Funding Opportunity Number PA-FPH-19-001-01 Amend.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

AGENCY: Office of the Assistant Secretary for Health, Office of Population Affairs

FUNDING OPPORTUNITY TITLE: Announcement of Availability of Funds for Title X

Family Planning Services Grants

ACTION: Notice

ANNOUNCEMENT TYPE: INITIAL COMPETITIVE GRANT

FUNDING OPPORTUNITY NUMBER: PA-FPH-19-001-01 AMENDED

CFDA NUMBER: 93.217

CFDA PROGRAM: Family Planning Services

DATES:

Technical Assistance: A technical assistance webinar for potential applicants will be held within

30 days of the posting date of this FOA. Please visit www.hhs.gov/opa for more information.

We recommend you review the entire announcement promptly so you can have any questions answered well in advance of the application due date. We also recommend you subscribe to this announcement in Grants.gov so you receive any amendments, question and answer documents, or other updates.

Applications: Your application is due January 16, 2019 by 6 p.m. Eastern Time. To receive consideration, you must submit your application electronically via Grants.gov no later than this due date and time. If you do not submit your application by the specified deadline, we will return it to you unread. You must submit electronically via Grants.gov unless you obtain a written exemption from this requirement 2 business days in advance of the deadline from the http://www.hhs.gov/opa

Director, HHS/Office of the Assistant Secretary for Health (OASH) Office of Grants

Management (OGM). To obtain an exemption, you must request one via email from the

HHS/OASH OGM, and provide details as to why you are technologically unable to submit electronically through Grants.gov. Your request should be submitted at least 4 business days prior to the application deadline to ensure your request can be considered prior to 2 business days in advance of the deadline. If you request an exemption, include the following in your e-mail request: the HHS/OASH announcement number; your organization's DUNS number; your organization’s name, address and telephone number; the name and telephone number of your

Authorizing Official; the Grants.gov Tracking Number (for example, GRANT####) assigned to your submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to ogm.oash@hhs.gov. Note: failure to have an active

System for Account Management (SAM) registration prior to the application due date will not be grounds for receiving an exemption to the electronic submission requirement. Failure to follow

Grants.gov instructions to ensure software compatibility will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH OGM will only accept applications via alternate methods

(hardcopy paper via U.S. mail or other provider or PDF via email) from applicants obtaining prior written approval. If you receive an exemption, you must still submit your application by the deadline. Only applications submitted through the Grants.gov portal or alternate format (hardcopy paper via U.S. mail or other service or PDF via email) with an approved written exemption will be accepted. See Section D.7 (“Other Submission

Requirements”) for information on application submission mechanisms.

mailto:ogm.oash@hhs.gov

Executive Order 12372 comment due date: The State Single Point of Contact (SPOC) has 60 days from the application due date to submit any comments. For more information on the

SPOC see section D.4 Intergovernmental Review.

To ensure adequate time to submit your application successfully, HHS/OASH recommends that you register as early as possible in Grants.gov since the registration process can take up to one month. You must register an authorizing official for your organization.

HHS/OASH does not determine your organization’s authorizing official; your organization makes that designation. For information on registering for Grants.gov, refer to http://www.grants.gov or contact the Grants.gov Contact Center 24 hours a day, 7 days a week

(excluding Federal holidays) at 1-800-518-4726 or support@grants.gov.

Your organization is strongly encouraged to register multiple authorized organization representatives in Grants.gov to ensure someone is available to submit your application.

EXECUTIVE SUMMARY: The Office of Population Affairs announces the availability of funds for Fiscal Year (FY) 2019 grant awards under the authority of Title X of the Public Health

Service Act. This notice solicits applications from entities to provide Title X family planning services throughout the 50 United States, District of Columbia, Commonwealth of Puerto Rico, U.S. Virgin Islands, and Commonwealth of the Northern Mariana Islands, American Samoa, Guam, Republic of Palau, Federated States of Micronesia, and the Republic of the Marshall

Islands (hereafter, States). The Office of Population Affairs intends to make available approximately $260 million for competing grants throughout the States. While there is not a fixed cost-sharing percentage or amount, entities must show financial support from sources other than Title X, such as private funding, state funding, and income from private and public http://www.grants.gov/ mailto:support@grants.gov insurance for reimbursable services. The proposed budget should reflect 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. Grant funds under this announcement will be awarded to public and/or nonprofit private entities 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 fertility awareness-based methods (previously referred to as natural family planning), infertility services, and services for adolescents. HHS seeks a broad competition for Title X grant awards and is interested in innovative strategies to provide a diversity of options for clients with the intention of improving overall service provision, increasing the number of clients served, and expanding the breadth of services available in the states, territories and throughout the regions.

All activities funded under this announcement must be in compliance with requirements of the Title X statute, any legislative mandates, and any program regulations, as of the time the requirement is applicable and in effect. Copies of the Title X statute, regulations, and legislative mandates may be downloaded from the Office of Population Affairs web site at https://www.hhs.gov/opa/title-x-family-planning/about-title-x-grants/statutes-and-regulations/index.html.

HHS/OASH 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 its application complies with all requirements and instructions.

A. PROGRAM DESCRIPTION:

This announcement seeks applications from public and private nonprofit entities to establish and operate voluntary family planning services projects, which shall provide family planning services to all persons desiring such services, with priority for services to persons from low-income families. Section 1001 (b) assures the right of local and regional entities to apply directly to the Secretary for Title X grant funds. In a single application, applicants may propose to serve any combination of service areas or subset of a single service area listed. Applicants should use Table 1 – Estimated Funds Available as a guide when developing proposals.

Applicants proposing to serve an entire state (or territory), should base their Federal request

(Title X funding request) on the estimated amount for the state listed in Table 1. These estimates are calculated using the number of women in each state (or territory) in need of publically funded contraceptive services (those with family incomes of 0 - 250% of the federal poverty level) as a ratio of the number of women in the 50 states and the District of Columbia in need of publically funded contraceptive services. This ratio is then used to distribute the money available to each state through approved appropriation funding. The estimated funding available in Table 1 has been updated to reflect current reported data of women in need of publically funded contraceptive services.

Applicants proposing to serve a subsection of a state should first determine the total number of women in need of publically funded contraceptive services1 proposed to be served as part of the project and divide that number by the total number of females in need of publically funded contraceptive services for the state. That ratio should be multiplied by the total funding proposed for the state to provide guidance for the applicant’s request for federal funding. For proposals that cover a geographic area in multiple states, complete this process for each

This site (https://data.guttmacher.org/states) may provide guidance to identify the number of women in need of publicly funded contraceptive services for each state. Information is available by county within each state.

https://data.guttmacher.org/states subsection of each state to provide guidance for request for federal funding.

HHS intends to fund services in all areas listed within Table I. Award decisions (entities and amounts) will be based on the quality of applications received (as stated in the Application

Review Information section starting on pg. 47), eligibility of applicants (as stated in the

Eligibility Information section starting on pg. 17) and extent of geographic area proposed to be served. Local and regional entities are assured the right to apply. Award amounts made to a successful applicant or applicants that provide Title X services within the same area or areas may be greater or less than the estimated funds presented in Table 1.

Table 1

PROPOSED AREA TO BE SERVED

ESTIMATED FUNDS

AVAILABLE

Alabama $ 5,300,000

Alaska $ 1,600,000

Arizona $ 5,400,000

Arkansas $ 3,900,000

California $ 22,000,000

Colorado $ 3,900,000

Connecticut $ 2,500,000

Delaware $ 1,100,000

The District of Columbia $ 1,300,000

Florida $ 11,800,000

Georgia $ 8,300,000

Hawaii $ 2,000,000

Idaho $ 1,800,000

Illinois $ 8,500,000

Indiana $ 5,000,000

Iowa $ 3,800,000

Kansas $ 2,500,000

Kentucky $ 5,200,000

Louisiana $ 4,600,000

Maine $ 1,800,000

Maryland $ 4,000,000

Massachusetts $ 5,800,000

Michigan $ 7,600,000

Minnesota $ 3,300,000

Mississippi $ 4,300,000

Missouri $ 5,000,000

Montana $ 1,900,000

Nebraska $ 2,000,000

Nevada $ 3,200,000

New Hampshire $ 1,400,000

New Jersey $ 8,300,000

New Mexico $ 3,100,000

New York $ 14,600,000

North Carolina $ 7,700,000

North Dakota $ 1,000,000

Ohio $ 8,800,000

Oklahoma $ 4,300,000

Oregon $ 3,200,000

Pennsylvania $ 12,700,000

Rhode Island $ 1,100,000

South Carolina $ 5,500,000

South Dakota $ 1,000,000

Tennessee $ 6,600,000

Texas $ 16,000,000

Utah $ 2,100,000

Vermont $ 800,000

Virginia $ 4,600,000

Washington $ 4,200,000

West Virginia $ 2,400,000

Wisconsin $ 3,800,000

Wyoming $ 900,000

Puerto Rico $ 3,400,000

U.S. Virgin Islands $ 900,000

America Samoa $ 300,000

Commonwealth of the Northern Mariana Islands $ 200,000

Federated States of Micronesia $ 400,000

Guam $ 300,000

Republic of the Marshall Islands $ 200,000

Republic of Palau $ 200,000

An applicant may propose a family planning service project that either is comprised of a single provider or a group of partnering providers who deliver coordinated and comprehensive family planning services. For applicants that will not provide all services directly, the applicant must document the process and criteria it will use for selecting subrecipients as well as a plan to monitor their performance. The applicant will take into consideration the extent to which the subrecipient(s) indicates it can provide the required services and best serve individuals in need throughout the proposed service area (or part thereof). If an applicant plans to only provide a limited range of family planning methods, they must select subrecipients who offer additional family planning methods or act as a subrecipient for another applicant. In order to fulfill the requirements in the Title X statute, the project, made up of the applicant, and any subrecipients, must provide a broad range of family planning methods to clients throughout the proposed service area. A broad range of family planning services should include several categories of methods, such as: abstinence counseling, hormonal methods (oral contraceptives, rings and patches, injection, hormonal implants, intrauterine devices or systems), barrier methods

(diaphragms, condoms), fertility awareness-based methods and permanent sterilization. A

“broad range” would not necessarily need to include all categories, but should include hormonal methods since these are requested most frequently by clients and among the methods shown to be most effective in preventing pregnancy. The application shall ensure that if family planning services are provided by contract or other similar arrangements with actual providers of services, those services will be provided in accordance with a plan which establishes rates and method of payment for medical care. These payments must be made under agreements with a schedule of rates and payment procedures maintained by the applicant. The applicant must be prepared to substantiate that these rates are reasonable and necessary (42 CFR § 59.5(b)(9)).

Family planning services are those services offered to women and men that assist them in preventing or achieving pregnancy. These should be client-centered such that care is respectful of, and responsive to, individual client preferences, needs, and values. Successful Title X projects will provide the following core family planning services:

1. Discussion with the client about their reproductive life plan.

(https://www.cdc.gov/preconception/planning.html).

2. A broad range of acceptable and effective family planning methods and services for delaying or preventing pregnancy, which should include:

Counseling, especially for adolescents, that avoiding sex is the only 100% effective method to prevent pregnancy and STDs; therefore, delaying the onset of sexual activity, or if already sexually active, choosing to avoid sexual activity for a defined period of time, is an option; and

Instruction in fertility awareness-based methods (previously referred to as natural family planning) that includes staff who are specifically trained in providing instruction in these methods; and

Availability of several categories of contraceptive methods, such as:

hormonal methods (oral contraceptives, rings and patches, injection, implants, intrauterine devices or systems), barrier methods (diaphragms, condoms), and/or permanent sterilization.

3. The broad range of family planning services does not include abortion as a method of family planning.

4. Pregnancy testing and counseling

5. Services centered around pre-conception health and achieving pregnancy, which should include:

Basic infertility services;

https://www.cdc.gov/preconception/planning.html

STD prevention education, screening, and treatment;

HIV testing and referral for treatment when appropriate; and

Screening for substance use disorders and referral when appropriate to help reduce adverse pregnancy-related outcomes and improve individuals’ reproductive health generally.

Title X projects may also include other reproductive health and related preventive health services that are considered beneficial to reproductive health such as HPV vaccination, provision of HIV pre-exposure prophylaxis (PrEP), breast and cervical cancer screening, and screening for obesity, smoking, drug and alcohol use, mental health, and intimate partner violence.

Program Priorities

Title X Priorities include all of the legal requirements covered within the Title X statute, regulations, and legislative mandates. All applicants must comply with the requirements regarding the provision of family planning services that can be found in the statute (Title X of the

Public Health Service Act, 42 U.S.C. § 300 et seq.) and the implementing regulations (42 CFR part 59, subpart A), as applicable. In addition, sterilization of clients as part of the Title X program must be consistent with 42 CFR part 50, subpart B (“Sterilization of Persons in

Federally Assisted Family Planning Projects”).

Title X Statute and Regulations: Title X of the Public Health Service Act (the Act) authorizes the Secretary of Health and Human Services (HHS) to award grants to entities to provide family planning services to those desiring such services, with priority given to persons from low-income families. Therefore, in order to ensure that all prospective low income clients are able to access services, no charge will be made for services to persons from a low-income family (families whose annual incomes do not exceed 100 percent of the most recent federal poverty guidelines), except to the extent that payment will be made by a third party, including a government agency, which is authorized or under legal obligation to pay this charge. For persons whose annual family incomes do not exceed 250 percent of the federal poverty guidelines, charges must be based on a schedule of discounts, and individuals whose family incomes exceed 250 percent of the federal poverty guidelines are charged a schedule of fees designed to recover the reasonable cost of providing services. All Title X projects must have the ability to bill third parties (through public or private insurance) for the cost of services without the application of discounts, and reasonable efforts must be made to collect charges without jeopardizing client confidentiality.

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).” Natural family planning methods are now referred to as fertility awareness-based methods.

Family planning includes a broad range of services related to achieving and preventing pregnancy, assisting women, men, and couples with achieving their desired number and spacing of children. A broad range of acceptable and effective methods of family planning services including, contraception must be provided within each funded applicant’s project, and the project must also include meaningful provision of fertility awareness-based methods (FABM) by including access to providers with training specific to these methods. Entities that provide only one method of family planning can participate as part of a project, as long as the entire project provides a broad range of family planning methods. A broad range of family planning services should include several categories of methods, such as: abstinence counseling, hormonal methods

(oral contraceptives, rings and patches, injection, hormonal implants, intrauterine devices or systems), barrier methods (diaphragms, condoms), fertility awareness-based methods and/or permanent sterilization. A “broad range” would not necessarily need to include all categories, but should include hormonal methods since these are requested most frequently by clients and among the methods shown to be most effective in preventing pregnancy.

Services for adolescents must be provided as a part of the broad range of family planning services. Section 1001 of the statute requires that, to the extent practicable, Title X applicants shall encourage family participation in family planning services projects. This is particularly important in relation to adolescents seeking family planning services. Basic infertility services and services to aid individuals and couples in achieving pregnancy also must be provided within the project as part of the broad range of family planning services. Pregnancy information and counseling must be provided in accordance with Title X regulations.

Services must be provided in a manner that protects the dignity of individuals, and services must be voluntary and free from coercion. Projects must not discriminate in the provision of services, on the basis of religion, race, color, national origin, disability, age, sex, number of pregnancies, or marital status.

Family planning medical services must be performed under the direction of a physician with special training or experience in family planning, and each family planning project must refer to other medical facilities when medically indicated, including in medical emergencies.

Projects must also provide informational and educational programs that inform the community about the availability of services, and should promote participation in the development, implementation, and evaluation of the project by persons broadly representative of the community to be served. Informational and educational materials made available through the project must be approved by an Advisory Committee that conforms to Title X regulations. The review of materials must take into account the educational and cultural background of individuals for whom the materials are intended, must consider the standards of the population or community, must ensure that the content is factually correct and is suitable for the intended population or community. The review and approval of such materials must be documented.

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

Legislative Mandates: The following legislative mandates have been part of the Title X appropriations language for a number of years. In addition, FY2019 appropriation language states that funds would be available “Provided, that amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office.” Title X family planning services 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.”

OPA expects every Title X project will comply with applicable state laws in the proposed service area and will have project-wide monitoring and state-specific policies and procedures related to reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, and human trafficking. These policies and procedures will include details related to: 1) annual staff training on policies and procedures, 2) implementation of policies, 3) applicant monitoring throughout the project to ensure training and state-specific reporting is being followed, and (4) maintenance of documentation concerning compliance. These efforts will ensure clear understanding of and compliance with reporting processes, as well as permitting oversight and monitoring. In addition, any minor who presents with an STD, pregnancy, or any suspicion of abuse will be subject to preliminary screening to rule out victimization. Such screening is required for any individual who is under the age of consent in the State of the proposed service area.

Key Issues

While the requirements derived from statute, regulations, and legislative mandates described above are program priorities, there are additional key issues that represent overarching goals for the Title X program. These are determined based on priorities set by the Office of the Assistant

Secretary of Health (OASH) and the Office of the Secretary (OS) of the Department of Health and Human Services (HHS). Applicants should provide documentation of how they will address these key issues in their application. The FY 2019 key issues are as follows:

1. Assuring innovative quality family planning and related preventive health services that lead to improved reproductive health outcomes and overall optimal health, which is defined as a state of complete physical, mental and social well-being and not merely the absence of disease. Guidance regarding the delivery of quality family planning services is spelled out in the April 25, 2014, MMWR, “Providing Quality Family Planning

Services: Recommendations of CDC and the U.S. Office of Population Affairs”

(https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf). Periodic updates have been made to this publication and are available on the OPA website

(https://www.hhs.gov/opa/guidelines/clinical-guidelines/index.html). It is expected that the core family planning services listed in the Program Description, and which also are included in the Quality Family Planning Services document referenced above, will be provided by each project;

2. Providing the tools necessary for the inclusion of substance abuse disorder screening into family planning services offered by Title X applicants;

3. Following a model that promotes optimal health outcomes for the client (physical, mental and social health) by emphasizing comprehensive primary health care services, along with family planning services preferably in the same location or through nearby referral providers;

4. Providing resources that prioritize optimal health outcomes (physical, mental, and social health) for individuals and couples with the goal of healthy relationships and stable marriages as they make decisions about preventing or achieving pregnancy;

5. Providing counseling for adolescents that encourages sexual risk avoidance by delaying the onset of sexual activity as the healthiest choice, and developing tools to communicate the public health benefit and protective factors for the sexual health of adolescents found by delaying the onset of sexual activity thereby reducing the overall number of lifetime https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf https://www.hhs.gov/opa/guidelines/clinical-guidelines/index.html sexual partners;

6. Communicating the growing body of information for a variety of fertility awareness-based methods of family planning and providing tools for applicants to use in patient education about these methods;

7. Fostering interaction with community and faith-based organizations to develop a network for client referrals when needs outside the scope of family planning are identified;

8. Accurately collecting and reporting data, such as the Family Planning Annual Report

(FPAR), for use in monitoring performance and improving family planning services;

9. Promoting the use of a standardized instrument, such as the OPA Program Review Tool, to regularly perform quality assurance and quality improvement activities with clearly defined administrative, clinical, and financial accountability for applicants and subrecipients; and

10. Increasing attention to CDC screening recommendations for chlamydia and other STDs

(as well as HIV testing) that have potential long-term impact on fertility and pregnancy.

AUTHORITY: Section 1001 of the Public Health Service Act

B. FEDERAL AWARD INFORMATION

The Office of Population Affairs intends to make funds available for competing grants. We will fund awards in annual increments (budget periods) and generally for a project period of up to three (3) years, although we may approve longer or shorter project periods. Budget periods may also vary from the estimate indicated below due to timing of award issuance or other administrative factors. Funding for all approved budget periods beyond the first is generally level with the initial award amount, and is contingent upon the availability of funds, satisfactory progress of the project, adequate stewardship of Federal funds, and the best interests of the

Government.

Award Information

Estimated Federal Funds Available: $260,000,000

Anticipated Number of Awards: 60 - 100

Award Ceiling (Federal Funds including indirect costs): $22,000,000 per budget period

Award Floor (Federal Funds including indirect costs): $100,000 (See Table 1)

Anticipated Start Date: 04/01/2019

Estimated Project Period: 3 years, although we may approve longer or shorter project periods

Anticipated Initial Budget Period Length: 12 months

Type of Award: Grant

Type of Application Accepted: Electronic via Grants.gov ONLY, unless an exemption is granted

C. ELIGIBILITY INFORMATION

1. Eligible Applicants. Any public or private nonprofit entity located in a State (which includes one of the 50 United States, District of Columbia, Commonwealth of Puerto Rico, 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) 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 also eligible to apply for

Title X family planning services grants.

2. Cost Sharing or Matching: Program regulations stipulate that projects must identify additional sources of funding and not rely solely upon Title X grant funds. While there is not a fixed cost-sharing percentage or amount, projects must include financial support from sources other than Title X, such as private funding, state funding, and income from private and public insurance for reimbursable services. The proposed project’s budgets should reflect financial support in addition to Title X funds on both the Standard Form (SF) 424A, Budget Information, and in the budget 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. Note: OASH allows program income generated by fees collected to be used for cost sharing. The OASH Office of Grants Management 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 or level of financial match requirement for this program.

3. Other Eligibility Information:

Application Responsiveness Criteria

We will review your application to determine whether it meets the following responsiveness criteria. 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 applicant appears to have demonstrated:

Evidence that a broad range of acceptable and effective family planning methods and services will be provided by the proposed application as stipulated in the Title X statute and regulations and described earlier in Program Description;

Evidence that, for applicants that will not provide all services directly, the applicant has documented the process and criteria it will use for selecting subrecipients and has included a plan for monitoring their performance; and

Evidence of cost-sharing as described in this announcement (pgs. 3 and 17).

Application Disqualification Criteria

If you successfully submit an application, we will screen it to ensure it meets the below requirements. If we determine your application fails to meet the criteria described below we will disqualify it, that is, we will not review it, and it will receive no further consideration.

a) You must submit your application electronically via www.grants.gov (unless an exemption was granted 2 business days prior to the deadline) by the date and time indicated in the

DATES section of this announcement.

b) If you successfully submit multiple applications from the same organization for the same project, we will only review the last application received by the deadline.

c) HHS/OASH/OGM deems your application eligible according to section C.1 Eligible

Applicants.

d) You must complete the required forms in the application package: SF-424, SF-424A, SF-

424B, SF-LLL, and Project Abstract Summary.

e) Your Project Narrative section of the application must be double-spaced, on the equivalent of

8 ½ ” x 11” inch page size, with 1” margins on all sides (top, bottom, left and right) and font size not less than 12 points.

f) Your Project Narrative must not exceed 65 pages. NOTE: The following items do not count toward the Project Narrative page limit: all required forms, including SF-424, SF-424A, SF-

424B, SF-LLL, Project Abstract Summary, and Budget Narrative (including budget tables).

g) Your total application, including the Project Narrative plus Appendices, must not exceed

150 pages. NOTE: items listed in “f” immediately above do not count toward total page limit.

h) Your Federal funds request including indirect costs must not exceed the maximum indicated in Award Ceiling.

i) Your Federal funds request including indirect costs must not be below the minimum indicated in Award Floor.

j) Your application must meet the Application Responsiveness Criteria outlined above.

D. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

You may obtain an application package electronically by accessing Grants.gov at http://www.grants.gov/. You can find it by searching on the CFDA number shown on page 1 of this funding opportunity announcement. If you have problems accessing the application or difficulty downloading, contact:

Office of Grants Management

Phone: 240-453-8822

Email: ogm.oash@hhs.gov mailto:ogm.oash@hhs.gov

2. Content and Form of Application Submission

i. Application Format

Your application must be prepared using the forms and information provided in the online application package.

The Project Narrative, and total application including appendices, must adhere to the page limit indicated in Application Disqualification Criteria listed in Section C.

The page limit does not include the Budget Narrative (including budget tables), required forms, assurances, and certifications as described in the Application Disqualification

Criteria. Please do not number pages or include a table of contents. Our grants management system will generate page numbers once your application is complete. If your application exceeds the specified page limits for the Project Narrative or

Project Narrative plus Appendices when printed on 8.5” X 11” paper by

HHS/OASH/OGM, we will not review it. We recommend you print out your application before submitting electronically to ensure that it is within the page limits and is easy to read.

You must double-space the Project Narrative pages.

You should use an easily readable typeface, such as Times New Roman or Arial. You must use 12-point font. You may single-space tables or use alternate fonts but you must ensure the tables are easy to read.

Appendices Format

Your Appendices should include any specific documents outlined in Section D.2.iii., under the heading “Appendices” in the Application Content section of this funding opportunity announcement. Your documents should be easy to read. You should use the same formatting specified for the Project Narrative. However, documents such as résumés/CVs, organizational charts, tables, or letters of commitment may use formatting common to those documents, but the pages must be easy to read. All of your appendices must be uploaded as a single, consolidated file in the Attachments section of your

Grants.gov application.

Project Abstract Summary Format

You must complete the Project Abstract Summary form provided in the application package. The abstract will be used to provide reviewers with an overview of the application and will form the basis for the application summary in grants management and program summary documents. If your project is funded, HHS may publish information from your form; therefore, do not include sensitive or proprietary information.

Budget Narrative Format

The Budget Narrative should use the formatting required of the Project Narrative for the explanatory text. Budget tables may be single-spaced but should be laid out in an easily-readable format and within the printable margins of the page.

ii. Application Content

Successful applications will contain the following information:

Project Narrative Content

The Project Narrative is the most important part of the application, since it will be used as the primary basis to determine whether your project meets the minimum requirements for an award under this announcement. The Project Narrative should provide a clear and concise description of your project. HHS/OASH recommends that your project narrative include the following components:

1. The administrative, management, and clinical capability of the applicant organization including all services that will be provided with Title X grant funds;

2. The need for the proposed Title X services and a detailed description of the geographic area to be served including a demographic description of the specific population(s) in need of service;

3. Evidence that the proposed project will address the family planning needs of all those in need of service throughout the proposed area to be covered;

4. The applicant’s experience in providing clinical health services and qualifications to provide core family planning services, previously defined in the Program Description, for women, men, and adolescents that conform with current professional and medical standards of care;

5. Evidence of a system for ensuring quality family planning services, including:

a process for ensuring that all of the core family planning services, previously defined in the Program Description, will be provided within each project;

defined performance measures (see Performance Measures, page 61), including an agreement from applicant and subrecipients to collect required data and report those measures annually in the Family Planning Annual

Report, a process for systematically assessing the quality of services provided throughout the defined project;

a methodology for ensuring that health care practitioners have the knowledge and skills necessary to provide effective, quality family planning and related preventive health services that are consistent with current, national standards of care.

6. Goals and related outcomes that reflect the primary purposes and achievements of the proposed project. Goal statement(s) and related outcome objectives must be specific, measurable, achievable, realistic and time-framed (S.-M.-A-.R.-T);

7. A staffing plan which is reasonable and adheres to the Title X regulatory requirement that family planning medical services be performed under the direction of a physician with special training or experience in family planning;

8. Evidence that staff providing clinical services (e.g., physicians, state-recognized advanced practice nurses, physician assistants) will be licensed and function within the applicable professional practice acts for the state where they practice;

9. Evidence, including signed referral agreements with relevant referral agencies, that the applicant has a plan to facilitate access to the following:

comprehensive primary care services, if not provided by the project, and other needed health and social services for clients served in the Title X-funded family planning projects, such as HIV care and treatment services;

10. The plan for ensuring that all family planning services offered by the applicant and any subrecipients are provided in:

compliance with the Title X statute and program regulations, including the requirement that Title X funds will not be used for abortion as a method of family planning, as well as with regulations regarding sterilization of persons in federally-assisted family planning projects;

compliance with state laws applicable in the proposed service area(s) specific to requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, and human trafficking;

and compliance with the legislative mandate to encourage family participation in the decision of minors to seek family planning services, and incorporate resistance skills for minors to resist/avoid exploitation and/or sexual coercion;

11. A plan for how the applicant and subrecipients propose to incorporate the Key Issues identified in the Program Description;

12. The processes in place to ensure that persons from low-income families, with incomes that fall at or below 100% of the current Federal Poverty Level, (FPL), will not be charged except where third parties are authorized or legally obligated to pay;

and that all reasonable efforts will be made to obtain third party payment without the application of any discounts;

13. Evidence that the applicant has the ability to bill third parties, including private and public insurance such as Medicaid, when appropriate, and the ability to facilitate enrollment of clients into Medicaid;

14. A description of how the schedule of discounts was developed; or for applicants with multiple subrecipients, a policy that is applicable to subrecipients which meets the criteria set out in the Title X regulations at 42 CFR § 59.5(a)(7)-(9);

15. A plan for providing community informational and educational programs which promote understanding about the availability of services. The plan should include a strategy for maintaining records of community education activities;

16. A plan for an information and education advisory committee that is consistent with the Title X statute and regulations and that ensures that all informational and educational materials are current, factual, and medically accurate, as well as suitable for the population or community to which they will be made available; and

17. Evidence of the capability to collect and report the required program data for the Title

X annual data collection system, the Family Planning Annual Report (FPAR).

Budget Narrative Content

You must complete the required budget forms and submit a budget narrative with detailed justification as part of your application. You must enter the project budget on the

Budget Information Non-construction Programs standard form (SF 424A) according to the directions provided with this standard form. The budget narrative consists of a detailed line-item budget that includes calculations for all costs and activities by "object class categories" identified on the SF-424A and justification of the costs. You must indicate the method you are selecting for your indirect cost rate. See Indirect Costs below for further information.

Project budget calculations must include estimation methods, quantities, unit costs, and other similar quantitative detail sufficient to verify the calculations. If matching or cost sharing is required, you must include a detailed listing of any funding sources identified in box 18 of the SF-424 (Application for Federal Assistance).

Please be sure to carefully review section D.6 Funding Restrictions for specific information regarding allowable, unallowable, and restricted costs.

You must provide an object class category budget using Section B, box 6 of the SF 424A for the first year of the proposed project. Provide a budget justification, which includes explanatory text and line-item detail, for the first year of the proposed project. The budget narrative should describe how the categorical costs are derived. Discuss the necessity, reasonableness, and allocation of the proposed costs.

For subsequent budget years, provide a summary narrative and line item budget. For categories or items that differ significantly from the first budget year, provide a detailed justification explaining these changes. Note, do not include costs beyond the first budget year in the object class budget in box 6 of the SF- 424A or box 18 of the SF-424; the amounts entered in these sections should only reflect the first budget year.

Your budget narrative should justify the overall cost of the project as well as the proposed cost per activity, service delivered, and/or product. For example, the budget narrative should define the amount of work you have planned and expect to perform, what it will cost, and an explanation of how the result is cost effective. For example, if you are proposing to provide services to clients, you should describe how many clients are you expecting to serve, the unit cost of serving each client, and how this is cost effective.

Use the following guidelines for preparing the detailed object class budget required by box 6 of the SF-424A. The object class budget organizes your proposed costs into a set of defined categories outlined below. Both federal and non-federal resources (when required) must be detailed and justified in the budget narrative. "Federal resources" refers only to the HHS/OASH funds for which you are applying. "Non-federal resources" are all other non-HHS/OASH federal and non-federal resources. We recommend you present budget amounts and computations in a columnar format: first column, object class categories; second column, federal funds requested; third column, non-federal resources;

and last column, total budget.

Sample Budget Table

Object Class Federal Funds Requested (Title X funds)

Non-federal Resources (non-Title X funds)

Total Budget

Personnel $100,000 $25,000 $125,000

Note, subrecipient/contract and consultant detailed costs should all be included in those specific line items, not in the overall project object class line items, i.e., subrecipient travel should be included in the Contractual line item not in Travel.

Object Class Descriptions and Required Justifications

Personnel Description: Costs of staff salaries and wages, excluding benefits.

Personnel Justification: Clearly identify the project director or principal investigator, if known at the time of application. Provide a separate table for personnel costs detailing for each proposed staff person: the title; full name (if known at time of application), time commitment to the project as a percentage or full-time equivalent: annual salary and/or annual wage rate; federally funded award salary; non-federal award salary, if applicable;

and total salary. No salary rate may exceed the statutory limitation in effect at the time you submit your application (see D.6 Funding Restrictions, Salary Rate Limitation for details). Do not include the costs of consultants, personnel costs of delegate agencies, or of specific project(s) and/or businesses to be financed by the applicant. Contractors and consultants should not be placed under this category.

Sample Personnel Table

Position Title and Full Name

Percent Time Annual Salary Federally-funded Salary (Title X funds)

Non-federal Salary (non-Title X funds)

Total Project Salary

Project Director, John K. Doe

50% $100,000 $50,000 $0 $50,000

Data Assistant, Susan R.

Smith

10% $30,000 $3,000 $3,000

Fringe Benefits Description: Costs of employee fringe benefits unless treated as part of an approved indirect cost rate.

Fringe Benefits Justification: Provide a breakdown of the amounts and percentages that comprise fringe benefit costs such as health insurance, Federal Insurance Contributions

Act (FICA) taxes, retirement insurance, and taxes.

Travel Description: Costs of travel by staff of the applicant organization only.

Travel Justification: For each trip proposed for applicant organization staff only, show the date of the proposed travel, total number of traveler(s); travel destination; duration of trip; per diem; mileage allowances, if privately owned vehicles will be used; and other transportation costs and subsistence allowances. Do not include travel costs for subrecipients or contractors.

Equipment Description: "Equipment" means an article of nonexpendable, tangible personal property having a useful life of more than one year per unit and an acquisition cost that equals or exceeds the lesser of: (a) the capitalization level established by the organization for the financial statement purposes, or (b) $5,000. (Note: Acquisition cost means the net invoice unit price of an item of equipment, including the cost of any modifications, attachments, accessories, or auxiliary apparatus necessary to make it usable for the purpose for which it is acquired. Ancillary charges, such as taxes, duty, protective in-transit insurance, freight, and installation, shall be included in or excluded from acquisition cost in accordance with your organization's regular written accounting practices.)

Equipment Justification: For each type of equipment requested you must provide a description of the equipment; the cost per unit; the number of units; the total cost; and a plan for use of the equipment in the project; as well as a plan for the use, and/or disposal of, the equipment after the project ends. An applicant organization that uses its own definition for equipment should provide a copy of its policy, or section of its policy, that includes the equipment definition; include this with your Budget Narrative file. Reference the policy in this justification and include the policy copy in your Budget Narrative file

(not your appendices).

Supplies Description: Costs of all…