HRSA-26-045 Final.pdf

Notice of Funding Opportunity

Application due 08/12/2026

Federal Office of Rural Health Policy

Delta States Rural Development Network Program

Opportunity Number: HRSA-26-045

Table of Contents

Before You Begin

Step 1: Review the Opportunity

Basic information

Funding details

Eligibility

Program description

Award information

Step 2: Get Ready to Apply

Get registered

Find the application package

Application writing help

Step 3: Build Your Application

Application checklist

Application contents and format

Step 4: Understand Review, Selection, and Award

Application review

Selection process

Award notices

Step 5: Submit Your Application

Application submission and deadlines

Other submissions

Step 6: Learn What Happens After Award

Post-award requirements and administration

Reporting

Contacts and Support

Agency contacts

Help with systems

Appendices

Before You Begin

Health Resources and Services Administration

Federal Office of Rural Health Policy

Delta States Rural Development Network Program

HRSA-26-045

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.

Step 1: Review the Opportunity

Basic information

Support the planning, development and implementation of integrated health networks to increase access to, and improve quality and outcomes of, basic health care services in the rural

Mississippi Delta Region.

Summary

The Delta States Rural Development Network Program supports the planning, development, and implementation of integrated health care networks that collaborate in order to:

• (i) achieve efficiencies;

• (ii) expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes in rural areas within the eight rural Mississippi Delta

Region states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee); and

• (iii) strengthen the rural health care system as a whole.

Have questions? Go to Contacts and Support.

Key facts

Opportunity name: Delta States Rural Development Network Program

Opportunity number: HRSA-26-045

Announcement version: initial

Federal assistance listing: 93.619

Key dates https://dra.gov/ https://dra.gov/

NOFO issue date: 07/13/2026

See Join the webinar

Application deadline: 08/12/2026

Expected award date is by: 09/01/2026

Expected start date: 09/30/2026

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

Funding details

Application Types:

New

Expected total available funding in FY:

2026: $12,000,000

Expected number and type of awards:

12 G (Grant)

Funding range per award:

$905,664 - $1,188,684 total (up to $56,604 per required county/parish)

We plan to fund awards in three 12-month budget periods for a total 3-year period of performance from 09/30/2026 to 09/29/2029.

Eligibility

Who can apply

Types of eligible organizations

These types of *domestic organizations may apply:

• State governments

• County governments

• City or township governments

• Special district governments

• Independent school districts

• Public and State controlled institutions of higher education

• Native American tribal governments (Federally recognized)

• Public housing authorities/Indian housing authorities

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

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

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

• Private institutions of higher education

• For profit organizations other than small businesses

• Small businesses

• Others (see text field entitled "Additional Information on Eligibility" for clarification)

• Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled “Additional Information on Eligibility”

“Domestic” means 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.

Additional information on eligibility

Eligible applicants include domestic public or private, non-profit or for-profit entities including domestic faith-based and community-based organizations, tribes and tribal organizations. The applicant organization may be located in a rural or urban area and must have demonstrated experience serving, or capacity to serve, populations in rural areas within the eight Mississippi

Delta Region States (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee).

The applicant organization may not previously have received an award under 42 U.S.C. 254c(f) for the same or a similar project unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria

1. Have demonstrated experience serving, or capacity to serve, rural populations with limited access to care within the eight Mississippi Delta Region States (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee). You can demonstrate this by describing the buy-in from the rural community or communities your proposed project plans to serve in your project narrative.

2. Ensure all grant activities serve only counties and/or census tracts located in HRSA-designated rural areas of the Delta region – see ‘Geographic Service Area requirements’ for the Delta region. Refer to and provide required documentation in Attachment 3: Map of service area.

3. Represents a network that meets all Program Requirements and Expectations.

https://data.hrsa.gov/topics/rural-health/rural-health-eligibility

4. Have not previously received an award under this program (42 U.S.C. 254c(f)) for the same or similar project. If you have previously received an award under this program, you are eligible to apply if you:

• Expand the scope of the project or service area.

• Target a new population or new focus area.

• Include new or additional network members.

5. Consult your State Office of Rural Health (SORH) regarding your intent to apply to this program. Refer to Attachment 1: Required documentation from State Office of Rural

Health for required documentation from SORH required documentation from SORH.

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.

• Fails to cover the entire required service region, or that proposes a project to serve outside of the specified required service region, or that submit more than one proposal.

Applications submitted over the 50-page limit will be redacted to a 50-page total. Completeness and responsiveness will be assessed based on the redacted version of the application, if submission is over the page limit.

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.

Generally, you may not submit multiple applications under the same Unique Entity Identifier

(UEI) (previously DUNS) number and/or EIN.

You may only submit multiple applications under the same Unique Entity Identifier (UEI) number and/or EIN, if each proposes distinct projects and an appropriate EIN Exception Request is submitted with your application. We will only review your last validated application for each distinct project before the deadline.

For more information about UEI/EIN exceptions request, please see Attachment 9: EIN/UEI exception request and Attachment 10: Tribal EIN/UEI exception request.

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. Recipients agree that once committed, cost sharing amounts are enforceable and subject to reporting and auditing requirements under 2 CFR 200.

Post-award requirements https://www.hrsa.gov/rural-health/grants/rural-hospitals/sorh

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.

Program description

Purpose

The Delta States Rural Development Network Program (Delta Program) provides funding to the eight states in the Mississippi Delta Region for network and rural health infrastructure development. This program connects rural health care organizations so they can work together as a network to better address local challenges, expand access, and improve the quality of care in the rural communities these organizations serve. The program helps network participants work together on three legislative aims:

i. Achieve efficiencies;

ii. Expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes in rural areas within the eight rural Mississippi Delta Region states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and

Tennessee); and

iii. Strengthen the rural health care system as a whole.

Funding Opportunity Goals

• Expanding access to care resources in the designated Mississippi Delta counties/parishes.

• Utilization of evidence-based or promising practice models known to improve health outcomes and enhance the delivery of health care services.

• Collaboration with network partners in the planning and delivery of health care services to increase access to care and reduce chronic disease.

• Implementation of sustainable health care programs that improve population health, health outcomes, and demonstrate value to the local rural communities.

Background

HRSA’s Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within the U.S. Department of Health and Human Services. FORHP programs provide technical assistance and other activities as necessary to support improving health care in rural areas.

The Delta Program is authorized by 42 U.S.C. § 254c(f) (§ 330A(f) of the Public Health Service

Act). This program enables recipients to use federal funding for the planning, development and implementation of integrated health care networks to achieve efficiencies, improve health care services and associated health outcomes and strengthen the rural health care system.

The Delta Program helps advance the Making American Health Again (MAHA) priorities, which include:

• Expand access to primary care;

• Reducing chronic disease;

https://www.hrsa.gov/rural-health https://uscode.house.gov/view.xhtml?req=(title:42%20section:254c%20edition:prelim) https://uscode.house.gov/view.xhtml?req=(title:42%20section:254c%20edition:prelim) https://www.hhs.gov/maha/index.html

• Preventive health; and

• Early childhood health and nutrition.

Program requirements and expectations

Programs funded through this program must meet all program requirements and expectations outlined in this section.

Geographic Services Area Requirements

Eligible applicant organizations for the Delta Program must meet geographic service area requirements. HRSA expects to make one award per geographic service area. All of the Delta states have service regions. These service areas are based upon natural geographic, as well as state public health system regional formations.

You must follow these guidelines in your application:

• Alabama, Illinois, Kentucky, and Tennessee each have one service region that encompass all of their rural Delta counties.

o Applicants from these states must apply for the entire service region and serve all the required counties in that service region. Applicants may apply for a ceiling amount of $56,604 per required eligible county/parish per year (subject to the availability of appropriated funds).

o Applicants may choose to serve the optional counties but will not receive any additional funding to do so.

• Arkansas, Louisiana, Mississippi and Missouri have a larger number of Delta counties/parishes and are therefore divided into two service regions (Region A and

Region B).

o Applicants in Arkansas, Louisiana, Mississippi and Missouri must choose to apply for either Service Region A or Service Region B only. Applicants may apply for a ceiling amount of $56,604 per required eligible county/parish per year

(subject to the availability of appropriated funds). Applicants may choose to serve the optional counties but will not receive any additional funding to do so.

o Applicants in Arkansas, Louisiana, Mississippi and Missouri may not apply for both regions. Additionally, the applicant organization submitting a proposal for

Service Region A for instance, may not be the applicant organization or be a member of the consortia for Service Region B, and vice versa.

• Applicants who submit a proposal who do not apply for the entire required service region, or who include service areas outside of the specified service region, or who submit more than one proposal will be deemed non-responsive and will not be considered for this funding opportunity.

• Eligible applicant organizations for the Delta Program must propose projects to be implemented in a Delta state’s service region. Applicants must identify which Delta

Service Region they will serve in the Project Abstract.

• The applicant organization must include a legible map that clearly shows the location of network partners, the geographic area(s) that will be served by the network, and any other information that will help reviewers visualize and understand the scope of the proposed project activities in Attachment 3: Map of service area.

• All activities supported by a Delta Program grant must exclusively target populations in rural areas (rural areas are defined as HRSA-designated rural counties/parishes or rural census tracts in these counties). Please use HRSA’s Rural Health Grants Eligibility

Analyzer to determine whether the proposed rural census tract is rural, if applicable.

• HRSA may work with awardees in future years to adjust service areas based on need.

• HRSA may revisit county prioritization and service area expectations in future years based on appropriations, stakeholder engagement, Administration priorities, and other program redesign considerations.

The HRSA-designated rural service areas for single/multi-service Delta region states are defined as follows:

Alabama:

Service Region A (19 designated counties)

Required: Barbour, Bullock, Butler, Choctaw, Clarke, Conecuh, Dallas, Escambia, Greene, Macon, Marengo, Monroe, Perry, Pickens*, Sumter, Washington, Wilcox

Optional: Hale+, Lowndes*+, Arkansas:

Service Region A (20 designated counties)

Required: Arkansas, Ashley, Bradley, Calhoun, Chicot, Dallas, Desha, Drew, Grant, Jefferson*, Lee, Lincoln*, Lonoke*, Monroe, Ouachita, Phillips, St. Francis, Union

Optional: Cleveland+, Pulaski*

Service Region B (21 designated counties)

Required: Baxter, Clay, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Marion, Mississippi, Poinsett*, Prairie, Randolph, Searcy, Sharp, Stone, Van Buren, White, Woodruff

Optional: Craighead§

Illinois:

Service Region A (16 designated counties)

Required: Alexander*, Franklin, Gallatin, Hamilton, Hardin, Jackson*, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White

Optional: Williamson+

Kentucky:

Service Region A (21 designated counties)

Required: Ballard, Caldwell, Calloway, Carlisle, Christian*, Crittenden, Fulton, Graves, Hickman, Hopkins, Livingston, Lyon, Marshall, McLean*, Muhlenberg, Todd, Trigg, Union, Webster

Optional: Henderson+, McCracken‡

Louisiana:

Service Region A (26 designated parishes)

Required: Bienville, Caldwell, Claiborne, East Carroll, Franklin, Jackson, La Salle, Lincoln, Madison, Morehouse, Natchitoches, Rapides*, Red River, Richland, Tangipahoa*, Tensas, Union, Washington, West Carroll, West Feliciana, Winn

Optional: De Soto+, Webster+, Grant+, Vernon+, Sabine+

Service Region B (25 designated parishes)

Required: Acadia, Allen, Assumption*, Avoyelles, Beauregard, Catahoula, Concordia, Evangeline, Jefferson Davis, Lafourche*, Plaquemines*, Pointe Coupee*, St. Landry, St. Martin*, St. Mary, Optional: Ascension‡, Cameron+, East Feliciana+, Iberia+, Jefferson Parish*+, Livingston§, Orleans Parish*+, St. Helena+, St. James‡, Vermilion*+

Mississippi:

Service Region A (21 designated counties)

Required: Attala, Bolivar, Carroll, Coahoma, Grenada, Holmes, Lafayette, Leflore, Montgomery, Panola, Quitman, Sunflower, Tallahatchie, Tippah, Tunica, Union, Washington, Yalobusha

Optional: Benton+, Marshall+, Tate+

Service Region B (22 designated counties)

Required: Adams, Amite, Claiborne, Copiah, Covington, Franklin, Humphreys, Issaquena, Jasper, Jefferson, Jefferson Davis, Lawrence, Lincoln, Marion, Pike, Sharkey, Smith, Walthall, Warren, Wilkinson, Yazoo

Optional: Simpson+

Missouri:

Service Region A (16 designated counties)

Required: Butler, Carter, Crawford (except in Sullivan City), Dent, Douglas, Howell, Iron, Oregon, Ozark, Phelps, Reynolds, Ripley, Shannon, Texas, Wayne, Wright

Service Region B (12 designated counties)

Required: Dunklin, Madison, Mississippi, New Madrid, Pemiscot, Perry, St. Francois, St.

Genevieve, Scott, Stoddard, Washington

Optional: Bollinger+

Tennessee:

Service Region A (20 designated counties)

Required: Benton, Carroll, Chester, Decatur, Dyer, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Lake, Lauderdale, McNairy, Obion, Tipton, Weakley

Optional: Crockett+, Madison‡, Shelby*+

*Only certain census tracts in the counties/parishes are rural. Please use HRSA’s Rural Health

Grants Eligibility Analyzer to determine whether an address is rural.

+These eligible counties are optional counties that can be served within the funding amount provided for the required service area.

‡These previously required counties no longer meet the HRSA definition of rural. They are now optional counties that can be served within the funding amount provided for the required service area for 1 year. HRSA reserves the right to revisit the eligibility of these counties in subsequent funding years.

§ These previously optional counties no longer meet the HRSA definition of rural. They are now optional counties that can be served within the funding amount provided for the required service area for 1 year. HRSA reserves the right to revisit the eligibility of these counties in subsequent funding years.

Network Composition Requirements and Expectations

For the purposes of this Delta program, we define:

• Health care networks: at least three regional or local organizations that come together to develop strategies for improving health services in a community.

• Network participants: local organizations that come together to form a health care network.

Applicants must meet all the following Network requirements:

• Represent a health care network comprised of three or more network participants

(including the applicant organization). This includes:

o No less than three separately owned network participants with their own

EIN/UEI number, unless an exception is requested. See Attachment 9: EIN/UEI exception request or Attachment 10: Tribal exception request.

o Provide the EIN/UEI number for the applicant organization and each network participant in Attachment 7: Network organizational chart and network participant information showing:

• At least 66%, or two-thirds of the network participant organizations working directly on your proposed project, are physically located in a qualifying eligible HRSA designated rural area within the Delta region. The applicant organization must verify and indicate the https://data.hrsa.gov/topics/rural-health/rural-health-eligibility https://data.hrsa.gov/topics/rural-health/rural-health-eligibility rural or urban eligibility of each network member organization in Attachment 7:

Network organizational chart and network participant information.

• Scanned, signed copies of Memorandum of Understanding/Agreement or other formal collaborative agreements from each network participant are submitted under Attachment

6: Memorandum of Understanding/Agreement.

• Network participants may be located in rural or urban areas and can include all domestic public or private, non-profit or for-profit entities including faith-based, community-based organizations, tribes, and tribal organizations.

• Applicants are required to ensure that the rural populations with limited access to care in the local community or region to be served will benefit from and be involved in the development and ongoing operations of the network. Activities and services of the network must be provided in the designated proposed Delta Service Region.

• Network participants must prioritize addressing gaps in care and expand capacity to create long-term systems-based changes, resulting in practice transformation.

• The applicant organization is required to have the staffing and infrastructure necessary to oversee program activities, including a permanent Project Director or have established an interim Project Director capable of overseeing the network’s administrative, fiscal, and business operations at the time an award is made. HRSA recommends the Project

Director be the equivalent of a full-time employee (1.0 FTE/ 100 percent FTE) of the applicant organization and devote adequate time (recommended to be at least 1.0 FTE) to the project to ensure commitment is reasonable.

• Programs are required to utilize evidence-based or promising practices/models to promote successful program implementation. See the Project Narrative section for additional information.

Focus Areas and Evidence-Based/Promising Practice Requirements

1. Focus Area: Due to the medically underserved nature of the region, applicants are required to propose a project based on no more than two of the following focus areas: 1) diabetes, 2) cardiovascular disease, 3) obesity, 4) acute ischemic stroke, 5) chronic lower respiratory disease, 6) cancer, or 7) unintentional injury/substance use.

2. Evidence-Based/Promising Practice: HRSA recognizes the importance of identifying and implementing an evidence-based or promising practice model. Therefore, all recipients are required to adopt an evidence-based or promising practice approach that proves demonstrated outcomes and may be replicable in other communities. An example of a promising practice would be a small-scale pilot program that has generated positive outcome evaluation results that justify program expansion to new access points and/or to new service populations.

3. Value Based Care Approach: All applicants are encouraged to incorporate value-based care (VBC) models or reimbursement strategies where appropriate. If an applicant selects a value-based care approach, the applicant must provide the proposed value-based care model and describe how the model will benefit the project and target rural population.

Data Reporting Requirements

• In an effort to improve the quality of basic health care services and associated health outcomes relating to chronic disease or five-leading causes of death, applicants are strongly encouraged to propose projects that follow a manageable and similar population base throughout the project period so that meaningful longitudinal data can be collected.

Longitudinal data involves repeated observation of the same variable(s) (e.g., wellness screening measures) over an extended period. In addition to wellness screening measures, other health indicators such as changes in knowledge, behavior, attitudes, and quality improvement utilization data, such as hospital emergency room utilization and 30-day readmissions, are encouraged to be included in the project.

• All award recipients will be required to collect and submit data to HRSA after the end of each budget period (see Appendix A for draft measures). Additionally, award recipients will be required to report cost-savings data using a FORHP-specific cost savings calculator tool. Award recipients will not be asked to report performance measures that have not completed an OMB Paperwork Reduction Act process.

Technical Assistance

1. All award recipients will receive technical assistance (TA) throughout the three-year period of performance. Targeted TA will assist award recipients with achieving desired project outcomes, sustainability, and strategic planning, and will ensure alignment of the awarded project with the Delta Program goals. TA is provided to award recipients at no additional cost and is an investment made by FORHP to ensure the success of the awarded projects. FORHP has found that most award recipients benefit greatly from the support provided through these collaborations. If funded, award recipients will learn more about the targeted technical assistance and evaluation support.

Statutory authority

42 U.S.C. § 254c(f) (§ 330A(e) of the Public Health Service Act)

Award information

Changes in HHS regulations As of October 1, 2025, HHS has adopted 2 CFR Part 200, with some modifications included in 2

CFR Part 300. These regulations replace those in 45 CFR Part 75.

Policies

• To make an award, funding must be available and allocated for this program and purpose, at which point we will move forward with the review and award process.

• Have clear policies and good financial practices to avoid spending HRSA funds on unallowable activities. Like other award rules, we may audit your policies, procedures, and controls.

• Support beyond the first budget year will depend on:

o Appropriation of funds.

https://uscode.house.gov/view.xhtml?req=(title:42%20section:254c%20edition:prelim) https://www.ecfr.gov/current/title-2/part-200 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-300 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-300 o Your satisfactory progress in meeting the project’s objectives.

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

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

o Fund more applicants from the rank order list.

o Extend the period of performance.

o Award supplemental funding.

General limitations

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

o Allowable and Unallowable Costs and Activities in the HHS Grants Policy

Statement.

• All costs must be reasonable, necessary, allocable to the award, and adequately documented (2 CFR 200.403).

• You cannot earn profit from the federal award. See 2 CFR § 200.400(g).

• Current appropriations law includes a salary limit of $228,000 as of January 2026 that applies to this program. You may pay salaries at a higher rate if the rate beyond the salary rate limit (Executive Level II) is paid with non-HHS funds. For help calculating salaries under this limit, read more at “salary rate limitation” in Step 1 of the How to Apply –

Application Guide.

Program-specific statutory or regulatory limitations

• 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.

• To make an award, funding must be available and allocated for this program and purpose, at which point we will move forward with the review and award process.

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.

To incur indirect costs, you can select one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 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/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.404 https://www.ecfr.gov/current/title-2/section-200.405 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.403 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g) https://www.hrsa.gov/sites/default/files/hrsa/grants/how-to-apply-application-guide.pdf#page=6 https://www.hrsa.gov/grants/manage-your-grant

Method 2 – De minimis rate. Per 2 CFR § 200.414(f), if you do not have a current negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is up to 15% of modified total direct costs (MTDC). See 2 CFR § 200.1 for the definition of MTDC. You can use this rate indefinitely for all your federal awards or until you choose to receive a negotiated rate.

Consider your indirect costs when developing your budget.

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 2 CFR 200.307.

Step 2: Get Ready to Apply

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 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 and How to Apply for Grants.

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-26-045.

https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/section-200.307 https://sam.gov/content/entity-registration 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 https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/search-grants https://www.grants.gov/search-grants

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

If you need additional information about getting registered or finding the application package, see Step 2 in the How to Apply – Application Guide.

Application writing help

Visit HHS Tips for Preparing Grant Proposals.

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

See Apply for a Grant for other help and resources.

Join the webinar

For more information about this opportunity, join the webinar. More information on the HRSA-

26-045 webinar will be posted at a later date to the documents tab in Grants.gov.

We recommend that you “Subscribe” to the NOFO on Grants.gov to receive updates when we post documents.

We will record the webinar.

Step 3: Build Your Application

Application checklist

There are two types of forms in Grants.gov.

• Some forms allow you to upload components of your application to the form. These include components like your project narrative, budget and budget narrative, and attachments, as applicable.

• Other forms are more typical, fill-in-the-blank forms.

Make sure that you have everything you need to apply.

Narratives

Component Grants.gov form Included in page limit*?

◻ Project narrative

Use the Project Narrative Attachment form.

Project Narrative Attachment form.

Yes

◻ Budget narrative Budget Narrative Attachment form.

Yes https://www.hrsa.gov/sites/default/files/hrsa/grants/how-to-apply-application-guide.pdf#page=8 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 https://www.hrsa.gov/grants/apply-for-a-grant

Use the Budget Narrative Attachment form.

Attachments

Insert each in the Attachments Form in this order.

Component Included in page limit*?

◻ 1. Documentation from State Office of Rural Health No

◻ 2. Work plan Yes

◻ 3. Map of service area Yes

◻ 4. Staffing plan and job descriptions Yes

◻ 5. Biographical sketches Yes

◻ 6. Memorandum of Understanding/Agreement (MOU/A) Yes

◻ 7. Network organizational chart and network participant information

Yes

◻ 8. Funding preference documentation Yes

◻ 9. EIN/UEI exception request Yes

◻ 10. Tribal exception request Yes

◻ 11. Current and previous grants Yes

◻ 12. CMS Rural Health Transformation program details Yes

◻ 13. Other relevant document Yes

◻ 14. Other relevant document Yes

◻ 15. Other relevant document Yes

Other required forms

Upload using each required form in Grants.gov.

Forms Submission requirement

Application for Federal Assistance (SF-424) With application.

Project Abstract Summary Form With application.

Grants.gov Lobbying Form With application.

Disclosure of Lobbying Activities (SF-LLL), optional With application.

Project/Performance Site Location(s) With application.

Budget Information for Non-Construction Programs (SF 424A) With application.

Key Contacts With application.

*Only what you attach in these forms counts toward the page limit. The forms themselves do not count.

Application contents and format

This section includes guidance on each component found in the application checklist.

Application page limit: 50

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

Required format

You can find technical guidance for formatting your application documents in Step 5 of the

NOFO and in Step 5 of the How to Apply - Application Guide.

Project narrative

Introduction

See merit review criterion 1: Need

• Briefly describe the purpose of your project, the focus area(s), project goals and expected outcomes. Project activities must comply with the nondiscrimination requirements.

• Briefly describe the evidence-based or innovative, evidence-informed model(s) that will be used.

• If applicable, briefly describe any modification(s) made to the model your project proposes to use.

Need See merit review criterion 1: Need

This section will help reviewers understand who you will serve. Complete responses include citations referencing any relevant federal, state, local data, if possible. If availability of data is limited to cite, indicate this and use alternative means to document how needs were assessed.

• Specifically outline the service region and the specific target population(s) you will serve through this funding.

• Describe the health care needs and related upstream drivers of health (e.g. such as employment, education, income, housing, transportation) of the target population within your entire rural service region.

• Describe the current rural health landscape, including strengths as well as barriers and gaps impacting health care delivery in your specific rural service region.

Approach See merit review criterion 2: Response

This section will help reviewers understand how you will address your stated needs and meet the program requirements and expectations described in this NOFO.

https://www.hrsa.gov/sites/default/files/hrsa/grants/how-to-apply-application-guide.pdf#page=25

• Describe how your proposed project will help meet the health care-related needs of your target population within the rural service region. Make sure they are clear, realistic, and can be measured. Include when you plan to complete them.

• Describe the evidence-based or promising approach your project will use. Explain why this approach is a good fit for the rural community and the people you will serve.

o Describe any changes you made to the approach, if any. Explain how those changes will help the approach work better for your project and rural community.

• Tell us how you’ll meet the funding opportunity goals and all the program requirements and expectations described in this NOFO.

• Explain how your project will build from, but does not duplicate other federal, regional, state, local or tribal programs.

High-level work plan See merit review criteria 2: Response and 4: Impact

This section will help reviewers understand how you will achieve each of the objectives during the period of performance. You must also include a detailed work plan in table format in

Attachment 2: Work Plan that aligns with the requirements described here.

• Give an overview of the specific activities you will implement during the period of performance to successfully execute your proposed project and meet the Delta Program funding opportunity goals. The overview should include:

o Key activities you will carry out during the entire three-year period of performance.

o A timeline for each activity. Show that your plan is realistic and achievable.

o Clearly identify which network participant(s) or individual(s) will be responsible for each activity during the entire period of performance.

o Identify the measures you will use to track progress for each activity. These may include process measures, outcome measures, or benchmarks. Explain how you will use them to monitor progress and determine whether you are meeting your objectives.

o Describe the expected results of your activities. Explain how they will affect the target population, the network, and network participants.

• Explain how you will share reports, products, and results. Include how you will communicate with network participants and other key stakeholders.

• Explain how network participants will work together to plan, design, and carry out the activities in the work plan.

You will also include a more detailed work plan in Attachment 2: Work Plan.

Resolving challenges See merit review criterion 2: Response

This section will help reviewers understand how you will address anticipated challenges and barriers.

• Discuss possible challenges you may face in designing and carrying out the activities in the work plan. Explain how you will resolve them. Include how you will adapt to changes and new information you gather during the project.

Performance management See merit review criteria 3: Performance reporting and evaluation and 5: Resources and capabilities

• This section will help reviewers understand your plan for assessing project performance, tracking data and associated health outcomes for a manageable and consistent population enabling the collection of meaningful longitudinal data. Describe how you will work with network participants to collect and report information to HRSA accurately and on time.

• Describe how you will manage and securely store data, including how you will protect data against cybersecurity threats, breaches, or other loss of data integrity.

• Describe how you will monitor and analyze performance data/information to continually improve your program. This includes helping the network set shared goals and using data to guide the workplan activities.

See the reporting section for more information.

Sustainability See merit review criterion 4: Impact

You must include and describe your sustainability plans in the project narrative. This section will help reviewers understand your plan to sustain key functions, activities, or services of the proposed project.

• Propose a plan for project sustainability after the federal funding ends.

• Describe the actions you’ll take to obtain future sources of funding.

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

Organizational information See merit review criterion 5: Resources and capabilities

This section will help reviewers understand the capacity of the applicant organization and its network participants, as well as the proposed project staffing to carry out this project.

Applicant Organization

• Provide a brief overview of your organization that includes:

o Current mission.

o Structure, leadership, size of organization, and staffing.

o Scope of relevant current and past activities.

o Connection to and ability to serve the target rural service area within the Delta region.

o Ability to manage the project and personnel.

o Financial practices and systems in place to ensure your organization can properly account for and manage federal funds.

• Explain how these details relate to your capacity to lead the proposed project.

Key personnel and staffing

• Describe your plan to staff the project and how you will make sure all required roles and functions described in the program requirements and expectations are fulfilled.

o Include details of each position in Attachment 4: Staffing plan and job descriptions.

o For each staff member reflected in the staffing plan, provide a brief biographical sketch in Attachment 5: Biographical sketches that clearly demonstrates the staff member has appropriate and applicable experience for their role(s)on the project.

o If anyone will fulfill more than one role, describe why this is needed and how you will make sure they meet all relevant expectations.

• Briefly describe how you will manage the project team and ensure work is done effectively and efficiently.

Network Participants

• Describe how you will ensure that network participants and other community stakeholders are engaged and actively participating throughout the project.

• Give an overview of current or proposed network participants and your planned network structure. Include:

o Why the network participants were selected and what each will contribute to the project.

o How your network will meet the requirement that at least 66% of network participants are physically located (either the headquarters or a satellite site) in the target rural service area within the Delta region.

o How you will ensure that network participants have demonstrated experience serving, or capacity to serve, high-need rural populations.

o How will decision making be shared within and across the network and how often the network will meet to ensure there is a shared responsibility to carry out this project for the rural communities.

• Include signed MOU/A with all network participants (not including the applicant organization) in Attachment 6: Memorandum of Understanding/Agreement.

• This network overview should be consistent with the information found in Attachment 7:

Network organizational chart and network participant information.

Budget and budget narrative

See merit review criterion 6: Support requested

Your budget should follow the instructions in budget narrative: detailed instructions section of the Application Guide and the instructions listed in this section. Your budget should show a well-organized plan.

HHS now uses the definitions for equipment and supply 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.

The total project or program costs are all allowable (direct and indirect) costs used for the HRSA award activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include maintenance of effort, if applicable).

The budget narrative supports the information you provide in Standard Form 424-A. It includes an itemized breakdown and a clear justification of the costs you request. The merit review committee reviews both.

https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#p-200.1(Supply)

As you develop your budget, consider:

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

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

• Travel: Allocate travel funds for up to two (2) program staff per year to attend an annual

2.5-day technical assistance workshop in Washington, DC and include the cost in this budget line item. To determine estimated travel costs to Washington, D.C., see the U.S.

General Services Administration (GSA) per diem rates for FY 2026.

• Contractual: You are responsible for ensuring that your organization or institution has an established and adequate procurement system with fully developed written procedures for awarding and monitoring all contracts (including any sub-contracts that may be awarded with this funding).

o Consistent with 2 CFR 200, you must provide a clear explanation of the purpose of each contract, how the costs were estimated, and the specific contract deliverables.

• Budget for multi-year award: You include a budget narrative for each year of the three-year period of performance submitted with your application.

o Funding beyond the one-year budget period is subject to availability of funds, satisfactory progress of the awardee, and a determination that continued funding would be in the best interest of the Federal Government.

• Funding distribution among network participants: You must include in the budget narrative how federal award funds will be distributed to network participants.

o Include how the flow of funding and decision-making authority will be handled among rural network participants to best serve rural service areas.

To create your budget narrative, see budget narrative detailed instructions in Step 3 section of the

How to Apply – Application Guide.

Attachments

Place your attachments in this order in the Attachments Form. See application checklist to determine if they count toward the page limit.

Unless the instructions below require it, do not submit organizational brochures or other promotional materials (for example, slides, films, clips).

Attachment 1: Documentation from State Office of Rural Health The State Office of Rural Health serves as a focal point for rural health within each respective state.

Eligible applicant organizations are required to prepare and submit their application, in consultation with the appropriate State Office of Rural Health or another appropriate State entity.

You are expected to start this coordination early enough to allow sufficient time for discussion and input prior to submission.

• To meet this requirement, include a copy of your correspondence with the appropriate

State Offices of Rural Health (SORH).

https://www.gsa.gov/travel/plan-book/per-diem-rates https://www.hrsa.gov/sites/default/files/hrsa/grants/how-to-apply-application-guide.pdf#page=14 https://www.hrsa.gov/sites/default/files/hrsa/grants/how-to-apply-application-guide.pdf#page=14 https://plus.nosorh.org/Web/Membership/Directory/State_Members_List.aspx

• If you are an applicant from the U.S. territories and do not have the functional equivalent of a SORH or another appropriate State entity, please state this as your response to this attachment.

o For applicants in the U.S. territories without a SORH or another appropriate entity, this requirement does not apply, and applicants from U.S. territories are still eligible to apply.

Attachment 2: Work Plan Attach the project’s work plan. Make sure it includes each year of the grant program’s three-year period of performance and includes everything required in the Project Narrative section under

Work Plan section. This attachment is required in addition to the Work Plan description included in the Project Narrative.

The work plan must:

• Identify the network participant(s) or person responsible for carrying out each activity.

• Include a timeline for all three years of the period of performance. The minimum timeline increment is by quarter.

We recommend a table format and the sample headings outlined here:

• Goals and objectives.

• Key action steps (including target population where applicable).

• Activities.

• Outputs, data source, and program self-assessment methods.

o These might include the direct products or deliverables of program…