HRSA 26-083_Final.pdf

Notice of Funding Opportunity

Application due 07/08/2026

Federal Office of Rural Health Policy

Rural Community Health Support Program Opportunity number: HRSA-26-083

Contents Before you begin 3

Step 1: Review the Opportunity 4 Basic information 5 Eligibility 6 Program description 10 Award information 13

Step 2: Get Ready to Apply 17 Get registered 18 Find the application package 18 Application writing help 19

Step 3: Build Your Application 20 Application checklist 21 Application contents and format 23

Step 4: Understand Review, Selection, and Award 38 Application review 39 Selection process 47 Award notices 47

Step 5: Submit Your Application 48 Application submission and deadlines 49 Other submissions 49

Step 6: Learn What Happens After Award 50 Post-award requirements and administration 51 Reporting 54

Contacts and Support 55

Appendix 58

Endnotes 59

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 07/08/2026.

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 https://sam.gov/ https://grants.gov/ court orders.

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

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 6

Program description 10

Award information 13

Basic information Health Resources and Services Administration

Federal Office of Rural Health Policy

Developing, delivering, and coordinating nationally available technical assistance (TA) that supports community organizations and rural health stakeholders serving rural populations.

Summary The purpose of the Rural Community Health Support Program (R-CHSP) cooperative agreement is to develop, deliver, and coordinate nationally available technical assistance (TA) that supports community organizations and rural health stakeholders serving rural populations.

Funding details Application types: New

Expected total available funding in FY2026: $4,500,000

Expected number and type of awards: 1 cooperative agreement

Funding range per award: Up to $4,500,000

We plan to fund awards in three budget periods for a period of performance from 09/01/2026 to 08/31/2029.

Have questions?

Go to Contacts and Support.

Key facts Opportunity name:

Rural Community Health Support Program number:

version:

Initial

93.912

Key dates

06/05/2026 webinar:

See Join the Webinar deadline:

07/08/2026

09/01/2026

09/01/2026

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

Eligibility 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”

Additional information on eligibility All domestic public or private, non-profit or for-profit entities including domestic faith-based and community-based organizations, tribes and tribal organizations.

Individuals are not eligible applicants under this NOFO.

This section outlines other eligibility requirements for successful award recipients of this cooperative agreement. Failure to adequately respond to the requirements in this section may result in your application being marked ineligible. These include:

Rural Communities Successful award recipients are expected to deliver technical assistance (TA) that improves health care access, care delivery and health outcomes for rural populations nationally.

This should be demonstrated by experience and expertise documented in responses provided under the project narrative section of this notice.

This includes expectations that:

• You will deliver TA to key rural health stakeholders, which includes community-based organizations and other relevant rural stakeholders serving rural populations. This also includes rural health care organizations, rural health networks, tribal organizations and other rural health care providers, among others.

◦ This also includes current and future applicants and recipients of FORHP community-based programs, particularly for the Outreach Program (Outreach).

• TA will be delivered to rural audiences across local, multi-state, and regional settings in rural areas located in the continental U.S. and U.S. territories.

• TA is provided exclusively to communities located in HRSA-eligible rural counties or rural census tracts.

Partnerships You have in place, at the time of the award, partnerships that effectively:

• Contributes to a broad range of expertise and experience (subject matter experts) providing TA to rural communities.

• Supports a wide range of rural community health-related needs.

• Carry out the full range of program requirements and expectations, roles and responsibilities and program goals outlined in this notice.

• Maintains identified partner collaborations throughout the duration of the award.

• Helps collaborations at the local, regional, state, and national levels to share information and best practices that improve health care services and outcomes in rural communities.

The successful recipient clearly shows these requirements are met in responses provided throughout the project narrative and documentation provided under Attachment 8 and Attachment 5.

https://data.hrsa.gov/topics/rural-health/rural-health-eligibility?tab=Address https://uscode.house.gov/view.xhtml?req=(title%3A42%20section%3A254c%20edition%3Aprelim) https://data.hrsa.gov/topics/rural-health/rural-health-eligibility?tab=Address https://data.hrsa.gov/topics/rural-health/rural-health-eligibility?tab=Address

Evidence-Informed The recipient has had direct prior experience delivering TA based on evidence-informed strategies to improve health outcomes, strengthen rural healthcare networks, and improve the access to and delivery of quality healthcare services in rural communities across a wide range of healthcare topics and rural healthcare organizations. For example, topics may include chronic disease management, telehealth/telemedicine, maternal health, mental health, disease prevention, workforce development, and board development (see Appendix A for some topic examples), among others.

This includes:

• Delivering TA to a wide range of community-based organizations and rural health stakeholders serving rural populations. This includes FORHP community-based award recipients and potential applicants that would benefit from FORHP community-based programs.

• Development of evidence-based tools and best practice models specifically designed for dissemination to community-based organizations and other rural health stakeholders serving rural populations nationwide.

• Identification and analysis of successful rural community health initiatives to help develop best practices models and strategies for TA tools and resources.

You must clearly show a successful history of evidence-informed experience and results by providing technical assistance to community-based organizations and other relevant rural stakeholders serving rural communities in responses provided throughout the project narrative and Attachment 5.

Non-duplication of federal funding Funding under this program must be used for Rural Community Health Support Program (HRSA-26-083) activities that are clearly non-duplicative, coordinated or complementary of other federally funded activities. You must complete responses to the non-duplication of federal funding information requested in Attachment 9.

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

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

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

Program description Purpose The purpose of the Rural Community Health Support Program (R-CHSP) cooperative agreement is to develop, deliver, and coordinate nationally available technical assistance (TA) that supports community-based organizations and rural health stakeholders serving rural populations.

The aim is to improve and expand healthcare access for rural communities with a focus on:

• Supporting a full range of healthcare delivery in rural communities.

• Improving chronic disease management, nutrition, and preventive services.

• Helping organizations to work better and provide higher quality care.

• Addressing emergent public health needs and priorities.

You will provide TA to a wide range of rural community-based organizations and other relevant rural stakeholders serving rural populations. This includes Federal Office of Rural Health Policy (FORHP) community-based award recipients. It also includes potential applicants that would benefit from FORHP community-based programs.

Funding opportunity goals

• Increase access to and delivery of rural health care services by providing targeted, nationally available TA to community-based organizations and other relevant rural stakeholders serving rural populations, with a focus on current and future FORHP community-based awardees.

• Help R-CHSP TA recipients successfully address their unique unmet community needs through the development and implementation of adaptive TA models.

• Develop and share effective and usable evidence-based and best practice resources, models, tools and information, including information about rural health federal funding opportunities, for use by TA recipients serving rural populations.

• Facilitate collaboration across local, regional, state, and national levels to enhance the exchange of information and best practices that strengthen sustainable health care services and improve health outcomes in rural communities.

Background The Department of Health and Human Services (HHS) is dedicated to improving the health and well-being of all Americans. This aligns with the HHS Secretary’s Make America Healthy Again (MAHA) priorities, which focus on addressing the root causes of America’s health crisis through preventing and managing chronic disease for children, adults, and older adults across the United States.

Rural areas often face unique challenges in accessing quality healthcare services. They face higher rates of chronic diseases and related mortality with higher rates of common chronic conditions such as high cholesterol and high blood pressure and report higher rates of multiple chronic conditions.

Rural residents also have a higher percentage of preventable premature deaths from heart disease, stroke, and chronic lower respiratory disease.[1]

These challenges stem from various factors, including geographic isolation, limited resources and shortage of healthcare providers.[2]

The Rural Community Health Support Program (R-CHSP) will provide a reliable national platform of rural-focused TA expertise designed support community-based organizations and other relevant rural health stakeholders serving rural populations. R- CHSP TA will strengthen the healthcare services and health outcomes of rural communities through delivery of tailored, targeted, and innovative TA that enhances the effectiveness, sustainability, and outcomes of rural health projects.

Program requirements and expectations If funded, you will be expected to meet all program requirements and expectations, as evidenced throughout project narrative responses.

Customized TA Provides a wide range of intensive and targeted, hands-on and on-demand TA with a focus on current and future applicants and recipients of FORHP community-based programs, particularly Outreach, to achieve grant funded project and program goals.

For example, some TA recipients may be well established and experienced with their projects. Other TA recipients may be experiencing challenges related to project implementation, organizational structure, or may be in the early development stage of their project. This TA includes, but is not limited to:

• Targeted TA is uniquely tailored for delivery, based on readiness and positioning for receipt of TA, such as TA delivered through a tiered structure.

• Targeted TA, specific to regions, states, Tribal territories and specific health issues.

https://uscode.house.gov/view.xhtml?req=(title%3A42%20section%3A254c%20edition%3Aprelim)

• Regular 1:1 TA calls with individual FORHP community-based award recipients, and other relevant rural stakeholders or customized cohorts serving rural populations.

• In-person or virtual site visits, as needed.

• Learning opportunities such as Learning Collaboratives, Peer-to-Peer Networking, Policy Academies, etc.

• In-person or virtual partnership meetings, webinars, workgroups, town halls and training.

◦ This includes coordinating and leading logistics for one national rural health meeting occurring each year during the project period for each FORHP community-based award recipient program in the Washington, DC Metropolitan area or a region for regional programs, as applicable.

• Other new TA methods as recommended by HRSA or the R-CHSP award recipient.

• Responds in real-time, to TA needs of FORHP community-based award recipients and other recipients of TA, including the needs of rural health networks, local- and state level organizations and agencies, HRSA and HHS level rural health priorities, and other needs as they present.

• Prioritizing TA for applicants who have not received federal funding before.

We will assess you for compliance throughout the period of performance. If we identify noncompliance, we will place a condition on your award. If you do not resolve the issue successfully, we may cancel all or part of your award.

Statutory authority Section 711(b)(5) of the Social Security Act (42 U.S.C. 912(b)(5)) https://uscode.house.gov/view.xhtml?req=711%2B%28b%29%2B%285%29%2Bof%2Bthe%2BSocial%2BSecurity%2BAct%2B%2842%2BU.S.C.%2B912%29&f=treesort&fq=true&num=2&hl=true&edition=prelim&granuleId=USC-prelim-title42-section9

Award information Cooperative agreement terms Our responsibilities Aside from monitoring and technical assistance, we also get involved in these ways:

• Collaborate with you on refining R-CHSP objectives and activities in your project work plan to support emerging needs or priorities, such as changes in the health care landscape or prioritizing methods or delivery of TA.

• Provide support for identifying and selecting:

◦ Effective methods for delivering TA.

◦ Focus areas and methods for developing evidence-based resources, tools, and program-specific deliverables.

• Review and advise on TA approach, including any changes to the approach during the period of performance.

• Review and advise on TA materials and resources developed for format, tone, and expected impact.

◦ Review and advise on TA products, including presentations and online resources, before they are printed, disseminated, or implemented.

• Participate, as appropriate, in the planning of any meetings, educational activities, or work groups held during the period of performance, including, but not limited to:

◦ Selecting dates.

◦ Developing the agenda.

◦ Inviting speakers.

• Identifies opportunities and provides guidance on strategies to share information about programs, activities, and resources, including key organizations and channels for dissemination.

◦ Provide guidance on TA delivered to rural community-based organizations and other relevant rural stakeholders serving rural populations. This includes current and future applicants and recipients of FORHP community-based programs, particularly Outreach, to identify emerging health care needs and priorities that impact health outcomes, health care delivery, and access to high quality health care services.

• Identify and suggest special projects, products, resources, or technical assistance focused on improving health care in rural communities.

• Provide guidance and help in identifying key organizations to partner and collaborate with.

◦ This includes facilitating collaboration with other HRSA/federal partners.

Your responsibilities You must follow all relevant laws and policies. Your other responsibilities will include:

• Collaborate with HRSA and other relevant federal, non-federal and national partners to provide TA nationwide.

◦ This includes current and future applicants and recipients of FORHP community-based programs, particularly Outreach, to achieve their grant-funded project and program goals.

◦ Coordinate with national, federal, state and local organizations to develop and carry out your workplan.

• Collaborate with HRSA for the planning, execution and assessment of R-CHSP activities, including the identification of R-CHSP TA and educational/ developmental needs and implementation strategies.

• Compliance with R-CHSP goals and program requirements and expectations.

• Collaborate with HRSA to develop and disseminate TA tools and resources to TA recipients and the broader public, such as through publications and webinars.

• Collaborate with HRSA to revise and carry out R-CHSP work plan in alignment with administration, HHS and HRSA priorities, and changes in the health care landscape.

• Participate and provide input in HRSA and related stakeholder meetings.

• Collaborate with HRSA to effectively measure and assess the impact of TA activities.

• Coordinate with other FORHP-funded TA providers to ensure alignment across programs in how TA impact is measured.

• Submit the performance measures outlined in your R-CHSP Notice of Award, including any subsequent revisions to the work plan authorized by FORHP.

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

• Attend regular calls with the FORHP project or grants management specialist to discuss your project’s progress and challenges.

◦ The meetings may include key personnel, as determined by FORHP.

• Identify and provide access to subject matter experts (SMEs) with experience implementing projects in communities located in rural areas.

◦ SMEs will also help execute TA activities and develop tools/deliverables, including FORHP community-based grant program deliverable templates such as strategic plans, sustainability plans, cost savings estimation plans, data dashboards, etc.

• Use a data-driven approach to tailor TA strategies, including the review and analysis of FORHP Community-based recipient performance metrics.

• Maintain and use platforms that provide FORHP community-based award recipients and rural communities access to regularly updated information and resources.

◦ This includes examples of promising and innovative practices related to health care policies, rural health service delivery and sustainability strategies across topics such as food and nutrition security, mental health, chronic disease prevention and management, among others (see appendix for examples of potential topics).

Funding policies and limitations 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:

◦ Appropriation of funds.

◦ Your 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.

◦ Extend the period of performance.

◦ Award supplemental funding.

https://www.ecfr.gov/current/title-2/part-200

General limitations

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

◦ Project Budget Information in Section 3.1. of the Two-Tier Application Guide

[PDF].

◦ 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost.

◦ 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 the Two-Tier Application Guide [PDF].

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.

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.

https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.hhs.gov/sites/default/files/hhs-grants-policy-statement-april-2025-archived.pdf#page%3D81 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/two-tier-application-guide.pdf#page%3D19 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/section-200.307

Step 2:

Get Ready to Apply

Get registered 18

Find the application package 18

Application writing help 19

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.

If you need additional information about user roles in SAM.gov, see “Get registered:

SAM.gov user roles” in the Application Guide [PDF].

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-26-083.

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

https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D4 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/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/search-grants

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 Webinar information will be posted to the Related Documents tab on Grants.gov. We recommend you “Subscribe” to the NOFO on Grants.gov to receive updates when documents are posted.

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

Step 3:

Build Your Application

Application checklist 21

Application contents and format 23

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 Project Narrative Attachment form. Yes

Budget narrative Budget Narrative Attachment form. Yes

Attachments Insert each in the Attachments form in this order.

Included in

2. Staffing plan and job descriptions

No

4. Agreements with other entities

5. Attestation of expertise and experience

6. Attestation of nationwide scope No

7. Project organizational chart No

8. Non-duplication of federal funding No

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.

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

Note: Failure to provide all required components in response to this NOFO may result in your application being marked ineligible.

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

Application page limit: 60

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

Required format Required format for project summary, project narrative, budget narrative, and attachments.

Font: A readable font like Arial, Courier, CG Times, or Times New Roman

File format: We only accept the following document formats:

• .PDF - Adobe Portable Document Format

• .DOC/.DOCX - Microsoft Word

• .RTF - Rich Text Format

• .TXT - Text

• .WPD - Word Perfect Document

• .XLS/.XLSX - Microsoft Excel

• .VSD - Microsoft Visio

Size: 12-point font Footnotes, charts, graphics, and budget tables may be 10-point or higher.

Ink color: Black

Spacing: Single-spaced, including all text and tables.

Alignment: Left

Headings: Bold all headings and align left.

Size: 8.5 x 11 (Make sure the print area is set and allows printing to 8.5 x 11.)

Margins: 1-inch on all sides

Footer: On each page as the footer, include your organization’s name and page numbers. If a competing continuation or competing supplement, also include your 10-digit award number.

Page numbering:

• Do not number the standard OMB-approved forms.

• Number each attachment page sequentially (that is, 1, 2, 3).

• Reset the numbering for each attachment.

• Treat each attachment as a separate section.

File names: You can find guidance for naming your files in the Application Guide [PDF].

Project narrative Introduction See merit review criterion 1: Need

• Describe how you will advance R-CHSP goals. Complete responses address how your prior experience providing TA to U.S. domestic community-based-organizations and other relevant rural stakeholders serving rural populations and expertise provides the capacity, knowledge and ability to meet all R-CHSP goals, program requirements and expectations and cooperative agreement terms.

Responses are expected to align with information provided in Attachment 5.

Specifically, address your ability to:

◦ Support rural community-based organizations and other relevant rural stakeholders serving rural populations, including current and future applicants and recipients of FORHP community-based programs, particularly Outreach, to:

▪ Implement sustainable cost-effective grant projects across multiple rural health care settings and rural health care focus areas.

▪ Meet grant funding goals, including improving access and delivery of quality care and health outcomes for rural communities.

◦ Provide targeted 1-1 TA support to current and future applicants of FORHP community-based programs, particularly Outreach that meets a wide range of rural community needs.

◦ Tailor and customize TA to community-based organizations and other rural stakeholders serving rural populations and current and future applicants and recipients of FORHP community-based programs, based on organization need and readiness, providing a spectrum of low, medium and most intensive TA support levels. In particular, you must specify how you will target TA to historically underfunded organizations, including but not limited to:

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

▪ Faith-based organizations.

▪ Small businesses.

◦ Provide rural community health TA resources, information and products to the public on a national scale.

◦ Provide TA to organizations that have not received federal funding before.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D26

Need See merit review criterion 1: Need

• Describe your understanding of U.S. domestic rural populations and community level health needs based on your prior experience. Use current information and recent quantitative and qualitative data (within the last three years) to describe the needs and drivers of these needs. This section should include:

◦ Gaps in access to healthcare services for rural populations.

◦ Challenges and barriers related to health care service delivery and health system infrastructure operations in rural settings.

◦ The importance of strategies for sustainability in rural community health projects.

◦ How planned TA will:

▪ Meet the needs of community-based organizations and other rural health stakeholders serving rural populations, including current and future applicants and recipients of FORHP community-based programs, particularly Outreach.

▪ Strengthen the delivery of and access to health care.

▪ Improve health outcomes of rural populations.

• Describe how collaborating with other rural health constituents and rural subject-matter experts (SMEs) support the needs of community-based organizations and other relevant rural health stakeholders serving rural populations.

• Describe how collaborating with other rural health constituents and rural SMEs supports the needs of community-based organizations and other relevant rural health stakeholders serving rural populations.

Approach See merit review criterion 2: Response

• Detail the methods you will use to deliver TA that fulfills the goals, program requirements and expectations and cooperative agreement terms of R-CHPS, based on your past direct experience providing TA to domestic U.S. rural communities.

• Describe how you will deliver different levels of TA tailored to support recipients most effectively based on their individual needs and readiness. Complete responses describe how your prior experience providing TA to rural communities informs your approach, including how you will:

◦ Define different levels of TA.

◦ Determine the recipient’s readiness for the different levels of TA you defined.

◦ Determine the recipient’s need for the different levels of TA you defined.

• Detail how your TA approach will assist recipients through all phases of their funded projects from planning to implementation. This includes how:

◦ Different levels of TA and methods for delivering TA are appropriate and aligned to support community-based organizations and other relevant rural health stakeholders serving rural populations, including current and future applicants and recipients of FORHP community-based programs, particularly Outreach.

◦ You will use your prior rural-specific experience using innovative approaches to inform how you provide TA.

▪ Include unique examples of rural community or network engagement (collaborative relationship for sharing resources and/or improving health outcomes) and how it can be used in your approach to TA.

• Describe the resources, training, and other tools you will use to provide TA recipients with information and skills to support successful use and application of evidence-informed, best practice models, and resources to:

◦ Meet rural community health needs of TA recipients.

◦ Reach funded grant project and program goals of TA recipients’ rural health projects.

• Describe how you will develop, update, and host TA products, tools, and learning activities, such as webinars, templates, and newsletters. Complete responses include:

◦ Information about the types of resources you plan to develop.

◦ Your plan to distribute reports, products, or project outputs to clearly specified target audiences.

◦ Your plan to target audiences that have not historically received federal funding.

◦ How you will make TA tools, assessments, and resources publicly available, including the platforms that will be used to store and share information broadly.

• Discuss how you will monitor and notify HRSA about issues that could affect award recipients’ ability to succeed and address HHS/HRSA priorities.

• Describe the method you will use to collaborate and communicate with HRSA and other rural stakeholders.

• Describe how your approach to TA will have an impact on TA recipients serving rural populations.

• Include your plan to assist TA recipients in understanding FORHP community-based program funding opportunities available for rural areas.

• Describe your TA approach to address the sustainability of rural community-based initiatives implemented by rural community-based organizations and other relevant rural health stakeholders, including current and future applicants and recipients of FORHP community-based programs.

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

Describe your work plan. Your description is expected to align with the work plan you have provided in table format in Attachment 1: Work Plan. Clearly address how your workplan supports:

• Achieving the R-CHSP goals and advancing objectives and activities outlined in your workplan during the period of performance.

Your workplan must also clearly include:

• An appropriate timeline for proposed activities during the R-CHSP period of performance.

• Who will be responsible for overseeing implementation of each activity.

• How key stakeholders will help plan, design, and carry out these activities.

• Framing that accounts for how your work plan can be adapted to evolve, in collaboration with HRSA, to best meet the needs of TA recipients.

Resolving challenges See merit review criterion 2: Response

• Discuss possible challenges you may face in designing and carrying out the TA activities in your work plan. Include how any prior direct experience providing TA will inform how you will address challenges. At minimum, include the following challenges with explanations describing how you will resolve each:

◦ Challenges associated with working with HRSA and other rural stakeholders assisting with the provision of TA.

◦ Challenges associated with providing TA to community-based organizations and other relevant rural health stakeholders serving rural populations, including current and future applicants and recipients of FORHP community-based programs.

◦ Challenges associated with identifying new organizations that have not historically received federal funding.

◦ Challenges anticipated in assessing TA activities and TA delivered. Discuss how you will address them.

◦ Challenges, including rural specific challenges anticipated, at the local community, state or regional levels.

• Internal challenges within TA recipient organizations and the recipient organization’s respective partners.

• Identify the resources or infrastructure in place that will help address potential challenges and overcome barriers to delivering TA across a wide range of rural geographies, health care infrastructures, and community-identified health care needs.

• Detail how your cooperative agreement will be complementary, versus duplicative, of other HHS and HRSA-funded activities. Complete responses align with responses provided in Attachment 8.

Performance reporting and evaluation See merit review criteria 3: Performance reporting and evaluation

• Outcomes / Performance measurement

◦ Describe the expected outcomes of the R-CHSP activities outlined in your work plan. Your response should clearly explain:

▪ Expected results of rural health educational or training sessions delivered, including in person or virtual partnership meetings and site visits. Be specific how these sessions will influence and strengthen the projects of TA recipients.

▪ Expected outcomes of one-on-one TA calls with individual recipients and applicants to FORHP community-based programs, and other relevant rural stakeholders or customized cohorts serving rural populations.

◦ Explain how you will coordinate with other FORHP-funded TA providers to ensure consistent and aligned approaches to measuring impact across programs.

◦ Describe how you will assess and quantify both the scope and impact of the TA provided under this award.

◦ Describe how you will have successfully aided organizations that have not previously received federal funding. In particular, provide updates on how you will measure outcomes in providing TA to historically underfunded organizations, including but not limited to:

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

▪ Faith-based organizations.

▪ Small businesses.

• Evaluation / Self-assessment

◦ Describe how you will assess the effectiveness of TA activities provided to R- CHSP TA recipients and how you will continually improve your approach.

Strong responses should clearly:

▪ Identify who will be responsible for conducting these assessments and specify whether it is a staff member from the lead organization or a partner organization.

▪ Describe the self-assessment questions, methods, and types of data you will collect. Include your approach and timeline for gathering feedback and conducting ongoing assessments of TA activities through the period of performance.

◦ Describe the inputs that will inform your self-assessment process. Strong responses identify and explain:

▪ What data sources or resources will be used to gather relevant information.

▪ How participation and attendance at training events will be incorporated into your assessment.

▪ How frequently data will be collected.

◦ Explain how you will use your self-assessment results and findings to communicate key lessons learned to HRSA and other rural stakeholders.

◦ Describe how you will report on the effectiveness of new TA approaches and evaluate different TA methods by comparing their impact.

◦ Identify at least one individual who will work directly with FORHP to ensure TA activities are continuously monitored, evaluated and improved over time.

See the reporting section for more information.

Sustainability See merit review criterion 4: Impact

• Describe how you will assist TA recipients build and sustain the organizational, financial, and clinical capacity of rural health projects, including current and future applicants and recipients of FORHP community-based programs over time.

• Detail how you will help TA recipients in sustaining efforts across a wide range of rural geographic locations, health care infrastructures and community identified health care needs and explain:

◦ The methods, tools and resources you will use to support TA recipients in positioning for sustainability.

◦ Outcomes related to sustainability from previous experience providing TA to rural health stakeholders.

Organizational information See merit review criterion 5: Resources and capabilities

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

Explain how these will help you carry out the goals, program requirements and expectations and cooperative agreement terms of R-CHSP. Complete responses clearly align with details about your organization provided in your project narrative and information in your project organizational chart attachment.

• Detail evidence that you have the necessary staffing, infrastructure, and capacity to provide TA at a national level to U.S. domestic community-based organizations and other relevant rural health stakeholders serving rural communities, including current and future applicants and recipients of FORHP community-based programs, to oversee program activities, and serve as the fiscal agent for R-CHSP.

Attachment 2 (Staffing Plan) and Attachment 3 (Biosketches) will support the information provided in this section. Complete responses address:

◦ Your organizational profile, budget, partners, and key processes.

◦ Staff’s skills, knowledge, and direct experience to carry out all aspects of the project nationally.

▪ Provide specific examples and outcomes based on prior experience providing TA to FORHP community-based awardees to support organizational experience.

◦ How you will follow the approved project work plan, keep track of all federal funds, and record all costs to avoid issues during the project audit.

◦ Specific examples of how your prior direct experience providing rural health TA will inform how you address future challenges and allow you to begin service upon award.

◦ Provide specific examples of the TA provided, including the methods of TA delivery and resulting outcomes from the TA your organization delivered to these audiences.

◦ Detail how the TA you delivered showed success in the long term sustainability of FORHP community-based recipient rural community initiatives.

• Provide examples of TA documents and materials your organization has produced for community-based organizations and other rural health stakeholders serving rural populations nationally, including applicants and recipients of FORHP community-based programs, particularly Outreach. Examples may be provided as attachments with this application package (attachments 9-15) and/or via external hyperlinks to materials you have published electronically.

• Identify the rural stakeholders and partnerships who will be involved in the implementation of R-CHSP TA. Complete responses include details about the roles and activities partners will contribute to fulfill the goals, program requirements and expectations and cooperative agreement terms of R-CHSP. This must include organizations dedicated to providing TA to organizations that have not received federal funding before.

◦ Attach a letter of support that details the partner’s commitment to helping you address national rural TA needs and achieve the objectives for your R- CHSP award in Attachment 4.

• Describe your organization’s prior direct experience providing TA to FORHP’s community-based grant awardees and other rural stakeholder organizations serving rural populations that would benefit from applying to FORHP grant funding.

◦ Describe existing collaborations with key national rural organizations and rural constituencies, such as the National State Offices of Rural Health, and other relevant rural SMEs.

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 [PDF] 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.

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.

To create your budget narrative, see budget narrative detailed instructions in the Application Guide [PDF].

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).

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D16 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) https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D16

Attachment 1: Work plan Attach your project’s work plan. Make sure it includes each year of the cooperative agreement’s three-year period of performance and aligns with responses completed in your project narrative. This attachment is required in addition to the work plan description provided in the project narrative.

The work plan must:

• Outline the 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.

• Indicate flexibility to collaborate with HRSA to fulfill the goals, program requirements and expectations and cooperative agreement terms of R-CHSP.

We recommend that you format your work plan as a table and use these headings:

• Goals and objectives.

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

• Activities.

• Outputs, data sources, and program assessment methods.

◦ These might include the direct products or deliverables of activities and how you will assess…