HRSA-26-104_final.pdf

Notice of Funding Opportunity

Application due 07/10/2026

MATERNAL AND CHILD HEALTH BUREAU

Transforming Pediatrics for Early Childhood (TPEC) Program

HRSA-26-104

Table of Contents

Before You Begin

Step 1: Review the Opportunity

Basic information

Funding details

Eligibility

Other Eligibility Criteria

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

Appendix A: Glossary

Before You Begin

Health Resources and Services Administration

MATERNAL AND CHILD HEALTH BUREAU

Division of Home Visiting and Early Childhood Systems

Transforming Pediatrics for Early Childhood (TPEC) Program

HRSA-26-104

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

Tagline: Transforming high-quality pediatric primary care for young children and their families by placing early childhood development experts directly in practices.

Summary

The Transforming Pediatrics for Early Childhood Program (TPEC) will advance the U.S.

Department of Health and Human Services’ Make America Healthy Again (MAHA) priorities by preventing chronic disease early in life and promoting healthy development in early childhood.

TPEC recipients - organizations with statewide[1] or tribal reach - will place early childhood development (ECD) experts in local pediatric practices to deliver team-based care to young children and their families. Recipients will improve the quality and cost-effectiveness of pediatric care by delivering a comprehensive, team-based approach that focuses on factors critical to child development. Through this approach, pediatric primary care staff are expected to:

• Screen children and their families for their needs related to mental health, housing, nutrition, and child development.

• Build safe, stable, and nurturing relationships between parents/caregivers and their children.

• Educate parents/caregivers on developmental milestones and how to watch for them.

• Make sure that families get referrals and access to additional or specialized support.

TPEC recipients are expected to:

1. Place ECD experts[2] in pediatric practices[3] that serve a high percentage [4] of families covered by Medicaid/Children’s Health Insurance Program (CHIP) and deliver high-quality ECD services using a team-based approach.

2. Build the skills of pediatric primary care staff statewide to deliver high-quality ECD services using a team-based approach.

3. Improve statewide administrative policies and financing strategies to expand and sustain team-based pediatric primary care, improving the standard of care for all young children.

TPEC is expected to result in measurable improvements in service delivery rates and early childhood development outcomes.

Have questions? Go to Contacts and Support.

Key facts

Opportunity name: Transforming Pediatrics for Early Childhood (TPEC) Program

Opportunity number: HRSA-26-104

Announcement version: initial

Federal assistance listing: 93.110

Key dates

NOFO issue date: 06/08/2026

Informational webinar: See Join the webinar

Application deadline: 07/10/2026

Expected award date is by: 09/30/2026

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: $9,500,000

Expected number and type of awards:

10 CA (Cooperative Agreement)

Funding range per award:

$0 - $950,000

If additional funds become available, additional awards may be made for a shorter period of performance, ending September 29, 2031.

We plan to fund awards in five 12-month budget periods for a total five year period of performance from 09/30/2026 to 09/29/2031.

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

Eligibility

Only one eligible non-Tribal entity per state or jurisdiction will receive an award under this funding opportunity to ensure best use of resources and geographic coverage. Any Tribal government or Tribal organization, regardless of geographic location, is eligible to receive an award.

Existing award recipients under the FY 2022 TPEC program funding opportunity (HRSA-22-

141) whose period of performance ends September 29, 2027, are eligible to apply for funding under this announcement. If funded, the existing FY 2022 TPEC award will be relinquished, and a new award period of performance will begin. If an existing recipient applies but is not awarded funding under this announcement, their FY 2022 TPEC award will continue at the original level of funding through the end of the project period.

You can apply if your organization is a domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C. § 5304 (formerly cited as 25

U.S.C. § 450b)). See 42 CFR § 51a.3(a). Domestic faith-based and community-based organizations are also eligible to apply. If funded, for-profit organizations are prohibited from earning profit from the federal award (see 2 CFR 200.400(g)).

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)

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 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g)

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

Other Eligibility Criteria

“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.

Individuals are not eligible applicants under this NOFO.

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.

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 Transforming Pediatrics for Early Childhood Program (TPEC) should advance the U.S.

Department of Health and Human Services’ Make America Healthy Again (MAHA) priorities by preventing chronic disease early in life and promoting healthy development in early childhood.

TPEC recipients - organizations with statewide or tribal reach - should place early childhood development (ECD) experts in local pediatric practices to deliver team-based care to young children and their families. Recipients should improve the quality and cost-effectiveness of pediatric primary care by delivering a comprehensive, team-based approach that focuses on factors critical to child development. Through this approach, pediatric primary care staff are expected to:

• Screen children and their families for mental health, housing, nutrition, and child development needs.

• Build safe, stable, and nurturing relationships between parents/caregivers and their children.

• Educate parents/caregivers on how to monitor developmental milestones.

• Make sure that families get referrals and access to additional or specialized support.

TPEC recipients should:

1. Place ECD experts in pediatric practices that serve a high percentage of families covered by Medicaid/CHIP and deliver high-quality ECD services using a team-based approach.

2. Build the skills of pediatric primary care staff statewide to deliver high-quality ECD services using a team-based approach.

3. Improve statewide administrative policies and financing strategies to expand and sustain team-based pediatric primary care, improving the standard of care for all young children.

TPEC should result in measurable improvements in service delivery rates and early childhood development outcomes.

Funding Opportunity Goals

• The program's goal is to increase statewide access to high-quality ECD services for young children and their families delivered directly in pediatric primary care by a team of health professionals.

• 1. Place ECD experts in pediatric practices that serve young children and families enrolled in Medicaid/CHIP and deliver high-quality ECD services using a team-based approach.

TPEC recipients and local pediatric practices selected as partners should work towards:

- 90% of young children in partner pediatric practices receiving a timely well-child visit.

- 90% of children in partner pediatric practices receiving a timely developmental screening using a validated parent-completed tool.

- 75% of families with young children in partner pediatric practices comprehensively screened for families' needs (like caregiver depression, food assistance, and housing).

• 2. Build the skills of pediatric primary care staff statewide to deliver high-quality ECD services using a team-based approach.

TPEC recipients should:

- Continually increase the total number of unique pediatric primary care staff trained across the state during the award period of performance.

• 3. Improve statewide administrative policies and financing strategies to expand and sustain team-based pediatric primary care, improving the standard of care for all young children.

TPEC recipients should:

- Continually increase the total number of ECD experts placed in pediatric practices across the state during the award period of performance.

Background

History

The TPEC program began in 2022 to address the needs of families with young children who are eligible for Medicaid/CHIP or are uninsured through the delivery of high-quality ECD services in pediatric primary care using a team-based approach. In 2023, Congress increased funding for

TPEC. This funding opportunity will build upon the success of the previous iteration and continue to show measurable improvements in service delivery rates and early childhood development outcomes.

Current TPEC awardees have made significant strides in transforming how pediatric primary care is delivered to young children and their families. Awardees have placed 139 ECD experts within 51 partner pediatric practices since the beginning of the program. Families receiving care in these practices have seen improved service delivery – in these practices, teams with ECD experts delivered 38,700 well child visits and 27,000 developmental screenings in FY 2025.

Additionally, successful transformation to team-based care by current TPEC awardees has shown decreased turnover of staff, fewer no-shows and cancellations of appointments, and healthcare savings on emergency medical care, compared to before TPEC funding.

Need

Children develop rapidly between birth and age five, making the early childhood period a critical window of opportunity to prevent chronic disease early in life and promote healthy development.[5]

Despite the lifelong benefits of early detection and intervention, many young children covered by

Medicaid are not receiving basic ECD services guaranteed to them through the Early and

Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. For example, between 2023-

2024, only 36.5% of young children (30% on public insurance) received a parent-completed developmental screening from a provider in the past year.[6] Even when young children receive basic ECD services, one provider cannot meet all of a family’s needs alone. Well-child visits are short and often focus on just the physical health of the child, leaving a single provider unable to give enough time to identify and address a family’s broader needs. The TPEC program fills this gap by placing ECD experts in pediatric practices to work as part of a team of health professionals that collectively ensure healthy development in early childhood.

Program requirements and expectations

Successful implementation of the core activities described below means that pediatric primary care staff are providing ECD services in alignment with EPSDT to all children, in addition to:

• Building safe, stable, and nurturing relationships between parents/caregivers and their children.

• Educating parents/caregivers on developmental milestones and how to watch for them.

• Improving the processes between providers when families need additional or specialized support.

https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment

TPEC recipients - organizations with statewide or tribal reach – are responsible for the placement of ECD experts in pediatric practices. Recipients are expected to target placement within pediatric practices that serve a high percentage of families covered by Medicaid/CHIP.

Successful recipients are expected to scale high-quality ECD services using a team-based approach in pediatric practices across the state or tribal nation. Successful recipients will train pediatric primary care staff across the state or tribal nation to build skills that expand team-based care.

Successful recipient organizations are expected to have a significant ability to influence state administrative policies and financing approaches (i.e. Medicaid) to sustain high-quality ECD services long-term.

TPEC recipients should plan to carry out the following core activities.

Core Activity 1: Place ECD experts in pediatric practices that serve young children and families covered by Medicaid/CHIP and deliver high-quality ECD services using a team-based approach.

• Partner with local pediatric practices to hire and place ECD experts. Partner pediatric practices should serve a high percentage of families covered by Medicaid/CHIP or uninsured. HRSA defines this as one or both of the following:

o A service population with at least 50% Medicaid or CHIP-eligible or uninsured, or o A Medicaid/CHIP or uninsured utilization rate of at least one standard deviation above the average for pediatric primary care practices in the state that receives

Medicaid payments.

o You may partner with local pediatric practices in rural areas [7], pediatric practices that serve primarily Tribal populations, or are federally qualified health centers.

o You may hire and place ECD experts in local pediatric practices via direct financial support (e.g. subawards), in-kind contributions of staff time or other shared resources, and/or other means.

• Provide individualized technical assistance (TA) to partner pediatric practices to deliver high-quality ECD services using a team-based approach. TA should improve:

o Guidelines and procedures within pediatric practices for delivering ECD services with ECD experts.

o Use of electronic health records and other data (including feedback from families) to continually assess how well ECD services are meeting the needs of families.

o Referral processes that connect young children and their families with other community-based resources and services.

• Host cross-practice TA offerings. TA should focus on:

o Sharing best practices and lessons learned.

o Building continuous quality improvement (CQI) capacity and skills.

o Standardizing data collection and analysis.

Core Activity 2: Build the skills of pediatric primary care staff statewide to deliver high-quality ECD services using a team-based approach.

• Develop or refine training for pediatric primary care staff. Training should address:

o Guidelines and procedures within pediatric practices for delivering ECD services by a team of health professionals.

o Safe, stable, and nurturing relationships between parents/caregivers and their children.

o Parent/caregiver knowledge of developmental milestones and how to watch for them.

o Referral processes between providers when families need additional or specialized support.

• Host regular training series for pediatric primary care staff statewide. You may choose to organize training by role, such as primary care providers, mental and behavioral health staff, community health workers, and family partners.

• Use post-training feedback to continually assess how well trainings are meeting the needs of pediatric primary care staff and the impact of the training on staff knowledge and behavior.

Core Activity 3: Improve statewide administrative policies and financing strategies to expand and sustain team-based pediatric primary care.

• Improve state-level policies and financing strategies. This may include, but is not limited to:

o Using the expertise of family leaders to guide statewide work.

o Coordinating key state partners to scale practice-level strategies statewide.

o Ensuring that practices are successfully billing and receiving reimbursement for team-based ECD services.

• Use state-level data to continually assess how placement of ECD experts in partner pediatric practices impact well-child visit and developmental screening rates and early childhood development outcomes. You may choose to look at the Medicaid Child Core

Set, Patient-Centered Medical Home Quality Standards, or other available state-specific data

Performance measurement, evaluation, and continuous quality improvement (CQI)

Recipients are expected to measure performance on key activities and program objectives, and conduct CQI activities.

You are expected to report progress towards program objectives to HRSA annually through the

Discretionary Grant Information System (DGIS), as noted in the Reporting section. In addition to the standard DGIS elements, you are expected to report progress on the following measures:

• Number of pediatric primary care staff trained statewide.

• Number of partner pediatric practices.

• Number of ECD experts placed in partner pediatric practices.

• Percentage of children (aged 5 and under) served in partner pediatric practices that received a timely well-child visit.

https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/pcmh-standardized-measurement/ https://mchb.hrsa.gov/data-research/discretionary-grants-information-system-dgis

• Percentage of children (aged 9-30 months) served in partner pediatric practices that received a timely developmental screening using a validated parent-completed tool.

• Percentage of children (aged 5 and under) and their families served in partner pediatric practices comprehensively screened (e.g., caregiver depression, food assistance, housing, etc.).

• Percentage of children (aged 5 and under) and their families served in partner pediatric practices that received appropriate follow-up services.

• Percentage of children (aged 6 months-5 years) served in partner pediatric practices that meet flourishing criteria, as aligned with the National Survey of Children’s Health.

You are expected to also complete progress reports with qualitative and quantitative information, and requests for information, as required. HRSA will provide additional reporting instructions after awarding funds.

You may choose to conduct a recipient-led evaluation. If you choose to do so, you are expected to propose evaluation questions in your application and submit a final evaluation plan to HRSA within 9 months post award.

Statutory authority

TPEC is authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act).

Award information

Cooperative agreement terms

Our responsibilities Aside from monitoring and technical assistance, we also get involved in these ways:

• Participation in the planning and development of all phases of this cooperative agreement.

• Participation, as appropriate, in relevant meetings, committees, conference calls, and working groups related to the cooperative agreement and its projects to provide strategic input and support alignment with federal goals.

• Review of plans for activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement.

• Assistance to support collaboration with federal and state contacts, HRSA-funded grants, and other entities.

• Participation with award recipients in peer-to-peer information exchange and the dissemination of project findings, best practices, and lessons learned from the project.

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

• Work with the federal project officer during the award to refine data and reporting plans to align with the TPEC performance measurement approach.

• Collaboration with HRSA on CQI efforts, including responding to surveys, participating in interviews, and providing other reports upon request.

• Participation in recipient peer networking and other TA opportunities.

https://nschdata.org/browse/survey/results?q=10092&r=1

• Advance notice of any publications or materials produced, giving the federal project officer the opportunity to review, discuss, and provide input on any publications, audiovisuals, and/or other materials produced as part of the project (drafts and final products).

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.

• 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 Project Budget Information in the Application Guide.

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.

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.

https://www.ecfr.gov/current/title-2/part-200 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 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.ecfr.gov/current/title-2/section-200.414

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.

• 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.

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.

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

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-26-104.

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

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://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=4 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

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.

FAQs will be posted on our TA webpage after the webinar with a link to Grants.gov Related

Documents tab.

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.

Have questions? Go to Contacts and Support.

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

Use the Budget Narrative Attachment form.

Budget Narrative Attachment form.

Yes

Attachments

Insert each in the Attachments Form in this order.

Component Included in page limit*?

◻ 1. Work plan Yes

◻ 2. Staffing plan and job descriptions Yes

◻ 3. Biographical sketches Yes 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

◻ 4. Project organizational chart Yes

◻ 5. Partner pediatric practice table Yes

◻ 6. Agreements with other entities Yes

◻ 7. Multi-year budgets, fifth year budget No

◻ 8. Other relevant document Yes

◻ 9. Other relevant document Yes

◻ 10. Other relevant document Yes

◻ 11. Other relevant document Yes

◻ 12. Other relevant document 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: 40 pages

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 o .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.

Project narrative

Introduction See merit review criterion 1: Need

• State the purpose and goals of your initiative and describe how TPEC funding will help you to advance these goals.

• Briefly describe how you’ll carry out the Program Requirements and Expectations, including:

o The number and types of pediatric practices you are proposing to partner with,

▪ State if any identified pediatric practices are in rural areas, pediatric practices that serve primarily Tribal populations, or are federally qualified health centers.

o The number and types of ECD experts you will place within partner pediatric practices, and o The administrative policies and financing strategies you will prioritize over the award period of performance.

Need https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=26

See merit review criterion 1: Need

• Briefly describe the needs of young children (aged 5 and under) and their families in your state that are relevant to healthy development in early childhood. Focus on the unique needs of Medicaid/CHIP or uninsured families.

• Provide the state-level well-child visit rate and developmental screening rate, using the most recent Medicaid Child Core Set data.

• Describe challenges in your state that have influenced the design of your proposed approach, such as policy and financing barriers, workforce needs, and coordination gaps between healthcare providers and early childhood programs.

• If applicable, describe any aligned policy and financing efforts in your state and how they have influenced the design of your proposed approach.

Approach See merit review criterion 2: Response

Core Activity 1: Place ECD experts in pediatric practices that serve young children and their families covered by Medicaid/CHIP and deliver high-quality ECD services using a team-based approach.

• Describe how you selected the pediatric practices included in this application, including how you have applied the requirement to serve a high percentage of Medicaid/CHIP or uninsured families.

• Describe how you will evaluate the readiness of pediatric practices for implementation and finalize formal agreements for partnership, including your planned methods and amounts of support (including direct financial support such as subawards) to the pediatric practice.

• Describe the types of ECD experts that will be hired and placed in partner pediatric practices, including your rationale for this decision.

• Describe how you will provide individualized and cross-practice TA for partner pediatric practices, including how you will address the focus areas listed in the Program

Requirements and Expectations.

• Describe how you will sustain ECD expert positions after the period of federal funding ends.

Core Activity 2: Build the skills of pediatric primary care staff statewide to deliver high-quality ECD services using a team-based approach.

• Describe how you will develop or refine training that addresses the topics listed in the

Program Requirements and Expectations.

• Describe how you will host regular training series for pediatric primary care staff, including any roles you choose to prioritize.

• Describe how you will collect post-training feedback and how you will use the feedback to assess impact and engage in CQI.

Core Activity 3: Improve statewide administrative policies and financing strategies to expand and sustain team-based pediatric primary care.

https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures

• Describe the state-level health, early childhood, and parent leaders you will work with to simplify processes that connect young children and their families with resources and supports. Include the rationale for your approach.

• Describe the data sources you will use to continually assess the impact of your practice-level activities as compared to the state.

• Describe the administrative policies and financing strategies you will work towards, and the state partners you will work with to do so. Include the rationale for your approach.

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

• Provide a work plan in Attachment 1 that includes each major step you will take to implement the core activities as proposed over the award period of performance. Include who is responsible for each step and any partners who will be engaged.

Resolving challenges See merit review criterion 2: Response

• Identify potential barriers and describe how you propose to resolve them, if they arise.

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

• Describe how you plan to structure and implement high-quality monitoring and performance reporting for each of the core activities. Include a description of the resources, systems, and key processes you plan to use, such as data sources, data collection methods, frequency of data collection, etc.

• Describe how you plan to carry out CQI activities for each of the core activities proposed, including how you plan to incorporate feedback from families. Include a description of the resources, systems, and key processes you plan to use, such as data sources, data collection methods, frequency of data collection, etc.

• Describe how you plan to prepare partner pediatric practices to collect and report the required measures as described in the Performance Measurement, Evaluation, and CQI section.

o Provide an assurance that data privacy, consent, and cybersecurity protections will be maintained. As applicable, include plans for seeking Institutional Review

Board (IRB) approval, establishing Health Insurance Portability and

Accountability Act (HIPAA) compliance, and use of Electronic Health Record data.

• Describe how you plan to collect and report accurate data for the measures listed below:

o Number of pediatric primary care staff trained statewide.

o Number of partner pediatric practices engaged.

o Number of ECD experts integrated in partner pediatric practices.

o Percentage of children (aged 0-5 years) served in partner pediatric practices that received a timely well-child visit.

o Percentage of children (aged 9-30 months) served in partner pediatric practices that received a timely developmental screening using a validated parent-completed tool.

o Percentage of children (aged 5 and under) and their families served in partner pediatric practices comprehensively screened (e.g., caregiver depression, food assistance, housing, etc.).

o Percentage of children (aged 5 and under) and their families served in partner pediatric practices that received appropriate follow-up services.

o Percentage of children (aged 6 months-5 years) served in partner pediatric practices that meet flourishing criteria, as aligned with the National Survey of

Children’s Health.

• Clearly state if you are choosing to conduct an optional, recipient-led evaluation.

• If applicable, propose evaluation questions you plan to seek to answer and briefly describe how you plan to structure your evaluation.

o Provide an assurance that your final evaluation plan, submitted 9 months post award, plans to follow the HHS Evaluation Policy, as well as the standards and best practices described in OMB Memorandum M-20-12.

See the reporting section for more information.

Sustainability See merit review criterion 4: Impact

• Describe your plan to sustain successful TPEC activities after the period of federal funding ends.

• Describe how you plan to sustain ECD expert positions after the period of federal funding ends, including how your administrative policies and financing strategies align with this plan.

Organizational information See merit review criterion 5: Resources and capabilities

• Describe your organizational capacity to achieve the program goals and core activities.

Include your current and planned staffing structure and describe your experience carrying out similar projects.

• Describe how you plan to properly account for federal funds and document all costs to avoid audit findings. If you plan to make subawards or expend funds on contracts, describe the systems and procedures your organization has in place to ensure proper documentation of funds and costs incurred by subrecipients.

• Provide a list of key personnel, including those outside of your organization that you have identified as partners, that plan to fulfill the requirements of TPEC. Describe relevant qualifications, expertise, and experience to carry out the proposed work plan.

• Provide a project organizational chart in Attachment 4.

• Provide a table of pediatric practices in your state that you propose engaging as partners in Attachment 5.

• Specify anticipated subrecipients and their associated scope of work.

https://nschdata.org/browse/survey/results?q=10092&r=1 https://nschdata.org/browse/survey/results?q=10092&r=1 https://aspe.hhs.gov/reports/department-health-human-services-evaluation-policy https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf

• Identify advisory bodies, stakeholder groups, and other key partners that plan to support your project. Include your plans for engagement of identified partners, if not currently working with them. Include letters of support from key partners in Attachment 6.

• If you are an existing award recipient under the FY 2022 TPEC program funding opportunity (HRSA-22-141) whose period of performance ends September 29, 2027, include an acknowledgment that you understand you will have to relinquish the existing grant (including any unobligated balance) if funded under this FY 2026 funding opportunity.

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.

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.

• Provide a narrative for the entire period of performance (Years 1-5) that explains the amounts requested under each line in the budget.

o Specifically describe how each item supports the achievement of proposed objectives.

o For Years 2-5, highlight the changes from Year 1 or clearly indicate that there are no substantive budget changes during the period of performance.

• Be sure to include details and justification for costs associated with:

o Engagement of partner pediatric practices, o The time commitment and other contributions of key partners, o Performance reporting and CQI activities, o Securing TA and subject matter expertise from the field, and o A recipient-led evaluation (optional).

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)

To create your budget narrative, see budget narrative detailed instructions in the 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: Work Plan Attach the project’s work plan. Make sure it includes everything required in the Project Narrative section.

Attachment 2: Staffing plan and job descriptions Include a staffing plan that shows the staff positions that support the project, and key information about each. Justify your staffing choices, including their education and experience. Explain your reasons for the amount of time you request for each staff position.

For each key staff member, attach a one-page job description, including their role, responsibilities, and qualifications.

Attachment 3: Biographical sketches Include biographical sketches for people who will hold the key positions you describe in

Attachment 2.

Each biographical sketch should be no more than two pages. Do not include non-public, personally identifiable information. If you include someone you have not hired yet, provide a letter of commitment from that person along with the biographical sketch.

Attachment 6: Agreements with other entities Provide any documents that describe working relationships between your organization and others you mention in your project narrative. If you include documents that confirm actual or pending contracts or agreements, the documents should clearly describe the roles of subrecipients and contractors and any deliverables. It is not necessary to include the entire contents of lengthy agreements, so long as the portions you include describe the working relationship between you and the other organization. Make sure letters of agreement are signed and dated.

Attachment 7: For multi-year budgets, fifth year budget For the fifth budget year, submit a copy of Section B of the SF-424A as an attachment. We do not count this in the page limit however, any related budget narrative does count. See Section

3.1.4 of the Application Guide.

Attachment 4: Project organizational chart Provide a one-page diagram that shows the full project’s organizational structure.

Attachment 5: Partner pediatric practice table Provide a table of pediatric practices in your state that you propose engaging as partners. Include the name and type of practice, the estimated number of children aged 5 and under that were served by that practice in the last calendar year, and an expected timeline for onboarding.

Attachment 8-13: Other relevant documents https://grants.gov/learn-grants/grant-terminology#p https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13

You may use attachments 8 through 13 to add other relevant documents.

Other required forms

You will need to complete some other forms. Upload the following forms at Grants.gov. You can find them in the NOFO application package or review them and any available instructions at

Grants.gov Forms.

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.

Form instructions The application guide has detailed instructions for:

• The Application for Federal Assistance (SF-424).

• The Budget Information for Non-Construction Programs (SF-424A).

Project abstract summary form instructions Complete the information in the Project Abstract Summary form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more information, see Section 3.1.2 of the Application

Guide.

Important: Public information

When filling out your SF-424 form, pay attention to Box 15: Descriptive Title of Applicant’s

Project.

We share what you put there with USAspending. This is where the public goes to learn how the federal government spends their money.

Instead of just a title, insert a short description of your project and what it will do.

See instructions and examples.

Step 4: Understand Review, Selection, and Award https://grants.gov/forms/forms-repository/sf-424-family https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=8 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.usaspending.gov/…