oppHRSA-19-073-cfda93.501-cidHRSA-19-073-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Primary Health Care

School-Based Health Center Capital (SBHCC) Program

Funding Opportunity Number: HRSA-19-073

Funding Opportunity Type(s): New Catalog of Federal Domestic Assistance (CFDA) Number: 93.501

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date in Grants.gov: April 17, 2018 Supplemental Information Due Date in HRSA EHB:

May 31, 2018

Ensure your SAM and Grants.gov registrations and passwords are current immediately!

Deadline extensions are not granted for lack of registration.

Registration in all systems, including SAM.gov, Grants.gov, and HRSA EHB may take up to 1 month to complete.

Issuance Date: February 9, 2018

Peggie Harrison, Public Health Analyst Office of Policy and Program Development Bureau of Primary Health Care Telephone: (301) 594-4300 Email: sbhc@hrsa.gov

Authority: 42 USC 280h-4 mailto:sbhc@hrsa.gov

HRSA-19-073 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) is accepting applications for the fiscal year (FY) 2019 School-Based Health Center Capital (SBHCC) Program. The purpose of this grant program is to increase access to mental health, substance abuse, and childhood obesity-related services in operational school-based health centers (SBHCs), by funding minor alteration/renovation (A/R) projects and/or the purchase of moveable equipment, including telehealth equipment.

Funding Opportunity Title: School-Based Health Center Capital

(SBHCC) Program Funding Opportunity Number: HRSA-19-073 Due Date for Applications – Grants.gov:

April 17, 2018 (11:59 p.m. ET)

Due Date for Supplemental Information –

HRSA EHB:

May 31, 2018 (5 p.m. ET)

Anticipated Total Annual Available FY18 Funding:

Approximately $10 million

Estimated Number and Type of Awards: Up to 100 Estimated Award Amount: Up to $100,000 Cost Sharing/Match Required: No Project Period/Period of Performance: February 1, 2019 through January 31, 2021 (2 years) Eligible Applicants: Applicant must be a school-based health center or a sponsoring facility of a school-based health center.1

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf, except where instructed in this NOFO to do otherwise. A short video explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

1 Under the authorizing statute, the terms ‘‘school-based health center’’ and ‘‘sponsoring facility’’ have the meanings given those terms in section 2110(c)(9) of the Social Security Act (42 USC 1397jj(c)(9)).

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/

HRSA-19-073 ii

Technical Assistance

Application resources, including sample forms, webinar(s), and a frequently asked questions document, are available at the SBHCC Technical Assistance Web site at http://bphc.hrsa.gov/programopportunities/fundingopportunities/SBHCC.

Refer to “How to Apply for a Grant”, available at http://www.hrsa.gov/grants/apply, for general (i.e., not SBHCC specific) videos and slides on a variety of application and submission components.

The BPHC Primary Health Care Digest is a weekly email newsletter containing information and updates pertaining to the Health Center Program, including competitive funding opportunities. Organizations interested in seeking funding under the Health Center Program are encouraged to subscribe at https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHH

SHRSA_118.

Throughout the application development and preparation process, you are encouraged to work with Primary Care Associations (PCAs), and/or National Cooperative Agreement funding recipients (NCAs), such as the School-Based Health Alliance, to prepare a quality, competitive application. For a listing of HRSA-supported PCAs and NCAs, refer to HRSA’s Strategic Partnership’s Web site at http://www.bphc.hrsa.gov/qualityimprovement/supportnetworks/index.html.

http://bphc.hrsa.gov/programopportunities/fundingopportunities/SBHCC http://www.hrsa.gov/grants/apply https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 http://bphc.hrsa.gov/qualityimprovement/supportnetworks/index.html

HRSA-19-073 iii

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/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Abstract (Submitted in Grants.gov)

ii. Project Narrative (Submitted in HRSA EHB)

iii. Budget (Submitted in HRSA EHB)

iv. Budget Narratives (Submitted in HRSA EHB)

v. Program-Specific Forms (Submitted in HRSA EHB)

vi. Attachments (Submitted in HRSA EHB)

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND

SYSTEM FOR AWARD MANAGEMENT

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 AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX A: BUDGET INFORMATION

HRSA-19-073 1

I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Health Resources and Services Administration (HRSA) School-Based Health Center Capital (SBHCC) Program, authorized by 42 USC 280h-4. This notice of funding opportunity details the eligibility requirements, review criteria, and awarding factors for organizations seeking a SBHCC award in fiscal year

(FY) 2019.

FY 2019 SBHCC awards will increase access to mental health, substance abuse, and childhood obesity-related services in operational school-based health centers (SBHCs), by funding minor alteration/renovation (A/R) projects and/or purchase of moveable equipment, including telehealth equipment. Applicants must demonstrate how their proposal will support the provision of effective, efficient, quality health care, and lead to improvements in access to mental health, substance abuse, and childhood obesity-related services at the SBHC site(s).

Project Requirements

Applicants may submit one application to request funding for up to four minor A/R projects or one equipment-only project and up to three minor A/R projects. You must demonstrate that the SBHC site(s) for which capital funding is provided under this NOFO is currently operational and providing services to patients.

• Minor A/R: A minor A/R project is defined as all of the allowable A/R-related activities proposed at a single SBHC site, with a total site-specific project cost that is less than $500,000.2 You may propose up to four minor A/R projects at four different sites. The total request for SBHCC funding across all proposed projects may not exceed $100,000, and each site-specific total project cost, including other non-SBHCC funding sources, must be less than $500,000 (excluding moveable equipment). Projects may include:

o Work required to modernize, improve, and/or reconfigure the interior arrangements or other physical characteristics of a facility and/or installation of equipment in an existing facility, and o Purchase of related moveable equipment3 to be located at the site proposed to be altered/renovated.

A minor A/R project may not increase the total square footage of an existing building (e.g., by construction of a building addition) and may not be part of a larger construction project.

2 The total project cost (less than $500,000) includes both the federal funding request and all other funding sources, but excludes moveable equipment costs.

3 See the instructions for the Equipment List form for more information regarding moveable equipment.

HRSA-19-073 2

• Equipment-only: An equipment-only project includes the proposed purchase only moveable items3 with a useful life of more than one year. The unit cost of equipment can be of any value.4 You may propose one equipment-only project to purchase equipment for any number of operational SBHC sites, alone or in addition to proposed minor A/R project(s). Examples of equipment that you may propose in an equipment-only project include mobile medical vans, telehealth equipment, exercise equipment, health education equipment, laptops, servers, videoconferencing equipment, and scales.

You must use funds provided under this NOFO only for alterations and renovations and/or equipment. You may not use funds provided for expenditures for personnel or to provide health services.

You are also required to provide an assurance that funds awarded under this NOFO shall not be used to provide any service that is not authorized or allowed by Federal, State or local law.

Funding Preference

HRSA will give funding preference5 to SBHCs that serve a large population of children eligible for medical assistance under the state Medicaid plan under title XIX of the Social Security Act or under a waiver of such plan or children eligible for child health assistance under the State child health plan under title XXI of that Act (42 USC 1397aa et seq.).

2. Background

SBHCs provide a variety of comprehensive primary health services to children and adolescents, including primary care, mental health, substance abuse, dental services, case management, nutrition education, health education, and health promotion. A SBHC operates through partnership between a school and a community health organization, such as a community health center, hospital, local health department, or tribal organization that serves as the sponsoring facility for the SBHC. SBHCs emphasize age appropriate services, with a particular focus on prevention, early intervention, and risk reduction.6 The Centers for Disease Control and Prevention

4 Moveable equipment includes non-expendable items with a useful life of more than one year that are not permanently affixed and can be easily moved. For purposes of this funding opportunity, items with a unit cost of $5,000 or more and items with a unit cost of less than $5,000 with a useful life of more than one year are considered moveable equipment. There is no specific minimum or maximum per unit cost for equipment items. However, if the total cost of equipment is greater than $100,000, the maximum award amount of $100,000 still applies.

5 42 USC 280h-4.

6 See HRSA’s School Based Health Centers Web site at https://www.hrsa.gov/our-stories/school-health-centers/index.html.

https://www.hrsa.gov/our-stories/school-health-centers/index.html

HRSA-19-073 3

reports that the onset of mental, behavioral, and developmental disorders often occurs in childhood, with higher rates among low-income children.7 In addition, approximately one in six school-aged children are considered obese.8 Thus, SBHCs are uniquely positioned to provide access to services that address the most pressing health needs in children and adolescents, including mental health, substance abuse, and obesity.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

Approximately $10,000,000 is expected to be available in one-time funding to approximately 100 recipients. You may apply for a ceiling amount of up to $100,000 total cost.9 The project period is February 1, 2019 through January 31, 2021, (2 years).

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

For the purposes of this funding opportunity, eligible applicants must:

• Be a SBHC10 or a sponsoring facility11 of a SBHC applying on behalf of a SBHC.

A SBHC:

(i) Is located in or near a school facility of a school district or board, or a school facility of an Indian tribe or tribal organization;

(ii) Is organized through school, community, and health provider relationships;

(iii) Is administered by a sponsoring facility;

7 The Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report is available at https://www.cdc.gov/mmwr/volumes/66/ss/ss6608a1.htm.

8 More information about childhood obesity is available at https://www.cdc.gov/obesity/data/childhood.html.

9 Regardless of the type or number of projects proposed, the total funding request must be less than or equal to $100,000.

10 Defined in section 2110(c)(9)(A) of the Social Security Act (42 USC 1397jj(c)(9)).

11 Defined in section 2110(c)(9)(B) of the Social Security Act (42 USC 1397jj(c)(9)).

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.cdc.gov/mmwr/volumes/66/ss/ss6608a1.htm https://www.cdc.gov/obesity/data/childhood.html

HRSA-19-073 4

(iv) Through health professionals, provides primary health services to children in accordance with State and local law, including laws relating to licensure and certification; and

(v) Satisfies such other requirements as a State may establish for the operation of such a clinic.

A sponsoring facility of an SBHC includes any of the following:

(i) A hospital.

(ii) A public health department.

(iii) A community health center.

(iv) A nonprofit health care agency.

(v) A local educational agency (as defined under section 9101 of the

Elementary and Secondary Education Act of 1965 (20 USC 7801).

(vi) A program administered by the Indian Health Service or the Bureau of

Indian Affairs or operated by an Indian tribe or a tribal organization.

• Submit Attachment 1: SBHC Operational Agreement(s) for each proposed SBHC site to demonstrate status as an operational SBHC (or sponsoring facility of an operational SBHC) and indicate current operational status on the Project Qualification Criteria form.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Applications that exceed the ceiling amount of $100,000 will be considered non-responsive and will not be considered for funding under this notice.

Applications that propose either of the following unallowable projects, as noted on the Project Qualification Criteria form or described in the narrative, will be considered non-responsive and will not be considered for funding under this notice:

• Construction (i.e., a project that will increase physical square footage – either by building on to an existing facility or constructing a new facility from the ground up).

• Major alteration/renovation activities (i.e., an A/R project that is part of a larger construction project or has a total project cost of $500,000 or more).

Applications that propose a minor A/R project at a site that received funding for A/R or construction through a previous SBHCC funding opportunity in FY 2011 (HRSA-11- 127), FY 2012 (HRSA-12-113), or FY 2013 (HRSA-13-140) will be considered non-responsive and will not be considered for funding under this notice.

Any application that fails to satisfy the deadline requirements referenced in Section IV.4 will be considered non-responsive and will not be considered for funding under this notice.

HRSA-19-073 5

NOTE: Multiple applications from an organization are not allowable.

HRSA will only accept your first validated electronic submission, under the correct funding opportunity number in Grants.gov. Applications submitted after the first submission will be marked as duplicates and considered ineligible for review. If you wish to change information submitted in a Grants.gov application, you may do so in the HRSA Electronic Handbooks (HRSA EHB) application phase.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov and HRSA EHB. You must use a two-tier submission process associated with this NOFO and follow the directions provided at http://www.grants.gov/applicants/apply-for-grants.html and HRSA

EHB.

• Phase 1 – Grants.gov – Required information must be submitted and validated via Grants.gov with a due date of April 17, 2018 at 11:59 p.m. Eastern Time; and

• Phase 2 – HRSA EHB – Supplemental information must be submitted via HRSA

EHB with a due date of May 31, 2018 at 5 p.m. Eastern Time.

Only applicants who successfully submit an application in Grants.Gov (Phase 1) by the due date may submit the additional information and SBHCC Program- Specific Information in HRSA EHB (Phase 2).

Effective December 31, 2017 - You must use the Grants.gov Workspace to complete the Grants.gov forms and submit your Grants.gov application package for Phase 1.

After this date, you will no longer be able to use PDF application packages.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing the notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html

HRSA-19-073 6

2. Content and Form of Application Submission

Application Format Requirements Section 5 of HRSA’s SF-424 Two-Tier Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide except where instructed in the NOFO to do otherwise. Applications must be submitted in the English language and must be in terms of U.S. dollars (45 CFR § 75.111(a)).

You must submit the following application components in Grants.gov:

• Application for Federal Assistance (SF-424)

• Project Abstract (attached under box 15 of the SF-424)

• Project/Performance Site Locations

• Grants.gov Lobbying Form

• Key Contacts

You must submit the following application components in HRSA EHB:

• Project Narrative (submitted as the Proposal Cover Page form)

• Program-Specific Forms o Assurances for Construction Programs (SF-424D) o Project Qualification Criteria o Project Cover Page o Consolidated Budget Information for Construction Programs (SF-424C) o Project-Specific Budget Information for Construction Programs (SF-424C) o Funding Sources o Equipment List o Form 5B: Service Sites o Environmental Information and Documentation (EID) Checklist o Other Requirements for Sites

• Attachments o Project-Specific Budget Justification (uploaded to Project Cover Page form) o Floor Plans/Schematic Drawings/Site Plan (uploaded to Project Cover

Page form) o Landlord Letter of Consent (uploaded to Other Requirements for Sites form) o Property Information (uploaded to Other Requirements for Sites form) o SBHC Operational Agreement(s) (Attachment 1) o Collaboration Documentation (Attachment 2) o Consolidated Budget Narrative (Attachment 3)

See Section 9.5 of HRSA’s SF-424 Two-Tier Application Guide for the Application Completeness Checklist.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-19-073 7

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, budget narrative, attachments, and letters of commitment and support. Standard OMB-approved forms that are included in the application package do not count in the page limitation. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, validated by Grants.gov, and submitted under the correct funding opportunity number prior to the Grants.gov and HRSA EHB deadlines to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 USC 3321.)

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included in Attachment 5: Other Relevant Documents.

See Section 5.1 viii of HRSA’s SF-424 Two-Tier Application Guide for additional information on all certifications.

Program-Specific Instructions In addition to application requirements and instructions in Sections 4 and 5 of HRSA’s SF-424 Two-Tier Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), please include the following:

Application for Federal Assistance SF-424 (Submitted in Grants.gov) See Section 3.2 of HRSA’s SF-424 Two-Tier Application Guide. Further information for noted fields is provided below.

• Box 2: Type of Applicant: New

• Box 5a: Federal Entity Identifier: Leave blank.

• Box 5b: Federal Award Identifier: 10-digit award recipient number starting with

H80 for current Health Center Program award recipients. If not, leave blank.

• Box 8c: Organization’s DUNS. An incorrect or mistyped DUNS number will cause the application to be rejected.

• Box 14: Areas Affected by Project: Leave blank.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-19-073 8

• Box 15: Descriptive Title of Applicant’s Project: Type the title of the NOFO (School Based Health Center Capital Program) and upload the project abstract.

See instructions in Section IV.2.i.

• Box 17: Proposed Project Start Date and End Date: Provide the start date (February 1, 2019) and end date (January 31, 2021) for the proposed 2-year project period.

• Box 18: Estimated Funding: Complete the required information. The funding request should be entered on line a. Federal (not to exceed $100,000).

• Box 19: Review by State: See Section IV.5 for guidance in determining applicability.

i. Abstract (Submitted in Grants.gov) See Section 5.1.ix. of HRSA’s SF-424 Two-Tier Application Guide. In addition, the abstract should include:

• A brief history of the SBHC;

• A brief description of the population served by the SBHC;

• A brief description of the need for the minor alteration/renovation and moveable equipment expenditures; and

• A brief summary of the proposed project(s), how the project(s) will address the minor A/R and moveable equipment needs of the SBHC, and the expected impact related to improving student access to mental health, substance abuse, and childhood obesity-related services.

ii. Project Narrative (Submitted in HRSA EHB) This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, and well organized so that reviewers can understand the proposed project. You will enter the Project Narrative as part of the Proposal Cover Page form in HRSA EHB.

Proposal Cover Page (Submitted in HRSA EHB per application)

The Proposal Cover Page provides a consolidated summary of the proposed SBHCC project(s). The Proposal Cover Page must align with the information provided in the Project Cover Page and other program-specific forms. You must propose project(s) that, once completed, will increase access to mental health, substance abuse, and childhood obesity-related services in operational SBHCs. Note that funds may not be used for the provision of services.

Successful applications will contain the information below.

1) NEED -- Corresponds to Section V’s Review Criterion 1: NEED (Maximum 8,000 characters including spaces)

1. Describe the SBHC target population and the unmet need for mental health, substance abuse, and childhood obesity-related services.

2. Describe how the SBHC’s physical infrastructure is insufficient to address current needs for mental health, substance abuse, and childhood obesity-related services.

HRSA-19-073 9

3. If you propose to purchase equipment, describe the need for additional or new equipment to support increasing access to mental health, substance abuse, and childhood obesity-related services.

2) RESPONSE -- Corresponds to Section V’s Review Criterion 2: RESPONSE

(Maximum 9,000 characters including spaces)

1. Describe how the proposal, including minor A/R and/or equipment purchases, will enable the SBHC to increase access to mental health, substance abuse, and childhood obesity-related services. Your response should align with and reference more detailed project-related information in, the Project Description section of the Project Cover Page(s), including the scope of work, established goals, and floor plans/schematic drawings/site plan(s) for the proposed project(s).

2. Describe how the SBHC will leverage primary health care services already provided to children to support the initiation and/or expansion of mental health, substance abuse, and childhood obesity-related services.

3. Describe collaboration and coordination of services with other health care providers in the area. Provide evidence of support from such providers, community members, and/or other stakeholders through letters of support uploaded as Attachment 2: Collaboration Documentation.

3) SERVICE IMPACTS -- Corresponds to Section V’s Review Criterion 3: IMPACT

(Maximum 8,000 characters including spaces)

1. Describe how the completed project(s) will enhance the quality of care and patient outcomes in the areas of mental health, substance abuse, and childhood obesity-related services.

2. Describe the expected impacts of the completed project(s), including the number of unduplicated patients served annually at the SBHC who will have increased access to mental health, substance abuse, and childhood obesity-related services.

4) RESOURCES/CAPABILITIES -- Corresponds to Section V’s Review Criterion 4:

RESOURCES/CAPABILITIES (Maximum 8,000 characters including spaces)

1. Describe the extent of primary health care services currently provided at the SBHC and the scope of the SBHC-sponsoring facility partnership, consistent with Attachment 1: SBHC Operational Agreement(s). If the SBHC is not located at the school, describe how you ensure that students can access services at the SBHC site.

2. Describe the SBHC’s capacity (e.g., staffing, resources for sustainability) to begin providing or increase services to address childhood mental health, substance abuse, and obesity needs.

3. Describe how the SBHC has the appropriate resources and capabilities to successfully implement and complete the proposal (e.g., prior capital experience, project management, reasonable control of the SBHC site).

4. Describe the SBHC’s administrative structure and oversight capability, with additional detail in the Project Cover Page(s), including:

HRSA-19-073 10

• The roles and responsibilities of the SBHC’s key management staff and governing board, if applicable, in supporting the goals for the project(s); and

• The relevant expertise and experience of the Project Manager and Project Team, if applicable, who will manage the project(s).

5. Describe the SBHC’s acquisition policies and procedures, as well as how the SBHC will comply with federal procurement requirements.

6. Explain the roles of key personnel (e.g., board, management team, project team) in ensuring that the proposal will be completed on time (within the 2-year project period) and within budget, consistent with, and further detailed in, the Project Cover Page(s).

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Application Section Review Criteria

Need on Proposal Cover Page (1) Need

Response on Proposal Cover Page

Project Description on Project Cover Page

Attachment 2: Collaboration Documentation

(2) Response

Service Impacts on Proposal Cover Page (3) Impact

Resources/Capabilities on Proposal Cover Page

Project Management on Project Cover Page

Attachment 1: SBHC Operational Agreement(s)

(4) Resources/Capabilities

Budget Presentation (Budget Forms, Consolidated Budget Narrative, and Project-Specific Budget Justification(s))

(5) Support Requested

iii. Budget (Submitted in HRSA EHB) See Section 5.1.iv of HRSA’s SF-424 Two-Tier Application Guide. Please note: the directions offered in the SF-424 Two-Tier Application Guide may differ from those offered by Grants.gov. Follow the instructions included in the Application Guide and the additional budget instructions provided below and in Appendix A. A sample format for the Budget Narrative and samples of the forms are available at the SBHCC Technical Assistance Web site.

Reminder: The Total Project or Program Costs are the total allowable costs incurred by the recipient to carry out a HRSA-supported project or activity. Total project or http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/assistance/sbhcc http://www.hrsa.gov/grants/apply/assistance/sbhcc

HRSA-19-073 11

program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement as applicable.

The SBHCC application requires the following budget forms:

Budget Information Sections A and C (Required per application) Complete the Budget Information in HRSA EHB after the SF-424 Basic Information.

The Budget Information in these sections must correspond to the total cost of the proposal, inclusive of all projects.

• Section A – Budget Summary: Under New or Revised Budget, enter the federal funding requested in the Federal column and enter all other project costs in the Non-Federal column. The Total column must align with the Total Project Costs on Line 16a of the Consolidated SF-424C. Estimated Unobligated Funds are not applicable for this funding opportunity.

• Section C – Non-Federal Resources: Not including the federal funding request, enter the amount of all other sources of funding for the proposal. The total in Section C must be consistent with the Non-Federal Total in Section A.

Budget Information for Construction Programs (SF-424C) – Project-Specific Budget (Required per project) Complete the SF-424C as presented for each proposed project. See instructions in Appendix A for further details on allowable and unallowable costs.

• Column A – Total Cost: Indicate the total cost of the project in this column.

• Column B – Costs Not Allowable for Participation: Only costs defined as unallowable in the chart in Appendix A should be entered in Column B.

Requested federal funds may not be used to cover these costs. Do not include costs in Column B merely to reduce Column C to the award amount.

• Column C – Total Allowable Costs: Subtract Column B from Column A.

Column C should contain all allowable costs, whether or not these costs will be paid with award funds.

Enter the federal amount requested for the project in Line 17, Column C. Requested award funds cannot exceed the amount in Line 16, Column C. The federal percentage share is calculated by HRSA EHB in Line 17.

Budget Information for Construction Programs (SF-424C) – Consolidated Budget (Required per application) HRSA EHB will populate this form based on information provided for each project budget SF-424C, as described above.

Funding Sources Form (Required per project) Identify the total cost associated with each project and other sources of funding for the project, including governmental agencies, other award funds, or proposed debt.

Identify the status of obtaining the full funding needed to undertake the project, specifically, whether the funds are secured, expected (you have assurances that the funds will be received), or forthcoming (receipt of funds is unknown at this time).

HRSA-19-073 12

These funding sources must be consistent with information in the Consolidated Budget Narrative. Include letters of commitment from expected funding sources in Attachment 2: Collaboration Documentation.

Project Equipment List (Required for each project that includes equipment) For each minor A/R project that includes a request for related equipment, include the requested equipment for only that project/site. For equipment-only projects, provide a single equipment list for one or more SBHC site(s).

For each item on the equipment list, complete the following fields:

• Type – Select clinical or non-clinical.

• Item Description – Provide a description of each item.

• Unit Price – Enter the estimated cost of each item.

• Quantity – Enter of the number of each item to be purchased.

• Total Price – HRSA EHB will calculate the total price by multiplying the unit price by the quantity entered.

Any equipment purchased with grant funds must be pertinent to the project goals of improving access to mental health, substance abuse, and childhood obesity-related services. Further, equipment purchased with grant funds must be procured through a competitive process and maintained, tracked, and disposed of in accordance with 45 CFR part 75. See more information about procurement rules at http://bphc.hrsa.gov/policiesregulations/capital/postaward/faqprocurment.pdf.

Allowable equipment includes moveable items that are non-expendable, tangible personal property (including information technology systems and mobile medical vans) having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of (a) the capitalization level established by the applicant for its financial statement purposes, or (b) $5,000. Moveable equipment can be readily shifted from place to place without requiring a change in the utilities or structural characteristics of the space and is usually purchased outside of any construction contract.

You may also include moveable equipment with a useful life of one year or greater and a unit cost of less than $5,000, if necessary for the SBHCC project. This may include telehealth or administrative equipment (e.g., laptops, servers, videoconferencing equipment), and equipment used for mental health, substance abuse, and childhood obesity-related services activities (e.g., scales, exercise equipment).

Permanently affixed equipment (e.g., heating, ventilation, and air conditioning (HVAC), generators, lighting) are not moveable equipment. These items are categorized as minor A/R and are allowable as A/R costs.

The selection of all equipment should be based on a preference for recycled content, non-hazardous substances, non-ozone depleting substances, energy and water http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://bphc.hrsa.gov/policiesregulations/capital/postaward/faqprocurment.pdf

HRSA-19-073 13

efficiency, and consideration of final disposal (disposed in a manner that is safe, protective of the environment, and compliant with all applicable regulations), unless there are conflicting health, safety, and performance considerations. Applicants are strongly encouraged to employ the standards established by either the Electronic Product Environmental Assessment Tool (EPEAT) or Energy Star, where practicable, in the procurement of equipment. Following these standards will mitigate the negative effects on human health and the environment. Additional information for these standards can be found at http://www.epeat.net and http://www.energystar.gov.

iv. Budget Narratives (Submitted in HRSA EHB) See Section 5.1.v. of HRSA’s SF-424 Two-Tier Application Guide and the program-specific budget instructions provided below and in Appendix A.

• Consolidated Budget Narrative: In addition to the SF-424C and individual project budget forms listed in Section IV.2.iii, you must submit a Consolidated Budget Narrative, uploaded as Attachment 3. The Consolidated Budget Narrative must be consistent with information provided in the forms and other attachments.

Use the chart in Appendix A as a guide to describe the costs of the project(s).

Justify how the costs for each line item will contribute to the goals and objectives of the proposal. Consistent with information in the Funding Sources form, describe the plan for obtaining the balance of the funds that are not secured.

• Project-Specific Budget Justifications: You must also submit a Project-Specific

Budget Justification for each project (uploaded to the Project Cover Page) included in the application.

Note that funds may not be used for the provision of services. See the funding restrictions listed in Section IV.6 and unallowable costs indicated in the chart in Appendix A.

v. Program-Specific Forms (Submitted in HRSA EHB) Consolidated and project-specific budget-related forms are described above in Section IV.2.iii. Applicants must also complete the following program-specific forms in HRSA EHB, as applicable.

Proposal Cover Page (Required per application) In addition to the Project Narrative fields described in Section IV.2.ii, applicants must provide eligibility information about the SBHC and include the number of unduplicated patients served annually at the SBHC who will have increased access to mental health, substance abuse, and childhood obesity-related services.

In order to be considered for the funding preference applicable to this funding opportunity, you must certify on the Proposal Cover Page that the SBHC serves a large population of:

• Children eligible for medical assistance under the state Medicaid plan under title XIX of the Social Security Act or under a waiver of such plan.

http://www.epeat.net/ http://www.energystar.gov/

HRSA-19-073 14

or

• Children eligible for child health assistance under the state child health plan under title XXI of the Social Security Act.

SF-424D Assurances for Construction Programs (Required per application) By signing and submitting this form, the authorized representative certifies that the applicant will comply with all applicable requirements of Federal laws, executive orders, regulations, and policies.

Project Qualification Criteria (Required per project) Answer the questions regarding your proposed project. This form will be used to assess eligibility and unallowable costs.

1) Is the applicant SBHC:

• Located in or near a school facility of a school district or board, or a school facility of an Indian tribe or tribal organization;

• Organized through school, community, and health provider relationships;

• Providing, through health professionals, primary health services to children in accordance with State and local law, including laws relating to licensure and certification; and

• In compliance with such other requirements as a State may establish for the operation of such a clinic?

2) Will the proposed project occur at a site that is currently open and operating as a

SBHC?

3) Is the proposed project new construction (increase in square footage of the building or a new facility)?

4) Does the proposed project have a total (federal and non-federal) cost of $500,000 or more, not including moveable equipment purchases?

5) Will the work of the proposed project supplant any currently active HRSA award for capital activities at the physical site address?

Project Cover Page (Required per project) You must complete the Project Cover Page for each proposed project. The Project Cover Page must align with the information provided in the Proposal Cover Page and other program-specific forms. You must complete a project cover page for each proposed minor A/R site. An equipment-only project can describe equipment across multiple sites.

1) Site Information

Improved Project Square Footage: Enter the total square feet of the area to be altered/renovated. For equipment-only project, enter zero.

2) Project Description (Maximum 4,000 characters including spaces) Provide a detailed description of the project’s scope of work and established goals.

HRSA-19-073 15

For equipment-only projects:

• Describe how the project's potential adverse impacts on the environment will be minimized. Indicate whether, and if so, how the project will implement green/sustainable practices (e.g., recycled content, energy efficiency).

For minor A/R projects:

• Identify the major clinical and non-clinical spaces that will be improved by the project, including the area (in square feet) or dimensions of the spaces to be altered/renovated.

• List key improvements, such as permanently affixed equipment to be installed;

modifications and repairs to the building exterior (including windows); heating, ventilation, and air conditioning (HVAC) modifications (including the installation of climate control and duct work); electrical upgrades; plumbing work; and any work outside the building.

• Describe how the project's potential adverse impacts on the environment will be minimized. Indicate whether, and if so, how the project will implement green/sustainable design practices/principles (e.g., using project materials, design/renovation strategies, equipment selection).

3) Project Management (Maximum 4,000 characters including spaces)

Explain the oversight for the project, including the Project Manager and the Project Team, if applicable, responsible for managing the project. Describe how the Project Manager will ensure successful management and achievement of the project’s established goals.

Indicate the start and end dates for each of the following milestones within the 2-year project period: planning, project development, A/R, equipment purchases, and project completion. Provide a justification for the reasonableness of each timeframe, the predicted challenges, and plans for mitigating them to ensure that the project is completed within the 2-year project period.

4) Project Budget Justification (Required attachment for minor A/R projects)

If you are requesting funding for minor alteration/renovation, attach a project budget justification that shows quantities, unit prices, and total cost for each line item in the budget, as well as a breakout of federal and non-federal costs for each line item. Explain how the costs contribute to meeting the project’s objectives/goals. Consistent with information in the Funding Sources form, describe the plan for obtaining the balance of the funds that are not secured.

See Section IV.2.iv and Appendix A for details.

5) Environmental Information and Documentation (EID) Checklist (Required attachment for minor A/R projects) Attach an EID Checklist for each minor A/R project. A template is available in HRSA EHB to download, complete, and upload to the Project Cover Page.

HRSA-19-073 16

The National Environmental Policy Act of 1969 (NEPA) (P.L. 91-190; 42 USC 4321 et.seq.), the National Historic Preservation Act (NHPA) (P.L. 89-665; 16 USC 470 et seq.), and other associated laws require, among other things, that HRSA consider the environmental impacts and potential effects on historical and archeological resources of any federal action, including minor A/R projects supported with federal funds. In order to initiate reviews under NEPA and NHPA, submit a completed EID Checklist (OMB Form No. 0915-0324) for each site for which any federal funds are being requested for minor A/R. You must explain each response of “yes” on the EID Checklist.

If funded, you must receive HRSA approval prior to beginning any A/R projects.

Such approval may be contingent on the provision of additional documentation such as a hazardous materials survey, abatement plans, or initiation of Section 106 consultation. If you do not have in-house expertise in environmental and historic preservation compliance, you are advised to secure the services of a consultant with the appropriate background.

Until any required environmental and historic preservation reviews are completed and associated conditions are lifted from the Notice of Award, award recipients are not authorized to acquire fixed equipment or initiate work beyond the design and permitting stage of the project. For additional information on environmental and historic preservation compliance, see https://bphc.hrsa.gov/programopportunities/fundingopportunities/capdev.html.

6) Floor Plans/Schematic Drawings/Site Plan (Required attachment for minor A/R projects) If you propose minor A/R project(s), you must attach line drawings for each site where minor A/R activities will occur. These drawings should:

• Be legible on an 8.5" x 11" sheet of paper.

• Include a scale and the linear dimensions for each room.

• Clearly show the work described in the project description and budget justification.

• Indicate the location of the proposed renovation area in the existing building.

• Distinguish improved space from unaffected space.

• Note the total net and gross square footage of space to be renovated, and any changes or additions to existing mechanical and electrical systems.

• Provide an overall site plan (or key plan) that shows the location of the project within the overall facility and, if applicable, shows any allowable exterior improvements included for the project.

These drawings are not required to be completed by an architect.

Form 5B: Service Sites (Required per project) Applicants must complete a separate Form 5B for each site where equipment purchased will be located, or where minor A/R activities will occur. Provide the required data for each site, including:

• Site address;

https://bphc.hrsa.gov/programopportunities/fundingopportunities/capdev.html

HRSA-19-073 17

• Location type (permanent, seasonal, or mobile van);

• Site setting (school, hospital, or all other clinic types);

• Site operational date (must be prior to application, unless the site is a mobile medical van purchased with SBHCC funding to expand capacity for an operational SBHC);

• Total hours of operation per week.

NOTE: If the site setting is not the school, Attachment 1: SBHC Operational Agreement(s) must describe how you ensure access to services (e.g., transportation for patients between the school and the SBHC site).

Other Requirements for Sites (Required per minor A/R project) If you propose minor A/R project(s), you must complete the Other Requirements for Sites form for each site where minor A/R activities will occur. This form addresses site control, federal interest, and cultural resources and historic preservation considerations related to each A/R project.

1) Site Control and Federal Interest

Identify if the applicant organization owns the SBHC site or not. If so, select “owned.” If the site is not owned by the applicant organization, regardless of whether you will pay a recurring fee to use the property, select “leased.”

If the site is leased, certify that:

• The existing lease will provide you reasonable control of the project site for at least a period of 5 years after the renovation is completed;

• The existing lease is consistent with the proposed scope of project;

• You understand and accept the terms and conditions regarding federal interest in the property.

The federal government retains a reversionary interest in real property constructed, acquired, or improved with federal funds. The federal interest is based on the total allowable project costs (federal), excluding movable equipment, as a percent of the value of the property after completion of the project.

For minor A/R projects, federal interest exists for the useful life attributable to the A/R funded under this award. Since new construction and major A/R projects with a total cost of $500,000 or more are not allowable under this award, you are not required to file a Notice of Federal Interest (NFI). However, if funded, by accepting the Notice of Award and drawing down funds, you are acknowledging that the federal interest exists irrespective of the filing of a NFI. The award recipient must maintain documentation to track and protect the federal interest.

Such documentation includes communications between the lessor and the lessee related to protecting such interest, in accordance with the standard award terms and conditions.

HRSA-19-073 18

See frequently asked questions about federal interest at http://bphc.hrsa.gov/policiesregulations/capital/nfifilingguide.pdf.

2) Cultural Resource Assessment and Historic Preservation Considerations Respond to the following questions:

• Was the project facility constructed prior to 1975?

• Is the project facility 50 years or older?

• Does any element of the overall work at the project site include:

o Any renovation/modification to the exterior of the facility (e.g., roof, HVAC, windows, siding, signage, exterior painting, generators); or o Ground disturbance activity (e.g., expansion of building…