opportunity 6

Regional structure CMS has aligned all states, territories, and Washington, D.C., into six regions of the country for this award. This structure helps interested nurses easily identify the appropriate entity to contact for a financial incentive (see figure 1).

The regions are:

• Region 1: ME, NH, MA, RI, CT, VT, NY, NJ, DE, PA, MD, DC, VA, WV

• Region 2: NC, SC, GA, FL, KY, TN, MS, AL, PR

• Region 3: MN, WI, IL, IN, MI, OH

• Region 4: NM, TX, OK, AR, LA

• Region 5: MO, IA, NE, KS, CO, UT, WY, MT, ND, SD

• Region 6: WA, OR, ID, NV, CA, AZ, HI, AK, GU

Awards are based on these regions in the following way:

• CMS will evaluate applicants’ coverage of the entire country but will award up to three applicants to serve each of the six regions. We will not award more than three applicants for any one region.

• We may award applicants to serve more than one region.

• In regions with three awards, one awardee will be responsible for administering financial incentives to RNs who obtained a four-year degree (bachelor’s degree in nursing), another awardee will be responsible for administering financial incentives to RNs who obtained a two-year degree (associate’s degree in nursing), and the third awardee will be responsible for administering financial incentives to LPNs. In regions with two awards, one awardee will be responsible for administering financial incentives to two types of nurses, and the other awardee will be responsible for administering financial incentives to the remaining type of nurses. For example, CMS may assign one awardee to administer financial incentives to RNs who obtained a two-year degree (associate’s degree in nursing) and LPNs. The other awardee would be responsible for administering financial incentives to RNs who obtained a four-year degree (bachelor’s degree in nursing).

• If we award only one cooperative agreement in a specific region, the awardee will focus on all types of licensed nurses (two-year and four-year RNs, and LPNs).

Step 1: Review the Opportunity 7

For example:

• Region 1 awardees: Applicant A and Applicant B

• Region 2 awardees: Applicant B, Applicant C, and Applicant D

• Region 3 awardees: Applicant A, Applicant B, and Applicant E

• Region 4 awardees: Applicant C and Applicant E

• Region 5 awardees: Applicant B

• Region 6 awardees: Applicant C and Applicant F

Figure 1.

Step 1: Review the Opportunity 8

Eligibility Eligible applicants Only these types of organizations may apply:

Education organizations

• Public and state-controlled institutions of higher education.

• Private (nonprofit) institutions of higher education.

Nonprofit nursing and educational organizations

• National associations for nursing schools.

• National associations for nurses.

• National associations for nursing students.

Nonprofit organizations

• Nonprofits that have a 501(c)(3) status with the IRS, other than institutions of higher education.

• Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education.

• Community and consumer-focused nonprofit groups.

Other organizations

• Small nonprofit businesses.

Faith-based organizations that meet the organizational eligibility requirements above are welcome to apply.

Other eligibility requirements This NOFO is only open to nonprofit nursing and educational organizations, such as national associations for nursing schools, nurses, or nursing students.

Your organization must have demonstrated experience working with large numbers of nursing schools (hundreds) and large numbers of nurses (thousands) across multiple states. Institutions of higher education may also partner with other entities as a subrecipient to support the primary applicant’s ability to cover multiple states. See the merit review criteria for more information.

Step 1: Review the Opportunity 9

Other eligibility limitations The following organizations are ineligible:

• Individual nursing homes, nursing home chains, or nursing home associations.

• State agencies or government-owned entities, except for institutions of higher education.

• CMS Quality Improvement Networks or Quality Improvement Organizations.

CMS will also review and disqualify organizations with a perceived conflict of interest that could imply that the funds or activities would be directed to an area, nursing home, or set of nursing homes in an unfair or subjective manner, or that funds might be used in a manner that is inconsistent with the intent of this program.

Completeness and responsiveness criteria We will review your application to make sure it meets the requirements found in Eligibility, Application contents and format, and Application submission and deadlines.

We won’t consider an application that:

• Is from an organization that doesn’t meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

• Is not submitted through Grants.gov.

• Meets any of the eligibility limitations.

• The Division of Grants Management director or deputy director may choose to continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

Step 1: Review the Opportunity 10

Application limits You may only submit one application under this NOFO.

Cost sharing This program has no cost-sharing requirement, meaning you do not need to contribute to the costs of this project.

If you choose to include cost-sharing funds, we will not consider it during the application review and selection process. If you receive an award, we will include your voluntary commitment in the award, and you must report on the funding.

Step 1: Review the Opportunity 11

Program description Purpose CMS, through its Center for Clinical Standards and Quality (CCSQ), is accepting applications for cooperative agreements to entities to administer financial incentives, such as loan repayment and stipends, to RNs and LPNs to work in a qualifying nursing home or in an oversight role with a state agency for three years.

CMS will enter into cooperative agreements with organizations, which will become Financial Incentive Administrators (FIAs). These FIAs will identify and accept applications from individuals, who would then receive funds contingent on their working in a qualifying nursing home or state survey agency for three years (with an average of 30 or more hours per week).

In addition, FIAs will coordinate closely with individual states, which will provide additional funding directly to the FIA to increase the number of financial incentives available to recruit nurses in their state, and to gain a deeper understanding of each state’s specific staffing needs. FIAs will also work with other stakeholders, such as nursing homes, associations, or private organizations, which may contribute additional funds to the campaign or identify other ways to enhance the program.

Background CMS is committed to increasing staffing in nursing homes. For example:

• In 2015, CMS implemented a new program to collect and report staffing information for nursing homes, the Payroll-Based Journal (PBJ) program.

• In 2018, CMS began using this data to calculate each nursing home’s Five Star Quality Rating, incentivizing nursing homes to increase their staffing.

• In 2022, we began calculating and posting rates of nursing staff turnover, which is also related to the level of staff nursing homes have and the quality of care they provide.

The nursing home staffing campaign (NHSC) will continue these efforts to improve nursing home staffing and quality of care by helping recruit nurses to work in nursing homes or in an oversight capacity with a state survey (inspection) agency.

Step 1: Review the Opportunity 12

Program requirements and expectations Program timeline The timeline for this program includes three distinct phases that CMS will evaluate to determine the continuity of a project throughout the expected period of performance:

• Infrastructure setup: Starts at the beginning of the cooperative agreement and lasts for approximately six months.

• Recruitment period: Begins prior to the completion of infrastructure setup so that nurses can begin working and receive incentive payments as soon as or before infrastructure setup is complete. You will conduct recruitment for approximately 18 to 21 months.

• Work completion period: Starts after recruitment and lasts for three years while financial incentives are being administered. This phase includes all of years 3, 4, and 5 of the period of performance.

Figure 2.

1. National coverage Even though CMS will award cooperative agreements for specific regions (as described in the regional structure section), you must demonstrate your ability to perform outreach and maintain coverage for four-year and/or two-year degree RNs, and LPNs, in all states. Organizations that become Financial Incentive Administrators will administer financial incentives (loan repayment and stipends) to RNs and LPNs for a three-year work commitment during the program period. See Figure 2.

Step 1: Review the Opportunity 13

2. Infrastructure setup You must set up your project infrastructure, such as hiring staff, building websites or portals to receive nurse applicants, implementing the process to distribute funds to nurses, and creating processes to ensure that nurses are completing their three-year commitment.

The infrastructure setup period is estimated to be six months. However, we prefer shorter timelines.

FIAs are expected to begin recruitment activities (see 3. Recruitment activities) before completing their infrastructure setup so that nurses can begin working and receive incentive payments immediately upon completion of infrastructure setup or sooner. For example, in month three, FIAs can begin recruiting nurses to start working in month five or six, when the systems to administer financial incentives should be in place.

Note: CMS may require all FIAs to use the same technology system to create consistency for the program and for nurses throughout the country. CMS may also provide the system, in which case FIA costs of developing, purchasing, or maintaining the system would be removed. (See the budget narrative section for how this might impact FIAs’ funding.)

3. Recruitment activities Next, you must recruit nurses. You will only recruit nurses during the designated recruitment period, which lasts approximately a year and a half.

The designated recruitment period will begin immediately after the infrastructure setup has been completed, although we acknowledge some recruitment activities could start earlier. The recruitment period will end three years prior to the end of the program period. This timeline will allow you to distribute funds for RNs/LPNs’ entire three-year work commitment during the program period. See example in figure 2.

We also note that there may be overlap between the recruitment period and when RNs/LPNs begin receiving financial incentives, as RNs/LPNs will start to receive funds as soon as they begin their work commitment, as outlined in the following section. Toward the end of the recruitment period (prior to the end of Year 2), CMS will evaluate the program results to determine if we should add an additional year for the recruitment period. This extension would result in a total program duration of six years. Any extension of the program and/or funding available to recipients is contingent on availability of funds, performance evaluation, and other factors determined by CMS.

Step 1: Review the Opportunity 14

4. Financial incentive administration You must administer funds to nurses according to these guidelines.

a. Distribute funds to qualified RNs and LPNs Funding can include one or both of these options:

• Payment for student loan debt amounts up to $40,000 (as determined by CMS), depending on an individual’s outstanding loan debt for a two-year or four-year RN degree, or LPN program.

• $10,000 as a stipend for living expenses for working in a qualified location (see information on qualified locations). The stipend will need to be adjusted for the cost of living for a particular area based on the current wage index used in the CMS Skilled Nursing Facility (SNF) Prospective Payment System (PPS).

You must distribute funds to recipients every three months in equal (or relatively equal) amounts so that the final payment to an individual occurs at the end of their three-year commitment.

CMS is allocating the following proportions of all funds to maximize the use of funds (minus any funds allocated to administer this award):

• 30%: LPNs

• 50%: Two-year-degree RNs

• 20%: Four-year-degree RNs

CMS will also allocate amounts for each state and region. For example, if a total of $10,000,000 were allocated to a region, and a state had $3,000,000 allocated to it out of that total, the state would allocate $900,000 to LPN incentives, $1,500,000 for two-year RNs, and $600,000 for four-year RNs. This example is for illustrative purposes only and does not account for administrative costs to manage the award. See the estimated number of qualified nursing homes in each state in Appendix A.

Note: CMS may change the financial incentive structure and allocation amounts during the program.

CMS may also remove the expectation that FIAs distribute payments, and instead have them work with CMS and its partners to have payments distributed to nurses through another method or entity (see Budget Narrative section for how this may impact FIAs’ funding).

Note: If an RN or LPN is recruited during the recruitment period but starts working in a qualifying location less than three years from the end of the period of performance, the RN’s or LPN’s work commitment will be shortened

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 15 https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index#:~:text=The%20FY%202023%20SNF%20PPS,FY%202025%20%2D%20Proposed%20(ZIP) https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index#:~:text=The%20FY%202023%20SNF%20PPS,FY%202025%20%2D%20Proposed%20(ZIP) to the amount of time left in the program period. Their loan repayment and/or stipend will be prorated based on the shortened work commitment.

Note: Unused funds that were intended for RN/LPN incentives will be returned back to the source of those funds. For example, if the recruitment period ends and we do not extend it, and there are remaining funds that were intended for nurse incentives, those funds will be returned to the appropriate source. Also, if CMS or a state opts to target fewer nurses for recruitment than originally sought, the funds commensurate with the reduction in recruitment will also be returned to the appropriate source.

b. Maintain systems for RNs and LPNs to apply This system could be a website used to qualify applicants. The system could, for example:

• Verify licensure/credentials and outstanding student loan debt.

• Maintain any other relevant information.

• Track each RN’s/LPN’s fulfillment of the work commitment to receive the funds, such as working an average of 30 hours per week in the nursing home or state agency where they accepted an assignment as a condition for receiving the financial incentive.

◦ For example, a process confirming the RN/LPN is fulfilling the work commitment could be submission of paystubs with hours per week worked and/or employer verification at regular intervals until the end of the work commitment.

Your process or processes should make sure that RNs/LPNs who fail to provide evidence of fulfilling their work commitments do not continue to receive funds.

Note: CMS may require all FIAs to use the same technology system to create consistency for the program and for nurses throughout the country. CMS may also provide the system (see budget narrative section for how this may impact FIAs’ funding).

5. Stakeholder collaboration

• You are expected to work with individual states and CMS partners, which may opt to provide additional funding directly to you to increase the funds available for loan repayment and stipends. The additional funding from states should be used in a manner consistent with the guidelines of this program as outlined in this NOFO, or as approved by CMS.

Step 1: Review the Opportunity 16

◦ Note: FIAs must report any voluntary contributions from stakeholders to CMS, and these funds can only be used to support the purposes outlined in this NOFO. See also the section on cost sharing. If you receive an award, we will include your voluntary cost-sharing commitment in the award, and you must report on the funding.

• FIAs will also work with other stakeholders, such as nursing homes, associations, or private organizations, which may contribute additional funds to the campaign or identify other ways to enhance the program.

• You are required to coordinate and cooperate with CMS, its contractors, partners, states, and other stakeholders to ensure continuity of program operations and to maximize results. For example, this may include sharing results with CMS strategic partners or collaborating with CMS’s contractors to raise awareness on this program through targeted marketing.

6. Vacancy and placement coordination You will be expected to coordinate placement of RNs/LPNs in jobs by:

• Implementing a process to maintain an updated list of qualifying nursing homes that are seeking to hire RNs/LPNs in their region.

• Working with state agencies to understand their RN/LPN staffing needs.

• Matching recruited nurses to a nursing home or state agency that most aligns with their work preferences and location.

7. Qualifying nursing homes Qualifying nursing homes must meet CMS’s criteria for prioritization within areas of high nurse labor shortages. CMS will publish a list of these nursing homes and update it throughout the period of performance.

You should prioritize the nursing homes in these areas, based on the number of RN/LPN staffing vacancies or staffing levels. To assist you with their proposals, Appendix A includes the estimated number of qualifying nursing homes in high-labor-shortage areas in each state.

Note: These estimates are preliminary and will likely increase. You should base your estimates on the amount of funds available and assume more nursing homes will qualify as eligible. For example, you could estimate how many LPNs, two-year RNs, and four-year RNs you plan to recruit based on the funding available for each type of nurse (see Program requirements and expectations, Financial incentive administration), minus administrative costs.

Step 1: Review the Opportunity 17

Of the total funding, CMS estimates administrative costs should be approximately 15% or lower.

Note: If a qualifying nursing home loses its qualifying status after an RN/LPN has started or has committed to working there under this program, the RN/ LPN may continue to work in the nursing home for the entire three-year commitment and continue to obtain their full financial incentive.

Note: While we are prioritizing the recruitment of RNs/LPNs for nursing homes in high-labor-shortage areas, based on program results including recruitment efforts, CMS may expand the scope of the program, such as expanding the criteria for qualifying nursing homes.

8. RN/LPN employment qualifications

• RNs/LPNs must meet all licensure requirements for the state they will be working in.

• RNs/LPNs must work an average of at least 30 hours per week for each quarter. CMS will consider limited exceptions, such as medical leave or a single extended absence. However, the expectation is that the RN/LPN is a full-time employee of the nursing home or state agency.

• RNs/LPNs must be a direct employee of the nursing home or state agency. RNs/LPNs working as a contractor or through a staffing agency (like a travel nurse agency) are not eligible for this program.

• RNs/LPNs with any student loan debt for education related to licensure are eligible for this program, regardless of when they obtained their degree or license. See also the alternative options we are soliciting feedback on in the project narrative section of this NOFO.

• RNs/LPNs who have obtained their license in the previous 12 months but do not have student loan debt are still eligible for the stipend for the same three-year commitment. However, nurses with no student loan debt will not be eligible for loan repayment funds for any previous education expenses that they paid. See also the alternative options we are soliciting feedback on in the project narrative section.

• RNs/LPNs must start working at a nursing home or state agency after applying for financial incentives to qualify for this program. See also the alternative options we are soliciting feedback on in the project narrative section.

Step 1: Review the Opportunity 18

9. Administrative costs You must manage the distribution of loan repayment for student loan debt and stipends, as described in the financial incentive administration section in the program description.

Note: Of the total funding, CMS estimates administrative costs should be approximately 15% or lower.

Step 1: Review the Opportunity 19

10. Reporting and meetings You are expected to meet the stated timelines listed here.

• Within two weeks of award:

◦ Kickoff meeting with CMS.

• Within one month of award:

◦ Implementation plan submitted to CMS.

• Within every 30 days after submission of implementation plan, for 120 days (four reports):

◦ Implementation status report.

◦ Status update call with CMS.

• Every 30 days after implementation starts:

◦ Monthly status call with CMS.

◦ Written brief, which must include relevant information about your program such as:

▪ Number of nurse applicants.

▪ Number of incentives and the amount of incentives distributed.

▪ Work locations of nurses.

▪ Number of nurses offered a position from a qualifying facility/ agency but declined. Include their reasons.

▪ Number of qualified facilities/agencies that had a nurse position available to offer, but did not extend an offer. Include their reasons, reported vacancy status, and RN hours per resident per day (HPRPD) when the position was available.

▪ A brief narrative of program operations, status of working with states, and other areas identified by CMS.

• 120 days after implementation, and every 90 days thereafter:

◦ Quarterly call with CMS (can be combined with a monthly call).

◦ Report including a cumulative summation of the monthly briefs and the previous quarter’s operations, including an updated budget report.

• Within five days following scheduled and unscheduled meetings/calls with CMS:

◦ Meeting minutes that summarize the discussion, action items, and other relevant information.

Step 1: Review the Opportunity 20

• Within 90 days after the end of the first award year:

◦ Annual report, which is a comprehensive review of the year’s results, operations, and budget.

• Within 120 days after the end of the final award year:

◦ Final report—a comprehensive review of all project results, operations, budget, lessons learned, and best practices.

Cooperative agreement terms Cooperative agreements require substantial CMS project involvement after an award is made. There are specific roles for both you and CMS. We may be in contact at least once a month, and more frequently when appropriate.

Your responsibilities

• Comply with the terms and conditions of the award.

• Collaborate with CMS staff to implement and monitor the project.

• Submit the performance measures requested.

• Submit all required performance assessments, evaluations, and financial reports included in the terms and conditions.

• Attend monthly calls with the CMS project and/or grants management specialist to discuss your project’s progress and challenges. The meetings will include key personnel and the project officer.

• Participate in any virtual meetings.

Our responsibilities

• Monitor the project’s performance and progress.

• Collaborate with you and provide substantial project planning and implementation input.

• Provide substantial input in evaluation activities.

• Make recommendations for continuing the project.

• Review and approve website content before launch and updates.

• Review and approve all key personnel.

• Maintain regular communication with you through at least monthly conference calls along with technical assistance and consultation.

• Review and provide feedback on all required performance assessment reports.

• Review and approve all required submitted data.

Step 1: Review the Opportunity 21

• Provide a structured approach to sharing, integrating, and actively applying improvement concepts, tactics, and lessons learned.

Substantial involvement relates to programmatic involvement, not administrative oversight.

Statutory authority This program is funded under the authority of Title 18 Section 1819(h)(2)(B)(ii)(IV)(ff) and Title 19 Section 1919(h)(2)(B)(ii)(IV)(ff) of the Social Security Act (SSA), which authorizes the Secretary of the Department of Health and Human Services to use a portion of civil money penalties (CMPs) collected to support activities that benefit nursing home residents. This authority is codified in 42 CFR 488.433, which states that these funds must be used entirely for activities that protect or improve the quality of care or quality of life for residents.

Funding policies and limitations Changes in HHS regulations As of October 1, 2025, HHS adopted 2 CFR 200, with some exceptions included in 2 CFR 300. These regulations replace those in 45 CFR 75.

Limitations We do not allow the following costs:

• Pre-award costs.

• Meeting matching requirements for any other federal funds or local entities.

• Services, equipment, or supports that are the legal responsibility of another party under federal, state, or tribal law, such as vocational rehabilitation or education services.

• Services, equipment, or supports that are the legal responsibility of another party under any civil rights law, such as modifying a workplace or providing accommodations that are obligations under law.

• Goods or services not allocable to the project.

• Supplanting existing state, local, tribal, or private funding of infrastructure or services, such as staff salaries.

• Construction.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.ecfr.gov/current/title-2/part-200

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life as a direct cost, except with our prior written approval.

• The cost of independent research and development, including their proportionate share of indirect costs. See 2 CFR 300.477.

• Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.

• Certain telecommunications and video surveillance equipment. See 2 CFR 200.216.

• Other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a state, local, or tribal government in policymaking and administrative processes within the executive branch of that government, funding awarded under this NOFO may not be used for:

◦ Paying the salary or expenses of any grant recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before the Congress or any state government, state legislature, or local legislature or legislative body.

◦ Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

For guidance on some types of costs that we restrict or do not allow, see 2 CFR Part 200 Subpart E—General Provisions for Selected Items of Cost.

General policies

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 23 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72

Indirect costs Indirect costs are those shared across multiple projects and not easily separated. Costs included in the indirect cost pool must not be charged as direct costs.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. If you currently have an indirect cost rate approved by your cognizant federal agency, you may use that rate.

Method 2 — De minimis rate. If you do not have a negotiated indirect cost rate, you may elect to charge a de minimis rate (see 2 CFR 200.414(f)). This rate is 15% of modified total direct costs (MTDC). See the definition of MTDC (2 CFR 200.1). You can use this rate indefinitely.

Salary rate limitation The salary rate limitation in the current appropriations act applies to this program. As of January 2026, the salary rate limitation is $228,000.

Program income If you earn any money from your award-supported project activities (known as program income), you must use it for the purposes and under the conditions of the award. Find more about program income at 2 CFR 200.307.

Post-award requirements

Before you apply, make sure you understand the requirements that come with an award.

See Step 6: Learn What Happens After Award for information on regulations that apply, reporting, and more.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 24 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/section-200.307

Step 2:

Get Ready to Apply

In this step

Get registered 26

Find the application package 27

Get registered SAM.gov You must have an active account with SAM.gov to apply. SAM.gov registration can take several weeks. Begin that process today.

To register:

• Go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for the information you will need to register.

• You must agree to the financial assistance general certifications and representations [PDF] specifically. Those for contracts are different.

When you register, you will also receive your required Unique Entity Identifier

(UEI).

Once you register:

• You will have to maintain your registration throughout the life of any award.

• If your organization has multiple UEIs, use the one associated with your physical location.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 26 https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf http://grants.gov/applicants/applicant-registration https://www.grants.gov/quick-start-guide/applicants

Need Help? See Contacts and Support.

Find the application package The application package has all the forms you need to apply. You can find it at this NOFO’s Grants.gov opportunity page.

We recommend that you select the Subscribe button from the View Grant Opportunity page for this NOFO to get updates.

If you can’t use Grants.gov to download application materials or have other technical difficulties, including issues with application submission, contact Grants.gov for assistance.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 27 https://www.grants.gov/search-results-detail/361025 https://www.grants.gov/support https://www.grants.gov/support

Step 3:

Build Your Application

In this step

Application checklist 29

Application contents and format 30

Application checklist Make sure that you have everything you need to apply:

Narratives Component How to upload Page limit

Project summary Use the Project Abstract Summary form. 1 page

Project narrative Use the Project Narrative Attachment form. 15 pages

Budget narrative Use the Budget Narrative Attachment form. 10 pages

Attachments Insert each in a single Attachments form.

Component Page limit

Indirect cost rate agreement None

Proof of nonprofit status None

Resumes and job descriptions None

Business assessment of applicant organization 12 pages

Other required forms Complete each required form in Grants.gov.

Component Page limit

SF-424: Application for Federal Assistance None

SF-424A: Budget Information for Non-Construction Programs None

Project/Performance Site Location None

Disclosure of Lobbying Activities (SF-LLL) None

Step 3: Build Your Application 29

Application contents and format We will provide instructions on how to build your application, including document formats in the following sections. See completeness and responsiveness criteria to understand what may disqualify your application from consideration.

Your organization’s authorized organizational representative (AOR) must certify and submit your application.

See requirements for intergovernmental review, if any.

Project summary Limit to one page. May be single spaced. Follow other formatting requirements for the project narrative.

Write a one-page summary of your proposed project including its purpose and outcomes. Do not include any proprietary or confidential information. We will use this document for information sharing and public information requests if you get an award. Include:

• The name of your organization.

• The names of any subrecipients or sub-awardee organizations, if applicable.

• Project goals.

• Total budget amount.

• A description of how you will use funds.

Step 3: Build Your Application 30

Project narrative The project narrative is the most important part of your application and should clearly describe your proposed project. You must address the proposed goals, measurable objectives, and milestones in accordance with the instructions in the following sections.

See the scoring criteria under each section to understand how reviewers will assess and score your project narrative.

Required format for project narrative Page limit: 15 Endnotes are not included in the page limit.

File name: Project narrative

File format: PDF

Font size: 12-point font

Font color:

Footnotes and text in graphics may be 10-point.

Spacing for project abstract, tables, and footnotes: Single-spaced

Spacing for main content: Double-spaced

Margins: 1-inch

Page size: 8.5 x 11

Include consecutive page numbers throughout.

Your project narrative should include the following elements.

Step 3: Build Your Application 31

Overall criteria Each element of the NOFO will be scored based on a sliding scale. The first box under each header represents the full set of points you can receive if you successfully meet all the requirements. Subsequent boxes reflect reduced points for instances where you partially meet or fail to meet the requirements.

Criteria Points (Maximum = 100)

Experience and competency: Your organization’s experience (the organization applying and/or the key personnel) operating programs with similar components and objectives, such as your existing relationships with nursing schools (two-year and/or four-year RN degree and LPN schools) or nursing students that will support your ability to recruit RNs/LPNs in all states.

25 points

Operational proposal: How you propose to implement the components of the program.

25 points

Timeline and milestones: The timeline with specific milestones across all components of the program that you will meet to support a successful program.

20 points

Communications plan: How you will meet the expectations for reporting and meetings.

10 points

Budget narrative and administrative costs. 20 points

Experience and competency As part of the experience and competency requirements, you will need to establish your ability to address the national coverage requirement. Here are some examples of how you could document this ability:

• You could provide documentation that shows that hundreds of four-year-and/or two-year-degree nursing schools are members of your association, and include the locations of those schools.

• You could provide a letter of intent signed by many nursing schools and include their locations. This letter would indicate the schools’ willingness to partner with you on this program.

• You could provide documentation demonstrating that thousands of members of your association are nurses who recently obtained (or will soon obtain) their licenses through a four-year- and/or two-year-degree program.

Step 3: Build Your Application 32

For the other experience and competency requirements, please respond to the criteria in the first box of the following chart.

Criteria Points (Maximum = 25)

Evidence of both of the following:

• Operating programs in the past that are similar to the program described in this NOFO.

• Existing relationships with the majority of two-year- and/or four-year-degree RN schools and LPN programs or evidence of existing relationships with recent or soon-to-be RN or LPN graduates (students who will graduate or obtain their license within six months) in four or more of the regions identified in the NOFO. Relationships can be defined as nursing schools or nurses that are members of the association applying, or existing communication channels with nursing schools or nurses where routine communication occurs.

21 to 25 points

Evidence of both of the following:

• Operating programs in the past that are not similar, but comparable to the program described in this NOFO.

• Existing relationships with the majority of two-year- and/or four-year-degree RN schools and LPN programs, or evidence of existing relationships with recent or soon-to-be RN or LPN graduates (students who will graduate or obtain their license within six months) in two or more of the regions identified in the NOFO.

16 to 20 points

Evidence of either, but not both, of the following:

• Operating programs in the past that are similar or comparable to the program described in this NOFO.

• Existing relationships with the majority of two-year- and/or four-year-degree RN schools and LPN programs, or evidence of existing relationships with recent or soon-to-be RN or LPN graduates (students who will graduate or obtain their license within six months) in one or more of the regions identified in the NOFO.

The number of points will be based on the degree of similarity or comparability to the program described in this NOFO or the strength and number of relationships with nursing schools or recent or soon-to-be RN or LPN graduates in the regions identified in this NOFO.

11 to 15 points

Step 3: Build Your Application 33

Criteria Points (Maximum = 25)

Very little or no evidence of either of the following:

• Operating programs in the past that are similar or comparable to the program described in this NOFO.

• Existing relationships with the majority of two-year- and/or four-year-degree RN schools and LPN programs, or evidence of existing relationships with recent or soon-to-be RN or LPN graduates (students who will graduate or obtain their license within six months) in any of the regions identified in the NOFO.

0 to 10 points

Operational proposal In addition to the directions stated in this section, please also review the program requirements and expectations section of the NOFO for additional information on these requirements and what you should provide in your application. Also address the items in the criteria chart at the end of this section.

For infrastructure setup, you must detail your proposed process and the expected timeframe. Address the major milestones, including:

• When you will begin recruiting nurses.

• When you will start disbursing financial incentives.

For recruitment, your description should include:

• Strategies you will use for recruitment, such as relationships and communication channels you will rely on.

• How you have successfully done similar programs or activities in the past.

• Estimates of the number of nurses you will recruit to work in qualifying nursing homes or state survey agencies. Include the methodology used to calculate the estimate.

For financial incentive administration, you should demonstrate experience administering (or the ability to administer) similar types of programs. In your application, you must describe how you will administer funds to nurses according to the guidelines stated in the program requirements and expectations, including:

• Distribute funds for student loan debts up to $40,000 over three years and/or $10,000 as a stipend for living expenses over three years.

• Distribute funds every three months in equal (or relatively equal) amounts so that the final payment to an individual occurs at the end of their three-year work commitment.

Step 3: Build Your Application 34

• Maintain a process to qualify applicants (verify licensure and outstanding loan debt).

• Maintain a process to track each RNs/LPN’s fulfillment of their work commitment, such as confirming the individual is fulfilling the work commitment through submission of paystubs and/or employer verification.

• Ensure payment ceases to RNs/LPNs who do not provide evidence of fulfilling their work commitments.

For stakeholder collaboration, describe how you will coordinate and cooperate with required stakeholders (CMS, its contractors, partners, states, and other stakeholders) to ensure continuity of program operations and to maximize results. You should also detail plans to work with individual states who will provide additional funding to increase the amount of loan repayment and stipends available to recruit nurses. Additionally, you should summarize how you’ll work with other stakeholders, such as nursing homes, associations, or private organizations, that may contribute additional funds to the campaign or identify other ways to enhance the program.

For vacancy and placement coordination, explain how you will:

• Maintain an updated list of nursing homes with vacancies.

• Work with state agencies to understand their RN/LPN staffing needs.

• Match recruited nurses to the nursing home or state agency that best aligns with their work preferences and location.

For RN/LPN employment qualifications, explain how you will:

• Identify RN/LPNs who meet licensure requirements.

• Identify and hire RNs/LPNs who will work a minimum of 30 hours, on average, per week each quarter.

• Identify and hire direct employees of nursing homes or state agencies.

Step 3: Build Your Application 35

Alternative options (optional) Please also provide any additional suggestions, recommendations, and rationales for the following alternative options. CMS will make a final decision about these items before the start of the recruitment period, and all recipients will operate under these decisions.

• Provide any additional suggestions to CMS on methods for identifying qualifying nursing homes in high-labor-shortage areas.

• Currently, RNs/LPNs with any student loan debt for education related to licensure are eligible for this program, regardless of when they obtained their degree or license. Please provide recommendations and rationales for any alternatives, such as whether there should be a time limit for when a nurse obtained their degree or license to qualify for this program (for example, within the last 12 months).

• Currently, RNs/LPNs who have obtained their license in the previous 12 months but do not have student loan debt are still eligible for the stipend for the same three-year commitment. We are soliciting alternative options from applicants for this component. Please provide any recommendations for alternative options.

• We are soliciting feedback on the eligibility of nurses who started working…