HRSA-25-078 FINAL.pdf

Notice of Funding Opportunity

Application due March 20, 2025

Bureau of Health Workforce Division of Medicine and Dentistry, Medical Training and Geriatrics Branch

Primary Care Training and Enhancement—Residency Training in Street Medicine (PCTE-

RTSM)

Opportunity number: HRSA-25-078

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 9

Award information 11

Step 2: Get Ready to Apply 14

Get registered 15

Find the application package 15

Application writing help 15

Step 3: Prepare Your Application 17

Application contents and format 18

Step 4: Learn About Review and Award 31

Application review 32

Selection process 36

Award notices 40

Step 5: Submit Your Application 41

Application submission and deadlines 42

Application checklist 43

Step 6: Learn What Happens After Award 45

Post-award requirements and administration 46

Contacts and Support 49

Contents 2

Endnotes 52

Contents 3

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 March 20, 2025.

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 4 https://sam.gov/ https://grants.gov/

Jump to a step

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

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 7

Program description 9

Award information 11

Basic information Health Resources and Services Administration

Bureau of Health Workforce

Division of Medicine and Dentistry, Medical Training and Geriatrics Branch

Enhancing primary care residency training, focusing on people experiencing homelessness.

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name: Primary Care Training and Enhancement—Residency Training in Street Medicine

(PCTE-RTSM)

Opportunity number:

HRSA-25-078

Announcement version:

New

Federal assistance listing:

93.884

Statutory authority: 42 USC §293k (Section 747(a)(1)(A) of the Public Health Service Act)

Key dates

NOFO issue date: December 20, 2024 Informational webinar:

Visit BHW’s open opportunities website to learn more.

Application deadline:

March 20, 2025 Expected award date is by:

July 1, 2025 Expected start date: July 1, See other submissions for other time frames that may apply to this NOFO.

Summary The purpose of the Primary Care Training and Enhancement—Residency Training and Street Medicine (PCTE-RTSM) Program is to enhance training in street medicine for residents enrolled in accredited primary care residency programs.

Funding details Application Types: New

Expected total available funding in FY 2025: $9,500,000

Expected number and type of awards: 19 grants.

Funding range per award: Up to $500,000 per year.

We plan to fund 19 awards in five 12-month budget periods for a total five-year period of performance of July 1, 2025 to June 30, 2030. Your request for each of years two through five cannot exceed your request for year one.

The program and estimated awards depend on the future appropriation of funds and are subject to change based on the availability and amount of appropriations.

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

Step 1: Review the Opportunity 6 https://bhw.hrsa.gov/fundingopportunities/default.aspx

Eligibility Who can apply You can apply if your organization is an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract, which for this NOFO is an entity that operates an ACGME-accredited primary care residency training program.

Types of eligible organizations If otherwise eligible, these types of domestic* organizations may apply.

• Public institutions of higher education.

• Private nonprofit institutions of higher education.

• Nonprofits with or without a 501(c)(3) IRS status.

Individuals are not eligible applicants under this NOFO.

“Domestic” means located in the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Other eligibility criteria ACGME accreditation The applicant organization’s training program must be accredited by the ACGME in family medicine, internal medicine, pediatrics, or combined internal medicine and pediatrics (“med-peds”). You must provide documentation of your ACGME accreditation in Attachment 1.

Trainee eligibility To receive support under this program, a trainee must be enrolled in the ACGME-accredited training program and be one of the following:

• A U.S. citizen or non-citizen national.

• An individual lawfully admitted for permanent residence to the United States.

• Any other “qualified alien” under section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104-193, as amended.

Step 1: Review the Opportunity 7

Project Director (PD) eligibility The proposed PD must be board certified physician in a primary care specialty, and employed by, on staff of, or hold an academic appointment with the applicant organization. The PD should dedicate approximately 20% of their time to grant activities, whether charged to the grant as salary or provided to the project as an in-kind contribution. Your application should indicate the time commitment and qualifications of the PD in the project narrative. HRSA recognizes only one PD.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

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

• Is submitted after the deadline.

• Is incomplete/fails to include all the required information.

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

Step 1: Review the Opportunity 8

Program description Purpose The purpose of the Primary Care Training and Enhancement—Residency Training in Street Medicine (PCTE-RTSM) Program is to enhance training in street medicine for residents enrolled in accredited primary care residency programs. Awardees may use funds to support enrolled Graduate Medical Education (GME) residents.

Background In fiscal year 2022, the Department of Housing and Urban Development reported that around 653,100 Americans were experiencing homelessness on a single night.[1] In a prior assessment in 2021, an estimated 1,214,000 people in 940,000 households in the U.S. experienced sheltered homelessness at some point during the year.[2]

Among people experiencing homelessness, the most prevalent comorbid conditions are tobacco use (77%), followed by depression (58%), drug use disorder (56%), anxiety disorder (50%), hypertension (44%), and alcohol use disorder (43%).[3]

Such individuals face particular challenges in obtaining medical care, often leading to greater and more complex medical needs, including higher rates of chronic conditions, more severe illness, and high rates of mental health and substance use disorders.

Street medicine focuses on bringing care and resources to people, outside of traditional clinical settings. By bringing health care to people experiencing homelessness, providers can build rapport with these individuals and begin bridging them into the services they need.[4]

Clinicians caring for patients experiencing homelessness must understand the implications and challenges related to the Social Determinants of Health (SDoH) in diagnosis, treatment, and continuing management of patients.[5] They must be trained to make appropriate referrals and consultations with a multi-disciplinary team, including social workers and other professionals equipped to help patients address SDoH.[6] Legal consultation and referral may at times be necessary and establishment of medical-legal partnerships can facilitate these interactions.[7]

Current health professions curricula do not adequately prepare health care providers to deliver appropriate, unbiased primary care for people experiencing homelessness.[8]

This funding opportunity seeks to prepare physician-trainees to provide more empathetic, interprofessional, patient-centered primary care for people experiencing homelessness.

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

Step 1: Review the Opportunity 9 https://bhw.hrsa.gov/glossary#s

The PCTE-RTSM Program addresses these national challenges by funding existing primary care graduate medical education residency programs to include clinical rotations to train residents in street medicine, to provide care to people experiencing homelessness.

Program goal The goal of the PCTE-RTSM Program is to increase the number of physicians trained in a primary care specialty (i.e., family medicine, internal medicine, pediatrics, and combined internal medicine-pediatrics) who are prepared to provide care for people experiencing homelessness, by bringing care to people outside of traditional clinical settings.

Program objectives To accomplish the program goal, projects must meet the following objectives:

• Develop or enhance trainings, clinical rotations, and didactic and clinical curricula content to train residents in street medicine to provide sensitive and quality care for people experiencing homelessness. Attention to mental health and substance use disorders is expected.

• Increase residents’ knowledge and skills to meet the unique needs of people experiencing homelessness and assist patients with navigation of the medical, behavioral health, legal, and social support systems related to clinical care.

• Increase residents’ knowledge and skills to work in interprofessional teams, including chronic disease management, mental health, substance use, and medical-legal interprofessional teams, to address the SDoH that impact patient care.

Program requirements and expectations If you receive an award, you must meet the following requirements and expectations in carrying out your training program. You should address all these requirements in the project narrative section of your application and follow the more detailed instructions throughout that section.

• Build or expand a targeted curriculum that focuses on delivering primary care services to a population experiencing homelessness.

• Provide residents with training in the prevention, identification, diagnosis, treatment, and referral of services for behavioral health conditions, with a focus on substance use disorders and Medication for Opioid Use Disorder (MOUD) as part of their primary care training.

Step 1: Review the Opportunity 10

• Provide experiential training in the use of an interprofessional team to provide treatment for health conditions experienced by homeless populations, specifically focusing on the treatment of chronic conditions.

• Develop partnerships between academic, community-based organizations (CBOs), and other service providers to develop clinical rotations for residents to learn to provide care for homeless populations, including at least two one-month rotations that focus on providing health care to the homeless.

• Provide residents with a robust education in SDoH as they relate to the causes, epidemiology, and treatment of health conditions experienced by homeless populations.

• Provide residents with didactic and experiential learning experiences about cultural and linguistic competency.

• Provide training to residents regarding how to interact with the legal systems that may impact their patients’ care, through partnerships with legal-aid organizations or medical legal partnerships.

• Ensure that residents have a National Provider Identifier (NPI) number.

• Maintain ACGME accreditation of the qualifying residency program, and promptly report to HRSA any change in accreditation status.

• Participate in federally designed evaluations to assess program effectiveness and efficiency upon request.

Award information Funding policies and limitations Policies

• 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 year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting the project’s objectives.

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

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list.

Step 1: Review the Opportunity 11

◦ Extend the period of performance.

◦ Award supplemental funding.

Maintenance of effort Federal funds must add to any existing non-federal funds for your proposed activities. If you receive an award, you will have to spend at least as much as you spent in the last fiscal year before the award. PHSA Section 797(b) requires this. We will enforce these statutory requirements through all available mechanisms. You must provide supporting documentation in Attachment 5.

General limitations

• For guidance on some types of costs we do not allow or restrict, see Project

Budget Information in section 3.1.4 of the R&R Application Guide. You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items of Cost.

• You cannot earn profit from the federal award. See 45 CFR 75.400(g).

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2024, the salary rate limitation is $221,900. Note this limitation may apply in future years and will be updated.

See Manage Your Grant for other information on costs and financial management.

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

Per 45 CFR 75.414, indirect costs for training awards cannot exceed 8 percent of modified total direct costs (MTDC).

For modified total direct costs, we use the definition at 2 CFR 200.1. MTDC means all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $50,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs and with the approval of the cognizant agency for indirect costs.

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

Step 1: Review the Opportunity 12 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=15 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.400 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-45/section-75.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

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

Step 1: Review the Opportunity 13 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 15

Find the application package 15

Application writing help 15

Get registered SAM.gov You must have an active account with SAM.gov to apply. This includes having a Unique Entity Identifier (UEI). 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 to find out what you’ll need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

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.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-25-078.

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

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

Step 2: Get Ready to Apply 15 https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

Join the webinar For more information about this opportunity, join the technical assistance (TA) webinar. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for you to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website to learn more about the resources available for this funding opportunity.

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

Step 2: Get Ready to Apply 16

Step 3:

Prepare Your Application

In this step

Application contents and format 18

Application contents and format Applications include five main components. This section includes guidance on each.

Application page limit: 60 pages.

Submit your information in English and express budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission Form Included in the page limit?

Project abstract Use the Project Abstract Summary Form. No

Project narrative Research and Related Other Project Information

Yes

Budget narrative Use the Research and Related Budget form.

(Line L)

Yes

Attachments Insert each in the Other Attachments form. Yes, unless otherwise marked.

Other required forms Upload using each required form. Indicated in the other required forms section.

See the application checklist for a full list of all application requirements. See form instructions for more detail on completing each form.

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in section 3.2 of the R&R Application Guide.

Project abstract Complete the information in the Project Abstract Summary Form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. When applicable,

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

Step 3: Prepare Your Application 18 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=25 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=25 identify if you are requesting a funding priority or preference. For more information, see section 3.1.2 of the R&R Application Guide.

Project narrative In this section, you will describe all aspects of your project. Project activities must comply with the nondiscrimination requirements.

Use the section headers and the order that follow.

Introduction and purpose See merit review criterion 1: Purpose and need

Briefly describe the purpose of your project. Include the demographics of the community and populations that participants will serve, such as data on the SDoH, behavioral health, and primary care needs that the project will address.

Need See merit review criterion 1: Purpose and need

• Describe your residency program and unmet needs this program will address.

Include the need to develop or enhance trainings, clinical rotations, and clinical curriculum content to train residents to care for people experiencing homelessness, specifically focusing on the treatment of chronic conditions and mental health and substance use disorders in non-traditional treatment settings.

• Provide information on existing services and gaps in services that may exist.

• Use demographic data to support your descriptions and explanations, as applicable.

Approach See merit review criterion 2: Response

• Tell us how you will address your stated needs and meet the program requirements and expectations described in this NOFO.

• Describe how you will enhance your curricula to increase residents’ knowledge of and competence to care for people experiencing homelessness. Curricula should cover the treatment of chronic conditions, behavioral health needs, and SDoH’s impact on the ability to provide treatment for health conditions.

• Describe how you will establish the two one-month required rotations to train residents in street medicine to provide care for people experiencing homelessness.

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

Step 3: Prepare Your Application 19 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=1

• Describe your plans for training residents in interprofessional teams, including behavioral health, and medical-legal teams.

• Explain how you will provide training in the social and legal needs of people experiencing homelessness, through partnerships with legal aid organizations or medical-legal partnerships (MLP).

• Describe your proposed training project. Include related items such as faculty hiring, support staff hiring, clinical space, and contractual services. Include costs for these items in your budget and budget narrative.

• Explain your strategies to improve residents’ cultural competence to meet the needs of people experiencing homelessness. Include strategies based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

High-level work plan See merit review criterion 2: Response

• Describe how you will achieve the program’s goal, each of the three objectives, and the program requirements and expectations during the period of performance.

• Provide a timeline that includes each activity and identifies who is responsible for each.

• Include the extent to which the applicant will work with stakeholders to address the Objectives and the Requirements of this NOFO.

• Describe the locations of clinical sites (for example, medical vans serving people experiencing homelessness) in Attachment 4. Describe the supervision and support you will provide to the residents at clinical rotation sites.

• You will also include a more detailed work plan in your standardized work plan (SWP). See Standard Forms.

Resolving challenges See merit review criterion 2: Response

Discuss challenges that you are likely to encounter in designing and carrying out the activities in the work plan. Explain approaches that you’ll use to resolve them. Such challenges might include:

• Recruitment of residents.

• Providing primary care services to people experiencing homelessness, including those with chronic conditions, substance use disorders (SUD) and other behavioral health disorders.

• Barriers to residents’ access to education and training in your program.

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

Step 3: Prepare Your Application 20 https://thinkculturalhealth.hhs.gov/clas

• Supervision and support of residents at sites other than the academic home.

• Safety of residents and faculty at clinical sites.

Performance reporting and evaluation See merit review criteria 3: Impact and 4: Resources and capabilities

• Outcomes. Describe the expected outcomes (desired results) of the funded activities.

• Performance measurement and reporting. See Report on Your Grant for performance measure requirements and examples of reporting forms.

◦ Describe how you will collect and report required performance data accurately and on time.

◦ Describe how you will manage and securely store data.

▪ Include how you will report National Provider Identifier (NPI) numbers for participants. Project trainees in eligible disciplines must apply for and report on an NPI.

◦ Describe your process to track trainees after program completion for up to one year.

◦ Describe how you will monitor and analyze performance data to support continuous quality improvement.

• Program evaluation. The evaluation should examine processes and progress towards the program goal, program objectives, and expected outcomes.

Evaluations must follow the HHS Evaluation Policy, as well as the standards and best practices described in OMB Memorandum M-20-12. Describe your plan to evaluate the project. Include:

◦ The evaluation questions, methods, data to be collected, and timeline for implementation.

◦ The evaluation barriers and your plan to address them.

◦ The evaluation capacity of your organization and staff. Include experience, skills, and knowledge.

◦ How you will disseminate results, how you will assess whether your dissemination plan is effective, whether the results are national in scope, and the extent of potential replication.

• See reporting for more information.

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

Step 3: Prepare Your Application 21 https://bhw.hrsa.gov/funding/report-on-your-grant https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/200386/hhs-evaluation-policy.pdf https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf

Sustainability See merit review criterion 3: Impact

We expect you to sustain key project elements that improve practices and outcomes for the target population. Propose a plan for project sustainability after the period of federal funding ends.

Describe the actions you’ll take to:

• Highlight key elements of your project. Examples include training methods or strategies that have been effective.

• Obtain future sources of funding.

• Determine the timing to become self-sufficient.

• Discuss challenges that you’ll likely encounter in sustaining the program. Include how you expect to resolve these challenges.

Organizational information See merit review criterion 4: Resources and capabilities

• Briefly describe your mission, structure, and the scope of your current activities.

Explain how they support your ability to carry out the program requirements.

• Discuss how you’ll follow the approved plan, account for federal funds, and record all costs to avoid audit findings.

• Describe how you’ll assess the unique needs of the trainees you serve.

• Describe the organizations you will partner with to fulfill the program goal and meet the training objectives. Include key agreements and letters of support in Attachment 8 and Attachment 9.

• Include a project organizational chart in Attachment 2.

• Include a staffing plan and job descriptions for key faculty and staff in Attachment 3.

• Include biographical sketches for key staff using the Research & Related Senior/ Key Person Profile form. See other required forms.

Budget and budget narrative See merit review criterion 5: Support requested

Your budget should follow the instructions in section 3.1.4 of the R&R Application Guide and any specific instructions listed in this section.

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

Step 3: Prepare Your Application 22

HHS now uses the definitions for equipment and supplies in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

Reminder: Indirect costs for training awards cannot exceed 8% of modified total direct costs. The total project or program costs are all allowable (direct and indirect) costs incurred for the HRSA award activity or project. This includes costs charged to the award and non-federal funds used to satisfy any matching or cost sharing requirement (which may include maintenance of effort, if applicable).

The budget narrative supports the information you provide in the Research and Related Budget Form. See other required standard forms. Your budget should show a well-organized plan. The merit review committee reviews both.

The budget narrative includes an itemized breakdown and a clear justification of the requested costs. As you develop your budget, consider:

• Any faculty development costs.

• If the costs are reasonable and consistent with your project’s purpose and activities.

• The restrictions on spending funds. See funding policies and limitations.

• The budget amount for each year of the period of performance must not exceed the year one request. If a successful applicant requests funds for years two through five that exceed the year one request, then we will reduce the budget for years two through five down to the year one amount.

To create your budget narrative, see detailed instructions in section 3.1.5 of the R&R Application Guide. Follow these additional instructions specific to this NOFO.

Participant and trainee support costs If you include participant or trainee support costs:

• List tuition, fees, health insurance, travel, and other costs.

• Identify the number of participants and trainees.

• Separate these costs from others so we can identify them easily.

• Include a sub-total entitled “Total Participant and Trainee Support Costs” with the summary of these costs.

Preceptor costs Preceptors can be either your employee, contractor, or consultant. Preceptor costs are unique and different than trainee costs, which are for your residents. They provide supervision and mentorship to residents during clinical training, and their costs—such

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

Step 3: Prepare Your Application 23 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Supplies) as salary or stipends—are distinct from trainee costs, which cover the expenses directly related to supporting the trainees, like salaries, tuition, or stipends.

Allowable preceptor costs may include:

• stipends (other than to employees)

• percentage of salary (for employee time spent on award activities).

• continuing education, other trainings, and fees

• travel

Note: You cannot require students to pay for preceptor costs.

• If the preceptor is an employee, specify those costs under section B, Other Personnel; section D, Travel; and Section F, Other Direct Costs.

• If the preceptor is a consultant or contractor, lists those costs under section F, Other Direct Costs (e.g., Consultant Services or Subawards/Contractual Costs).

• Include the number of preceptors in your budget narrative.

Consultant services Identify each consultant, the services they will perform, the total number of days they will work, travel costs, and the total estimated costs.

Legal Services Grant funds cannot be used for legal services for patients.

Attachments Place your attachments in order in the Attachments form.

Attachment 1: Accreditation documentation Required. Counts toward page limit.

You must provide documentation of your residency program’s ACGME accreditation.

Please do not provide only the web link to the accreditation body’s website. HRSA will not open any links included in the application. A copy of the ACGME letter must be included in Attachment 1.

Attachment 2: Project organizational chart Required. Counts toward page limit.

Provide a one-page diagram that shows the full project’s organizational structure.

Include all aspects, not just the applicant organization.

Step 3: Prepare Your Application 24

Attachment 3: Staffing plan and job descriptions Required. Counts toward page limit.

See Section 3.1.7 of the R&R Application Guide.

Include a staffing plan that shows the staff positions that will support the project and key information about each. Justify your staffing choices, including education and experience qualifications and your reasons for the amount of time you request for each staff position.

For key personnel, attach a one-page job description. It must include the role, responsibilities, and qualifications.

Attachment 4: Clinical community-based rotations table Required. Counts toward page limit.

Provide a table of the clinical community-based rotation sites where your residents will train to provide health care for people experiencing homelessness. This could include shelters, motels, encampments, temporary housing, and mobile medical vans.

Community-based Clinical Rotation Sites

Clinical training site name

Full address

County Is site located in a tribal facility ? (Y/N)

Is site located in a rural area as determined by FORHP, using the Rural Health Grants Eligibility Analyzer ?

(Y/N)

Is site located in a Primary Care

HPSA

with a score of 17 or greater as listed at

HPSA-

Find ?

(Y/N and score)

Does the clinical site serve homeless populations?

(Y/N)

Length of rotation

Number of residents to be trained by year

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

Step 3: Prepare Your Application 25 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=1 https://www.ihs.gov/findhealthcare/ https://www.ihs.gov/findhealthcare/ https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/shortage-area/hpsa-find

Attachment 5: Maintenance of effort documentation Required. Counts toward page limit.

Specify the non-federal funds that support proposed activities. These include cash, in-kind, or other contributions. Do not include any federal funds. See maintenance of effort requirement.

Use the sample format below to provide the maintenance of effort documentation.

FY Before Application:

Actual non-federal expenditures

First FY of Award:

Estimated non-federal expenditures

Attachment 6: Funding preference documentation As applicable. Counts toward page limit.

Provide documentation that proves you qualify for the funding preference.

funding preferenceSee selection process for information about how this applies.

Do not submit this attachment if you do not qualify.

Attachment 7: Funding priority documentation As applicable. Counts toward page limit.

Provide documentation that proves you qualify for the funding priority.

See funding priority for information about how to qualify.

See selection process for information about how this applies.

Do not submit this attachment if you do not qualify.

Attachment 8: Letters of agreement, memoranda of understanding, and contracts As applicable. Counts toward page limit.

Provide any documents that describe working relationships between your organization and other organizations and programs you cite in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe the roles of the contractors and partners and any deliverables. Make sure any letters of

Step 3: Prepare Your Application 26 agreement are signed and dated. Organizational relationships that are necessary to carry out the proposal must be included here.

Attachment 9: Letters of support As applicable. Counts toward page limit.

You may provide letters of support from organizations or departments involved in the proposed project. Letters of support can also be from individuals within your institution who hold the authority to speak for the organization or department, such as a CEO or chair.

Recommenders should indicate an understanding of and commitment to the project.

Recommenders should sign and date their letters of support.

Attachments 10 to 15: Other documents as applicable Optional. Counts toward page limit.

You may submit other documents that you think are necessary to support your application.

Other required standard forms You will need to complete some other forms. Upload the forms listed at Grants.gov. You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms. See the application checklist for a full list of all application requirements.

Forms Submission Requirement

SF-424 R & R (Application for Federal Assistance) form

With application.

Research and Related Other Project Information

With application.

Standardized Work Plan (SWP) form With application.

Research and Related Senior/Key Person Profile (Expanded) form

With application.

Research and Related Budget form With application.

R & R Subaward Budget Attachment(s) Form If applicable, with the application.

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

Step 3: Prepare Your Application 27 https://www.grants.gov/forms

Forms Submission Requirement

Project/Performance Site Locations(s) form With application.

Disclosure of Lobbying Activities (SF-LLL) Form If applicable, with the application or before the award.

BHW Program Specific Data Form With application.

Form instructions SF-424 R&R form Does not count toward the page limit.

Follow the instructions for Application for Federal Assistance in section 3.1.1 of the R&R Application Guide.

Research and Related Other Project Information Only the project narrative counts toward the page limit.

In addition to the requirements in the project narrative section, you will provide some additional information in this form.

• Complete sections 1 through 6.

• Upload a blank document in item 7: Project Summary/Abstract to avoid a cross-form error with your Project Abstract Summary Form.

• Upload your project narrative in item 8.

• Leave items 9, 10, and 11 blank.

• If you have more than 10 subawards, you may use item 12 to add subaward budgets that could not fit in your R&R Subaward Budget Attachment(s) Form.

Standardized work plan form Does not count toward the page limit.

• In addition to the requirements in the high-level work plan section of the project narrative, follow these instructions:

• Submit your work plan through the SWP form. Provide a detailed work plan that demonstrates your experience or ability implementing a project of the proposed scope.

• Follow the instructions in the SWP form and in the high-level work plan section of the project narrative.

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

Step 3: Prepare Your Application 28

• The goal and three objectives in your SWP must exactly match the ones listed in the program description and copied as stated as the SWP goal. The goal for the PCTE-RESM program is to increase the number of physicians trained in a primary care specialty (family medicine, internal medicine, pediatrics and combined internal medicine-pediatrics [med-peds]) to provide care for people experiencing homelessness.

• All three program objectives must be included in each budget period.

• All sub-objectives should fit within one of the existing program objectives.

• For the person responsible for each activity, use job titles instead of names.

Research and Related Senior/Key Person Profile (Expanded) form The attached biographical sketches do not count toward the page limit.

In addition to the requirements in Project Narrative, Organizational Information, follow these instructions Include biographical sketches for people who will hold the key positions.

• Try to use no more than two pages per person.

• Do not include non-public, personally identifiable information

• If you include someone you have not hired yet, include a letter of commitment from that person with their biographical sketch.

• Upload sketches in this form.

• Include:

◦ Name and title.

◦ Education and training: For each entry include Institution and location, degree and date earned, if any, and field of study.

◦ Section A, Personal Statement. Briefly describe why the individual’s experience and qualifications make them well-suited for their role.

◦ Section B, Positions and Honors. List in chronological order previous and current positions. List any honors. Include present membership on any federal government public advisory committee.

◦ Section C, Other Support. This section is optional. List selected ongoing and completed projects during the last three years. Begin with any projects relevant to the proposed project. Briefly indicate the overall goal of the projects and responsibilities of the person.

◦ Other information. If applicable, include language fluency and experience working with populations that are culturally and linguistically different from their own.

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

Step 3: Prepare Your Application 29 https://grants.gov/learn-grants/grant-terminology#p

Please note, the R&R Application Guide states that biographical sketches count toward the page limit. However, per this Notice of Funding Opportunity, your biographical sketches will not count toward the page limit.

Research and Related Budget form Only the budget narrative counts toward the page limit.

In addition to the requirements in the budget and budget narrative section, follow these instructions:

Complete the Research and Related Budget Form. Follow the instructions in section

3.1.4 of the R&R Application Guide.

You will complete the form for each 12-month budget year for the proposed five-year period of performance. After completing the first budget period in the form, you may click “Add Period” to move to the next.

R&R Subaward Budget Attachment(s) Form Only the subaward budget narratives count toward the page limit.*.

You will also complete R&R Subaward Budget Attachments for each subaward you propose. These include subcontracts. You will attach these using the R&R Subaward Budget Attachment(s) Form.

To complete the budget forms, follow the instructions in Grants.gov

If you have more than 10 subawards, you may upload the extra budget forms in the Research and Related Other Project Information form in Item 12, Other Attachments.

Project/Performance Site Location(s) form Counts toward the page limit.

Follow the form instructions in Grants.gov.

Disclosure of Lobbying Activities (SF-LLL) Form Does not count toward the page limit.

Follow the form instructions in Grants.gov.

BHW Program Specific Data Form Does not count toward the page limit.

Follow the form instructions in Grants.gov.

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

Step 3: Prepare Your Application 30 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=43

Step 4:

Learn About Review and Award

In this step

Application review 32

Selection process 36

Award notices 40

Application review Initial review We review each application to make sure it meets eligibility criteria, including the completeness and responsiveness criteria. If your application does not meet these criteria, it will not be funded.

Also, we will not review any pages over the page limit.

Merit review A panel reviews all applications that pass the initial review. The members use these criteria.

Criterion Total number of points = 100

1. Purpose and need 15 points

2. Response 35 points

3. Impact 20 points

4. Resources and capabilities 20 points

5. Support requested 10 points

Criterion 1: Purpose and need 15 points.

See Project Narrative Introduction and Purpose and Need sections.

The panel will review your application for:

• How well it describes the purpose of your project, including the demographics of the community and populations that residents will serve, such as data on the SDoH and primary care needs that the project will address.

• How well it provides information on existing training and gaps that may exist.

Criterion 2: Response 35 points.

See Project Narrative Approach, High-Level Work Plan, and Resolving Challenges sections.

Step 4: Learn About Review and Award 32

Approach (15 points) The panel will review your application for how well it:

• Describes how you will address your stated needs, as well as the program requirements and expectations described in this NOFO.

• Describes how you will enhance curricula to train residents in street medicine to provide care people experiencing homelessness, including addressing SDoH and behavioral health needs.

• Describes how you will implement the required rotations to serve people experiencing homelessness.

• Describes your plans for faculty hiring, support staff hiring, clinical space, and any contractual services in the proposed project.

• Describes how you will train residents in interprofessional teams including behavioral health and medical-legal teams.

• Explains your strategies to improve residents’ cultural competence to meet the needs of people experiencing homelessness. Your strategies should draw on the CLAS in Health and Health Care Standards.

High-level work plan (15 points) The panel will review your application for how well it:

• Describes how you will achieve the goal and three program objectives of this NOFO and describes how you will meet the Program Requirements and expectations.

• Provides in the SWP a timeline for each of the five budget years by quarter that includes each activity and identifies who is responsible for each by their title.

• Provides requested information about the community-based rotations.

• Provides Attachment 4: Clinical Community-based Rotations Table. Table should be clear and complete.

• Describes how you will work with community-based sites to assure adequate supervision and logistical support for residency rotations.

• Describe how you will work with stakeholders to address the Objectives and the Requirements of this NOFO.

Resolution of challenges (5 points) The panel will review your application for how well it:

• Describes the obstacles and challenges you may face during project design and implementation. This includes the quality of your plan to deal with them.

• Responds to specific areas of potential challenge, including but not limited to:

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

Step 4: Learn About Review and Award 33

◦ Recruiting residents.

◦ Providing services to people experiencing homelessness.

◦ Barriers to residents’ access to education and training in your program.

◦ Supervising and supporting residents at sites other than the academic home.

◦ Safety of residents and faculty at clinical sites.

Criterion 3: Impact 20 points.

See Project Narrative Performance Reporting and Evaluation and Sustainability sections.

Performance reporting and evaluation (10 points) The panel will review your application for how well it:

• Proposes an effective project that is likely to have a strong impact on the community and people served.

• Describes plans for effectively disseminating project results that could be replicated by others or be national in scope.

• Demonstrates strong and effective methods to monitor and evaluate project results.

• Includes measures that will assess how well program objectives have been met and to what extent the results are because of the project.

• Presents a quality plan to collect and manage data to ensure accurate and timely performance.

• Describes your process to collect and report NPI numbers for eligible participants.

This includes a process to track residents after program completion for up to one year.

• Proposes a plan to use collected data for continuous quality improvement and to monitor and evaluate project results.

• Anticipates evaluation obstacles and explains how you propose to address them.

Sustainability (10 points) The panel will review your application for how well it:

• Proposes a solid plan for sustaining the project beyond the duration of federal funding.

• Describes likely challenges to be encountered in sustaining the program and describes logical approaches to resolving the challenges.

Step 4: Learn About Review and Award 34

Criterion 4: Resources and capabilities 20 points.

See Project Narrative Organizational Information and Performance Reporting and Evaluation sections.

The panel will review your application to determine the extent to which:

• Project staff have the training…