Notice of Funding Opportunity

Application due 10/19/2026

BUREAU OF PRIMARY HEALTHCARE

Ongoing Investments

Fiscal Year (FY) 2027 Service Area Competition (SAC) Opportunity number: HRSA-27-005

Contents 2

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Funding details 7

Eligibility 8

Program description 13

Award information 16

Step 2: Get Ready to Apply 19

Get registered 20

Find the application package 21

Application writing help 21

Step 3: Build Your Application 22

Application checklist 23

Application contents and format 25

Step 4: Understand Review, Selection, and Award 47

Application review 48

Selection process 54

Award notices 56

Step 5: Submit Your Application 57

Application submission and deadlines 58

Other submissions 58

Step 6: Learn What Happens After Award 60

Post-award requirements and administration 61

Reporting 66

Contacts and Support 67

Before you begin 3

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up to date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time on 10/19/2026.

All activities proposed in your application and budget narrative must align with applicable law and policies, including but not limited to statutes, executive orders, federal regulations and applicable judicial holdings. Accordingly, discretionary awards shall not be used to fund, promote, encourage, subsidize, or facilitate: racial preferences or other forms of racial discrimination by the recipient, including activities where race or intentional proxies for race will be used as a selection criterion for employment or program participation; denial by the recipient of the sex binary in humans, or the belief that sex is a chosen or mutable characteristic; illegal immigration; or any other initiatives that compromise public safety. If an application does not align, the application will not receive funding to the extent permitted by law and applicable court orders.

https://sam.gov/ https://grants.gov/

Step 1:

Review the Opportunity

In this step

Basic information 6

Funding details 7

Eligibility 8

Program description 13

Award information 16

Step 1: Review the Opportunity 6

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

Basic information Health Resources and Services Administration (HRSA)

BUREAU OF PRIMARY HEALTHCARE

Ongoing Investments

Improve the health of those who are medically underserved or live in areas with limited access to care through the delivery of comprehensive, high-quality primary and preventive health care in the United States and its territories.

Summary The Fiscal Year (FY) 2027 Health Center Program Service Area Competition (SAC) funding improves the health of medically underserved communities and populations by providing grants to support the delivery of comprehensive, high-quality primary and preventive health care services in the United States and its territories.

For each SAC Notice of Funding Opportunity (NOFO), service areas available for competition are announced in the Service Area Announcement Table (SAAT). If a funded health center can no longer serve its area, we may announce new service areas through a Service Area Competition-Additional Area (SAC-AA) during the year.

Opportunity name: Fiscal Year (FY) 2027 Service Area Competition (SAC)

Opportunity number:

HRSA-27-005

Announcement version:

93.224

NOFO issue date:

09/18/2026

Application deadline:

10/19/2026

Expected award date:

04/01/2027

04/01/2027 https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/service-area-announcement-table

Step 1: Review the Opportunity 7

Funding details Application Types: Competing continuation, Competing supplement, and New

Expected total available funding: $267,773,700

Expected number and type of awards: 63 Grants (G)

Funding range per award: amount varies.

Fiscal Year (FY) 2027 Service Area Competition (SAC) awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

FY27 SAC anticipates funding awards in one or four 12-month budget periods.

• If you receive a one-year period of performance, your period of performance will be from April 1, 2027, to March 31, 2028. Please see additional guidance on a one-year period of performance in the post-award requirements and administration sections.

• If you receive a four-year period of performance, your performance will be from April 1, 2027, to March 31, 2031. Your funding request for years two through four cannot exceed your year one funding request.

You may request funding up to the Total Funding listed in the SAAT, including all funding categories, for the proposed service area.

Funding Reduction To be eligible for a service area, you must propose to serve at least 75% of the SAAT Patient Target during the patient target assessment period. If you propose to serve 75% to less than 95% of the SAAT Patient Target, your funding request must be reduced according to Table 1. If you do not submit your funding request correctly, HRSA will reduce your award accordingly. Use the funding calculator to determine whether your patient projection requires a funding reduction.

Table 1: Funding Reduction by Proposed Patients

Patient Projections vs. SAAT Patient Target (Rounded to the Nearest Tenth)

Funding Request Reduction (%)

At least 95% of patients listed in the SAAT No reduction

At least 90% but less than 95% of patients listed in the SAAT 1.25%

At least 85% but less than 90% of patients listed in the SAAT 2.5%

At least 80% but less than 85% of patients listed in the SAAT 3.75% http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/patient-budget-calculator http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/

Step 1: Review the Opportunity 8

Patient Projections vs. SAAT Patient Target (Rounded to the Nearest Tenth)

Funding Request Reduction (%)

At least 75% but less than 80% of patients listed in the SAAT 5%

Less than 75% of patients listed in the SAAT Not eligible for funding

We will assess your performance and determine if you are meeting your patient target based on the Budget Period Progress Report (BPR), site visits, and Uniform Data System (UDS) data. In the future, we may adjust service area funding amounts, patient targets, or ZIP codes as needed to ensure continuity of care in the communities and populations served by the Health Center Program.

2 CFR part 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, and any successor regulation, applies to all HRSA awards.

Eligibility A Health Center Program (H80) award is funded under section 330(e) of the Public Health Service Act. Awards may include funding to support health centers serving special medically underserved populations, as detailed on the SAAT for each service area. You can apply if you propose to serve a service area listed in the SAAT and you meet the criteria in the Other Eligibility Criteria section.

You can apply as a:

• Competing Continuation applicant if you are a current Health Center Program (H80) award recipient, and you are applying to continue serving your current service area.

• Competing Supplement applicant if you are a current Health Center Program (H80) award recipient who will serve an announced service area by adding one or more new, full-time, permanent service delivery sites to serve the additional area.

• New applicant if you are not currently funded through the Health Center Program, and you are applying to serve a service area listed in the SAAT. If you are a Health Center Program Look-Alike, you must apply as a new applicant. If awarded, you will stop being a look-alike and become a funded health center (H80).

http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200

Step 1: Review the Opportunity 9

Types of eligible organizations These types of *domestic organizations may apply:

State governments

County governments

City or township governments

Special district governments

Native American tribal governments (Federally recognized)

Public housing authorities/Indian housing authorities

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

Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education

Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education

“Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Additional information on eligibility *Organizations eligible to apply include community and religious or faith-based nonprofit organizations.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria

Eligibility Requirement What We Check

You must be a private, nonprofit entity or a public agency in the United States or its territories. Tribal and Urban Indian Organizations may apply.

Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

• Form 1A: General Information Worksheet

• Attachment 11: Evidence of Nonprofit or Public Agency Status

You must propose to serve at least one medically underserved area or medically underserved population (MUA/MUP) within the proposed service

• Form 1A: General Information Worksheet https://bphc.hrsa.gov/compliance/compliance-manual/chapter1 https://bphc.hrsa.gov/compliance/compliance-manual/chapter1 https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf

Step 1: Review the Opportunity 10 area. HRSA’s MUA/P tool lists all MUA/P areas and their unique identification numbers (ID). Identify each MUA/P ID that will be served and list the IDs on Form 1A.

You must provide all Health Center Program required services within the service area on a sliding fee based on income and family size. You may not provide a subset of the required services or target only a sub-population in the proposed service area.

• Project Narrative Response section

• Form 5A: Services Provided

• Attachment 10: Sliding Fee Discount Schedule

You must provide general primary medical care directly and/or through subawards or contracts for which the health center pays.

• Form 5A: Services Provided

You must perform a substantive role in the project. To determine if you perform a substantive role in the project, HRSA will consider whether:

• Most of your clinical and administrative functions are provided through direct employment, contractors, or a single affiliated or related organization.

• Most of your key management staff (CEO, CMO, CFO, etc.) are directly employed by you. (Note: You must directly employ the CEO.)

• Your relationships or agreements with other entities restrict or infringe upon your board’s required authorities and functions.

• Your key management staff or board members work for an organization that provides financial or other support that creates any type of ownership, control, or operational relationship (parent company, affiliated subsidiary), which may create conflicts of interest.

• Project Narrative Capacity section

• Budget Narrative

• Attachment 2: Bylaws

• Attachment 6: Co-Applicant Agreement

• Attachment 7: Summary of Contracts and Agreements (as applicable)

• Attachment 8: Articles of Incorporation (as applicable)

• Form 5A: Services Provided

• Form 8: Health Center Agreements and their attachments

You must provide continuity of care to patients in an announced service area. You must:

• Service Area ID: Include the service area ID from the SAAT that is announced under this NOFO.

• Patients: Project to serve at least 75% of the SAAT Patient Target.

• Services: Include on Form 5A all additional services listed on the SAAT for your proposed service area (Additional Dental Services, Mental Health Services, Substance Use Disorder Services).

• Service Area ZIP Codes (New or Competing Supplement Applicants):

Enter on Form 5B a combination of SAAT Service Area ZIP codes that total at least 75% of the ZIP Code Patient Percentage column. If the SAAT does

• Service Area ID: Project Abstract and Summary Page

• Patients: The total number of unduplicated patients for the assessment period on Form 1A: General Information Worksheet

• Services: The additional services included on Form 5A:

Services Provided

• Service Area ZIP Codes: The ZIP codes listed on Form 5B:

https://data.hrsa.gov/topics/health-workforce/shortage-areas/mua-find https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf

Step 1: Review the Opportunity 11 not announce ZIP codes where 75% of current patients reside, you must propose to serve all SAAT-announced ZIP codes for the service area.

Current Service Area ZIP codes will auto-populate for Competing Continuation applicants.

• Special Medically Underserved Populations: Maintain services in the proposed service area to all currently funded special medically underserved populations. You will do this by:

◦ Maintaining the funding distribution of the population types listed in the SAAT. For all funded population types, propose the amounts provided in the SAAT. If you are taking a funding reduction, apply the % reduction uniformly across all funded population types.

◦ Proposing patients for each funded population type.

Service Sites (administrative-only sites will not be included in the count)

• Special Medically Underserved Populations:

The funding distribution on the SF-424A: Budget Information Form and number of patients for each population type on Form 1A:

General Information Worksheet

New or competing supplement applicants must propose at least one new full-time (open at least 40 hours per week) permanent, fixed building service site.

• “Service site” is defined in Chapter 5: Sites of the Scope Manual.

• You may not propose a site that is in the same building as a site that is included in the Scope of Project of an existing Health Center Program award recipient or a Health Center Program Look-Alike.

• New applicants may meet this requirement by proposing existing sites that are not supported by H80 funding.

• Competing supplement applicants must propose at least one new, full-time, permanent service delivery site to meet this requirement. They may also include sites from their current Scope of Project only if those sites will provide services to the proposed new patients in the service area.

• The valid street address for each proposed site on Form 5B: Service Sites, and the proposed hours of operation for each site

RESIDENTS OF PUBLIC HOUSING (RPH) APPLICANTS: New or competing supplement applicants applying for RPH funding must show that you consulted with public housing residents as you planned your new site(s). You must also explain how you will have ongoing input from public housing residents.

• Project Narrative Collaboration section

HOMELESS POPULATION (HP) and RESIDENTS OF PUBLIC HOUSING (RPH) APPLICANTS: Per sections (h) and (i) 42 U.S.C. 254b, new or competing supplement applicants applying for HP or RPH funding must use this funding to supplement, and not supplant, the expenditures of the health center and the value of in-kind contributions for the delivery of services to these populations.

• Attestation on the Summary Page https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/sample-sf-424a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/sample-sf-424a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/compliance/scopemanual.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf http://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title42-section254b&num=0&edition=prelim https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf

Step 1: Review the Opportunity 12

Post-award requirements

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

See Step 6: Learn What Happens After Award for information on regulations that apply, As necessary, we may use other information in the application to confirm your eligibility.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Does not meet both deadlines for Phase 1: Grants.gov and Phase 2: EHBs.

• Requests more than the Total Funding amount listed on the SAAT for Year 1.

• Does not include a Project Narrative.

• Does not include Attachment 11: Evidence of Nonprofit or Public Agency Status.

• Does not include Attachment 12: Operational Plan if you are a new or competing supplement applicant.

• Does not include Attachment 13: Health Center Program Compliance.

Application limits You may submit more than one application for this funding opportunity under the same Unique Entity Identifier (UEI) if you are applying for more than one service area.

We will review your last validated application for each distinct project submitted before the deadline. If you plan to submit more than one application under this NOFO, you must contact the SAC Team through the BPHC Contact Form for guidance.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. Recipients agree that once committed, cost-sharing amounts are enforceable and subject to reporting and auditing requirements under 2 CFR 200.

https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/service-area-announcement-table https://hrsa.my.site.com/support/s/

Step 1: Review the Opportunity 13

Program description Purpose The purpose of the FY 2027 Health Center Program Service Area Competition (SAC) is to improve the health of medically underserved communities and populations by providing grants to support the delivery of comprehensive, high-quality primary and preventive health care in the United States and its territories. Through the Service Area Competition, health centers will:

• Ensure access to high-quality, affordable care while making investments that strengthen the nation’s primary and preventive health care infrastructure.

• Address the nation’s most pressing health challenges through chronic disease prevention and data-supported programs that focus on the underlying causes of disease in areas of greatest need.

• Empower individuals and families to take charge of their physical and mental health, with a focus on promoting better health through improved nutrition and the prevention and management of chronic diseases.

Background Through the SAC, organizations compete for Health Center Program funding to provide comprehensive primary and preventive health care services in service areas that are currently served by program awardees. Health centers provide a range of services, including:

• Prevention and management of chronic conditions in children, adults, and older adults

• Cancer screening

• Health and nutrition education

• Mental health services

• Patient support services, such as those that support access to healthy foods and other resources that can address barriers to health and well-being.

The health center model helps individuals and families take charge of their physical and mental health by emphasizing proper nutrition, chronic disease prevention and management, and access to high-quality, affordable care. HRSA considers the Patient Centered Medical Home (PCMH) model foundational to delivering high-quality primary and preventive health care. Numerous studies have documented the model’s benefits for the prevention and management of chronic diseases, further positioning health centers to advance Make America Healthy Again (MAHA) priorities.

https://www.hhs.gov/maha/index.html

Step 1: Review the Opportunity 14

Health Center Program award recipients must provide services on a sliding fee based on income and family size.

Service areas and patient populations listed in the FY 2027 SAC Service Area Announcement Table (SAAT) are currently served by Health Center Program award recipients whose awards end in FY 2027. Each service area is defined by a list of ZIP codes where an applicant must propose to provide services. Service areas may also include specific requirements, such as serving special medically underserved populations or providing certain service types. The full eligibility criteria are outlined in this NOFO and on our TA webpage.

We have assigned a unique Service Area Identification Number (SAC ID) to each service area. You must enter the SAC ID on the Summary Page to identify the service area you propose to serve. You must describe how you will make primary and preventive health care services accessible within the announced service area, including how you will serve the SAAT Patient Target and special medically underserved population type(s) with the available funding. HRSA will make only one award for each announced service area.

Program requirements and expectations Required Services You must ensure access to all required Health Center Program primary and preventive health services within the service area on a sliding fee based on income and family size.

You must provide all services identified in the SAAT for your service area. For details about these services, see the Health Center Program Compliance Manual and the Service Descriptors for Form 5A: Services Provided. You may provide these services directly, through a subaward or contract, or through a formal referral arrangement as described in the Form 5A Service Delivery Method Descriptors.

Service Delivery Sites

You must operate at least one service delivery site full-time in the service area (open for patient care at least 40 hours per week) in a permanent, fixed-building service site.

Additional requirements for new and competing supplement applicants

• You must open all proposed sites within 120 days of the Notice of Award (NOA). At that time, staffing and systems must be in place to deliver all required primary and preventive health services, as well as any proposed additional services to the medically underserved population. Sites and services must align with Form 5B:

Service Sites, Form 5A: Services Provided, the Project Narrative, and Attachment 12: Operational Plan.

https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf https://bphc.hrsa.gov/compliance/compliance-manual https://bphc.hrsa.gov/sites/default/files/bphc/compliance/form-5a-service-descriptors.pdf https://bphc.hrsa.gov/sites/default/files/bphc/compliance/form-5a-column-descriptors.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf

Step 1: Review the Opportunity 15

• If you do not verify that all sites are operational within 120 days of the NOA, HRSA will place a condition on your award and allow up to 180 days to open each site. If you do not resolve a site-related condition within the specified time frame, HRSA may terminate all or part of your SAC award.

• All proposed sites must be open for the proposed hours of operation within one year of the NOA. Sites and services must align with Form 5A: Services Provided, Form 5B: Service Sites, the Project Narrative, and Attachment 12: Operational Plan.

Patient Target

You must make every reasonable effort to serve the number of unduplicated patients projected on Form 1A: General Information Worksheet during the assessment period.

HRSA will track progress toward meeting the total unduplicated patient projection through the Uniform Data System (UDS) report.

Health Center Program Compliance

You must demonstrate in Attachment 13: Health Center Program Compliance that you will comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable law and regulations. Appendix A:

Health Center Program Compliance outlines the required content.

Special Medically Underserved Populations

Applicants planning to serve one or more special medically underserved populations must:

• Comply with additional requirements of sections 330(g), (h), and/or (i) of the PHS Act (42 U.S.C. 254b).

• Use HP and RPH funding to supplement, and not supplant, other resources for the delivery of services to these populations (42 U.S.C. 254b (h)(3) and (i)(2)).

Statutory authority

Section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b) https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html http://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title42-section254b&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title42-section254b&num=0&edition=prelim https://www.govinfo.gov/app/collection/comps/p https://uscode.house.gov/view.xhtml?req=(title%3A42%20section%3A254b%20edition%3Aprelim)%20OR%20(granuleid%3AUSC-prelim-title42-section254b)&f=treesort&edition=prelim&num=0&jumpTo=true

Step 1: Review the Opportunity 16

Award information Changes in HHS regulations As of October 1, 2025, HHS has adopted 2 CFR Part 200, with some modifications included in 2 CFR Part 300. These regulations replace those in 45 CFR Part 75.

Policies

• To make an award, funding must be available and allocated for this program and purpose, at which point we will move forward with the review and award process.

• You must have clear policies and good financial practices to avoid spending HRSA funds on unallowable activities. Like other award rules, we may audit your policies, procedures, and controls.

• You must comply with Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable laws and regulations.

• All uses of funds must align with your scope of project.

• The federal award may be terminated in part or in its entirety by the federal agency or pass-through entity if an award no longer meets the program goals or agency priorities.

• You must maintain your H80 award status throughout the SAC period of performance to maintain this funding.

• You must have accounting structures and internal controls in place that provide accurate and complete information for costs associated with this award. HRSA funding and expenditures for SAC must be tracked and documented in alignment with the specifications described in 2 C.F.R. § 200.302

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list.

◦ Extend the period of performance.

◦ Award supplemental funding.

General limitations

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

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

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

◦ Allowable and Unallowable Costs and Activities, in the HHS Grants Policy Statement.

https://www.ecfr.gov/current/title-2/part-200 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-300 https://bphc.hrsa.gov/compliance/compliance-manual/introduction https://www.ecfr.gov/current/title-2/section-200.302 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.hhs.gov/sites/default/files/hhs-grants-policy-statement-april-2025-archived.pdf#page%3D81

Step 1: Review the Opportunity 17

• All costs must be reasonable, necessary, allocable to the award, and adequately documented (2 CFR 200.403).

• You cannot earn profit from the federal award. See 2 CFR § 200.400(g).

• Current appropriations law includes a salary limit of $228,000, effective as of January 2026 that applies to this program. You may pay salaries at a higher rate if the rate beyond the salary rate limit (Executive Level II) is paid with non-HHS funds. For help calculating salaries under this limit, read more at “salary rate limitation” in the Two-Tier Application Guide.

Program-specific statutory or regulatory limitations You may not spend funds for:

• Costs already paid for by any other federal awards.

• Costs not aligned with Health Center Program purpose.

• Costs for services and activities that are not provided directly by or on behalf of the health center.

• Purchase or upgrade of an electronic health record (EHR) that is not certified by the Office of the National Coordinator for Health Information Technology’s Health IT Certification Program.

• Construction and alteration/renovation of facilities.

• Purchase and installation of trailers and prefabricated modular units.

• Concrete or asphalt paving of new areas outside of a building.

• Facility or land purchases.

Under existing law, and consistent with Executive Order 13535 (75 FR 15599), you must not use federal funds to provide abortions, except in cases of rape or incest, or when a physician certifies that the woman has a physical disorder, physical injury, or physical illness that would place her in danger of death unless an abortion is performed. This includes all funds awarded under this notice and is consistent with past practice and long-standing requirements.

See Manage Your Grant for other information on costs and financial management.

Indirect Costs Indirect costs are costs you incur across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

To incur indirect costs, you can select one of two methods:

https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.404 https://www.ecfr.gov/current/title-2/section-200.405 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.403 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g) https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://healthit.gov/certification-health-it/onc-health-it-certification-program-test-method/ https://healthit.gov/certification-health-it/onc-health-it-certification-program-test-method/ https://www.hrsa.gov/grants/manage-your-grant

Step 1: Review the Opportunity 18

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 – De minimis rate. Per 2 CFR § 200.414(f), if you do not have a current negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is up to 15% of modified total direct costs (MTDC). See 2 CFR § 200.1 for the definition of MTDC. You can use this rate indefinitely for all your federal awards or until you choose to receive a negotiated rate.

Consider your indirect costs when developing your budget.

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 2 CFR § 200.307.

The non-federal share of the project budget includes all program income sources, such as fees, premiums, third-party reimbursements, and payments generated from the delivery of services. The non-federal share also includes other revenue sources, such as:

• State, local, or other federal grants or contracts.

• Private support, donations, or contributions.

• Income generated from fundraising.

In accordance with 42 USC § 254b (e)(5)(D), health centers must use non-grant funds, including funds in excess of those originally expected, “as permitted under this section,” and may use such funds “for such other purposes as are not specifically prohibited under this section if such use furthers the objectives of the project.”

https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#200.307 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#200.307 https://www.govinfo.gov/content/pkg/USCODE-2021-title42/html/USCODE-2021-title42-chap6A-subchapII-partD-subparti.htm

Step 2:

Get Ready to Apply

Get registered 20

Find the application package 21

Application writing help 21

Step 2: Get Ready to Apply 20

Get registered SAM.gov You must have an active account with SAM.gov to apply. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register:

• Go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for the information you will need to register.

• You must agree to the financial assistance general certifications and representations specifically. Those for contracts are different.

When you register, you will also receive your required Unique Entity Identifier (UEI).

Once you register:

• You will have to maintain your registration throughout the life of any award.

• If your organization has multiple UEIs, use the one associated with your physical location.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

If you have already registered on Grants.gov, make sure your account is active, and your Authorized Organization Representative (AOR) is approved.

HRSA Electronic Handbooks (EHBs) You must also have a user account in EHBs.

See Knowledge Base for how to get started.

https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://grants.hrsa.gov/EAuthNS/external/account/SignIn https://help.hrsa.gov/display/public/EHBSKBFG/Registration%2Band%2BUser%2BAccounts%2BFAQs#%3A%7E%3Atext%3DHow%20do%20I%20register%20in%20the%20EHBs%3F%201%2CStep%203%3A%20Submit%20your%20Organization%20Registration%20for%20Approval

Step 2: Get Ready to Apply 21

Have questions? Go to Contacts and Support.

Find the application package The application package has all the forms you need to apply for phase 1 of the application process. You can find it online. Go to Search Grants at Grants.gov and search for opportunity number HRSA-27-005.

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

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

See Apply for a Grant for other help and resources.

The Apply for SAC TA webpage includes:

• Resources to help you develop your application

• Answers to frequently asked questions

• Details about our pre-application TA webinar

• Contact information

The Health Center Program Compliance Manual explains the Health Center Program’s requirements. You need to understand the requirements and show how you meet them in your application.

The HRSA-supported Health Center Resource Clearinghouse includes links to many health center resources.

The Health Center Performance Improvement Framework and Toolkit can help you assess performance in seven performance areas, describe how you want to perform in the future, and identify how to achieve and sustain improved performance. Health centers can use the toolkit to set goals, prioritize activities, and improve over time.

Join the webinar For more information about this opportunity, details will be posted on the SAC TA webpage.

https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition https://bphc.hrsa.gov/compliance/compliance-manual https://www.healthcenterinfo.org/ https://bphc.hrsa.gov/focus-areas/health-center-performance-improvement https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition

Step 3:

Build Your Application

Application checklist 23

Application contents and format 25

Step 3: Build Your Application 23

Application checklist Make sure that you have everything you need to apply.

This program has a two-phase submission process.

• Phase 1: Submit the required forms in Grants.gov.

• Phase 2: Submit the required program-specific forms and attachments in EHBs.

Phase 1: Grants.gov submission Complete each required form in Grants.gov by the Phase 1 deadline.

Component Included in page limit?

Application for Federal Assistance (SF-424) No

Project Abstract Summary Form No

Project/Performance Site Location(s) No

Key Contacts Form No

Grants.gov Lobbying Form No

Disclosure of Lobbying Activities (SF-LLL), optional No

Other Attachments Form, optional No

Phase 2: EHBs submission Complete supplemental information, including narratives, program-specific forms, and attachments in EHBs by the Phase 2 deadline.

Narratives

Project narrative Yes

Budget narrative with staff justification table Yes

Standard and Program-Specific Forms Each of the following forms is required. Refer to the SAC Technical Assistance webpage for samples and instructions.

Step 3: Build Your Application 24

Component Included in page limit?

Form 1A: General Information Worksheet No

Form 1C: Documents on File No

Form 2: Staffing Profile No

Form 3: Income Analysis No

Form 5A: Services Provided No

Form 5B: Service Sites No

Form 6A: Current Board Member Characteristics No

Form 6B: Request for Waiver of Board Member Requirements No

Form 8: Health Center Agreements No

Form 12: Organization Contacts No

Summary Page No

Budget Information Form for Non-Construction Programs

(SF-424A)

No

Attachments Upload the following attachments as file uploads in EHBs.

1. Service Area Map and Table No

2. Bylaws No

3. Project Organizational Chart Yes

4. Position Description for Key Management Staff Yes

5. Biographical Sketches for Key Management Staff Yes

6. Co-Applicant Agreement (Public agency applicants only)

No

7. Summary of Contracts and Agreements No

8. Articles of Incorporation (New applicants only) Yes

Step 3: Build Your Application 25

9. Collaboration Documentation No

10. Sliding Fee Discount Schedule No

11. Evidence of Nonprofit or Public Agency Status No

12. Operational Plan (New and Competing Supplement applicants only)

No

13. Health Center Program Compliance No

14. Other Relevant Documents Yes (except for Indirect Cost Rate Agreement)

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

Application page limit: 120. We will not review any pages that exceed the page limit.

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

Required format You can find technical guidance for formatting your application documents in Step 5 of the NOFO.

Step 3: Build Your Application 26

Required forms Phase 1: Grants.gov You will need to complete some other forms. Upload the following forms to Grants.gov.

You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms.

Forms Submission Requirement

Application for Federal Assistance (SF-424) With application.

Project Abstract Summary Form With application.

Project/Performance Site Location(s) With application.

Key Contacts Form With application.

Grants.gov Lobbying Form With application.

Disclosure of Lobbying Activities (SF-LLL), optional With application.

Other Attachments Form, optional With application.

https://grants.gov/forms/forms-repository/sf-424-family

Step 3: Build Your Application 27

Form instructions Follow the form instructions in Grants.gov Forms and any additional instructions included in this section.

The Two-Tier Application Guide has detailed instructions for:

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

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

Application for federal assistance (SF-424) This form collects general information and is your application for federal assistance.

Follow the instructions in Section 3.1 of the Two-Tier Application Guide and any additional instructions provided here.

Project abstract summary form instructions

Complete the information in the Project Abstract Summary form. Describe the needs you plan to address and proposed project services. Include a short description of how your project addresses:

• Disease prevention

• Management of chronic diseases

• Improving health outcomes

Use the Service Area Announcement Table (SAAT) to provide the Service Area Identification Number (SAC ID) for your proposed service area.

https://grants.gov/forms https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D1 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D9 https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/service-area-announcement-table

Step 3: Build Your Application 28

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

We share what you put there with USAspending. This is where the public goes to learn

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

Project/performance site location(s) Follow the form instructions in Grants.gov Forms. Use the “Next Site” option rather than “Additional Location(s)” to add more than one project/performance site location.

Project narrative The project narrative is required for completeness.

In this section, you will describe all aspects of your project.

Use the section headers and the order listed. Number your responses in each section. This ensures reviewers can understand your proposed project.

Need See merit review criterion 1: Need

1. Describe the proposed service area (consistent with Attachment 1: Service Area Map and Table), including:

a. The service area boundaries.

b. If it is located in an Opportunity Zone.

c. How the boundaries of the service area ensure that services are accessible to residents of the area.

d. How the overlap of political subdivisions, school districts, and areas served by federal and state health and social programs affects access to primary and preventive health care services in the service area.

e. How you will annually review the proposed service area to identify where your patients reside, available health resources, and unmet need.

f. If your urban/rural selection on Form 1A is different from the service area type listed on the SAAT, explain why, and include relevant data sources to explain the difference.

2. Describe health care needs in the service area including the needs of any special medically underserved population listed in the SAAT. Address needs related to the https://www.usaspending.gov/ https://www.hhs.gov/sites/default/files/hhs-writing-award-descriptions.pdf https://grants.gov/forms/forms-repository/sf-424-family https://www.irs.gov/credits-deductions/businesses/opportunity-zones https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sac/

Step 3: Build Your Application 29 following:

a. Comprehensive primary and preventive health care services, including in-scope chronic disease management, preventive health and education, cancer screening, nutrition, and mental health and substance use services.

b. Patient support services that facilitate a patient’s health care access to improve health outcomes, including patient outreach, case management, referrals, health education, transportation, language assistance, and enrollment in health insurance.[1]

c. Any other significant needs that impact health status or needs for primary care services.

3. Describe any recent or potential changes in the local health care landscape and how those changes may affect the needs of the medically underserved population.

4. Based on your Form 1A: General Information Worksheet, describe how you determined the number of:

a. Unduplicated patients you project to serve. If your projection is different than the Patient Target advertised in the SAAT, explain why.

b. Patients that you project to serve for each service type.

c. Patients that you project to serve for each special medically underserved population listed in the SAAT.

d. Competing continuation applicants: Describe changes to the service area since your last SAC application using Uniform Data System (UDS) data.

Include an analysis of factors affecting your patient trend since your previous SAC application, with particular attention to any decline.

5. Describe how you:

a. Have worked with community partners to assess the needs, strengths, opportunities, and priorities of the community.

b. Will regularly update your Scope of Project in response to the needs for additional services.

c. Plan to use patient and community input to inform and improve your service delivery.

Response See merit review criterion 2: Response

1. Describe how the proposed service delivery sites on Form 5B: Service Sites will support access to your services (consistent with Form 5A: Services Provided) and minimize barriers within the service area, including:

a. Where your service delivery sites are located, compared to where the medically underserved population lives and works.

b. How you will address barriers based on geography and hours of operation.

https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/

Step 3: Build Your Application 30 combination of your currently funded service area and the new service area that you are

c. New or competing supplement applicants: If the proposed service area is not contiguous with your existing service area (immediately adjacent to or within 15 miles of an urban service area, or within 30 miles of a rural service area), describe how you will make all required and additional services accessible throughout the resulting combined service area. Refer to the SAAT for the service area type designation for the announced service area.

2. Document how you will provide all required services and any proposed additional services on Form 5A: Services Provided directly, through formal written contracts or agreements in which the health center pays, or through formal written referral arrangements. In the narrative, address the following:

a. How all age groups will have access to all required services and any proposed additional services in the proposed service area identified in your needs assessment.

b. Any required services on Form 5A: Services Provided that you will not provide in-person at all service delivery sites and how you will make those services accessible throughout the proposed service area. Include how you will ensure access to any services that you will not pay for and will provide only through a formal referral arrangement.

c. How you will provide in-scope patient-centered chronic disease prevention and management, preventive health services and education, cancer screening, nutrition, mental health, and patient support services.

d. How you will provide patient support services that facilitate a patient’s health care access to improve health outcomes, including patient outreach, case management, referrals,…