Revised_Foa_Content_of_hrsa-26-006.pdf

Notice of Funding Opportunity

Application due Monday, November 10, 2025

Bureau of Primary Health Care Health Center Program

Service Area Competition Opportunity number: HRSA-26-006

Modified on 7/28:

Deadline modified to Monday, November 10, 2025

Contents

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 8

Program description 12

Statutory authority 15

Award information 15

Step 2: Get Ready to Apply 18

Get registered 19

Find the application package 19

Application writing help 20

Step 3: Prepare Your Application 21

Application checklist 22

Application contents and format 24

Step 4: Learn About Review and Award 45

Application review 46

Selection process 51

Award notices 53

Step 5: Submit Your Application 54

Application deadline 55

Step 6: Learn What Happens After Award 57

Post-award requirements and administration 58

Reporting 59

Contacts and Support 61

Before you begin 4

Contents 2

Appendix A: Health Center Program Compliance 64

Contents 3

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 Monday, November 10, 2025.

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

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 8

Program description 12

Statutory authority 15

Award information 15

Have questions?

Go to Contacts and Support

Key facts Opportunity name:

Service Area Competition

Opportunity number:

HRSA-26-006

Announcement version:

Initial announcement

Federal assistance listing:

93.224

Key dates NOFO issue date: July 24, Phase 1 Application deadline in Grants.gov:

November 10, 2025

Phase 2 Supplemental information deadline in HRSA Electronic Handbooks (EHBs):

December 10, 2025

Expected award date is by:

May 1, 2026

Expected start date: June 1, 2026

See other submissions for other time frames that may apply to this NOFO.

Basic information Health Resources and Services Administration (HRSA)

Bureau of Primary Health Care

Health Center Program

Summary The FY 2026 Health Center Program Service Area Competition (SAC) funding improves the health of underserved communities and populations by providing grants to support the delivery of comprehensive, high-quality primary 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).

Throughout the year, we may announce additional service areas in a Service Area Competition-Additional Area (SAC-AA) if an awarded health center cannot continue to provide services in the funded service area.

Funding details Application Types: Competing Continuation, Competing Supplement, New

Expected total available funding: $181,000,000

Expected number and type of awards 48 grants

Funding range per award: Funding amounts vary per award

Awards may be made for one or four 12-month budget periods.

Award recipients are granted a period of performance with the following dates:

• If you receive a one-year period of performance, your period of performance will be from June 1, 2026, to May 31, 2027. 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 period of performance will be from June 1, 2026, to May 31, 2030. Your funding request for years two through four cannot exceed your year one funding request.

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

You may apply for funding up to the Total Funding listed in the SAAT for the proposed service area.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 6 https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/service-area-announcement-table http://bphc.hrsa.gov/sac/

You must propose to serve at least 75% of the SAAT Patient Target in the patient target assessment period. If you propose to serve fewer patients than listed in the SAAT, reduce the grant funding portion of your budget request by the amount in Table 1. If you do not reduce your funding request, HRSA will reduce your award by the amount in Table 1. You can use the funding calculator to determine if you must reduce funding.

Table 1: Funding Reduction by Proposed Patients

Patient Projections Compared toSAAT 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%

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.

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

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 7 http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/sac/patientbudgetcalculator.html http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

Eligibility Who can apply A Health Center Program (H80) award is funded under §§ 330(e) of the PHS Act. Awards may include funding to support health centers to serve a population that is medically underserved (community health center or CHC funding) or to serve one or more special medically underserved populations as defined in §§ 330 (g) Migratory and Seasonal Agricultural Workers (MSAW funding), (h) Homeless Population (HP funding), and/or (i) Residents of Public Housing (RPH funding).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.

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

• You can apply as a 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 can apply as a new applicant. If awarded, you will stop being a look-alike and become a funded health center (H80).

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

• Nonprofits with or without 501(c)(3) IRS status

• State, county, city, township, and special district governments, including the District of Columbia, domestic territories, and freely associated states

• Native American tribal governments

• Native American tribal organizations

* “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, or the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Step 1: Review the Opportunity 8

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.

• Attachment 11: Evidence of Nonprofit or Public Agency Status for new applicants

You must propose to provide all required health services as outlined on Form 5A: Services Provided. All services must be provided without regard for the ability to pay. You may not propose to provide only a single service or any subset of the required primary health care services.

• Form 5A: Services Provided (Columns 1, 2, and 3)

• Sliding Fee Discount Schedule

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

• Form 5A: Services Provided (Columns 1 and 2)

You must perform a substantive role in the project. When determining 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: the CEO must be directly employed by you.)

• 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 also 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 (Column 1)

• Form 8: Health Center Agreements and their attachments

You must make services accessible to all. You may not propose to serve only a single age group or address a single health issue or disease. If you propose a site that targets only a sub-population (for example, a school-based site), you must explain how you will make all required services available to the entire underserved population in the service area.

• Project Narrative Response section

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

• Service Area ID: Project Abstract and Summary Page

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://bphc.hrsa.gov/compliance/compliance-manual https://bphc.hrsa.gov/compliance/compliance-manual 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-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/sites/default/files/bphc/funding/summary-page.pdf

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

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

• Services: Project to serve patients in all service types listed on the SAAT for your proposed service area (Medical, Dental, Mental Health, Substance Use Disorder, Vision, Enabling).

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

On Form 5B, enter a combination of SAAT Service Area ZIP codes that total at least 75% of the ZIP Code Patient Percentage column. If the SAAT does not advertise ZIP codes where 75% of current patients reside, you must propose to serve all SAAT-advertised ZIP codes for the service area.

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

• Special Medically Underserved Populations: Propose to maintain services to all currently funded medically underserved populations, including homeless populations, residents of public housing, and migratory and seasonal agricultural workers. You will do this by maintaining the funding distribution of those population types listed in the SAAT where the funding level is not $0, and by proposing patients for each funded population type.

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

• Services: The patients listed for each service type on Form 1A: General Information Worksheet

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

Service Sites (administrative-only sites will not be considered)

• 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 Policy Information Notice 2008-01.

• 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 Awardee or a Health Center Program Look-Alike.

• If you propose to serve only migratory and seasonal agricultural workers, you may propose a full-time seasonal (rather than permanent) site.

• 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 plan your new site(s). You must also explain how you will have ongoing input from public housing residents.

• Project Narrative Collaboration section

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ 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 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-5b.pdf 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/compliance/pin-2008-01.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf

HOMELESS POPULATION (HP) and RESIDENTS OF PUBLIC HOUSING (RPH) APPLICANTS: 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

*In limited circumstances, we may use other information in the application to confirm your eligibility.

Post-award requirements

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

See Step 6: Learn What Happens After Award for information on regulations that apply, reporting, and more.

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 your application if it:

• 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 6: Co-Applicant Agreement if you are a public agency.

• Does not include Attachment 11: Evidence of Nonprofit or Public Center Status if you are a new applicant.

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

Application limits You may submit multiple applications under the same Unique Entity Identifier (UEI), if each proposes to serve a different service area. We will only review your last validated application for each announced service area before the Grants.gov due date. If you plan

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf https://www.gsa.gov/about-us/organization/federal-acquisition-service/technology-transformation-services/integrated-award-environment-iae/iae-systems-information-kit/unique-entity-identifier-update to apply to serve two or more service areas announced under this NOFO, you must contact the SAC Team through the BPHC Contact Form for guidance.

Program description Purpose The purpose of the FY 2026 Health Center Program Service Area Competition (SAC) improves the health of underserved communities and populations by providing grants to support the delivery of comprehensive, high-quality primary health care in the United States and its territories.

Background The Health Center Program is authorized by 42 U.S.C. 254b (330 of the Public Health Service (PHS) Act).

Through the SAC, organizations compete for Health Center Program funding to provide comprehensive primary health care services in service areas and to populations served by the Health Center Program.

In alignment with the President’s Make American Healthy Again (MAHA) priorities, this funding opportunity supports health centers, which are trusted resources in their communities, to prevent and manage chronic illness and disease in rural and urban communities across the United States. This includes:

• Support for services integral to the prevention and management of chronic conditions in both children, adults, and older adults

• Cancer screening

• Health and nutrition education

• Mental health services

• Patient support services such as services to support patients’ access to healthy foods and other resources that can address barriers to health and wellbeing

These services are essential to both improving health outcomes in the populations served by health centers and reducing the costs of chronic disease. Health Center Program awardees provide all services on a sliding fee scale and regardless of a patient’s ability to pay.

HRSA considers the Patient Centered Medical Home (PCMH) model foundational for the provision of high-quality primary health care, with numerous studies documenting the benefits of PCMH to address chronic disease management, which further positions health centers to advance MAHA priorities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://hrsa.my.site.com/support/s/ http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.govinfo.gov/app/collection/comps/p https://www.govinfo.gov/app/collection/comps/p

Service areas and patient populations listed in the FY 2026 SAC Service Area Announcement Table (SAAT) are currently served by Health Center Program award recipients whose periods of performance end in FY 2026. The areas are defined by a list of ZIP codes where an applicant must propose to provide services. Each service area also has specific requirements that may include special medically underserved populations and service types you must provide. The full list of eligibility criteria is outlined in this NOFO and on our TA website.

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 which you are proposing to serve. You must describe how you will make primary health care services accessible in an announced service area. This includes providing services to the SAAT Patient Target and special population type(s) with available funding. We will make only one award for each announced service area.

Program requirements and expectations Required services You must demonstrate that you will provide and make all Health Center Program required primary health services available and accessible in the service area regardless of the patient’s ability to pay. You must also provide all additional service types that are listed in the SAAT for your service area. See Health Center Program Compliance Manual and the Service Descriptors for Form 5A: Services Provided for details about these services. You may provide these services directly, through a contract, or through a formal referral arrangement.

Service delivery sites You must show that at least one of your proposed service delivery sites will be a full-time (open for patient care at least 40 hours per week) permanent, fixed-building service site.

Patient target You must demonstrate that you will make every reasonable effort to provide services to the number of unduplicated patients you project to serve on Form 1A: General Information Worksheet in the assessment period.

We will track progress toward meeting the total unduplicated projection using the Uniform Data System (UDS) report. Your total projection may include patient projections from other awards through the Health Center Program. For more information, visit the Patient Target FAQs.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 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/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/patient-target-faq

If there is a downward three-year patient trend or evidence of a significant shift in the need for access to health center services in the service area for two consecutive SAC periods of performance, HRSA may compete the area in the next SAC competition with a different funding allocation, patient target, or service area ZIP codes.

Health Center Program compliance You must demonstrate in your application that you will comply with all Health Center Program requirements, including providing required and additional services as described in the Health Center Program Compliance Manual. You must also comply with all applicable laws, regulations, and Executive Orders. Failure to comply with Health Center Program requirements may jeopardize Health Center Program award funding per Uniform Guidance 2 CFR Part 200, as codified by the United States Department of Health and Human Services (HHS) at 45 CFR Part 75. Appendix A: Health Center Program Compliance outlines the required responses and documentation.

Additional requirements for new and competing supplement applicants

• Open all proposed sites within 120 days of the Notice of Award (NoA). Staff and systems must be in place to deliver all the required primary health services and proposed additional services to the target population. Sites and services must be consistent with Form 5B: Service Sites, Form 5A: Services Provided, the Project Narrative and Attachment 12: Operational Plan.

• If you do not verify that all sites are operational within 120 days of award, HRSA will place a condition on your award that will allow 180 days for resolution. If you do not resolve a site-related condition within the specified time frame, HRSA may terminate all, or part, of your SAC award per 45 CFR 75.371.

• Open all proposed sites for the proposed hours of operation within one year of the Notice of Award. Sites and services must be consistent with Form 5A: Services Provided, Form 5B: Service Sites, the Project Narrative, and Attachment 12:

Operational Plan.

Additional requirements for applicants planning to serve one or more special medically underserved populations

• Comply with additional requirements of 42 U.S.C. 254b (section 330 of the PHS Act):

◦ Section 330(g) for Migratory and Seasonal Agricultural Workers (MSAW funding) applicants.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200?toc=1 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFRb1309e6966399c7/section-75.371 https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim

◦ Section 330(h) for Homeless Population (HP funding) applicants.

◦ Section 330(i) for Residents of Public Housing (RPH funding) applicants.

• Use HP and RPH funding to supplement, and not supplant, other resources for the delivery of services to these populations.

Statutory authority Statutory authority: 42 U.S.C. 254b (Section 330 of the Public Health Service (PHS) Act)

Award information Funding policies and limitations Changes in HHS regulations As of October 1, 2025, HHS will adopt 2 CFR 200, with some modifications included in 2 CFR 300. These regulations replace those in 45 CFR 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.

• We will only make awards if this program receives funding.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Your satisfactory progress in meeting the project’s objectives.

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

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

• All uses of funds must align with your H80 scope of project.

• 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.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 15 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.govinfo.gov/app/collection/comps/p https://www.ecfr.gov/current/title-2/part-200 https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html

General limitations

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

Budget Information in Section 3.1.4 of the Application Guide. You can also see 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost .

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

• Current appropriations law includes a salary limit of $225,700 as of January 2025 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 not associated with the HHS awarded project.

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 the Health Center Program purpose

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

◦ 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

◦ Purchase of vehicles, except for mobile units

• 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 charge across more than one project that cannot be easily separated by project.

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

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 16 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g) https://www.healthit.gov/topic/certification-ehrs/2015-edition-cures-update-test-method https://www.hrsa.gov/grants/manage-your-grant

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 have never received a 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 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

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) of the PHS Act, 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.”

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 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/section-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

In this step

Get registered 19

Find the application package 19

Application writing help 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 click Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register. If you have already registered in SAM.gov, make sure your account is active. You must renew each year.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

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.

Need help? Go to Contacts and Support.

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

Find the application package The application package has all the forms you need for phase 1 of the application process. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-26-006.

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

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 19 https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://grants.hrsa.gov/EAuthNS/external/account/SignIn https://www.grants.gov/search-grants

Application writing help Visit HHS Tips for Preparing Grant Proposals.

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

The Apply for Service Area Competition (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 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.

Join the webinar Visit the Apply for Service Area Competition (SAC) TA webpage to view a pre-recorded webinar for applicants seeking funding through this opportunity.

Have questions? Go to Contacts and Support.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 20 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://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition https://bphc.hrsa.gov/compliance/compliance-manual/introduction https://www.healthcenterinfo.org/ https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition

Step 3:

Prepare Your Application

In this step

Application checklist 22

Application contents and format 24

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

Phase 1: Grants.gov Component Included in page limit?

Project Abstract No

Standard Forms

Application for Federal Assistance (SF-424) No

Project/Performance Site Locations(s) Form No

Grants.gov Lobbying Form No

Key Contacts Form No

Phase 2: EHBs Component Included in page limit?

Project Narrative Yes

SF-424A Budget Information Form for Non-Construction Programs

No

Budget Narrative Yes

Attachments

1. Service Area Map and Table No

2. Bylaws No

3. Project Organizational Chart Yes

4. Position Descriptions 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

Step 3: Prepare Your Application 22

Component Included in page limit?

8. Articles of Incorporation (New applicants only) Yes

9. Collaboration Documentation No

10. Sliding Fee Discount Schedule No

11. Evidence of Nonprofit or Public Agency Status (New applicants only)

No

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

Yes

13. Health Center Program Compliance No

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

Standard and Program-Specific Forms

Project Overview Form No

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 Form No

Form 5B: Service Sites No

Form 5C: Other Activities/Locations 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

Step 3: Prepare Your Application 23

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

This program has a 2-phase submission process. You will submit phase 1 information in Grants.gov, then follow with phase 2 information in EHBs.

There is a 120-page limit for the overall application. The Application checklist specifies what counts in this limit.

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

Required format You must format your narratives and attachments using our required formatting guidelines for fonts, size, color, format, and margins. Visit the Apply for Service Area Competition (SAC) TA webpage for additional guidance.

Phase 1: Grants.gov Forms Submission Requirement

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

Project Abstract Summary Form With application.

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

With application.

Disclosure of Lobbying Activities (SF-LLL) If applicable, with the application or before award.

Budget Narrative Attachment Form With application.

Project/Performance Site Location(s) With application.

Grants.gov Lobbying Form With application.

Key Contacts With application.

Form instructions Follow the instructions for Application for Federal Assistance in section 3.1 of the Application Guide and any additional instructions provided here.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 24 https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf

Project abstract summary form instructions Complete the information in this form. Include a short description of your proposed project. Include the needs you plan to address and the proposed services.

SF-424 Application for Federal Assistance This is your application for federal assistance. Follow the instructions in section 3.1.2 of the Two-Tier Application Guide and the form instructions in Grants.gov Forms.

Project/Performance Site Locations(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.

Key contacts Follow the Key contacts form instructions in Grants.gov Forms.

Grants.gov Lobbying Form Follow the form instructions in Grants.gov Forms.

Other attachments You will not use this form to upload attachments. Attachments can be uploaded during phase 2 in EHBs.

Phase 2: EHBs You will submit the following components through EHBs by the Phase 2 EHBs deadline:

Components Submission Format

Project narrative Use the Project Narrative Attachments form

Budget Use the Budget Information for Non-Construction Programs (SF-424A) form

Budget narrative and Personnel table

Use the Budget Narrative Attachment form to upload your budget narrative and Personnel Table

Attachments Upload each attachment individually in the Appendices

Other program-specific forms

Use the required program-specific forms.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 25 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page=9 https://www.grants.gov/forms/forms-repository/sf-424-family https://www.grants.gov/forms/forms-repository/sf-424-family https://www.grants.gov/forms/forms-repository/sf-424-family https://www.grants.gov/forms/forms-repository/sf-424-family

Important: public information

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

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

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

See instructions and examples.

Project narrative 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.

Make sure that you include all forms and attachments and that you’ve addressed everything.

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 available and accessible to the residents of the area.

d. How the overlap of political subdivisions, school districts, and areas served by Federal and State health and social programs affect access to primary 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 for the proposed service area on the SAAT, explain why, including data sources.

g. Competing continuation applicants: Using Uniform Data System (UDS) data, describe changes to the service area since your last SAC application.

2. Describe health care needs in the announced service area, including those that you are meeting or which are met by the current Health Center Program award recipient. If your service area includes HP, RPH, and/or MSAW funding, include the

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 26 https://www.usaspending.gov/ https://www.hhs.gov/sites/default/files/hhs-writing-award-descriptions.pdf https://www.irs.gov/credits-deductions/businesses/opportunity-zones needs of each special medically underserved population. Address needs related to the following:

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

b. Patient support services (for example, services that enable patients to access health center services, health and nutrition education services, and case management and care coordination services that can address health-related social factors such as those related to food insecurity, housing insecurity, and financial strain).

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 target population.

4. Describe how you determined the number of:

a. Unduplicated patients that you project to serve in the assessment period. 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 that is required for the service area (listed in the Service Type column of the SAAT).

5. Describe how you will:

a. Conduct and update your needs assessment.

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

c. 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 proposed service area, including:

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

b. How you will address geographic barriers, location of sites, and hours of operation.

c. Competing supplement applicants: If the proposed service area is not contiguous with the Health Center Program service area for which you are

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 27 https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf currently funded, how you will make all required and additional services accessible to all patients in the resulting combined service area.

Note: Your new service area will be the combination of your current service area and the new service area that you are applying for. HRSA may not fund an application for an announced service area if the applicant would not make all required services available and accessible to residents of the area, if the service area would not conform to boundaries of political subdivisions, school districts, and areas served by Federal and State health and social service programs, and if the service area would not eliminate barriers to access. See Chapter 3: Needs Assessment of the Compliance Manual.

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 additional services that are identified in your needs assessment.

b. Which required services on Form 5A: Services Provided you will not provide in-person at all service delivery sites and how you will make those services accessible to all patients.

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 support continuity, clinical effectiveness, and patient-centered care coordination.

e. How you will provide patient support services (for example, services that enable patients to access health center services, health and nutrition education services, and case management and care coordination services) to address health-related social factors such as those related to food insecurity, housing insecurity, and financial strain.

f. How your services will account for patient-centered care that is tailored to the individual, empowers them to make informed decisions about their health and to actively participate in their care, and supports the development of a comprehensive care plan to support patients in meeting their health goals.

g. How the additional services you provide will address any other unique needs that impact health status.

3. Describe how you will expand access to additional services such as nutrition counseling and wellness promotion in response to your needs assessment.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 28 https://bphc.hrsa.gov/compliance/compliance-manual/chapter3

4. Describe how you will keep providing the services that HRSA has previously supported through a supplemental award. Address all supplements awarded since FY 2023. If you have questions about the supplemental services provided in your service area, contact us using the BPHC Contact Form. In your narrative, include:

a. What level of services you currently provide and how you will continue to provide, change, or expand these services to meet the needs you identified in your needs assessment.

b. Competing supplement and new applicants: Describe how you plan to ensure patients continue to have access to the services that the current Health Center Program award recipient received funding to expand, including services supported by one-time funding for infrastructure improvements.

5. Describe the following aspects of your sliding fee discount program policies:

a. How you assess all patients for sliding fee discount eligibility based only on income and family size.