Notice of Funding Opportunity

Application due Monday, July 27, 2026

Center for Innovation and Partnership

A Demonstration to Scale Innovative Person-Centered Approaches to Falls Prevention through Clinical-Community Partnerships Opportunity number: HHS-2026-ACL-CIP-AAFP-0017

Contents

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 7

Program description 9

Step 2: Get Ready to Apply 23

Find the application package 24

Get registered 25

Step 3: Build Your Application 26

Application checklist 27

Application contents and format 28

Step 4: Learn About Review and Award 41

Application review 42

Award notices 44

Step 5: Submit Your Application 45

Application submission and deadlines 46

Step 6: Learn What Happens After Award 48

Post-award requirements and administration 49

Contacts and Support 51

Before you begin 3

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 Monday, July 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. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 7

Program description 9

Basic information Administration for Community Living (ACL)

Center for Innovation and Partnership

A notice of funding opportunity from the Administration for

Community Living for a demonstration project scaling falls prevention programs through community care hubs.

Have questions?

See Contacts and

Support.

Key facts

Opportunity name:

A Demonstration to Scale

Innovative Person-Centered

Approaches to Falls

Prevention through Clinical-

Community Partnerships

Opportunity number:

HHS-2026-ACL-CIP-AAFP-0017

Federal assistance listing:

93.048 – Special Programs for the Aging, Title IV, and Title II, Discretionary Projects

Cost sharing: None

NOFO version: Original

Key dates

Application submission deadline:

July 27, 2026

Optional notice of intent deadline:

July 10, 2026

Expected award date:

September 30, 2026

Expected project start date:

September 30, 2026

See intergovernmental review for other submission processes that may apply to this NOFO.

Summary In alignment with the U.S. Department of Health and Human Services’ Make America

Healthy Again agenda, the Administration for Community Living (ACL) is committed to addressing the significant issue of older adult falls. Falls in older adults are common and can lead to negative impacts on health outcomes, quality of life, independence, mortality, and cost to society. Fortunately, rigorous research demonstrates that falls are preventable. Scaling evidence-based falls prevention programs through the expansion of existing community capacity, in partnership with the health care sector, is key to reducing older adult falls.

Beginning in FY 2023, Congress appropriated funds to support research, demonstration, and evaluation (RDE) activities [PDF] in the Aging Network through an RDE Center. The current focus of the RDE Center is on the demonstration portion of the authorizing legislation. The statute [PDF] charges ACL with supporting “demonstration projects” to scale evidence-based programs that promote partnerships among aging services, community-based organizations, and Medicare and Medicaid providers, plans, and health systems.

As a part of a HHS multi-agency initiative, ACL intends to award a single cooperative agreement to one grantee for three-years with the expectation that the grantee will fund the scaling of a common approach to falls prevention through clinical-community partnerships (community care hubs) in five regional geographies with high potential for scaling. Successful applicants will demonstrate the capacity to (1) quickly administer sub-awards to community care hubs that can implement and scale the STEADI algorithm and the Stepping On program and (2) conduct rapid cycle evaluation to iterate and improve the impact of the interventions as they are scaled.

Funding details Type: Cooperative agreement

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

Step 1: Review the Opportunity 5 https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://www.cdc.gov/steadi/index.html https://www.ncoa.org/article/evidence-based-program-stepping-on/

Expected total program funding over the performance period: $$4,781,733

Expected total program funding per budget period: $4,781,733

Total expected awards: 1

Funding range per applicant per budget period: Up to $4,781,733

We plan to fund awards in one 36-month budget period for a three-year period of performance from September 30, 2026 to September 29, 2029.

Step 1: Review the Opportunity 6

Eligibility Eligible applicants Only these types of organizations may apply:

• Special district governments.

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

• Private institutions of higher education.

• Native American tribal governments (Federally recognized).

• City or township governments.

• Public housing authorities/Indian housing authorities.

• State governments.

• Independent school districts.

• Public and State controlled institutions of higher education.

• County governments.

• Native American tribal organizations (other than Federally recognized tribal governments).

Foreign entities are not eligible to compete for, or receive, awards made under this announcement. Faith-based and community organizations that meet the eligibility requirements are eligible to receive awards under this funding opportunity announcement.

Disqualifying factors We will review your application to make sure it meets these responsiveness requirements.

We won’t consider an application that:

• Is submitted after the deadline.

• Is from an individual, including a sole proprietorship, or a foreign entity.

• Is received in paper format that didn’t have a previously approved exemption from ACL.

• The total 36-month budget must not exceed $4,781,733.

• The project period must not exceed 36 months.

Step 1: Review the Opportunity 7

Application limits If you submit the same application more than once under this notice of funding opportunity (NOFO), we will only acknowledge the last on-time submission.

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 won’t consider it during review. If you receive an award, we will include your voluntary commitment in the award.

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.

Statutory authority Special Programs for the Aging, Title IV, and Title II, Discretionary Projects, Older

Americans Act of 1965, Title IV, Public Law 89-73, 79 Stat. 218, as amended; Public Law

97-115, 95 Stat. 1595; Public Law 98-459, 98 Stat. 1767; Public Law 100-175; Public Law

100-628, 42 U.S.C. 3031-3037b; Public Law 102-375; Public Law 106-501.

Step 1: Review the Opportunity 8

Program description Statement of need/background Falls among older adults represent a significant and growing public health concern with serious consequences for health, independence, and mortality. Older adult falls are common, with approximately one in four older adults experiencing a fall every year, resulting in an estimated 36 million falls nationwide. These incidents lead to approximately three million emergency room department visits, one million hospitalizations, and approximately 32,000 deaths annually. A prior fall significantly increases future risk; once an older adult falls, their likelihood of falling again doubles.

Recurrent falls are associated with declining physical function and premature transitions to institutional care. The cumulative impact of falls threatens older adults’ ability to remain independently in their homes and communities. In addition to significant harm to older adults, non-fatal falls cost an estimated $80 billion per year. Although rigorous research demonstrates that falls among older adults are preventable through person centered, evidenced based interventions, gaps remain in the widespread adoption, implementation and scaling of these strategies across the country.

Reducing falls among older adults is a national priority and is in alignment with this administration’s efforts to Make America Healthy Again. The U.S. Department of Health and Human Services (HHS), through the Administration for Community Living (ACL), is coordinating a cross-agency response to significantly reduce the incidence of falls among older adults. While HHS has invested in falls prevention for decades, the work was often siloed within agencies, for specific providers, and/or in specific communities. This effort, informed by the National Falls Prevention Action Plan [PDF], seeks to bring together tools and program investments across ACL, the Centers for Disease Control and Prevention

(CDC), the Health Resources and Services Administration (HRSA), the Center for Clinical

Standards and Quality in the Centers for Medicare and Medicaid Services, and the

National Institute on Aging (NIA) to realize significant progress over the next three years.

This funding opportunity will contribute to the overall goal of reducing falls by bringing together clinical and community partners to scale a specific falls prevention protocol that includes screening for falls risk and deploying an evidence-based, community-based falls prevention program. Specifically, this opportunity will use the CDC’s Stopping Elderly

Accidents, Deaths & Injuries (STEADI) Initiative tool to screen people for fall risk, assess modifiable risk factors, and intervene to reduce fall risk. This tool has been successfully used in a variety of health care settings, including primary care and hospital environments. HRSA will be working with Federally Qualified Health Centers to screen for falls risk using STEADI as part of the coordinated inter-agency effort to prevent falls. The

STEADI tool will be paired with Stepping On, a multifactorial community-based falls

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

Step 1: Review the Opportunity 9 https://www.cdc.gov/mmwr/volumes/72/wr/mm7235a1.htm https://pubmed.ncbi.nlm.nih.gov/39029927/ https://assets.ncoa.org/ffacfe7d-10b6-0083-2632-604077fd4eca/8dd5d7b0-b98f-48f2-a484-989d9e339f4a/2025_National_Falls_Prevention_Action_Plan.pdf https://www.cdc.gov/steadi/about/index.html https://www.cdc.gov/steadi/about/index.html https://www.cdc.gov/steadi/about/index.html prevention program that has demonstrated a 31% reduction in relative risk of falls and a reduction in emergency department visits. ACL funding has historically supported community implementation of this program in some states and communities and will increase access through this initiative.

ACL is committed to preventing falls in older adults, a major problem in the United

States, in alignment with our objective to improve the lives of older adults and people with disabilities. The reauthorization of the Older Americans Act in 2020 [PDF] created

ACL’s Research, Demonstration, and Evaluation (RDE) Center for the Aging Network. One authorizing function of the RDE Center statute charges us with supporting

“demonstration projects” to scale evidence-based programs that promote partnerships among aging services, community-based organizations, and Medicare and Medicaid providers, plans, and health (including public health) systems.

ACL’s mission, vision, and strategic priorities include several components relevant to this approach to scaling falls prevention programs:

• Whole-person health. ACL will advance approaches that integrate health care and community-based interventions to support independence, improve health, and reduce costs. We will scale evidence-based programs in nutrition, falls prevention, chronic disease self-management, and health promotion. And we will expand the capacity of community care hubs (CCHs) that specialize in bridging health care entities and networks of specialty community-based providers to scale integration and access.

• Operational drivers: how we work. To carry out these priorities, ACL and its grant recipients focus on five operational drivers that define how we achieve lasting, measurable impact. Three relevant operational drivers to this initiative include scaling (expanding what works), speed (responding to emerging needs), and outcomes (measuring what matters).

This funding opportunity also specifically focuses on the following goals of the National

Falls Prevention Action Plan:

• Broaden Funding Across Sectors. Broaden funding across sectors by expanding and coordinating spending at the national, state, and local levels on falls prevention awareness, screening, assessment, intervention, and management and improve the capacity of health care and community providers to obtain funds from government, health systems, insurers, and philanthropy to achieve their aims.

• Scale Evidence-Based and Proven Interventions. Scale evidence-based and proven interventions by increasing the number of evidence-based clinical interventions and community-based prevention programs with sizes and capacities sufficient to meet the needs of people at risk of falls, particularly those in historically underserved communities and those with the greatest social and economic need.

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

Step 1: Review the Opportunity 10 https://pubmed.ncbi.nlm.nih.gov/15341550/ https://pubmed.ncbi.nlm.nih.gov/27997482/ https://pubmed.ncbi.nlm.nih.gov/27997482/ https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf https://acl.gov/programs/strengthening-aging-and-disability-networks/improving-business-practices

• Drive More Clinical and Community Partnerships. Drive more clinical and community partnerships by creating the seamless infrastructure needed to support partnerships among clinical providers and community based, aging network, public health, and other social service providers and systems to prevent and reduce falls.

• Expand Access to Existing Technologies. Expand access to existing technologies by engaging a wide range of public and private partners so that products meet the unique needs of older people and are accessible to them no matter who they are or where they live.

Core Activities Our approach to this demonstration opportunity is driven by two important components: (1) a focus on scaling STEADI and Stepping On which are evidence based, address multiple falls risk factors, and have existing capacity to deliver results; and (2) leveraging community clinical partnerships—via community care hubs—as a scaling strategy to reach a large population of older adults at risk for falls.

We seek to rapidly increase older adult access to a multifactorial falls prevention program by building on the capability of the aging and disability organizations that act as community care hubs (CCHs). For more than a decade, aging and disability organizations have organized into networks led by a CCH. The CCH infrastructure has enabled these organizations to effectively partner with health care entities to serve more older adults and people with disabilities at risk for poor health outcomes in the community than they could on their own. This funding opportunity intends to leverage healthcare and CCH partnerships to deploy the falls protocol and rapidly increase access to screening, assessment, and interventions to reduce falls across five regions. There are

17 falls prevention programs that meet ACL’s criteria for evidence-based programs. All of the programs are important, and different programs work to prevent falls through different mechanisms (e.g., gait, strength, and balance; medication management; home hazards; etc.). However, not all falls prevention programs address multiple causes of falls, are broadly adopted, or have a proven return on investment.

Thus, for this demonstration program, we are interested in broad implementation of a common assessment tool (STEADI) and one multi-factorial falls prevention program with broad adoption (Stepping On).

• We recognize there is a large population of ambulatory older adults at risk for falls who could benefit from a comprehensive assessment and a community-based intervention that addresses multiple risk factors. While homebound older adults with limited mobility are also at risk for falls, we aim to reach a larger population at risk for falls in this demonstration. Focusing on STEADI and Stepping On in this falls prevention scaling demonstration will allow us to achieve the largest scale with maximum population health impact.

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

Step 1: Review the Opportunity 11 https://acl.gov/programs/falls-prevention/evidence-based-falls-prevention-programs https://acl.gov/programs/health-wellness/disease-prevention

• Stepping On is a multifactorial community-based falls prevention program that includes group education and behavior change workshops on balance and strength exercises, home modifications, medication review, and vision review. The target population is older adults who live independently, do not have cognitive impairments, do not use a walker indoors, and do not need a wheelchair.

Randomized controlled trial evidence shows a 31% reduction in relative risk of falls

(the strongest quality of evidence of the falls programs) and a reduction in emergency department visits.

The CBO network led by the CCH is capable of providing services at scale, including evidence-based interventions (such as falls prevention programs), nutrition services, care coordination, and more. For the purposes of this demonstration, it’s anticipated a CCH will work with health care partners on implementation of STEADI for falls risk screening and assessment, with subsequent referral to the CCH for appropriate follow up for identified risk factors as well as participation in Stepping On.

ACL intends to award a single cooperative agreement to support healthcare/CCH partnerships to scale STEADI and Stepping On in five geographical areas across the country. The grantee will identify and award funding to healthcare/CCH partnerships, provide technical assistance to the partnerships during program implementation, and conduct rapid-cycle analysis to support successful scaling of STEADI and Stepping On.

Successful applicants will demonstrate capacity to:

• Quickly administer sub-awards to CCHs that can implement and scale STEADI and

Stepping On.

• Provide targeted technical assistance to the sub-awardees and coordinate on additional technical assistance with the National Falls Prevention Resource Center.

• Conduct rapid cycle evaluation to iterate and improve the impact of the interventions as they are scaled.

Up to 25% of the award can remain with the cooperative agreement recipient to support coordination of technical assistance activities, rapid cycle evaluation activities, and administering the sub-awards. At least 75% of the award must be disbursed to the sub-awardees.

Applicants that propose to coordinate this effort, including sub-awards, with complementary ACL funding opportunities (Scaling Evidence-Based Falls Prevention

Programs [HHS-2026-ACL-AOA-FPSG-0004] and National Falls Prevention Resource

Center [HHS-2026-ACL-AOA-FPSG-0005]) are positioned to achieve an even greater impact.

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

Step 1: Review the Opportunity 12 https://www.ncoa.org/article/evidence-based-program-stepping-on/ https://pubmed.ncbi.nlm.nih.gov/15341550/ https://pubmed.ncbi.nlm.nih.gov/27997482/ https://pubmed.ncbi.nlm.nih.gov/27997482/

Part 1. Administering sub-awards to CCHs that can implement and scale STEADI and Stepping On

The cooperative agreement recipient will coordinate closely with ACL on a data-driven approach to identify and disburse sub-awards. The sub-awards will comprise 75% of the awardee’s budget. They will be awarded to five CCHs in geographic regions with strong opportunity for regional expansion of STEADI and Stepping On to the target population through community care hubs and their respective clinical and community partners.

• The cooperative agreement recipient must be able to disburse sub-awards within

120 days of award receipt. Additionally, the recipient is responsible for the monitoring and oversight of all sub-awards, and the process to solicit, objectively evaluate, select, and make sub-awards. Further, the successful recipient shall adhere to all requirements, including those for making and monitoring sub-awards, as outlined in 45 CFR Part 75.

• Sub-awardee intervention target population: Older adults at risk for falls.

◦ Consistent with the definition in the Older Americans Act (42 U.S.C. §3002(8)), we define an older adult as an individual who is 60 years of age or older. For tribes and tribal organizations, the age of older Indians is defined by the tribe and may vary.

◦ We define “at risk for falls” in a multifaceted manner as older adults who: (1) are screened as a fall risk using the STEADI algorithm (see multifactorial risks here [PDF]); (2) had a documented fall-related health care encounter in any clinical setting during the past 12 months (e.g., outpatient, inpatient, emergency department, urgent care, post-acute care, specialty, home health, or other health care setting); or (3) otherwise self-identify concerns related to falling, balance, or gait instability. Sub-awardees will identify priority at risk populations and the types of health care partners and encounters that will yield the highest volume of screening and referrals.

• Sub-awardee intervention: Sub-awardees must offer and focus on scaling the

Stepping On program in partnership with health care using the STEADI algorithm.

◦ Where possible, feasible, and appropriate, the ideal sub-awardee -would leverage technology solutions for predicting, identifying, and acting upon falls risk, potentially including artificial intelligence, data analytics, assistive technology, virtual delivery of interventions, tools to support consumer behaviors, and related data infrastructure. The ideal use of technology solutions would focus less on gadgets and more on infrastructure that connects clinical risk data with community-based interventions, less on detection of falls and more on prediction of falls. For example, literature demonstrates that gait analysis is critical to predicting fall risk, with sensors able to capture inputs like stride variability, postural sway, temporal symmetry, and dynamic stability.

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

Step 1: Review the Opportunity 13 https://www.cdc.gov/steadi/media/pdfs/STEADI-FactSheet-RiskFactors-508.pdf

Further, machine learning, predictive modeling, and AI can help enable and analyze data feeds from wearables and other sensors, linking them to interventions and clinical decision support. Sub-awardees should consider, when possible, partnership with state assistive technology programs to expand reach of technology to all areas of the market.

• Sub-awardee organization types and locations:

◦ Sub-awardees must be CCHs that have demonstrated capability to serve a large geography in partnership with health care entities.

▪ Definitions of CCHs are found here [PDF] and here and a map of CCHs is found here.

▪ Through their network, they should have current capability to deliver community-based evidence-based falls prevention programs and demonstrated capacity to scale Stepping On across a state or region.

▪ They should also demonstrate relationships with falls screening and referrals partners (such as accountable care organizations [ACOs], providers conducting Medicare annual wellness visits, etc.).

◦ Sub-awardees should have existing capacity for data collection related to falls prevention, including:

▪ The ability to participate in rapid cycle evaluation to iterate and improve the impact of the interventions as they are scaled as well as participate in an external evaluation to understand the impact on outcomes.

▪ The ability to report on or contribute to improving quality measures for falls prevention, such as those in the Healthcare Effectiveness Data and

Information Set (HEDIS [PDF]), the Merit-based Incentive Payment System

(MIPS [PDF]), or others.

◦ The sub-awardees must demonstrate engagement with aging and disability partners (such as AAAs, CILs, and ADRCs) as part of their CCH network.

◦ The sub-awardees are expected to partner with Federally Qualified Health

Centers, health systems, and other primary care providers committed to scaling the use of STEADI and referrals to Stepping On.

◦ The cooperative agreement recipient will coordinate closely with ACL on a data-driven approach to identify and disburse sub-awards to five CCHs in different geographies with strong opportunity for regional expansion of falls prevention programs. The sub-awards should last at least 2.5 years (i.e., most of the overall three-year cooperative agreement period). That approach should assess and prioritize geographies and organizations by assessing:

▪ The geographic market opportunity for health care contracting (e.g., presence of ACOs, Medicare Advantage plans, DSNPs, and more).

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

Step 1: Review the Opportunity 14 https://www.partnership2asc.org/wp-content/uploads/2023/05/Functions-of-a-Mature-Community-Care-Hub-May-2023.pdf https://coe.aginganddisabilitybusinessinstitute.org/what-is-a-community-care-hub/ https://coe.aginganddisabilitybusinessinstitute.org/national-cch-map/ https://wpcdn.ncqa.org/www-prod/wp-content/uploads/HEDIS-MY-2025-Measure-Description.pdf https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2025_Measure_155_MIPSCQM.pdf

▪ Strength of the CCH and its network partners in delivering falls prevention programs, including Stepping On, and other core services.

▪ CCH’s relationship with state agencies and state agencies’ support of the aging network, CCHs, and falls prevention programs.

▪ CCH’s ability to contract with health care partners.

▪ CCH’s degree of clinical integration with health care partners, including the ability of and magnitude to which clinical partners broadly implement the use of STEADI, integrate into the EHR workflow, and generate a high volume of referrals from STEADI.

▪ CCH’s strength of data security and IT infrastructure to support integration and data sharing with health care partners and CBO network for care delivery, coordination, quality improvement, and payment operations

(including billing capacity for fee-for-service Medicare).

▪ Ideally, the presence of and engagement with a state falls prevention coalition.

▪ Coordination with other ACL grantees to implement STEADI and Stepping On.

Part 2. Providing targeted technical assistance

The cooperative agreement recipient will provide targeted technical assistance to the sub-awardees to support the regional scaling demonstrations. Delivery of technical assistance should be interactive and engaging and informed by ongoing successes, barriers, and needs identified in the rapid cycle evaluation (see Part 3 below).

This includes TA to enable organizations across the aging services network (inclusive of

AAAs and SUAs) to support implementation and regional scaling of STEADI and Stepping through community-clinical partnerships.

The recipient is also expected to coordinate additional technical assistance activities with the ACL-funded National Falls Prevention Resource Center to avoid duplication and build on federal investments (i.e., STEADI and Stepping On resources, state falls coalitions, etc.). The recipient should ensure that sub-grantee needs and barriers documented in rapid-cycle evaluation are shared with the Resource Center to ensure TA to subgrantees is responsive to the results of those analyses and improves their performance.

Step 1: Review the Opportunity 15

Part 3. Conducting rapid cycle evaluation to iterate and improve the impact of the interventions as they are scaled.

• Within 120 days of grant award, the recipient must have the ability to collect, securely store, analyze, and report on sub-awardee data in a rapid cycle analysis fashion. Applicants should include a proposed data collection/management strategy for sub-awardees (to be confirmed in consultation with ACL). The recipient must demonstrate capacity to engage or previous experience engaging an efficient IRB approval process. The recipient must be able to conduct rapid cycle analysis on the limited set of process outcome metrics listed below. They should propose data sources, methods, techniques, and tools that will be used to determine if sub-awardees achieve anticipated outcomes, and to document lessons learned. The recipient must describe and demonstrate capacity or experience to perform rapid cycle evaluation to iterate and improve the impact of the interventions as they are scaled based on ongoing successes, barriers, and needs identified. The rapid cycle analysis should be part of and inform the TA function—for example, any challenges identified in rapid cycle analyses should be addressed quickly through TA. Key outcomes in the rapid cycle analyses may include:

◦ STEADI assessments fully implement and STEADI referrals made.

◦ Successful connection rate of STEADI referrals (ratio of referrals whose closure resulted from receipt of real benefit divided by all managed referrals).

◦ Stepping On program utilization, including not just individuals in the program, but those who complete it, and measures of program scaling (e.g., to new geographies, involvement of new partners, staff capacity, etc.).

◦ Self-reported program participant data (potentially including incidence of falls and fear of falling).

◦ Qualitative assessment of successes, challenges, barriers, and other needs.

• The recipient and sub-awardees must work with and participate in an external claims-based evaluation that ACL will separately fund. Key outcomes from the external evaluation may include:

◦ Prevalence of falls.

◦ Emergency department visits for falls.

◦ Hospitalizations and readmissions.

◦ ROI for scaling Stepping On and STEADI.

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

Step 1: Review the Opportunity 16 https://pmc.ncbi.nlm.nih.gov/articles/PMC11024758/

Partnership and stakeholder collaboration Applicants should describe how they plan to partner with other organizations—both inside and outside of the aging network—to address funding expectations.

• The applicant must have the capacity and expertise to work with multiple types of partners to facilitate collaboration and research with the Aging Network. The Older

Americans Act of 1965 (OAA) established a national network of federal, state, and local agencies to plan and provide services that help older adults to live independently in their homes and communities. This interconnected structure of agencies is known as the Aging Services Network. The nationwide Aging Services

Network is led by ACL, which sits within the Department of Health and Human

Services. The network includes 56 State Agencies on Aging, approximately 615 Area

Agencies on Aging, and more than 280 Title VI Native American aging programs.

Further, the network is supported by tens of thousands of service providers, community-based organizations, and hundreds of thousands of volunteers. There are also organizations representing national, state, and local aging partners.

• The applicant (lead applicant or partner organizations) must demonstrate experience with and clearly describe plans for engagement of health care partners, and organizations representing national, state, and local health care entities. The applicant should also clearly describe plans for engaging organizations that specialize in multistakeholder strategy for aligning health care and whole-person community care through community care hubs, including the ability to serve as a neutral convener.

• Outside of the aging network, the applicant must also describe plans for engagement of other partners, such as the Stepping On program developer and organizations advancing community care hubs and the implementation of the target interventions.

For any key partners the applicant intends to directly involve in this funding opportunity, the applicant should obtain letters of commitment stating their agreement to provide tangible, specific resources, personnel, funding, or other contributions.

Step 1: Review the Opportunity 17

Cooperative agreement terms Cooperative agreements require substantial ACL project involvement after an award is made. There are specific roles for both you and ACL.

Your responsibilities

• Fulfill all the requirements of the grant initiative as outlined in this program announcement, as well as carry out project activities as reviewed, approved, and awarded.

• Participate in ACL education and communication activities (including teleconferences and webinars) provided that ACL provides reasonable notice of the subject, date, and time of the teleconference.

• Comply with all other reporting requirements, as outlined in the Funding

Opportunity and the Notice of Award.

• Include ACL disclaimer language on all products produced using this grant funding.

• Engage with ACL and its external contractor on evaluation, including input into evaluation design and implementation, assisting with the collection and housing of required data, and sharing data with ACL and its contractor upon request.

• Work with ACL on a defined data-driven process for developing the application criteria for sub-awards and selecting sub-awards that maximize the potential for scaling success.

• Work with ACL on subgrantee reporting/monitoring strategy, including required data elements and reporting cadence.

• Ensure each subgrantee has appropriate licensing to offer Stepping On, as determined by the program administrator (Wisconsin Institute for Healthy Aging)

• Coordinate technical assistance with ACL and other ACL-funded technical assistance partners.

• Coordinate with ACL on selection of and agreements for external consultants and TA providers.

• Reach ACL defined performance milestones for draw down of grant funds to be approved by ACL.

◦ In first 30 days, collaborate with ACL on objective review criteria and an approach to sub-awards, including identifying priority geographic regions for

Stepping On scaling.

◦ In the first 120 days, disburse sub-awards.

◦ Within the first year, all sub-awardees are implementing STEADI with active referrals occurring to the Stepping On program.

Step 1: Review the Opportunity 18

Our responsibilities

ACL will carry out the following activities for the cooperative agreement:

• ACL Project Officer will perform the day-to-day Federal responsibilities of managing a grant initiative and will work with the grantee to ensure that the necessary requirements for the grant are met.

• Assist the grantee project leadership in understanding the policy concerns and/or priorities of ACL by conducting periodic briefings and by carrying out ongoing consultations.

• Within 30 days post-award, work cooperatively with the grantee to clarify programmatic and budgetary issues. If issues are identified, work with the grantee to revise the project work plan, detailing expectations for major activities and products during the grant.

• Provide technical assistance to the grantee on the coordination of technical support and associated tasks related to the fulfillment of the goals and objectives of this grant.

• Provide consultation to the grantee in identifying emerging issues as they relate to the goals and objectives of this grant program.

• Work with the grantee on the development and implementation of quality assurance systems to ensure that performance is measured and continuous improvement occurs.

• Provide guidance and technical assistance to the grantee in making sub-awards (i.e., sub-grants/contracts) as permitted in this funding opportunity.

• Review and provide technical advice to the grantee on all work products and other project deliverables and processes.

• Attend and participate in major project events as appropriate.

• Coordinate with other federal agencies that have infrastructure, technical assistance, or programmatic resources to support the success of this demonstration.

• Participate in multi-stakeholder consortia or groups that provide coordination and/ or strategic direction to this award and its work.

Step 1: Review the Opportunity 19

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.

Policies

All activities proposed in your application and budget narrative must align with applicable law, including but not limited to statutes, executive orders, federal regulations, and applicable judicial holdings. Accordingly, discretionary awards shall not be used to fund, promote, encourage, subsidize, or facilitate: racial preferences or other forms of racial discrimination by the recipient, including activities where race or intentional proxies for race will be used as a selection criterion for employment or program participation; denial by the recipient of the sex binary in humans, or the belief that sex is a chosen or mutable characteristic; illegal immigration; or any other initiatives that compromise public safety.

If an application does not align, the application will not receive funding to the extent permitted by law and applicable court orders.

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Support beyond the first budget period 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.

• You may not use funds from this NOFO for any diversity, equity, inclusion, and accessibility (DEI and DEIA) activities. This includes:

◦ DEI- or DEIA-related research.

◦ Activities that discriminate based on race, color, religion, sex, national origin, or other protected traits.

• Under this NOFO, you can’t continue existing projects without expansion or new and innovative approaches.

• Meals are allowed only in limited circumstances linked to program activities, like during travel or when approved in advance by ACL. See Allowable Costs and

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

Step 1: Review the Opportunity 20 https://www.ecfr.gov/current/title-2/part-200 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-300

Activities, Exhibit 4: Selected Items of Cost, Meals in the HHS Grants Policy

Statement.

• There are restrictions on certain telecommunications and video surveillance equipment. See 2 CFR 200.216 to make sure this does not apply to any proposed equipment in your application.

Unallowable costs

• Construction or major rehabilitation of buildings.

• Basic research, such as scientific or medical experiments.

• For guidance on other types of costs that we restrict or do not allow, see General

Provisions for Selected Items of Costs of the Uniform Guidance, 2 CFR 200.420.

Program-specific limitations and policies

Sub-awards should be used to fund the intervention, including staff, infrastructure to support clinical-community partnerships, data infrastructure for evaluation and quality improvement, use of assistive technology, and more.

Indirect costs

Indirect costs are those shared across multiple projects and not easily separated.

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 may be up to 15% of modified total direct costs (MTDC). See the definition of MTDC (2 CFR 200.1). You can use this rate indefinitely.

You may not charge costs included in your indirect cost pool as direct costs.

Subawards

As the prime recipient, you must maintain a substantive role in the project. This means that you conduct funded activities and provide services necessary and integral to completing the project.

Monitoring your subrecipient’s activities alone as described in 2 CFR 200.332 is not a substantive role.

We do not fund awards where your role is primarily a conduit for passing funds to other organizations unless that arrangement is authorized by statute.

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

Step 1: Review the Opportunity 21 https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.ecfr.gov/current/title-2/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200/section-200.414#p-200.414(f) 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/subtitle-A/chapter-II/part-200#200.332

All subrecipients must have a Unique Entity Identifier (UEI) through the System for Award

Management (SAM.gov).

Subrecipients must meet the eligibility requirements of this NOFO.

Salary rate limitation

The salary rate limitation in the current appropriations act applies to this program. You may not use awarded funds to pay a salary at a higher rate than the rate for Executive

Level II.

For the Executive Level II salary, please see the Office of Personnel Management information on executive and senior level employee pay.

The salary limitation reflects a person’s base salary (including any portion of the salary that is paid with indirect costs). It does not include fringe benefits or any income the person is allowed to earn outside of the duties of the applicant organization.

This salary limitation also applies to subawards, contracts, and subcontracts under an ACL grant or cooperative agreement.

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.

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

Step 1: Review the Opportunity 22 https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/ https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/ https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#200.307

Step 2:

Get Ready to Apply

In this step

Find the application package 24

Get registered 25

Find the application package The application package has all the forms you need to apply. You can search for it at

Grants.gov using opportunity number {HHS-2026-ACL-CIP-AAFP-0017}. Then select the

Package tab.

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

You can also find materials at Applying for Grants on ACL’s website.

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. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 24 https://grants.gov/search-grants https://acl.gov/grants/applying-grants https://www.grants.gov/support

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.

Need help? See Contacts and Support.

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

Step 2: Get Ready to Apply 25 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 https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants

Step 3:

Build Your Application

In this step

Application checklist 27

Application contents and format 28

Application checklist Make sure that you have everything you need to apply. You will find the forms in

Grants.gov.

Narratives

Item Grants.gov form Page limit

Project narrative Use the Project Narrative Attachment form. 20 pages

Budget narrative Use the Budget Narrative Attachment form. None

Attachments Insert each in a single Other Attachments form.

Item Page limit

Indirect cost agreement None

Commitment letters None

Proof of nonprofit status None

Resumes and job descriptions None

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

Item Page limit

Application for Federal Assistance (SF-424) None

Budget Information for Non-Construction Programs (SF-424A) None

Assurances for Non-Construction Programs (SF-424B) None

Key Contacts form None

Grants.gov Lobbying form (Certification Regarding Lobbying) None

Project/Performance Site Location form None

Step 3: Build Your Application 27

Application contents and format This section includes guidance on each component found in the application checklist.

Application page limit: 20 pages

Submit your information in English and express whole number budget figures using

U.S. dollars.

Required format Required format for project and budget narratives.

Font: Times New Roman or Arial

Format: PDF

Size: 11-point font

Footnotes and text in graphics may be 10-point.

Spacing for project narrative main content: Double-spaced

Spacing for budget narrative: As needed

Spacing for project summary, tables, footnotes: Single-spaced

Margins: 1-inch

Include page numbers.

Project narrative Page limit: 20

The project narrative is the most important part of the application. We use it as the primary basis to decide whether your project meets the statutory requirements and to review its merit. The project narrative should give a clear and concise description of your project.

Be sure to cite all your sources. Merit reviewers may lower your score if you do not.

Also study the merit review criteria under each section to make sure you answer all questions and cover all topics reviewers will look at.

Step 3: Build Your Application 28

Project summary

Provide a brief project summary of no more than 265 words. Write it for the general public. You will need to include:

• Goals: Broad overall purpose, like a mission statement that says what you want to do and where you want to be.

• Objectives: Narrow, specific, and clear steps toward the goals. These are the “hows” to achieve the goals.

• Overall approach: General overview of what you will do.

• Outcomes: These are the measurable results of a project. Include expected changes among those served, such as clients, systems, organizations, and communities.

These should tie directly to your goals and those of this funding.

• Products: The materials and other deliverables you expect to generate through the project.

• Duration: The anticipated start and end dates of the period of performance.

Step 3: Build Your Application 29

Project relevance and current need

Problem statement

• Describe your knowledge of the current landscape with respect to older adult falls, falls prevention, and scaling evidence-based falls prevention programs.

• Describe your understanding of health care/CCH partnerships and their potential to leverage STEADI and scale an evidence-based falls prevention program.

Goals and objectives

• Translate the knowledge demonstrated in the problem statement into clear goals and objectives for supporting and scaling STEADI and Stepping On through community care hubs via this funding opportunity.

Table: Scoring criteria

Reviewers…