MCHB-HRSA-24-036-(H61)-EHDI-State-Final 10-31.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Maternal and Child Health Bureau

Division of Services for Children with Special Health Needs

Early Hearing Detection and Intervention State/Territory Program

Funding Opportunity Number: HRSA-24-036

Funding Opportunity Type(s): Competing Continuation, New

Assistance Listing Number: 93.251

Application Due Date: November 6, 2023 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We won’t approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: August 8, 2023

Modified 10/31 – Updated Grants.gov links on page 9

Sandra Battiste, MPH Public Health Analyst Division of Services for Children with Special Health Needs Call: 301-443-0223 Email: SBattiste@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 280g-1(a) (Title III, § 399M(a) of the Public Health Service Act) mailto:SBattiste@hrsa.gov

HRSA-24-036 EHDI State/Territory i

508 COMPLIANCE DISCLAIMER

Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII Agency Contacts.

SUMMARY

Funding Opportunity Title: Early Hearing Detection and Intervention State/Territory Program

Funding Opportunity Number: HRSA-24-036

Assistance Listing Number: 93.251

Due Date for Applications: November 6, 2023

Purpose: The purpose of this program is to enhance the state/territory Early Hearing Detection and Intervention (EHDI) system infrastructure to improve language acquisition for deaf and hard-of-hearing (DHH) children up to age 3. Funding will support state and territory EHDI systems of services so that DHH newborns, infants, and young children up to age 3 receive appropriate and timely services, including hearing screening, diagnosis, and early intervention (EI).

Program Objective(s): Objectives for the EHDI State/Territory Program measure state/territory infrastructure to support newborn hearing screening and language acquisition in children ages 0-3 while emphasizing data collection, family engagement, provider education and partnerships.

Eligible Applicants: • Any state

• District of Columbia

• Commonwealth of Puerto Rico

• Northern Mariana Islands

• Guam

• American Samoa

• U.S. Virgin Islands

• Micronesia

HRSA-24-036 EHDI State/Territory ii

• Republic of the Marshall Islands

• Republic of Palau

In addition, you can apply if your organization is in the United States and is:

• Public or private

• Community-based

• Tribal (governments, organizations, as those terms are defined at 25 U.S.C. § 450b) o Native American tribal governments

(federally recognized) are eligible.

o Native American tribal organizations

(other than federally recognized tribal governments) are eligible.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

Anticipated FY 2024 Total Available Funding:

Up to $15,365,000

• EHDI State/Territory Program: $13,865,000

• EHDI Innovation Project Additional Activity:

$1,500,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

EHDI State/Territory Program: Up to 59: competing continuation or new grant(s)

Optional EHDI Innovation Project Additional Activity: Up to 20 competing continuation or new grant(s)

Estimated Annual Award Amount:

EHDI State/Territory Program with Optional EHDI Innovation Project Funding: Up to $310,000 per award, subject to the availability of appropriated funds:

• $235,000 base amount per award

HRSA-24-036 EHDI State/Territory iii

• $75,000 additional funds for optional EHDI Innovation Project Additional Activity

Cost Sharing or Matching Required:

No

Period of Performance: April 1, 2024 through March 31, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

Djuana Gibson Grants Management Specialist Division of Grants Management Operations, OFAM Email: dgibson@hrsa.gov

Program issues or technical assistance:

Sandra Battiste, MPH Project Officer, Division of Services for Children with Special Health Needs Maternal and Child Health Bureau Email: SBattiste@hrsa.gov

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA Application Guide (Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We have scheduled the following webinar:

Wednesday, August 23, 2023 2–3 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1610494635?pwd=dWh0anNXVjlFV3h4TldYaXpyUFJUZz09

Attendees without computer access or computer audio can use the following dial-in information:

Call-In Number: 1-833 568 8864 | Participant Code: 56291471 Meeting ID: 161 049 4635

We will record the webinar.

mailto:dgibson@hrsa.gov mailto:SBattiste@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1610494635?pwd=dWh0anNXVjlFV3h4TldYaXpyUFJUZz09 https://hrsa-gov.zoomgov.com/j/1610494635?pwd=dWh0anNXVjlFV3h4TldYaXpyUFJUZz09

HRSA-24-036 EHDI State/Territory iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: GLOSSARY OF KEY TERMS

HRSA-24-036 EHDI State/Territory 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Early Hearing Detection and Intervention (EHDI) State/Territory Program. The purpose of this program is to enhance the state/territory EHDI system infrastructure to improve language acquisition for deaf and hard-of-hearing (DHH) children up to age 3. Funding will support state and territory EHDI systems of services so that DHH newborns, infants, and young children up to age 3 receive appropriate and timely services, including hearing screening, diagnosis, and early intervention (EI).

Program Goals

HRSA funds a portfolio of coordinated programs to improve outcomes for DHH children, including the Early Hearing Detection and Intervention State/Territory Program (HRSA- 24-036), the Early Hearing Detection and Intervention (EHDI) National Centers (HRSA- 24-035), and the Pediatric Audiology Competitive Supplement to the Leadership Education in Neuro-developmental and Related Disabilities (LEND) Program (HRSA-21- 042).1 Together, these programs ensure DHH infants and children up to age 3 are identified in a timely manner and appropriate follow-up services are received to optimize language, literacy, cognitive, social, and emotional development. When children are identified as DHH early and provided timely and appropriate intervention services, their outcomes improve in these areas.

In alignment with Section 2 of the Early Hearing Detection and Intervention Act of 2022 (P.L. 117-241), which reauthorized the program and amended existing law,2 this funding opportunity will support state/territory-wide EHDI systems of services in developing and monitoring “statewide newborn, infant, and young child hearing screening, evaluation, diagnosis, and intervention programs and systems.” Specifically, the successful applicant will:

• Engage EHDI system stakeholders at the state/territory level to improve language acquisition3 outcomes,

• Disaggregate data to identify populations and address disparities in language acquisition outcomes,

• Provide a coordinated statewide infrastructure to ensure newborns are screened by 1 month of age, diagnosed by 3 months of age, enrolled in EI by 6 months of

1 See Appendix 2 Public Health Service Act, Title III, Section 399M (as added by P.L. 106-310, Sec. 702; as amended by P.L. 111- 337 and P.L. 115-71) 3 See Appendix.

https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-24-035%20 https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-24-035%20

HRSA-24-036 EHDI State/Territory 2 age (1-3-6 recommendations4), and loss to follow-up/loss to documentation is reduced,

• Support state/territory-wide capacity for hearing screening in young children up to age 3,

• Develop mechanisms to support and engage families with DHH children and DHH adults throughout the statewide EHDI system of services, and

• Engage, educate, and train health professionals and service providers5 in the statewide EHDI system about the 1-3-6 recommendations; the need for hearing screening up to age 3, the benefits of a family-centered medical home and the importance of communicating accurate, comprehensive, up-to-date, evidence-based information to families to facilitate the decision-making process to enroll in early intervention services.

Program Objectives

Your objectives should reflect the Program Goals set forth above and contribute towards the overall long-term goal of improving language acquisition for DHH children throughout your state/territory up to age 3. You are responsible to achieve, collect, and report on the following program objectives.

State/Territory Determined Objectives: These objectives should reflect the Program Goals and be based on the unique needs of your state/territory. In your application, propose at least one objective, including annual percent increases, in each of the following areas:

1. By the end of Year 1, you are expected to collect and report baseline data in the following:

• Strengthening the infrastructure to coordinate services across the statewide EHDI system for DHH children to improve language acquisition outcomes, including but not limited to, the following actions:

o Increasing data capacity and interoperability of data systems, which could include establishing language acquisition outcomes, collecting, and tracking data.

o Improving training and educating health care and other service providers.

o Building partnerships with other EHDI stakeholder organizations and entities. Such entities could include those that focus on early intervention, such as the Individuals with Disabilities Education Act

4 See Joint Committee on Infant Hearing, (2007) Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics Oct 2007, 120 (4) 898-921; DOI: 10.1542/peds.2007–2333.

5 See appendix https://sites.ed.gov/idea/about-idea/

HRSA-24-036 EHDI State/Territory 3

(IDEA) Part C programs, family-based organizations, provider organizations, etc.

o Strengthening mechanisms to engage families, including those traditionally underserved by EHDI, in DHH adult-to-family supports and services.

• Providing family-to-family supports and services across the EHDI system, which could include DHH adult-to-family supports and services.

2. By end of Year 5, you are expected to identify, collect, and report baseline data in the following area:

• Language acquisition outcomes for the population of 3-year-old DHH children in your state/territory.

1-3-6-Benchmarks: Recipients are expected to collect and report annually on the 1-3-6 benchmarks below. New recipients will establish baseline data in Year 1. Continuing recipients will report the state/territory’s data from the 2021 CDC (Centers for Disease Control and Prevention) EHDI Hearing Screening and Follow-up Survey (HSFS) as baseline data in Year 1.

By March 2029:

• Increase by 1 percentage point from baseline per year, or achieve at least a 95 percent screening rate, whichever is lower, the number of infants that completed a newborn hearing screen no later than 1 month of age.

• Increase by 10 percentage points from baseline, or achieve a minimum rate of 85 percent, whichever is lower, the number of infants that completed a diagnostic audiological evaluation no later than 3 months of age.

• Increase by 15 percentage points from baseline, or achieve a minimum rate of 80 percent, whichever is lower, the number of infants identified as DHH that are enrolled in EI services no later than 6 months of age.

For more details, see Program Requirements and Expectations.

2. Background

Authority

The Early Hearing Detection and Intervention State/Territory program is authorized by 42 U.S.C. § 280g-1(a), Title III, § 399M(a) of the Public Health Service Act.

About MCHB and Strategic Plan

The HRSA Maternal and Child Health Bureau (MCHB) administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and children with special health care needs. To achieve its mission of improving the health and well-being of America’s mothers, children, and families, MCHB is implementing a strategic plan that includes the following four goals:

https://sites.ed.gov/idea/about-idea/ https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html

HRSA-24-036 EHDI State/Territory 4

Goal 1: Assure access to high quality and equitable health services to optimize health and well-being for all MCH populations

Goal 2: Achieve health equity for MCH populations

Goal 3: Strengthen public health capacity and workforce for MCH

Goal 4: Maximize impact through leadership, partnership, and stewardship

To learn more about MCHB and the bureau’s strategic plan, visit Mission, Vision, and Work | MCHB.

Health Equity

Health equity is “the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons;

persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”6

Children and Youth with Special Health Care Needs Blueprint for Change

The Blueprint for Change: A National Framework for a System of Services for Children and Youth with Special Health Care Needs establishes a national agenda to ensure that every child gets the services they need to play, go to school, and grow up to become a healthy adult. The Blueprint for Change outlines strategies in four critical areas that will strengthen the systems serving CYSHCN: health equity; quality of life and well-being for CYSHCN and their families; access to services; and financing of services.

The Blueprint for Change provides a framework to guide EHDI programs as they move towards tracking long-term developmental outcomes, including language acquisition for DHH children. This work requires partnering with families, those with lived experience, health care and other service providers, payers, and others in the field to build state and system-level capacity.

Learn more by reading the Blueprint for Change Pediatrics Supplement.

Program Background

Approximately 1.8 of every 1,0007 U.S. newborns are documented as being identified early as congenitally deaf or hard-of-hearing (DHH). Children continue to be identified as DHH through early childhood and by kindergarten the prevalence more than

6 Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, 86 FR 7009, at § 2(a) (Jan. 20, 2021), https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021- 01753.pdf.

7 Centers for Disease Control and Prevention. (2022, September 29). 2020 Summary of Diagnostics Among Infants Not Passing Hearing Screening. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/hearingloss/2020-data/06-diagnostics.html https://mchb.hrsa.gov/about-us/mission-vision-work https://mchb.hrsa.gov/about-us/mission-vision-work https://publications.aap.org/pediatrics/issue/149/Supplement%207 https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf https://www.cdc.gov/ncbddd/hearingloss/2020-data/06-diagnostics.html

HRSA-24-036 EHDI State/Territory 5 doubles.8 Despite success in achieving near-universal newborn hearing screening rates, significant gaps remain, including timely diagnostic audiological evaluation, enrollment in IDEA Part C/Early Intervention (EI) services, and reducing loss to follow-up and documentation (LTF/D). Additional challenges include limited family engagement, DHH-specific support services,9 parent knowledge about availability and importance of EI,10 and pediatric provider knowledge of the 1-3-6 recommendations.11,12

When children are identified as DHH early and provided timely and appropriate intervention services, they have better outcomes than children identified later in life— particularly in the areas of vocabulary development, receptive language, expressive language, and social-emotional development.13, 14, 15, 16, 17 Early identification and intervention play a critical role in kindergarten readiness and long-term academic outcomes, such as reading proficiency.18,19 To improve developmental outcomes for DHH children, state/territory EHDI systems must partner with early childhood systems and service providers to track long term outcomes for this population.

The Blueprint for Change emphasizes the value and importance of partnering with families and individuals with lived experience at all levels of care to improve family and

8 Watkin, P., & Baldwin, M. (2012). The longitudinal follow up of a universal neonatal hearing screen: The implications for confirming deafness in childhood. International Journal of Audiology, 51(7), 519–528.

https://doi.org/10.3109/14992027.2012.673237 9 Family Leadership in Language and Learning (2018). Needs Assessment Report. Retrieved from:

https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf.

10 United States Government Accountability Office Report to Congressional Requestors. (2011). Deaf and Hard of Hearing Children – Federal Support for Developing Language and Literacy. GAO-11-357 11 American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Pediatrician Perspectives:

Executive Summary. August 2018.

12 American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Pediatrician Perspectives:

Executive Summary. August 2018.

13 Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics. 2017 Aug;140(2):e20162964. doi: 10.1542/peds.2016-2964. Epub 2017 Jul 8. PMID:

28689189; PMCID: PMC5595069.

14 Carren J. Stika, Laurie S. Eisenberg, Karen C. Johnson, Shirley C. Henning, Bethany G. Colson, Dianne Hammes Ganguly, Jean L. DesJardin, Developmental outcomes of early-identified children who are hard of hearing at 12 to 18 months of age, Early Human Development, Volume 91, Issue 1, 2015, Pages 47-55, ISSN 0378-3782, https://doi.org/10.1016/j.earlhumdev.2014.11.005.

15 Harris AB, Seeliger E, Hess C, Sedey AL, Kristensen K, Lee Y, Chung W. Early Identification of Hearing Loss and Language Development at 32 Months of Age. Journal of Otorhinolaryngology, Hearing and Balance Medicine. 2022;

3(4):8. https://doi.org/10.3390/ohbm3040008 16 Allen TE, Morere DA. Early visual language skills affect the trajectory of literacy gains over a three-year period of time for preschool aged deaf children who experience signing in the home. PLoS One. 2020 Feb 27;15(2):e0229591.

DOI: 10.1371/journal.pone.0229591 17 Tomblin, J. Bruce; Harrison, Melody; Ambrose, Sophie E.; Walker, Elizabeth A.; Oleson, Jacob J.; Moeller, Mary Pat. Language Outcomes in Young Children with Mild to Severe Hearing Loss. Ear and Hearing: 2015.36:76S-91S.

doi: 10.1097/AUD.0000000000000219 18 Jareen Meinzen-Derr, Susan Wiley, Wendy Grove, Mekibib Altaye, Marcus Gaffney, Ashley Satterfield-Nash, Alonzo T. Folger, Georgina Peacock, Coleen Boyle; Kindergarten Readiness in Children Who Are Deaf or Hard of Hearing Who Received Early Intervention. Pediatrics October 2020; 146 (4): e20200557. doi:10.1542/peds.2020- 19 Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics. 2017 Aug;140(2):e20162964. doi: 10.1542/peds.2016-2964. Epub 2017 Jul 8. PMID:

28689189; PMCID: PMC5595069.

https://doi.org/10.3109/14992027.2012.673237 https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf https://doi.org/10.1016/j.earlhumdev.2014.11.005 https://doi.org/10.3390/ohbm3040008

HRSA-24-036 EHDI State/Territory 6 child well-being and quality of life.20 The EHDI system of services relies on partnership between families and providers where information provided to families is high quality, “accurate, comprehensive, up-to-date, and evidence-based,”21 and communicated in an appropriate, timely, culturally sensitive way. Meeting the needs of DHH children and their families requires improved communication among health and other allied service professionals. Families with DHH children also benefit from family-to-family support and DHH adult to family support services.

II. Award Information

1. Type of Application and Award

Application type(s): Competing Continuation, New

We will fund you via a grant.

2. Summary of Funding

We estimate $13,865,000 will be available each year to fund up to 59 recipients. This includes 1 recipient in each of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, Guam, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau). You may apply for a ceiling amount of up to $235,000 annually (reflecting direct and indirect costs). An additional $1,500,000, subject to the availability of funds, will be awarded to up to 20 recipients at $75,000 each to implement an optional 1-year EHDI Innovation Project.

You may apply for a ceiling amount of up to $310,000 annually (reflecting direct and indirect), including $235,000 base amount and an additional $75,000 for the Optional EHDI Innovation Project). This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is April 1, 2024 through March 31, 2029 (5 years).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

20 Coleman, C. L., Morrison, M., Perkins, S. K., Brosco, J. P., & Schor, E. L. (2022). Quality of Life and Well-being for Children and Youth with Special Health Care Needs and Their Families: A Vision for the Future. Pediatrics, 149 (Supplement 7). https://doi.org/10.1542/peds.2021-056150g 21 Early Hearing Detection and Intervention Act of 2017, Public Health Service Act, Title III, Section 399M (as added by P.L. 106-310, Sec. 702; as amended by P.L. 111-337 and P.L. 115-71. Retrieved from:

https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf https://doi.org/10.1542/peds.2021-056150g https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf

HRSA-24-036 EHDI State/Territory 7

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

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

• Any state

• District of Columbia

• Commonwealth of Puerto Rico

• Northern Mariana Islands

• Guam

• American Samoa

• U.S. Virgin Islands

• Micronesia

• Republic of the Marshall Islands

• Republic of Palau

In addition, you can apply if your organization is in the United States and is:

• Public or private, non-profit

• Community-based

• Tribal (governments, organizations, as those terms are defined at 25 U.S.C. § 450b) o Native American tribal governments (federally recognized) are eligible.

o Native American tribal organizations (other than federally recognized tribal governments) are eligible.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-036 EHDI State/Territory 8

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

We may not consider an application for funding if it contains any of the following non-responsive criteria:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Multiple Applications

We will only review your last validated application before the Grants.gov due date.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-036 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them (includes a 55-page limit for the EHDI State/Territory Base Program and a 5-page limit for EHDI Innovation additional funding materials, Attachment 9). We won’t review any pages that exceed the page limit. Using the pages within the page limit, HRSA will determine eligibility using Section III. Eligibility Information of the NOFO.

https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-036 EHDI State/Territory 9

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.v. Attachments.

If you use an OMB-approved form that isn’t in the HRSA-24-036 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-036 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals22 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.23

• If you can’t certify this, you must include an explanation in Attachment 10–15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the Application Guide)

Program Requirements and Expectations To maintain and strengthen the EHDI system of services, recipients are expected to (1) conduct activities throughout the period of performance to ensure the 1-3-6 guidelines are followed; and (2) conduct activities that advance the EHDI system to ensure all children identified as DHH improve language acquisition outcomes. To achieve this long-term outcome, recipients are expected to conduct activities in two phases:

• Phase I: Planning

• Phase II: Implementation and Building Sustainable Practices

Throughout the period of performance:

Successful recipients are expected to propose methods and strategies to achieve the following:

22 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

23 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

HRSA-24-036 EHDI State/Territory 10

• Annually, at a minimum, convene a state/territory EHDI advisory committee24 to guide the overall program. A minimum of 25 percent of the committee should be comprised of parents of DHH children and DHH adults.

• Develop, maintain, and promote a website or webpage for the state/territory program that is user-friendly, 508 compliant, with culturally appropriate information for families and professionals. The site must highlight accurate, comprehensive, up-to-date, evidence-based information to allow families to make important decisions for their children, including decisions with respect to the full range of assistive hearing technologies and communication modalities, as appropriate.

• Participate in the annual grantee meeting for state/territory EHDI Coordinators and Family Leaders, where you will budget for at least one or two staff (could include early intervention/IDEA Part C staff) and at least one Family Leader to attend.

• Participate in technical assistance, training, learning collaboratives, and other activities facilitated by the EHDI National Network (HRSA-24-035). Participation with the EHDI National Network can include but is not limited to developing and refining state determined objectives, developing a statewide infrastructure plan and work plan, data collection and reporting mechanisms, improving family engagement and leadership, and provider engagement and education.

State/territory programs must report data to the Network, as needed or requested.

• Develop and implement a monitoring and evaluation plan to track progress to achieve project goals and objectives. These activities should be ongoing, and data should be shared in the annual progress and final reports. Use data to inform project activities, enhance program capacity, policy and systems building efforts. Submit patient level data (when applicable) and annual data to the CDC Annual Hearing Screening Follow-Up Survey, which is shared with HRSA.

Phase I – Planning: Phase I will take place in year one (1) of funding. This phase includes an assessment and analysis of the infrastructure to support your state/territory EHDI program to achieve the long-term goal to improve language acquisition outcomes for DHH children up to age 3 (plan described below). This includes establishing and maintaining partnerships necessary to track and report referrals and enrollment into services. Partners should include but are not limited to: health professionals, audiologists, speech language pathologists, EI providers, early care and education programs (for example, Early Head Start), state newborn screening programs, home visiting programs, professional provider organizations, birthing centers, hospitals and health systems, and other related state and local organizations who serve DHH children

24 See appendix

HRSA-24-036 EHDI State/Territory 11 and their families. Phase I should also include an assessment of how your EHDI- Information System (IS)25 will collect data and track project performance.

At the end of Phase 1/Year 1, you will provide a statewide infrastructure plan to the EHDI National Network (HRSA-24-035) that describes the following:

• System-level gaps in your current infrastructure for 1-3-6 recommendations on screening, identification, enrollment to EI up to age 3.

• Readiness and capacity to implement activities to achieve your state/territory identified objectives, including data capacity and interoperability with other service sectors, partners, and supportive policies, etc.

• Underserved26 populations and communities in your state.

• Needs of families served by your state/territory EHDI system, including family-to-family support and DHH consumer-to-family support.

• State/territory EHDI program role in building statewide capacity to screen children up to age 3.

• Mechanisms to increase access to language supports in DHH children up to age 3.

• Logic model presenting your conceptual framework to achieve project goals and objectives.

• Mechanisms to sustain project funding once HRSA funding ends.

• Work plan that outlines prioritized activities and identifies process and outcomes measures to reach state determined objectives. This work plan can be revised based on emerging needs identified in your state.

Phase II – Implementation and Building Sustainable Practices

Phase II will take place in years two (2) through five (5) of funding. This phase will focus on implementing and sustaining activities prioritized in the statewide infrastructure plan developed in Phase I. Guided by your state’s/territory’s needs and identified priorities, implementation should include the following:

• Engage all EHDI system stakeholders to improve language acquisition outcomes for DHH children.

• Strengthen the relationship with state/territory early intervention providers, which could include the IDEA Part C program at either the local and/or state level, through:

o Developing and implementing data sharing agreements

25 See appendix 26 See appendix https://www.cdc.gov/ncbddd/hearingloss/ehdi-is-functional-standards.html https://www.cdc.gov/ncbddd/hearingloss/ehdi-is-functional-standards.html

HRSA-24-036 EHDI State/Territory 12 o Maintaining mechanisms for formal communication, training, and referrals o Maintaining referral mechanisms to early intervention services o Collecting, tracking, and monitoring annual progress to reduce disparities in language acquisition outcomes for underserved populations using an EHDI Information System (EHDI IS), using disaggregated data to identify populations and address disparities.

o Promoting and supporting the development of resources, trainings, educational materials and/or other initiatives to reduce/eliminate the barriers to access EHDI services for underserved populations.

• Support and engage families with DHH children and DHH adults throughout the development, implementation, and evaluation of your state/territory EHDI program, through.

o Conducting outreach and education to inform families about opportunities to engage with the EHDI system and collaborate with leaders and policy makers to address challenges and provide solutions.

o Designating a point person to serve as Family Engagement Liaison, as your state/territory EHDI program’s family lead for support and engagement activities. This individual will also coordinate and communicate with the Family Leadership in Language and Learning Center about state/territory needs.

o At a minimum, allocating 20 percent* of awarded grant funds for family engagement and family support activities.27

• Engage and train health professionals and service providers in the EHDI system about the 1-3-6 recommendations; the need for hearing screening up to age 3;

the benefits of a family-centered medical home; the importance of communicating accurate, comprehensive, up-to-date, evidence-based information to families; and the importance of enrolling children in early intervention services to increase access to language acquisition supports, through:

o Developing partnerships and conducting outreach with health professionals and other allied service providers in the EHDI system.

o Facilitating partnerships among families, health care professionals, and service providers to ensure that providers have up-to-date, evidence-based information to engage with families, including families that are traditionally underserved.

27 See Appendix *States/territories with a birth rate below 5,000 may allocate 10 percent for family support and engagement activities.

HRSA-24-036 EHDI State/Territory 13

• Identify and measure practices and initiatives that improve access to language acquisition supports for DHH children up to age 3. Develop a plan to scale up these efforts to ensure all children identified as DHH in your state/territory are meeting language outcomes.

• Identify mechanisms, including financial support, that will allow your program to maintain or expand system-building efforts beyond the project period.

Optional EHDI Innovation Project

As part of this funding opportunity, you may also apply for an optional 1-year EHDI Innovation Project. Based on availability of funds, up to 20 competitive awards will be used to support innovative system enhancement efforts to build state/territory-level data and measurement capacity to improve language acquisition for DHH children identified up to age 3. This award should enhance your EHDI program’s data capacity by accelerating your ability to collect and analyze data through the application of implementation science and change management in peer-to-peer learning collaboratives.

Optional projects could include:

• Building data system capacity and interoperability

• Identifying measures, developing, and collecting language acquisition data

Additional details in the Approach section.

Program-Specific Instructions Include application requirements and instructions from Section 4 of the Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you’ll find in the workspace application package. Don’t upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the Application Guide.

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: NEED

HRSA-24-036 EHDI State/Territory 14

Narrative Section Review Criteria

Organizational Information Criterion 2: RESPONSE

Criterion 3: EVALUATIVE MEASURES

Criterion 4: IMPACT

Criterion 5: RESOURCES/CAPABILITIES

Criterion 6: SUPPORT REQUESTED

Need Criterion 1: NEED

Approach Criterion 2: RESPONSE

Criterion 3: EVALUATIVE MEASURES

Criterion 4: IMPACT

Criterion 6: SUPPORT REQUESTED

Work Plan Criterion 2: RESPONSE

Criterion 4: IMPACT

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES

Criterion 4: IMPACT

Criterion 5: RESOURCES/CAPABILITIES

Criterion 6: SUPPORT REQUESTED

Budget Narrative Criterion 6: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

Introduction -- Corresponds to Section V’s Review Criterion 1: Need

Briefly describe the purpose of the proposed project including how you will improve language acquisition outcomes for DHH children in your state/territory by age 3.

HRSA-24-036 EHDI State/Territory 15

Organizational Information -- Corresponds to Section V’s Review Criteria 2: Response, 3: Evaluative Measures, 4: Impact, 5: Resources/Capabilities, and 6: Support Requested o Succinctly describe your organization’s current mission, structure, experience working with the EHDI system and scope of current activities, and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations.

o Describe how these elements all contribute to the organization’s ability to meet the Program Requirements and Expectations. Include an organizational chart (Attachment 5) and staffing plan and job descriptions for key personnel (Attachment 2).

o Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

o Describe your ability to facilitate partnerships with and engage families, Deaf-led organizations, health professionals, and allied service providers, particularly those from underserved communities.

Need-- Corresponds to Section V’s Review Criterion 1: Need

This section will help reviewers understand the population of DHH children and their families, your state/territory EHDI system of services, and the communities you will serve with the proposed project. Use and cite data (for example, CDC Hearing Screening and Follow-up Survey and EHDI IS data) whenever possible to support the information provided.

o Describe how your state/territory is performing regarding 1-3-6 recommendations, including the number of births.

o Describe the needs of DHH children up to age 3 in your state/territory and their families, particularly communities who are underserved and have unmet health and social needs.

o Describe your state/territory EHDI system of services, infrastructure (including data and data systems), relationships with key stakeholders, partnerships with family-based organizations, Deaf-led organizations/entities, and other statewide MCH programs.

Approach -- Corresponds to Section V’s Review Criteria 2: Response, 3: Evaluative Measures, 4: Impact, and 6: Support Requested

Propose innovative and feasible methods and strategies that will be used to address the stated needs and meet the Program Requirements and Expectations.

As appropriate, include the development of effective resources and tools to

HRSA-24-036 EHDI State/Territory 16 achieve activities throughout the period of performance, Phase I (Planning) and Phase II (Implementation and Building Sustainable Practices).

Describe methods and strategies you will use to achieve the following:

Years 1–5 o Strengthen your state/territory EHDI system of services including collecting, analyzing, and reporting on the 1-3-6 recommendations and loss to follow-up/loss to documentation data.

o Convene a state/territory EHDI advisory committee,1 that includes parents of DHH children and DHH adults.

o Develop and maintain a website that is user-friendly, 508 compliant, and is culturally appropriate.

o Participate in the Annual Early Hearing Detection and Intervention (EHDI) Coordinators Grantee Meeting.

o Participate in technical assistance, training, and learning collaboratives facilitated by the Network Centers (HRSA-24-035).

o Sharing relevant data and resources with the Network Centers.

• Phase I- Planning o Develop a statewide infrastructure plan (including the use of an EHDI IS) to address all components described in the Program Requirements and Expectation section.

o Describe how your proposed methods and activities in the statewide infrastructure plan will impact your EHDI system of services.

• Phase 2- Implementation and Building Sustainable Practices o Describe how the identified needs in Phase I will be addressed during Phase II.

o Identify and maintain partnerships with EHDI system stakeholders to improve language acquisition outcomes for DHH children.

o Support engagement of families with DHH children and DHH adults throughout the EHDI system of services.

o Improve data sharing with your state/territory program and early intervention (EI) providers.

o Implement state or local-level data systems, which could include EHDI IS, and processes you will use to collect, track, and monitor progress to improve your ability to monitor language acquisition outcomes.

HRSA-24-036 EHDI State/Territory 17 o Engage and educate health care professionals and service providers in the EHDI system.

o Measure and scale up implementation of practices and initiatives that improve access to language acquisition for DHH children up to age 3 and how you will financially support and/or maintain these efforts.

Optional EHDI Innovation Project (not scored during merit review)

To be considered for the optional project, submit a proposal (including a description of the need and proposed methods work plan, budget, and budget narrative for a 1-year activity to build state/territory-level data and measurement capacity to improve language acquisition outcomes for DHH children.

The plan should be innovative and lend itself to a promising practice in advancing data collection and reporting language outcomes for children identified as DHH.

Please refer to the Program Requirements and Expectation section for a full description. If you apply for this optional project, the plan and budget should be included in Attachment 9 and no longer than 5 pages. The proposed EHDI innovation project should not require a long period of start-up time and be implemented within 6 months of the award. This portion of the proposal will be evaluated separately from the rest of the application by HRSA staff.

If awarded, the Optional EHDI Innovation Project amount will be on the notice of award (NOA).

Work Plan (Attachment 1) -- Corresponds to Section V’s Review Criteria 2: Response and 4: Impact o Describe the activities or steps that you will use to achieve each of the activities proposed during the entire period of performance in the Approach section. Use a timeline that includes each activity and identifies responsible staff in each Phase of the proposed project.

o As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including developing the application.

Resolution of Challenges -- Corresponds to Section V’s Review Criterion 2:

Response

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review Criteria 2: Response, 3: Evaluative Measures, 4: Impact, 5: Resources/ Capabilities and 6: Support Requested o Describe how your state/territory Core and State/Territory Determined Objectives will be monitored, tracked, and reported throughout the

HRSA-24-036 EHDI State/Territory 18 project period. Data for the 1-3-6-Benchmarks and State/Territory Determined Objectives will be established and submitted within the first year of the project, then collected and reported annually for the duration of the project to monitor and evaluate overall effectiveness of the program. Describe the expected outcomes for the proposed project, including improving language acquisition for DHH children.

o Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Include descriptions of the inputs (for example, organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities.

o Describe the systems and processes that will support your state/territory’s performance management requirements through effective tracking of performance outcomes, including a description of how…