PKG00249331-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Primary Health Care Office of Policy and Program Development

Oral Health Infrastructure (OHI)

Funding Opportunity Number: HRSA-19-079

Funding Opportunity Type(s): Competing Supplement Catalog of Federal Domestic Assistance (CFDA) Number: 93.527

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date in Grants.gov: April 22, 2019 Supplemental Information Due Date in HRSA EHBs: May 21, 2019

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

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: March 22, 2019

Renetta Boyd or Robyn Bess Public Health Analysts, Office of Policy and Program Development Contact: https://www.hrsa.gov/about/contact/bphc.aspx Telephone: (301) 594-4300 OHI Technical Assistance website:

http://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/index.html

Authority: Public Health Service Act, Section 330(e), (g), (h), and/or (i), as amended (42 U.S.C. 254b(e), (g), (h), and/or (i)) https://www.hrsa.gov/about/contact/bphc.aspx http://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/index.html

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019 Oral Health Infrastructure (OHI) under the Health Center Program.

The purpose of this one-time, competitive supplemental funding opportunity is to support infrastructure enhancements to provide new or enhance existing high quality, integrated oral health services.

Funding Opportunity Title: Oral Health Infrastructure (OHI) Funding Opportunity Number: HRSA-19-079 Due Date for Applications – Grants.gov:

April 22, 2019 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA EHBs

May 21, 2019 (5 p.m. ET)

Anticipated Total Available FY 2019 Funding:

$76,000,000

Estimated Number and Type of Awards: Up to 250 grants

Estimated Award Amount: Up to $300,000 Cost Sharing/Match Required: No Period of Performance: OHI funding will be awarded as a supplement to your current Health Center Program award, for use from September 1, 2019 through the end of your FY 2021 budget period.

Eligible Applicants: Existing Health Center Program award recipients that currently receive operational funding under section 330 of the Public Health Service Act (i.e., sections 330(e), (g), (h) and/or (i)).

See Section III of this notice of funding opportunity (NOFO) 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 https://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf, except where instructed in this NOFO to do otherwise.

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

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Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar for applicants seeking funding through this opportunity. Visit the OHI technical assistance website for webinar details and helpful resources. In addition, see BPHC’s Oral Health and Primary Care Integration website for resources on improving oral health and primary care integration in health centers.

The HRSA 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 have several staff subscribe at https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHH

SHRSA_118.

HRSA-supported Primary Care Associations (PCAs) and/or National Cooperative Agreement recipients (NCAs) are available to assist you in preparing a quality application. For a listing of HRSA-supported PCAs and NCAs, refer to HRSA’s Strategic Partnerships website.

https://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/ https://bphc.hrsa.gov/qualityimprovement/clinicalquality/oralhealth/index.html https://bphc.hrsa.gov/qualityimprovement/clinicalquality/oralhealth/index.html https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/index.html

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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. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Program-Specific Forms

vi. Attachments

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

APPENDIX A: SAMPLE ACTIVITIES FOR INFRASTRUCTURE ENHANCEMENTS FOR

ORAL HEALTH SERVICES

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for Fiscal Year (FY) 2019 Oral Health Infrastructure (OHI) funding. The purpose of the OHI supplemental funding is to support infrastructure enhancements to provide new or enhance existing high quality, integrated oral health services in health centers.

For purposes of this NOFO, the phrase “integrated oral health services” means preventive and primary dental health services and additional dental services, as appropriate, delivered through an interdisciplinary team-based approach in collaboration among health center professionals (e.g., medical, behavioral, dental). This funding opportunity will support one-time physical and organizational infrastructure investments, such as minor alteration and renovation (A/R), equipment purchases, health information technology (IT), and training, to enable health centers to establish or enhance integrated oral health services, including those provided using telehealth1 and virtual dentistry. Virtual dentistry utilizes telehealth technology to provide patients preventive and early intervention therapeutic services in community settings where they live or receive other health services, and gives providers and staff in remote sites access to professional resources.2

2. Background

This program is authorized by Section 330(e), (g), (h) and/or (i) of the Public Health Service Act, as amended (42 U.S.C. 254b(e), (g), (h) and/or (i)).

This funding opportunity builds upon previous HRSA investments to support integrated care in health centers. In 2016, HRSA awarded 420 health centers approximately $156 million in ongoing funding to increase access to integrated oral health care services and improve oral health outcomes for Health Center Program patients. Health centers used these funds to increase oral health service capacity by hiring approximately 1,660 new dentists and dental hygienists, assistants, and technicians to provide dental services to more than 450,000 new patients. HRSA-funded health centers served more than 6.1 million dental patients and provided nearly 15.7 million dental visits in 2017, an 8 percent increase from 2016.

1 Telehealth is defined, for purposes of this NOFO, as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. See https://www.hrsa.gov/rural-health/telehealth/index.html for telehealth resources.

2 Glassman, Harrington, Namakian, and Subar, “The virtual dental home: bringing oral health to vulnerable and underserved populations.” California Dental Association Journal, vol. 40, no. 7, pp. 569- 77, July 2012.

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.hrsa.gov/rural-health/telehealth/index.html

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Health Center Program award recipients (hereafter referred to as health centers)3 provide comprehensive required primary care services to medically underserved areas and populations, including preventive dental services. These services include basic dental screenings, oral health hygiene instruction and education, oral prophylaxis (commonly known as teeth cleaning), and the application of fluorides, and may include X-rays and the placement of dental sealants. Many health centers also offer additional dental services, such as diagnosis and treatment of tooth ailments, to address the oral health care needs of their patient population.

Health centers may face challenges providing integrated oral health services due to limitations in infrastructure, such as outdated equipment, insufficient space, and limited integration of primary care and oral health electronic health records. As a follow up to previous investments to expand oral health service capacity, OHI one-time funding will provide health centers an opportunity to make or build upon such infrastructure enhancements.

Proposal Requirements

Your application must demonstrate how you will use OHI funding to enhance your infrastructure to increase access to integrated oral health services. You must use funds provided under this NOFO for one-time physical and organizational infrastructure investments (e.g., minor A/R, equipment, health IT, training) to increase access to integrated oral health services, including telehealth and virtual dentistry. OHI funds may not support ongoing personnel or service provision costs. Infrastructure investments may occur at current, in-scope health center sites or new sites that are proposed through the OHI application for the purpose of expanding access to integrated oral health services. These sites (current or proposed) may be permanent or mobile.

Proposed new sites must be located within the current service area. See the instructions for completing Form 5B: Service Sites for details.

Your application may request funding for as many as four minor A/R projects, equipment purchases, and/or other infrastructure investments such as training, telehealth, and health IT that do not fall under the equipment category. Refer to Appendix A for a list of sample infrastructure-focused funding uses that may support the implementation of integrated oral health services.

Minor A/R (with or without equipment): A minor A/R project is defined as all of the allowable A/R-related activities proposed at a single health center site, with a total site-specific project cost that is less than $500,000.4 You may propose as many as four minor A/R projects, with each occurring at a different site. The total request for OHI funding across all proposed projects may not exceed $300,000. Projects may include work required to modernize, improve, and/or reconfigure the interior arrangements or

3 For the purposes of this funding opportunity, the term “health center” means organizations funded under Section 330(e), (g), (h), and/or (i) of the Public Health Service Act, as amended.

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

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other physical characteristics of a facility and/or installation of equipment in an existing facility. 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.

Equipment: Moveable items, including IT systems, with a per-unit cost of $5,000 or more are considered equipment (see the Equipment List Form instructions for the full equipment definition). You may propose to purchase equipment for any number of health center sites, alone or in addition to proposing up to four minor A/R projects.

Examples of equipment that you may propose include purchase of a mobile unit, dental chairs and other dental equipment, telehealth equipment, servers, and radiology equipment.

Other Infrastructure Investments: You may request funding for other infrastructure investments that do not fall under the categories of minor A/R and equipment. Examples include training, consulting, supplies, and licenses for health IT that enhance integrated oral health services.

II. Award Information

1. Type of Application and Award

Type of applications sought: Competing Supplement

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $76,000,000 in one-time funding to be available to fund 250 recipients. You may apply for a ceiling amount of up to $300,000 total cost (includes both direct and indirect costs). The period of performance is September 1, 2019 through the end of your FY 2021 budget period. If awarded, your OHI funding supplements your current Health Center Program award and will only be available in your FY 2020 and FY 2021 budget period if you are an active Health Center Program award recipient.

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

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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III. Eligibility Information

1. Eligible Applicants

Your organization must be an existing Health Center Program award recipient5 to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount of $300,000 on the SF-424A non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Applications that do not include the Project Narrative, as described in Section IV.2.ii, will be considered non-responsive and will not be considered for funding under this notice.

Applications that propose either of the following unallowable projects 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).

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 EHBs) application phase.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov and the HRSA EHBs.

You must use a two-tier submission process associated with this NOFO and follow the

5 Organization currently receiving operation funding under Section 330 of the Public Health Service Act (i.e., sections 330(e), (g), (h), and/or (i)).

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directions provided at http://www.grants.gov/applicants/apply-for-grants.html and in the HRSA EHBs.

• Phase 1 – Grants.gov – Required information must be submitted and validated via Grants.gov with a due date of April 22, 2019 at 11:59 p.m. Eastern Time; and

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

HRSA EHBs with a due date of May 21, 2019 at 5 p.m. Eastern Time.

Only applicants who successfully submit the workspace application package associated with this NOFO in Grants.Gov (Phase 1) by the due date may submit the additional required information in HRSA EHBs (Phase 2).

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) or workspace application package. This allows Grants.gov to email organizations in the event HRSA changes and/or republishes the NOFO 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 For Applicants page for all information relevant to desired opportunities.

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. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 9.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 50 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

The Indirect Cost Rate Agreement does not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

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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 EHBs 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 U.S.C. 3321.)

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included in Attachment 4: 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, assurances, certifications, and abstract), include the following:

i. Project Abstract See Section 5.1.ix. of HRSA’s SF-424 Two-Tier Application Guide. In addition, provide your active Health Center Program grant number (H80CSXXXXX), and a brief summary of the proposed infrastructure project(s) and how the project(s) will support access to

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative: Need, Response, Impact, and Resources/Capabilities.

NEED – Corresponds to Section V’s Review Criterion 1: NEED

1) Describe the current and anticipated integrated oral health needs of the patient population and/or underserved population in the service area.

2) Describe the infrastructure enhancements necessary to address these oral health needs.

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RESPONSE – Corresponds to Section V’s Review Criterion 2: RESPONSE

1) Describe your health center’s current oral health services, including service delivery methods (i.e., the extent to which services are provided directly (Form 5A: Services Provided, Column I), through contracts or agreements for which the health center pays (Form 5A, Column II), or through formal referral arrangements (Form 5A, Column III)).6

2) Describe the proposed infrastructure investments necessary for increasing access to integrated oral health services. Specifically describe:

a) Any proposed minor alteration/renovation (A/R) activities. Your response should align with and reference the project-related information in the Project Cover Page(s). If the site to be renovated is leased, include the lease agreement or intent to lease documentation in Attachment 2: Lease Documentation.

b) Any proposed equipment and supplies purchases, including dental, telehealth, and other equipment and technology to extend the reach of current dental providers through virtual dentistry. Your response should align with the Equipment List and budget information.

c) Any other infrastructure investments, such as training, improved workflows, systems consulting, and EHR enhancements.

3) If you are proposing to use OHI funds to enhance oral health services through the use of telehealth and/or virtual dentistry, specifically describe how this will be implemented.

4) If you are proposing to add a new service delivery site (permanent or mobile unit),7 describe the location of the new site(s) within your existing service area8 and how the site(s) are essential to addressing the identified oral health infrastructure needs.

Provide evidence of support for the new site from other health care providers in the service area through letters of support uploaded as Attachment 1: Collaboration Documentation. If you plan to use funds toward the purchase of a mobile unit, describe how and where the mobile unit will serve your existing service area.

6 Reference the Supplemental Information Form to view your current oral health services.

7 Proposed new site(s) must be indicated on Form 1B: Funding Request Summary and documented on Form 5B.

8 Your service area, as of the NOFO release date, may not be expanded through this application. See instructions for completing Form 5B for details.

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IMPACT – Corresponds to Section V’s Review Criterion 3: IMPACT

1) Describe the integrated oral health services that will be added/expanded9 as a result of the infrastructure investments outlined in the RESPONSE section above.

2) If new dental personnel are required to expand integrated oral health services, describe how those providers will be supported. If new dental personnel are not required, describe how current dental personnel will ensure expanded integrated

3) Describe how the completed project(s) will support the delivery of quality integrated

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

RESOURCES/CAPABILITES

1) Describe the capabilities and expertise that qualify the organization to carry out the proposed project, including:

a) Experience with successfully completing similar infrastructure projects, including how you avoided or minimized time and cost overruns.

b) The skills and experience of staff managing the project(s). If proposing minor A/R, your response should align with and reference the project-related information in the Project Cover Page(s).

c) The capability of key management staff to provide operational oversight.

2) Describe the health center’s acquisition policies and procedures, as well as how the health center will comply with federal procurement requirements, as applicable.

3) Describe existing and planned collaboration and coordination of oral health 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 1: Collaboration Documentation.

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.

9 New and expanded oral health services may require an approved post-award Scope Adjustment or Change in Scope. Refer to the Form 5A Service Descriptors document for clarification on required and additional services:

https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf.

Refer to the Scope of Project website for guidance on scope considerations.

https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf https://bphc.hrsa.gov/programrequirements/scope.html

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Narrative Section Review Criteria Need (1) Need

Response (including Project Description on Project Cover Page(s) for minor A/R projects)

(2) Response

Impact (3) Impact

Resources/Capabilities (including Project Management on Project Cover Page(s) for minor A/R projects)

(4) Resources/Capabilities

Budget Presentation (Budget Forms, Budget Narrative, and A/R Project Budget Justification(s))

(5) Support Requested

iii. Budget

See Section 5.1.iv of HRSA’s SF-424 Two-Tier Application Guide. Follow the instructions included in the Application Guide and the additional budget instructions provided below. A budget that follows the Application Guide will ensure that, if HRSA selects the application for funding, you will have a well-organized plan, and by carefully following the approved plan, you can avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient.

In addition, the OHI program requires the following:

You must present the total budget for the project, which includes OHI federal funds (up to $300,000) and all non-OHI award funds that will support the proposed project. Health centers have discretion regarding how they propose to allocate the total budget between OHI federal funds and other funding that supports the project, provided that the projected budget complies with all applicable HHS policies and other federal requirements.10

Budget Information Form (SF-424A):

• In Section A and B, enter only the OHI funding requested in the Federal columns.

The maximum amount that may be requested cannot exceed $300,000.

• In Section A – Budget Summary, under New or Revised Budget, enter the federal funding requested in the Federal column for each type of section 330 funding

10 See Chapter 17: Budget of the Compliance Manual.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-17.html

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(Community Health Center, Migrant Health Center, Health Care for the Homeless, and/or Public Housing Primary Care). Funding must be requested and will be awarded proportionately for all population types for which you currently receive Health Center Program funding. No new population types may be added. Enter all other project costs in the Non-Federal column. Estimated Unobligated Funds are not applicable for this funding opportunity.

• In Section B – Budget Categories, enter an object class category (line item) budget for the entire 2-year budget period. The amounts for each category in the federal and non-federal columns, as well as the totals, should align with the Budget Narrative. If requesting funds for minor A/R, include that amount on the Construction line.

• In Section C – Non-Federal Resources, enter the amount of all other sources of funding for the proposal, not including the federal funding request. The total in Section C must be consistent with the Non-Federal Total in Section A. When providing Non-Federal Resources by funding source, include other federal funds supporting the proposed project in the “other” category.

The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-245), Division B, § 202 states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” See Section 5.1.iv Budget – Salary Limitation of HRSA’s SF-424 Two-Tier Application Guide for additional information. Note that these or other salary limitations may apply in the following FY, as required by law.

iv. Budget Narrative See Section 5.1.v. of HRSA’s SF-424 Two-Tier Application Guide.

The OHI program requires a budget narrative that outlines federal and non-federal costs for the entire two-year budget period. Refer to the sample budget narrative available on the OHI technical assistance website.

Your budget narrative must:

• Clearly detail calculations for each line item on the SF-424A Budget Information Form, including cost per unit.

• Explain how each cost relates to your OHI project(s) to enable HRSA to determine if costs are allowed.11

• Align with the separate minor A/R project budget justification(s) and Equipment List Form, as applicable. See descriptions of requirements under Minor A/R Forms and Equipment List below.

11 Refer to the cost principles embedded in 45 CFR part 75, see http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 for details on allowable costs.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/index.html http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75

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v. Program-Specific Forms

Program-Specific Forms must be completed electronically in HRSA EHBs. To preview the forms to be completed in HRSA EHBs, visit the OHI technical assistance website.

FORM 1B: BPHC FUNDING REQUEST SUMMARY (REQUIRED)

Before completing Form 1B, the SF-424A Budget Information Form must be completed.

See the Budget section for instructions on completing the SF-424A.

1. OHI FUNDING REQUEST

• The form displays the OHI funding request, pre-populated from the SF-424A Budget Information Form, Section A.

• The maximum amount of federal funding that can be requested is $300,000.

• If changes are required, modify the appropriate section of the SF-424A.

2. OHI FUNDING ACTIVITIES

• Indicate if the one-time funds are for:

1) Equipment only;

2) Minor A/R with equipment;

3) Minor A/R without equipment; or

4) Activities other than minor A/R and equipment.

• If you select equipment only, you must enter the amount requested for equipment on the equipment line in Section B of the SF-424A.

• If you select minor A/R with equipment, you must enter the amount requested for minor A/R on the construction line and for equipment on the equipment line in Section B of the SF-424A.

• If you select minor A/R without equipment, you must enter the amount requested for minor A/R on the construction line in Section B of the SF-424A.

• If you select activities other than minor A/R and equipment (e.g., training, health IT consulting), the following forms will not be available in your application:

Equipment List, A/R Project Cover Page, and Other Requirements for Sites.

3. ADDITION OF SITES

• Indicate if you are proposing to add a new service delivery site (permanent or mobile and only within your existing service area) to address identified oral health infrastructure needs.

FORM 5B: SERVICE SITES (REQUIRED FOR ADDITION OF NEW SITES)

New service delivery sites may be added through this application if necessary to address identified oral health infrastructure needs. You must provide a street address for the proposed site(s). You may not list “to be determined” or provide a post office box as the site address.

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Ensure that any proposed site meets the definition of a service site (see PIN 2008- 01: Defining Scope of Project and Policy for Requesting Changes available at https://bphc.hrsa.gov/programrequirements/policies/pin200801.html. Providing intermittent services at locations using portable equipment would not be considered a service site.

Because OHI funds are intended to increase access to oral health services in your existing service area, your service area, as of the NOFO release date, may not be expanded through this application. Note the following requirements:

• Site Physical Address – The zip code of the Site Physical Address (where the new permanent site is located or where the new mobile unit will be parked) must be included in your current service area (based on the Service Area zip codes listed across all current sites in scope on Form 5B).

• Service Area Zip Codes – All service area zip codes listed for proposed site(s) must be included in your existing service area (based on the service area zip codes listed for current sites in your scope of project).

MINOR ALTERATION/RENOVATION FORMS

If you are requesting funding for minor A/R (with or without moveable equipment), you must complete the Project Cover Page and Other Requirements for Sites forms for each site where minor A/R is proposed (up to four). OHI funding cannot be used for new construction activities (e.g., additions or expansions), the installation of trailers/pre-fabricated modular units, or major A/R. For a minor A/R activity, the total federal and non-federal cost of the project cannot exceed $500,000, excluding the cost of moveable equipment.

An allowable minor A/R project must be a stand-alone project consisting of work in an existing facility, which may include:

• Installing dental operatories;

• Modernizing or improving dental operatories;

• Reconfiguring the interior arrangements or other physical characteristics of a facility;

• Repairing and/or replacing the exterior envelope;

• Improving accessibility such as curb cuts, ramps, or widening doorways; and/or

• Addressing life safety requirements.

The project may include the costs of permanently affixed items such as windows, signs in or on the existing building, or lighting. Fixed equipment includes items that require modification of the facility for its satisfactory installation or removal and is included in the construction contract. Examples include HVAC units, ductwork, generators, fume hoods, sinks, fixed shelving, built-in sterilizers, built-in refrigerators, and drinking fountains. You cannot increase the total square footage of an existing building or require ground disturbance (such as new parking surfaces or expansion of a building footprint).

https://bphc.hrsa.gov/programrequirements/policies/pin200801.html

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PROJECT COVER PAGE (REQUIRED FOR MINOR A/R PROJECTS)

You must complete the A/R Project Cover Page and provide the following information for each site where minor A/R activities will occur:

1. Site Information

• Enter the name and physical address of the site where minor A/R will occur.

• In the box for Improved Project Square Footage, enter the total square feet of the area to be altered/renovated.

2. Project Description (Maximum 4,000 characters including spaces)

• Provide a detailed description of the scope of work of the minor A/R project.

Identify the major clinical and non-clinical spaces to be improved by the project.

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

modifications and repairs to the building exterior (including windows); HVAC modifications (including the installation of climate control and duct work);

electrical upgrades; and plumbing work.

• Describe how 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).

Example Project Description – Project will renovate 500 square feet of space previously used for medical records storage that is adjacent to the dental clinic. The renovation work will create two additional dental operatories. Renovation work within the existing interior space will include: demolition of one wall; plumbing and electrical work to accommodate the dental operatories; installation of two dental chairs; and installation of 150 feet of interior ductwork and a condenser unit on the exterior roof.

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

• Explain the oversight for the minor A/R project, including the Project Manager and the Project Team, if applicable, responsible for managing the project.

• Describe how the Project Team has the expertise and experience necessary to successfully manage and complete the project within the timeframe and achieve the goals and objectives established for this project.

4. Is the proposed minor A/R project part of a larger scale renovation, construction, or expansion project?

• Select “no” to certify that the proposed project is a stand-alone project and includes only minor A/R costs, or select “yes” if the proposed project is part of a larger scale renovation, construction, or expansion project. NOTE: Projects that are part of larger scale renovation, new construction, or expansion are unallowable and may cause your application to be ineligible.

5. Project Budget Justification

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Attach a project budget justification for the minor A/R project. Describe in detail each cost element and explain how the costs contribute to meeting the project’s objectives/goals. Clearly identify other funding sources needed to support the minor A/R project and indicate whether these funds are secured or not. See the OHI technical assistance website for a sample A/R Budget Justification in the One-Time Funding section of the website.

The following chart lists sample allowable and unallowable minor A/R project costs.12

COST

CATEGORIES

ALLOWABLE UNALLOWABLE

Administrative and legal expenses

• Salary and consultant fees that are directly related to the administration of the technical aspects of the proposed project. Administrative and legal expenses should be less than 10% of total project costs.

• Costs associated with the evaluation of the environmental and historic preservation effects of the proposed project, obtaining public input, producing the necessary studies, analysis, and resultant reports, as well as compliance with other environmental and historic preservation laws

• Bid advertising

• Costs of groundbreaking and dedication ceremonies and items such as plaques

• Costs related to other sources of project financing

• Costs for preparing grant applications

Relocation • Costs to move and store furnishings temporarily during renovations

• The cost of moving furnishings back into the renovated areas

Architectural and engineering fees

• Fees associated with architectural and engineering professional services including, but not limited to, preparation of bid documents and inspections

• Associated expenses for preparation of specifications and reproduction of design documents

• Costs incurred no more than 90 days before award for architect’s

• Architectural and engineering fees for work that is not within the scope of the approved project

• Elaborate or extravagant designs or projects that are above the known local costs for comparable buildings/spaces

12 Refer to the cost principles embedded in 45 CFR part 75 at http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 for details on allowable costs.

https://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/

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CATEGORIES

ALLOWABLE UNALLOWABLE

fees and consultant’s fees necessary to the planning and design of the project, if the project is approved and funded and the costs comply with federal procurement requirements (when applicable)

• Sustainable design services, such as LEED, including commissioning

• Costs associated with the preparation of the Environmental Assessment and SHPO consultation

• Costs of abandoned designs (i.e., costs associated with a design that will not be used)

• Costs for work not directly related to the project

Project inspection fees

• Clerk-of-the-works, inspection fees, structural certification, etc., to be provided by architectural engineering firm or applicant’s staff

• Fees not directly related to the project

Site Work • Minor alteration at entrances and adjacent sidewalks as required for ADA compliance

• Fees not directly related to the project

• Exterior building work such as paving, retaining walls, foundations, etc.

• Landscaping costs

Demolition and removal

• Costs of demolition or removal of structures for improvements such as wall finishings and fixtures. Reduce the costs on this line by the amount of expected proceeds from the sale of salvage.

• Costs not directly related to the project

• Hazardous materials remediation/abatement

• Demolition and removal of debris that will not result in a usable structure

Alteration/ Renovation

• Costs of acquisition and installation of fixed equipment necessary for the functioning of the facility

• Costs for remodeling and alteration of an existing building that will be used for the project

• Special features for seismic code requirements. Use nationally recognized codes adopted by authorities having jurisdiction.

• Abandoned projects

• Relocation of utilities that are off site and off-site improvements

• Prorated cost of existing central utility plant and distribution systems, which serve the proposed facility

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CATEGORIES

ALLOWABLE UNALLOWABLE

• Costs of eliminating architectural barriers to the handicapped

• Bid guarantees and performance and payment bonds

• Costs of pollution-control equipment for the facility’s boilers, incinerators, waste water treatment, etc., which may be required by local, state, or federal regulations. The facility must meet requirements of both current and future pollution abatement regulations as described in currently approved pollution plans.

• Interior and exterior decorating fees and purchases (e.g., artwork, sculpture)

• Elaborate or extravagant materials that are above the known local costs for comparable buildings/spaces

• Fixed equipment if it is not part of the construction contract

• Bonus payments to contractors

Equipment • Moveable equipment that is pertinent to the project (include details on Equipment List from)

• Mobile dental unit

• Donated equipment

• Leased equipment

• Luxury furniture

• Vehicles for transportation

Contingencies • Contingencies are limited to 5% of the A/R and Demolition/Removal Lines. The contingency does not include moveable equipment costs.

• Contingency costs above the allowable percentage

6. Environmental Information and Documentation (EID) Checklist Attach an EID Checklist for each site where minor A/R activities will occur. A template is available in HRSA EHBs for you to download, complete, and upload to the A/R Project Cover Page. You must explain each response of “yes” on the EID Checklist.

The National Environmental Policy Act of 1969 (NEPA) (P.L. 91-190; 42 U.S.C. 4321 et.seq.), the National Historic Preservation Act (NHPA) (P.L. 89-665; 16 U.S.C. 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. The EID Checklist will initiate reviews under NEPA and NHPA.

If funded, you must receive HRSA approval prior to beginning any projects involving minor A/R. Such approval may be contingent on the provision of additional documentation such as a hazardous materials survey, abatement plans, or initiation of NHPA Section 106 consultation. If you do not have in-house expertise in environmental

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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 any 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/about/nepa-nhpa/capital-development.html.

7. Floor Plans/Schematic Drawings/Site Plan 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.

OTHER REQUIREMENTS FOR SITES (REQUIRED FOR MINOR A/R PROJECTS)

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, cultural resources, and historic preservation considerations related to the project.

1. Site Control and Federal Interest Identify if you own the site. If you do not own the site, regardless of whether you currently or 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 property 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.

https://bphc.hrsa.gov/about/nepa-nhpa/capital-development.html

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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 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 federal interest exists. You 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.

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 footprint, parking lot, sidewalks, utilities)?

• Does the project involve renovation to a facility that is, or near a facility that is, architecturally, historically, or culturally significant?

• Is the site located on or near Native American, Alaskan Native, Native Hawaiian, or equivalent culturally significant lands?

A/R projects will be reviewed under the terms of section 106 of the National Historic Preservation Act (NHPA). Prior to the expenditure of funds, an assessment must be made of the potential effects of undertakings on historic properties (including any prehistoric or historic district, site, building, structure, or object) that are eligible for listing or are listed on the National Register of Historic Places (NRHP). Pursuant to the regulations at 36 CFR Part 800, HRSA determines the project’s effect on historic properties in consultation with the State Historic Preservation Officer (SHPO), Tribal Historic Preservation Officers (THPO), representatives of the local government, and other affected Indian tribes and interested parties.

For the purpose of OHI funding, interior renovations to be made to a building that is over 50 years old or is historically, architecturally, or culturally significant will constitute an undertaking under the NHPA.