U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION Bureau of Primary Health Care School-Based Health Center Capital (SBHCC) Program Announcement Type: New Competitive Announcement Number: HRSA-10-276 Catalog of Federal Domestic Assistance (CFDA) No. 93.501 FUNDING OPPORTUNITY ANNOUNCEMENT Fiscal Year 2010 Application Due Date (Grants.gov and HRSA EHBs) July 30, 2010 Date of Issuance: June 30, 2010 Date of Release: June 30, 2010 Bureau of Primary Health Care Office of Policy and Program Development Telephone: 301-594-4300 Fax: 301-594-4997 Email: sbhc@hrsa.gov Technical Assistance Resources: http://www.hrsa.gov/grants/apply/assistance/sbhcc Legislative Authority: Patient Protection and Affordable Care Act (P.L. 111-148), Title IV, Section 4101(a)

Executive Summary The Health Resources and Services Administration (HRSA) administers the School-Based Health Center Capital (SBHCC) Program, as authorized by the Patient Protection and Affordable Care Act (ACA) ((P.L. 111-148), Title IV, Section 4101(a)). School-based health centers (SBHC) are a major component of the nation s health care safety net. SBHCs not only enable children with acute or chronic illnesses to attend school, but also improve their overall health and wellness through health screenings, health promotion, and disease prevention activities. This funding opportunity announcement details the eligibility requirements, review criteria, and awarding factors for organizations seeking a SBHCC Equipment grant in fiscal year (FY) 2010 for the purchase of moveable equipment 1. The SBHCC Equipment grants will address significant and pressing equipment needs to support the expansion of services at SBHCs. Applicants must demonstrate how their proposal will lead to improvements in access to health services for children at a SBHC. HRSA expects to award approximately $50 million for an estimated 1,000 SBHCC Equipment grants in FY 2010. All applicants requesting funding for a SBHCC Equipment grant must use this announcement. This funding opportunity announcement should be reviewed thoroughly prior to making a decision to apply. 1. Eligible Applicants (please refer to Section III for additional information on eligibility requirements) School-based health center or a sponsoring facility of school-based health centers eligible to apply includes any of the following: a hospital, a public health department, a community health center, a nonprofit health care agency, a local educational agency, or a program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization. 2. Application Submission Process For FY 2010, HRSA will use a two-part submission process for SBHCC Equipment applications via Grants.gov and HRSA s Electronic Handbooks (EHB). Please see the following discussion and chart for detailed information on the application process. The following are deadlines for each part: 1 Moveable equipment is a non-expendable item with a useful life of more than one year and a unit cost of $5,000 or more (or equal to the applicant s capitalization, if less than the $5,000 threshold) that is not permanently affixed and can be easily moved (e.g., medical exam tables, dental chairs, x-ray equipment, computers, modular workstations, autoclaves, and freezers). Trailers or modular units set up on portable chassis for temporary use may also be considered moveable equipment. Office supplies (paper, pencils, toner, and the like); medical supplies (syringes, blood tubes, plastic gloves, etc.), and educational supplies (pamphlets, educational videotapes, etc.) are not moveable equipment. ii

Part 1 - Grants.gov 5:00 PM ET on July 30, 2010 Part 2 - HRSA s EHB 5:00 PM ET on July 30, 2010. Note: Applicants can begin the application process for Part 1 in Grants.gov and Part 2 in HRSA s EHBs concurrently. Applicants do not need to submit to Grants.gov and wait for notification prior to entering the HRSA EHBs. Applicants MUST, however, submit the appropriate application materials through both Grants.gov and the HRSA EHBs prior to the deadline in order to be considered eligible for the funding opportunity. It is the responsibility of the applicant to ensure that the complete application is submitted electronically by the published due date and time. Applications will be considered as having been formally submitted and having met the deadline if: (1) the application has been successfully transmitted electronically by your organization s Authorized Organization Representative (AOR) through Grants.gov and it has been successfully validated by Grants.gov on or before the deadline date and time; and (2) the AOR has submitted the additional information in the HRSA EHBs on or before the deadline date and time. Applications which do not meet the criteria above are considered late applications and will not be considered in the current competition. Part 1 - Grants.gov Part 1 - Grants.gov: Application must be completed and successfully submitted via Grants.gov by 5:00 PM ET on July 30, 2010. To ensure adequate time to follow procedures and successfully submit the application, HRSA recommends that applicants register immediately in Grants.gov and HRSA s EHBs, if currently unregistered. The registration process can take up to one month. For Grants.gov technical assistance, please refer to http://www.grants.gov or call the Grants.gov Contact Center 24 hours a day, 7 days a week (excluding Federal holidays) at 1-800-518-4726 for information on registering. Applicants are strongly encouraged to register multiple authorizing organization representative(s) (AOR). Part 2 - HRSA s EHBs Part 2 - HRSA s EHBs: Application must be completed and successfully submitted by 5:00 PM ET on July 30, 2010. For information on registering in HRSA s EHBs, please refer to http://www.hrsa.gov/grants/userguide.htm or call the HRSA Call Center at 1-877-464-4772. If this registration process is not complete, you will be unable to submit an application. HRSA recommends that applications be submitted in Grants.gov and HRSA s EHB as soon as possible, to ensure that maximum time is available for completing the application within both systems. iii

FY 2010 SCHCC Equipment Application Submission Process Part Due Dates Helpful Hints Part 1: Grants.gov Please complete and submit the following by the Grants.gov deadline (all forms are available in the Grants.gov application package): SF-424 Face Page Project Summary/Abstract (uploaded on line 15 of the SF-424 Face Page) PHS-5161 HHS checklist SF-424 LLL Disclosure of Lobbying Activities Submit by 5:00 PM ET on July 30, 2010 Refer to http://www.hrsa.gov/grants/userguide.htm for detailed application and submission instructions. Registration in Grants.gov is required. As registration may take up to a month, start the process as soon as possible. The Central Contractor Registry (CCR) registration is an annual process. Verify the organization s CCR registration prior to Grants.gov submission, well in advance of the application deadline. The Grants.gov registration process involves three basic steps: Register the organization Register an individual as the Authorized Organization Representative (AOR) for the organization Get authorized as an AOR by the applicant organization Please visit the Grants.gov website at http://www.grants.gov/applicants/get_registere d.jsp or call the Grants.gov Contact Center at 1-800-518-4726 24 hours a day, 7 days a week (excluding Federal holidays) for additional technical assistance on the registration process. Part 2: HRSA s EHBs Complete and submit the following by the HRSA EHBs deadline (forms may be found online at Submit by 5:00 PM ET on July 30, 2010 Registration in HRSA s EHB is required. Refer to http://www.hrsa.gov/grants/userguide.htm for iv

Part Due Dates Helpful Hints http://www.hrsa.gov/grants/a pply/assistance/sbhcc): process instructions, and frequently-asked questions. Forms Proposal Cover Page SF-424 Face Page Budget Form (SF-424C) Equipment List Equipment Location Attachments Proposal Narrative Budget Justification Capitalization Threshold Certification for Sponsoring Authority SF-424D Assurances Construction Programs Letters of Support (as applicable) Other Documents (as applicable) The Authorizing Official (AO) must complete submission of the application. Please refer to http://www.hrsa.gov/grants/userguide.htm for information on registering in EHBs or call the HRSA Call Center at 1-877-464-4772. For more information and technical assistance refer to http://www.hrsa.gov/grants/apply/assistance/s bhcc. All applicants must submit using the two-part submission process for SBHCC Equipment applications, unless the applicant is granted a written exemption from this requirement in advance by the Director of HRSA s Division of Grants Policy or designee. To request an exemption, applicants must submit a request in writing from DGPWaivers@hrsa.gov, and provide details as to why they are technologically unable to submit electronically though the Grants.gov portal and/or the HRSA EHBs. When requesting a waiver, be sure to specify the announcement number HRSA-10-276 and include specific information, including any tracking numbers or anecdotal information received from Grants.gov and/or the HRSA Call Center, in the justification request. HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval. For those applicants that have been approved to submit paper applications, blank Program Specific Forms are available at http://www.hrsa.gov/grants/apply/assistance/sbhcc. The application must be received by the application deadline. The SF-424 face page, included in the required application package, must be electronically submitted by the applicant s authorized representative (e.g., Executive Director, Program Director, or Board Chair). This form certifies that all data/content in the application (including the program specific forms) are true and correct and that the document has been duly reviewed and authorized by the governing board of the applicant. It also certifies that the applicant will comply with the attached assurances if the assistance is awarded. v

The electronic signature in Grants.gov is the official signature when applying for a grant or cooperative agreement and is considered binding. Selection of the responsible person should be consistent with responsibilities authorized by the organization s bylaws. Authorized representatives who submit the SF-424 face page electronically are reminded that HRSA requires that a copy of the governing body s authorization permitting them to submit the application as an official representative must be on file in the applicant s office. Application Contact If you have questions regarding the FY 2010 SBHCC Equipment application and/or the review process described in this application guidance, please contact Beth Tchinski: 301-443-1389 Matt Kozar: 301-443-1034 in the Bureau of Primary Health Care s (BPHC) Office of Policy and Program Development or e-mail SBHC@hrsa.gov. The BPHC will conduct a pre-application technical assistance (TA) conference call for the SBHCC Equipment funding opportunity on July 7, 2010 at 1:30 p.m. ET. The call will be recorded and will remain available until after the closing date of July 30, 2010. The call will offer applicants an opportunity to ask questions pertaining to the SBHCC Equipment program requirements. Please visit http://www.hrsa.gov/grants/apply/assistance/sbhcc for the call information and additional resources. vi

Table of Contents I. Funding Opportunity Description...1 1. Purpose... 1 2. Background... 2 II. Award Information...2 1. Type of Award... 2 2. Summary of Funding... 2 III. Eligibility Information...2 1. Eligible Applicants... 2 2. Cost Sharing/Matching... 3 3. Other... 3 IV. Application and Submission Information...3 1. Application Materials and Required Electronic Submission Information... 3 2. Content and Form of Application Submission... 4 Application Format... 8 i. Application Face Page (SF-424) Grants.gov... 8 ii. Table of Contents... 9 iii. Application Checklist (Grants.gov)... 9 iv. Budget (EHBs)... 9 v. Budget Justification (EHBs)... 9 vi. Assurances (EHBs)... 10 vii. Certifications (Grants.gov)... 10 viii. Project Abstract (Grants.gov)... 10 ix. Funding Preference Request (EHBs)... 11 x. Program Narrative (EHBs)... 11 xi. Attachments (EHBs)... 13 3. Submission Dates and Times... 14 4. Intergovernmental Review... 14 5. Funding Restrictions... 14 6. Other Submission Requirements... 15 V. Application Review Information...16 1. Review Criteria... 16 2. Review and Selection Process... 18 3. Anticipated Announcement and Award Dates... 18 vii

VI. Award Administration Information...19 1. Award Notices... 19 2. Administrative and National Policy Requirements... 19 3. Reporting... 21 VII. Agency Contacts...22 VIII. Other Information...23 IX. Tips for Writing a Strong Application...23 Appendix A: SF-424C Budget Information Construction Programs...24 Appendix B: Federal Procurement Requirements...27 viii

I. Funding Opportunity Description 1. Purpose The Health Resources and Services Administration (HRSA) administers the School-Based Health Center Capital (SCHCC) Program, authorized by the Patient Protection and Affordable Care Act (ACA) ((P.L. 111-148), Title IV, Section 4101). This announcement solicits fiscal year 2010 applications for the SBHCC Equipment Program that will address significant and pressing equipment needs to support the expansion of services at school-based health centers (SBHCs). The announcement details the eligibility requirements, review criteria and awarding factors for eligible applicants seeking a grant for the purchase of moveable equipment 2 to be used in SBHCs, such as, but not limited to: Telehealth equipment (i.e., video cameras, TVs) Equipment to support an EHR system 3 (i.e., hardware, servers, licenses) Medical equipment (i.e., exam tables, nebulizers, AEDs) Office equipment (i.e., computers, desks, chairs, file cabinets). It is expected that the equipment purchased will support the SBHC in providing effective, efficient, and quality care. Applicants must also demonstrate how their proposal will lead to improvements in access to health services for children at a SBHC. A funding preference will be used for this announcement. In order to be eligible for the funding preference, applicants must certify that the school-based health center site(s) serves a large population of children eligible for medical assistance under the State Medicaid plan under title XIX of the Social Security Act or under a waiver of such plan or children eligible for child health assistance under the State child health plan under title XXI of that Act (42 U.S.C. 1397aa et seq.). An eligible applicant may submit one application to purchase moveable equipment for multiple school-based health center facilities. Applicants may not request SBHCC funds to support the provision of health services or personnel; expenses related to the acquisition or improvement of land; acquisition, construction, expansion, replacement, or other improvement to any building or other facility; or any other facility related expenses. 2 Moveable equipment is a non-expendable item with a useful life of more than one year and a unit cost of $5,000 or more (or equal to the applicant s capitalization threshold, if less than the $5,000 threshold) that is not permanently affixed and can be easily moved (e.g., medical exam tables, dental chairs, x-ray equipment, computers, modular workstations, autoclaves, and freezers). Trailers or modular units set up on portable chassis for temporary use may also be considered moveable equipment. Office supplies (paper, pencils, toner, and the like); medical supplies (syringes, blood tubes, plastic gloves, etc.), and educational supplies (pamphlets, educational videotapes, etc.) are not moveable equipment. 3 SBHCCs may purchase equipment only for EHRs that are certified by an organization recognized by the Secretary of Health and Human Services (HHS). HRSA-10-276 1

All applicants requesting funding for a SBHCC Equipment grant must use the guidance provided in this funding opportunity announcement. It should be reviewed thoroughly prior to making a decision to apply. 2. Background A SBHC is often operated as a partnership between the school and a community health organization, such as a community health center, hospital, or local health department that serves as the sponsoring facility for the SBHC. In general, services provided by the SBHC are determined locally through a collaborative approach between the families and students, the community, the school district, and associated health providers. Typically, a SBHC provides a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education, and health promotion. An overall emphasis is placed on the services being age appropriate, with a particular focus on prevention and early intervention. There are currently an estimated 1,910 SBHCs nationwide, as identified in a 2007-2008 census survey conducted by the National Assembly on School-Based Health Care. Although various service models exist, the typical SBHC is open every school day and staffed by a team of health providers. These health providers would also work closely with the school nurse and other community service providers. II. Award Information 1. Type of Award Funding will be provided in the form of a grant. 2. Summary of Funding HRSA anticipates awarding approximately $50 million for an estimated 1,000 SBHCC Equipment grants in FY 2010. Applicants may request funding up to $50,000 for a one-year project/budget period. $50,000 is the maximum amount of one-time SBHCC funding that can be requested by a sponsoring facility for a SBHCC Equipment grant application for the purchase of moveable equipment in FY 2010. III. Eligibility Information 1. Eligible Applicants For this funding opportunity, eligible applicants must be a school-based health center or a sponsoring facility of a school-based health center that comply with all of the following requirements: a. Meets the definition of a school-based health center under section 2110(c)(9)(A) of the HRSA-10-276 2

Social Security Act and is administered by a sponsoring facility (as defined in section 2110(c)(9)(B) of the Social Security Act); and b. Provides, at a minimum, comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with established standards, community practice, reporting laws, and other State laws, including parental consent and notification laws that are not inconsistent with Federal law; and c. Does not perform abortion services. An eligible sponsoring facility of school-based health centers is defined as a: hospital, public health department, community health center, nonprofit health care agency, local educational agency, or program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization. 2. Cost Sharing/Matching Cost sharing/matching is not a requirement for this program. 3. Other Applications that exceed the ceiling amount will be considered non-responsive and will not be considered for funding under this announcement. Any application that fails to satisfy the deadline requirements referenced in Section IV.3 will be considered non-responsive and will not be considered for funding under this announcement. While eligible applicants may only submit one application, the application may request Federal financial assistance under the SBHCC Equipment funding opportunity to purchase moveable equipment for multiple school-based health center facilities. If more than one application is submitted, HRSA will accept the applicant s last electronic submission validated by Grants.gov and/or EHB on or before the deadline date as the final and only acceptable application. HRSA will not allow applicants to edit their materials and add new information or attachments and resubmit their application through Grants.gov or the EHBs after the deadline. IV. Application and Submission Information 1. Application Materials and Required Electronic Submission Information Application Materials HRSA requires applicants for this funding opportunity to apply electronically through Grants.gov and EHB. All applicants must submit in this manner unless the applicant is granted a written exemption from this requirement in advance by the Director of HRSA s Division of Grants Policy or designee. Applicants must request an exemption in writing from DGPWaivers@hrsa.gov and provide details as to why they are technologically unable to submit electronically though the Grants.gov and EHB portal. Applicants must identify the announcement number and indicate specific information, including any tracking number or HRSA-10-276 3

anecdotal information received from the HRSA Call Center, in the justification request. As indicated in this guidance, HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval. For those applicants that have been approved to submit paper applications, blank Program Specific Forms are available online at http://www.hrsa.gov/grants/apply/assistance/sbhcc. Applicants must submit proposals according to the instructions in HRSA s Electronic Submission User Guide, available online at http://www.hrsa.gov/grants/apply/userguide.pdf, using this guidance in conjunction with Application Forms SF-424. Applicants must use SF- 424C budget and SF-424D for this funding opportunity. These forms contain additional general information and instructions for grant applications, proposal narratives, and budgets. These forms may be obtained from the following sites by: 1) Downloading from http://www.hrsa.gov/grants/forms.htm, OR 2) Contacting the HRSA Grants Application Center at: 910 Clopper Road Suite 155 South Gaithersburg, MD 20878 Telephone: 877-477-2123 HRSAGAC@hrsa.gov Instructions for preparing portions of the application that must accompany SF-424 appear in the Application Format section below. Note that the SF-424 is a compilation of forms that are used primarily for the competitive application process. 2. Content and Form of Application Submission The total size of the SBHCC Equipment grant application including all uploaded files, may not exceed the equivalent of 20 pages (or a total file size of 10 MB) when printed by HRSA. This 20-page limit includes the abstract, proposal narrative, budget justification, letters of support, and other applicable documents. The standard forms are NOT included in the page limit. Applications that exceed the specified limits (10 MB, or that exceed 20 pages when printed by HRSA) will be deemed non-compliant and will not be considered under this funding opportunity announcement. The following chart details the forms and documents (see column labeled, Form Type) that are required submissions for this funding opportunity and the order in which they must be submitted. Forms refer to those documents that are completed online in the system and that do not require any downloading or uploading. Documents are those requirements that must follow the template provided, are completed, and then uploaded into the system. Application Format Applications for SBHCC Equipment funding must consist of the following documents in the following order: HRSA-10-276 4

SF-424 Application Kit Table of Contents It is mandatory to follow the instructions provided in this section to ensure that your application can be printed efficiently and consistently for review. Failure to follow the instructions may make your application non-compliant. Non-compliant applications will not be given any consideration and those particular applicants will be notified. For electronic submissions, applicants only have to number the electronic attachment pages sequentially, resetting the numbering for each attachment, i.e., start at page 1 for each attachment. Do not attempt to number standard OMB approved form pages. For electronic submissions no table of contents is required for the entire application. HRSA will construct an electronic table of contents in the order specified. When providing any electronic attachment with several pages, add table of content page specific to the attachment. Such page will not be counted towards the page limit. Application Section Type Instruction Grant.gov Submission (http://www.grants.gov/) Application for Federal Assistance (SF-424) (Required) Project Summary/Abstract (Required) Form Document HRSA-10-276 5 Complete pages 1, 2 & 3 of the SF-424 face page. See detailed instructions in the Application Format section of this guidance. Type the title of the funding opportunity and upload the project abstract on page 2 of SF-424 - Box 15 Additional Congressional District Document If applicable, grantees serving multiple districts can upload a list of all districts served on page 2 of SF-424 - Box 16 HHS Checklist Form PHS-5161 (Required) SF-424 LLL Disclosure of Lobbying Activities (Required) HRSA/Program Guidelines Not counted in the page limit Counted in the page limit As applicable to HRSA; not counted in the page limit Form Complete pages 1 & 2 of the HHS checklist. Not counted in the page limit Form Complete this form online per the instructions embedded in the form. Not counted in the page limit Note the following specific information related to your submission. Understand that for your SBHCC Equipment application, only the forms mentioned in the Table of Contents listed above are submitted through Grants.gov. All supplemental information will be submitted through the HRSA EHBs. To create your application in the HRSA EHBs, go to https://grants.hrsa.gov/webexternal/home.asp, and log in using your username and password. (Refer to HRSA s Electronic Submission User Guide, which can be found at

http://www.hrsa.gov/grants/userguide.htm, for information on registering in the HRSA EHBs.) Click the Funding Opportunity link on the left side of the menu. Enter the SBHCC Equipment funding opportunity number HRSA-10-276 in the HRSA Preview Announcement Number Like field. Click the Search button. The SBHCC funding opportunity will appear on the results page. Click the Go button to begin the application. Application Section Type Instruction HRSA EHBs Submission (https://grants.hrsa.gov/webexternal/home.asp) HRSA/Program Guidelines Proposal Cover Page Form Complete this form electronically online. Not counted in the page limit Face Page Form Complete this form electronically online. Information provided must be consistent with the information provided in the Grants.gov Application for Federal Assistance (SF-424) SF-424C Budget Information for Construction Programs Form Complete Line 10 of Column A-Total Cost. Indicate the total cost of the project for the SBHCC Equipment project. Do not enter data in Column B-Costs Not Allowable for Participation. Column C-Total Allowable Costs: Enter amount from Column A. Not counted in the page limit Not counted in the page limit Equipment List Form Complete this form electronically online. Not counted in the page limit Equipment Location Form Provide the SBHC site(s) name, physical address and location setting electronically online. Attachment 1: Proposal Narrative (Required) Attachment 2: Budget Justification (Required) Attachment 3: SF-424D Assurances for Construction Programs (Required) Attachment 4: Capitalization Threshold Certification For Sponsoring Authority (Required) Document Document Applicants must upload a proposal narrative as outlined in the Grant Application Proposal Narrative section. Applicants must provide a budget justification (see Appendix A). Sample budget justifications are available at http://www.hrsa.gov/grants/apply/assistance/sbhcc. Not counted in the page limit Included in page limit Included in page limit Document Applicants will upload a digitally signed assurances document. Not counted in the page limit Document Moveable equipment is an individual item with a useful life of one year or more, and a unit cost of either $5,000 or greater, or equal or greater than the capitalization threshold that the applicant uses for its own accounting records. Supplies and items immediately expensed in the applicant s accounting system are not eligible costs. The applicant must submit with the application a signed and Included in page limit HRSA-10-276 6

Application Section Type Instruction HRSA EHBs Submission (https://grants.hrsa.gov/webexternal/home.asp) dated statement from the head of its Accounting Department that states: HRSA/Program Guidelines I affirm that all items listed as equipment in the application are being treated as capital items under [Organization s name] accounting system. Please note that equipment must be maintained, tracked, and disposed of in accordance with the grant regulations at 45 CFR Parts 74 and 92 and records must be maintained in accordance with 74.53(b)(2) and 92.42(c)(2). The Federal government retains interest in the equipment purchased with Federal funds in accordance with 2 CFR 215.34. Attachment 5: Letters of Support (as applicable) Document Upload any dated letters of support as appropriate to demonstrate support of and commitment to the proposed SBHCC Equipment grant. Support from local community stakeholders, patients, and collaborating organizations are as important as letters of support from elected officials. As necessary, applicants should also include a one-page list of all additional support letters that are not included in the application, but are available onsite. Merge various letters into a single document and upload it here. Included in page limit Attachment 6: Other Relevant Documents (as applicable) Document Applicants may include other relevant documents to support the proposed project plan such as floor plans or organizational brochures, etc. Merge all additional documents into a single document and upload it here. Included in page limit Applicants are reminded that failure to include all required documents as part of the SBHCC Equipment application may result in an application being considered as incomplete and non-responsive. All non-responsive applications will not be reviewed. HRSA-10-276 7

Application Format i. Application Face Page (SF-424) Grants.gov Complete Application Form SF-424. Prepare according to instructions provided in the form itself. For more information on completing each section of SF-424, activate the Help Mode function available at top of the electronic form. The Catalog of Federal Domestic Assistance (CFDA) number is 93.501. Please be sure to complete the SF-424 Face Page as follows: Box 4 Applicant Identifier: Not applicable-leave blank. Box 5a Federal Entity Identifier: No action needed. Box 5b Federal Award Identifier: No action needed. Box 8b Employer Identification Number (EIN): Enter the applicant s nine-digit IRS taxpayer identification number used to submit the organization s payroll taxes to the IRS. Box 8c Applicant organization s DUNS number. Box 12 Funding Opportunity Number and Title: HRSA-10-276 and School-Based Health Center Capital Program, respectively. Box 15 Descriptive Title of Applicant s Project: Type the title of the funding opportunity and upload the Project Abstract here. Box 16 Congressional Districts: Upload any additional congressional districts as applicable for the HRSA grant. Not counted in the page limit. Box 17 Proposed Project Start and End Date: Provide the start and end dates for the proposed project period (1-year project period). Box 18 Estimated Funding: Complete the required information based on the funding request for the project. This information should be consistent with the total provided in the applicant s SF-424C Budget for Construction Programs plus the total provided in the SF-424C Budget Information for Construction Programs (if applicable). DUNS Number All applicant organizations are required to have a Data Universal Numbering System (DUNS) number to apply for an award from the Federal Government. The DUNS number is a unique nine-character identification number provided by the commercial company, Dun and Bradstreet. There is no charge to obtain a DUNS number. Information about obtaining DUNS number can be found at http://www.hrsa.gov/grants/dunsccr.htm or by calling 866-705-5711. Include the DUNS number in item 8c on the application face page. The application will not be reviewed without a DUNS number. Note: A missing or incorrect DUNS number is the primary reason for an application to be Rejected for Errors by Grants.gov. Additionally, the applicant organization is required to register annually with the Federal Government s Central Contractor Registry (CCR) in order to do electronic business with the Federal Government. Information about registering with the CCR can be found at http://www.ccr.gov. HRSA-10-276 8

ii. Table of Contents The application should be presented in the order of the Table of Contents provided in Section IV, Application and Submission Information. For electronic applications no table of contents is necessary, as it will be generated by the system. (Note: the Table of Contents will not be counted in the page limit.) iii. Application Checklist (Grants.gov) Complete the HHS Application Checklist Form PHS 5161. Instructions can be found at http://www.hhs.gov/forms/phs-5161-1.doc. iv. Budget (EHBs) A complete budget presentation will include the following items: Standard Form SF-424C Budget Information for Construction Programs: Applicants requesting Federal funding for the purchase of moveable equipment must complete the SF-424C as presented. Complete Line 10 of Column A (Total Cost). Indicate the total cost of the project for the SBHCC Equipment project. Do not enter data in Column B (Costs Not Allowable for Participation). In Column C (Total Allowable Costs) enter amount from Column A. See instructions in Appendix A for further details on completing the SF-424C. Equipment List: Applicants must include all moveable equipment to be purchased with SBHCC Equipment funds. Non-expendable equipment items must be capitalized based on the organization s accounting practices. Equipment type will be categorized as clinical, non-clinical, or EHR. Please note that equipment must be maintained, tracked, and disposed of in accordance with 45 CFR Parts 74 and 92. While title to the equipment vests with the grantee, the Federal government retains interest in the equipment purchased with Federal funds in accordance with 2 CFR 215.34. v. Budget Justification (EHBs) Provide a narrative that justifies the amounts requested for each equipment item in the budget. This announcement is inviting applications for project/budget periods up to one year. The budget justification should specifically describe how each item being purchased will support the achievement of proposed objectives. The budget justification MUST be concise. Do NOT use the justification to expand the program narrative. If applicable, provide an extensive justification and a detailed status of current equipment when requesting funds for the purchase of computers and furniture items that will supplement existing items. Since the SBHCC Equipment grants only funds equipment purchases, the entire budget justification should be based on funds requested under line item 10. Include the following in the Budget Justification narrative: HRSA-10-276 9

Equipment: List equipment costs and provide justification under the program s goals. Applicants may only request Federal funding for moveable equipment. If applicable, provide an extensive justification and a detailed status of current equipment when requesting funds for the purchase of computers and furniture items that will supplement existing items. Moveable equipment is a non-expendable item with a useful life of more than one year and a unit cost of $5,000 or more (or equal to the applicant s capitalization threshold, if less than the $5,000 threshold) that is not permanently affixed and can be easily moved (e.g., medical exam tables, dental chairs, x-ray equipment, computers, modular workstations, autoclaves, and freezers). Trailers or modular units set up on portable chassis for temporary use may also be considered moveable equipment. Office supplies (paper, pencils, toner, and the like); medical supplies (syringes, blood tubes, plastic gloves, etc.), and educational supplies (pamphlets, educational videotapes, etc.) are not moveable equipment. HRSA reserves the right to request additional information for trailer or modular units. Equipment Location: Provide the SBHC site(s) name, physical address, and location setting. vi. Assurances (EHBs) Complete the SF-424D Assurances for Construction Programs provided with the application package. vii. Certifications (Grants.gov) Complete the Certifications and Disclosure of Lobbying Activities Application Form provided with the application package. viii. Project Abstract (Grants.gov) Provide a summary of the application. Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed grant project including the needs to be addressed, the proposed services, and the population group(s) to be served. The project abstract must be single-spaced and limited to one page in length. Place the following at the top of the abstract for the application: Project title Applicant organization name Program applying under, including funding opportunity number Project Director Address Congressional district(s) served Project Director phone numbers (phone and fax) Email address Organizational Website address, if applicable Type of equipment to be purchased Projected date for equipment to be purchased HRSA-10-276 10

The abstract narrative should include: A brief history of the applicant organization s administration of the SBHC(s); A brief description of the populations served by the SBHC(s); A brief description of the need for the moveable equipment; A brief description of any other relevant information; and Summary of need and goals for the SBHCC Equipment grant. All information provided in the abstract should be consistent with data included in the application. ix. Funding Preference Request (EHBs) Applicants requesting consideration of a funding preference must do so within the proposal cover page within the EHBs. x. Program Narrative (EHBs) The Program Narrative provides a comprehensive framework and description of all aspects of the SBHCC Equipment project. It should be succinct, self-explanatory, and well organized so that reviewers can understand the proposed project. The following provides a framework for the Program Narrative. The Program Narrative should be organized using the following section headers. All applicants should ensure that all of the specific elements in the Program Narrative are completely addressed (see Section V of this document for the corresponding Review Criteria). NEED i. Identify and describe the deficiencies or the needs to be addressed with the proposal (e.g., outdated/ineffective equipment) both for current equipment and the SBHC facility. ii. Describe the population(s) that will benefit, have improved access to care, and/or reduced health disparities as a result of this equipment. iii. Identify each SBHC that will receive equipment with funds from this proposal including: a. Facility name b. Address c. Service area zip codes d. Telephone number e. Census tracts RESPONSE i. Explain how the proposal will appropriately address the SBHC s immediate needs and how it will enhance the SBHC s effectiveness, efficiency, quality of care, and patient outcomes. ii. Discuss how the project is appropriate given the proposed number of staff and patients, and the current state of the existing facility. iii. Discuss the importance of this proposal to the organization s mission and the population it serves. HRSA-10-276 11

iv. Describe the ongoing commitment of the school to maintaining the operation of the SBHC. Explain how the SBHC will maintain the improved access/services resulting from the project within its existing operational budget/grant support in the long-term. v. Indicate the timeframe for implementing the project by identifying the start and end dates. vi. Discuss how the equipment purchased will be immediately and effectively utilized by the staff of the SBHC. vii. Explain potential challenges or difficulties and how the organization will manage any unexpected difficulties and/or challenges that may arise (i.e., lack of operational support). viii. Describe the applicant s and the SBHC s financial management and internal control policies and procedures. IMPACT i. Describe the impact of the purchase of the moveable equipment on the SBHC s effectiveness, efficiency, quality of care, and patient outcomes. Forecast the following outcomes, as a result of the completed project: a. Total number of patients to be served. b. Total number of additional, unduplicated patients served. c. Total number of additional visits. d. Total number of uninsured patients to be served. ii. Describe the overarching impact of the proposal on the operational budget. iii. Describe how the proposal will promote the sustainability or expansion of the services provided by the SBHC once the project has been completed. iv. Describe how the equipment will enhance the quality of care and patient outcomes. RESOURCES/CAPABILITIES i. Discuss why the applicant is the appropriate entity to receive the SBHCC Equipment funding (e.g., prior experience, project management capabilities). ii. Identify the unique characteristics and significant accomplishments of the organization in administering the SBHC. iii. Identify the administrative structure and oversight for the proposal, including the Key Staff who will be responsible for managing this project and the individuals (name and title) who comprise the Project Team. iv. Describe how the Project Team has the expertise and experience necessary to successfully manage the project within the timeline outlined and achieve the goals and objectives established for this project. v. Discuss the applicant s acquisition strategy, policies, and procedures. SUPPORT REQUESTED i. Provide a complete and reasonable budget (SF-424C). ii. Discuss how the proposed equipment contributes to the goals and objectives of the proposal. iii. Describe the equipment to be purchased including the number, type, and the itemized cost of the equipment to be purchased and how the costs contribute to the goals and objectives of the project. HRSA-10-276 12

xi. Attachments (EHBs) These and any other required application attachments must be included with their SBHCC Equipment application, as applicable. Attachments are supplementary in nature and are not intended to be a continuation of the program narrative. Attachment should be clearly labeled and attached in the appropriate section. Refer to the Required Attachments Table for a complete listing of all required attachments (Content and Form of Application Submission). Applicants will be prompted to upload the following attachments as appropriate for each section of the SBHCC Equipment application in the EHB: Attachment 1 Proposal Narrative (Required): Applicants must upload a proposal narrative as outlined in the Grant Application Proposal Narrative section. Attachment 2 Budget Justification (Required): The Budget Justification must provide a written description of each line item under Columns A, B, and C of the Budget Page (SF-424C). The budget justification must clearly describe each cost element and explain how each cost contributes to meeting the project s objectives/goals. The budget justification MUST be concise. Do NOT use the budget justification to expand the project narrative. A sample budget justification is available in Appendix A. Attachment 3 SF-424D Assurances for Construction Programs (Required): Applicants will upload a digitally signed assurances document. Attachment 4 Capitalization Threshold Certification for Sponsoring Authority (Required): Moveable equipment is a non-expendable item that is not permanently affixed and can be easily moved, with a useful life of more than one year and a unit cost of $5,000 or more (or equal to the capitalization threshold used by the applicant for its own accounting records, if less than the $5,000 threshold).supplies and items immediately expensed in the applicant s accounting system are not eligible costs. The applicant must submit with the application a signed and dated statement from the head of its Accounting Department that states: I affirm that all items listed as equipment in the application are being treated as capital items under [Organization s name] accounting system. Note that while title to the equipment vests with the grantee, the Federal government retains interest in equipment purchased in full or in part with grant funds in accordance with 2 CFR 215.34. These items must be maintained, tracked, and disposed of in accordance with the grant regulations at 45 CFR in accordance with 45 CFR Parts 74.34 and 92.32, and records must be maintained in accordance with 74.53(b)(2) and 92.42(c)(2). Attachment 5 Letters of Support (as applicable): Upload any dated letters of support as appropriate to demonstrate support of and commitment to the proposed SBHCC Equipment grant. Support from local community stakeholders, patients, and collaborating organizations are as important as letters of support from elected officials. HRSA-10-276 13

As necessary, applicants should also include a one-page list of all additional support letters that are not included in the application, but are available onsite. Merge various letters into a single document and upload it here. Attachment 6 Other Relevant Documents (as applicable): Applicants may include other relevant documents to support the proposed project plan such as floor plans or organizational brochures, etc. Merge all additional documents into a single document and upload it here. 3. Submission Dates and Times Application Due Date The due date for applications under HRSA-10-276 is July 30, 2010 at 5:00 PM ET. Applications will be considered as having been formally submitted and having met the deadline if: (1) the application has been successfully transmitted electronically by your organization s Authorized Organization Representative (AOR) through Grants.gov and it has been successfully validated by Grants.gov on or before the deadline date and time; and (2) the AOR has submitted the additional information in the HRSA EHBs on or before the deadline date and time. The Chief Grants Management Officer (CGMO) or designee may authorize an extension of published deadlines when justified by circumstances such as natural disasters (e.g., floods or hurricanes) or other disruptions of services, such as a prolonged blackout. The CGMO or designee will determine the affected geographical area(s). Applications must be submitted in both Grants.gov and the HRSA EHBs. To ensure adequate time to follow procedures and successfully submit the full application, HRSA recommends registering immediately in Grants.gov and the HRSA EHBs and completing the forms as soon as possible. Late Applications Applications which do not meet the criteria above are considered late applications will not be considered in the current competition. 4. Intergovernmental Review The SBHC program is not a program subject to the provisions of Executive Order 12372, as implemented by 45 CFR Part 100. 5. Funding Restrictions Applicants may submit one application for financial assistance to support the purchase of moveable equipment project for use in a SBHC(s). Funds awarded through SBHCC Equipment grants must be fully obligated by the end of the one-year project/budget period. HRSA-10-276 14

The following uses of grant funds are examples of costs that are NOT allowable under SBHCC Equipment grants: Costs incurred prior to March 23, 2010. Operating costs (e.g., funding direct services, clinical full-time equivalents, rent, mortgage payments, refinanced credit facilities). Construction, alteration, renovation, repair costs (e.g., any work that will improve a structure, expand the current square footage of a structure, or equipment that requires installation). Relocation costs. EHR software, however associated equipment is an allowable cost (e.g., server and computers). Expenditures for personnel. The provision of health care services. 6. Other Submission Requirements As stated above in Section IV.1, except in rare cases HRSA will no longer accept applications for grant opportunities in paper form. Applicants submitting for this funding opportunity are required to submit electronically through the Grants.gov and EHB. It is essential that the applicant organization immediately register in Grants.gov and become familiar with the Grants.gov site application process. If applicants do not complete the registration process they will be unable to submit an application. To be able to successfully register in Grants.gov, it is necessary that all of the following required actions are completed: Obtain an organizational Data Universal Number System (DUNS) number. Register the organization with Central Contractor Registry (CCR). Identify the organization s E-Business Point of Contact (E-Biz POC). Confirm the organization s CCR Marketing Partner ID Number (M-PIN) password Register an Authorized Organization Representative (AOR). HRSA recommends registering multiple AORs. Obtain a username and password from the Grants.gov Credential Provider. Please note that requests for a paper waiver due to applicant failure to complete timely registration prior to the application deadline will not be considered. Step-by-step instructions on registering and applying, tutorials and FAQs are available on the Grants.gov web site at http://www.grants.gov/. Assistance is also available 24 hours a day, seven days a week (excluding Federal holidays) from the Grants.gov help desk at support@grants.gov or by phone at 1-800-518-4726. It is incumbent on applicants to ensure that the Authorizing Official is available to submit the application to HRSA by the application due date. HRSA will not accept submission or re-submission of incomplete, rejected, or otherwise delayed applications after the deadline. HRSA-10-276 15