Senior Medicare Patrol State Project Grants - Pennsylvania

Foa_Content_of_HHS-2026-ACL-CIP-MPPG-0020.pdf

Administration for Community Living
Center for Innovation and Partnership
Senior Medicare Patrol State Project Grants - Pennsylvania
HHS-2026-ACL-CIP-MPPG-0020
04/13/2026

---

Table of Contents
Executive Summary .........................................................................................................................2
Additional Overview Content/Executive Summary ....................................................................2
I. Funding Opportunity Description ................................................................................................2
II. Award Information ....................................................................................................................10
III. Eligibility Information .............................................................................................................10
1. Eligible Applicants .................................................................................................................10
2. Cost Sharing or Matching ......................................................................................................11
3. Responsiveness and Screening Criteria .................................................................................11
IV. Application and Submission Information ................................................................................12
1. Address to Request Application Package ..............................................................................12
2. Content and Form of Application Submission .......................................................................13
Letter of Intent ...........................................................................................................................13
Project Narrative ........................................................................................................................14
Summary/Abstract .....................................................................................................................14
Problem Statement .....................................................................................................................15
Goals and Objectives .................................................................................................................15
Proposed Intervention ................................................................................................................15
Special Target Populations and Organizations ..........................................................................15
Outcomes ...................................................................................................................................15
Project Management ..................................................................................................................16
Evaluation ..................................................................................................................................16
Dissemination .............................................................................................................................17
Budget Narrative/Justification ...................................................................................................17
Work Plan ..................................................................................................................................17
Letters of Commitment from Key Participating Organizations and Agencies ..........................17
3. Unique Entity Identifier and System for Award Management (SAM) ..................................17
4. Submission Dates and Times .................................................................................................19
5. Intergovernmental Review .....................................................................................................20
6. Funding Restrictions ..............................................................................................................20
7. Other Submission Requirements ............................................................................................21
V. Application Review Information ..............................................................................................21
1. Criteria ...................................................................................................................................21
2. Review and Selection Process ................................................................................................24
Page 1 of 42

---

3. Anticipated Announcement Award Date ...............................................................................24
VI. Award Administration Information .........................................................................................24
1. Award Notices ........................................................................................................................24
2. Administrative and National Policy Requirements ................................................................24
3. Reporting ................................................................................................................................26
4. FFATA and FSRS Reporting .................................................................................................26
VII. Agency Contacts ....................................................................................................................26
VIII. Other Information .................................................................................................................27
The Paperwork Reduction Act of 1995 (P.L. 104-13) ...............................................................27
Appendix ........................................................................................................................................27
Instructions for Completing Required Forms ............................................................................28
Budget Narrative/Justification- Sample Format ........................................................................36
Instructions for Completing the Project Summary/ Abstract .....................................................41
ACL Center:
Center for Innovation and Partnership
Funding Opportunity Title:
Senior Medicare Patrol State Project Grants - Pennsylvania
Funding Opportunity Number:
HHS-2026-ACL-CIP-MPPG-0020
Primary CFDA Number:
93.048
Due Date for Letter of Intent:
03/03/2026
Due Date for Applications:
04/13/2026
Date for Informational Conference Call:
Applications that fail to meet the application due date will not be reviewed and will receive no
further consideration. You are strongly encouraged to submit your application a minimum of 3-5
days prior to the application closing date. Do not wait until the last day in the event you
encounter technical difficulties, either on your end or, with https://www.grants.gov. Grants.gov
can take up to 48 hours to notify you of a successful submission.
Executive Summary
Additional Overview Content/Executive Summary
I. Funding Opportunity Description
SMP Mission
Page 2 of 42

---

The mission of the SMP program is to empower and assist Medicare beneficiaries to prevent,
detect, and report healthcare fraud, errors, and abuse through outreach, counseling, and
education. To further this mission, all SMP program activities are organized around four
strategic program objectives:
1. Provide group education and one-on-one assistance to Medicare beneficiaries on a
statewide basis, with a specific emphasis on those with the greatest economic and social
need.
2. Recruit, train, and retain a sufficient, effective, and representative workforce equipped to
provide high-quality education and one-on-one support.
3. Monitor and assess SMP results through operational and quality measures.
4. Position SMP to nimbly and effectively respond to changes in the programmatic
landscape.
Program History
The Department of Health and Human Services Office of Inspector General (HHS-OIG)
estimates that Medicare loses billions of dollars each year due to errors, fraud, and abuse. The
1997 Senate Report 104-368 noted that "senior citizens are our best front-line defense against
these losses, but they often don't have the information and experience needed" to recognize and
accurately report cases of error, fraud, and abuse. These losses are due, to a considerable extent,
to the many ways in which the funds are disbursed as well as to the sheer magnitude surrounding
the dynamics of healthcare expenditures. Both factors increase the probability of errors while
opening wider opportunities for fraud and abuse.
To address this growing issue the Health Care Fraud and Abuse Control (HCFAC) Program was
created to coordinate federal, state, and local law enforcement activities with respect to
healthcare fraud and abuse. Now in its 28th year of operation, the HCFAC Program continues to
demonstrate its success in protecting beneficiaries by identifying and prosecuting the most
egregious instances of healthcare fraud and preventing future fraud and abuse. As partner in
these efforts, ACL administers the Senior Medicare Patrol (SMP) program which funds a
nationwide network of local community-based partners and team members to provide outreach
and education to Medicare beneficiaries about how to prevent, detect, and report healthcare
fraud. The SMP program plays an important role in the broader HCFAC Program by focusing on
community outreach and Medicare beneficiary empowerment with the goal of stopping fraud
before it occurs.
SMP Program Today
ACL funds 54 state SMP projects, including grantees in all 50 states, the District of Columbia,
Puerto Rico, Guam, and the US Virgin Islands. The SMP projects use this funding to provide
local outreach, education, and assistance to Medicare beneficiaries through a trained volunteer
and in-kind workforce. SMP projects teach Medicare beneficiaries to take proactive steps to
protect themselves and the Medicare program from potential fraud, errors, and abuse. SMP
projects actively disseminate fraud prevention and identification information through the media,
Page 3 of 42

---

outreach campaigns, community events, and one-on-one beneficiary support. SMPs help
individuals and their loved ones understand how to review their healthcare statements and bills
for accuracy, as well as how to identify and avoid potential fraud schemes. If suspicious activity
is identified or suspected, SMPs can help answer questions, resolve errors, or report suspicious
activity for further investigation.
One key role of the SMP projects is to assist beneficiaries by referring potential fraud complaints
on to other investigative entities, as appropriate. This process can include facilitating referrals to
the Department of Health and Human Services (HHS) - Office of Inspector General (HHS-OIG),
the Centers for Medicare & Medicaid Services (CMS), Federal Bureau of lnvestigations (FBI),
Federal Trade Commission (FTC), state Medicaid fraud control units (MFCUs), state attorney
generals, and other organizations. Capturing SMP program activity data is also a key function of
the projects, including tracking, analyzing, and reporting of beneficiary complaints, referrals,
potential savings, and other outcomes.
Annual OIG Report on SMP Program
In previous years, the HHS-OIG completed an annual performance report on the SMP projects.
In FY2023, the 54 SMP projects had a total of 5,532 active team members who conducted a total
of 22,356 group outreach and education events, reaching an estimated 1,244,697 people. In
addition, the projects had 270,348 individual interactions with, or on behalf of, Medicare
beneficiaries.
According to a previous OIG Report, the program has educated over 45 million beneficiaries
since its inception through 513,000 group education and outreach sessions. The true value of the
program and primary focus of SMP grantee work is on education, prevention, and teaching
beneficiaries how to protect themselves and avoid fraud in the first place. The impact of these
education and prevention activities is extremely difficult to quantify in dollars and cents. As
HHS-OIG indicated in their 2023 report on the SMP program:
We note that the projects may not be receiving full credit for recoveries, savings, and cost
avoidance attributable to their work. It is not always possible to track referrals to Medicare
contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and
abuse from the projects. In addition, the projects are unable to track the potentially substantial
savings derived from a sentinel effect whereby Medicare beneficiaries' scrutiny of their bills
reduces fraud and errors.
Strategic Program Objectives
This opportunity will fund SMP work done in the state of Pennsylvania only. Applicants must
address each of the following strategic program objectives as part of their project narrative to
further the goal of preventing Medicare fraud in Pennsylvania:
Page 4 of 42

---

1. Provide group education and one-on-one assistance to Medicare beneficiaries on a
statewide basis, with a specific emphasis on those with greatest economic and social
need.
2. Recruit, train, and retain a sufficient, effective, and representative workforce equipped to
provide high-quality education and one-on-one support.
3. Monitor and assess SMP results through operational and quality measures.
4. Position SMP to nimbly and effectively respond to changes in the programmatic
landscape.
Project narratives should propose specific goals and activities to address each component of the
four strategic program objectives as follows:
1. Provide group education and one-on-one assistance to Medicare beneficiaries on a
statewide basis, with a specific emphasis on those in Pennsylvania with the greatest
economic and social need. Applicants must describe a comprehensive plan to achieve
statewide SMP coverage. Statewide coverage means the applicant must have the capacity
to provide SMP services, including group education and one-on-one assistance, in each
county within the state. In the project narrative, applicants must:
1. Demonstrate knowledge of the geographic service area, including barriers to
program access and strategies specifically designed to overcome these barriers.
2. Identify populations with the greatest historical and current needs within the state,
any barriers to program access specific to these populations, and plans for
addressing those barriers.
3. Explain plans to provide one-on-one assistance, both in-person and virtually.
Applicants must describe the types and levels of service to be provided as well as
the approaches to achieve or enhance services, such as the development of
websites and web-based strategies, the use of toll-free lines, ability to flexibly
shift to atypical service provision as public need requires, and/or the development
of sub-grants, contracts, or partnerships with other local, regional, or statewide
organizations.
4. Explain plans to provide in-person group education sessions to teach beneficiaries
to prevent, detect, and report Medicare fraud, errors, and abuse. Applicants must
describe the types and levels of service to be provided, as well as the approaches
to achieving or enhancing services, such as the development of sub-grants,
contracts, or partnerships with other local, regional, or statewide organizations.
5. Describe plans to build on existing partnerships and the development of new
partnerships to establish a strong network to deliver SMP services. Examples of
potential partners could include, but are not limited to:
1. Other local or state programs receiving ACL funding to provide services
to older adults and people with disabilities, including but not limited to:
State Health Insurance Assistance Programs (SHIPs), Long-Term Care
Ombudsman programs, Elder Abuse Prevention programs, Benefits
Enrollment Centers, Centers for Independent Living (CILs), Aging and
Disability Resource Centers/No-Wrong Door (ADRC/NWD), Assistive
Technology programs, Traumatic Brain Injury Programs, State Councils
Page 5 of 42

---

on Developmental Disabilities, State Protection and Advocacy Systems,
Nutrition Services, Falls Prevention and Chronic Disease Self-
Management Programs, and Legal Assistance programs.
2. Local, state, and national organizations within the law enforcement and
health care networks, which may include state attorneys general, state
MFCUs, CMS, HHS-OIG, FBI, and FTC.
3. Partnerships to intentionally focus on reaching those in the greatest
economic and social need. This may include organizations or groups who
have demonstrated expertise and previous success in focusing on these
populations.
6. Outline a statewide media and outreach plan based on a preliminary assessment of
state and national healthcare fraud trends and issues, including focus on targeting
those in greatest economic and social need of SMP program services and those
traditionally underserved.
2. Recruit, train, and retain a sufficient, effective, and representative workforce
equipped to provide high quality education and one-on-one support. Applicants must
provide a plan to ready a nimble workforce to provide high quality service to
beneficiaries including, but not limited to, the following:
1. Describe a plan to initially and continually train and certify all SMP team
members (staff, in-kind, and volunteers) with the information necessary to
perform the work of the SMP program:
1. At the most basic level, including:
▪ Basic mission and functions of the SMP program;
▪ Medicare basics; and
▪ Healthcare fraud, errors, and abuse.
2. At a more advanced workforce training level, including:
▪ Development of effective skills in conducting educational
presentations and outreach;
▪ Resolution of beneficiary inquiries and complaints;
▪ Referrals for further action, when appropriate; and
▪ Understanding and implementation of skills to support serving
those in the greatest economic and social need.
3. The training plan should also cite the training materials and resources to
be used to achieve the training objectives. NOTE: The SMP National
Resource Center develops and provides training materials that are
available for use to all successful SMP awardees. Non-incumbent
applicants may contact the SMPRC for access to basic training-related
material information.
4. Minimum initial and ongoing training requirements, knowledge testing,
and certification of all SMP team member roles must be clearly defined by
the grantee and consistently applied to all team members.
Page 6 of 42

---

2. Describe a plan to recruit, train, retain, and manage paid, volunteer, and in-kind
team members throughout the state. The plan should include implementation of
ACL's Volunteer Risk and Program Management (VRPM) policies and the ACL
Conflict of Interest guidance for the SHIP, SMP, and MIPPA programs.
Identifying and appropriately managing risks related to team member
involvement and service delivery is an important aspect of effective program
management. Proposals should include approaches to ensure team members are:
1. Appropriately recruited and screened to ensure the ability to perform
assigned duties and to identify potential conflicts of interest;
2. Thoroughly trained to provide effective service, and enhance the quality of
the SMP program;
3. Consistently provided ongoing supervision, management, and support to
ensure the safety, integrity, and professionalism of the SMP workforce;
4. Habitually compliant with procedures and practices to ensure that
confidentiality of program information is maintained; and
5. Supported to ensure retention and continued high morale.
In every case, applicants should propose activities that will effectively employ the
unique skills, varied experiences, good will, and availability of team members in
assisting beneficiaries to become more educated about Medicare fraud, errors, and
abuse.
ACL's VRPM policy and procedure resources are available on ACL's website:
https://acl.gov/programs/senior-medicare-patrol/volunteer-risk-and-program-
management-vrpm-policies. The VRPM policies provide a framework that allows
each individual SMP project to have the flexibility and responsibility to develop
volunteer risk and program management policies and procedures. NOTE: Any new
(non-incumbent) SMP project grantees will receive a reasonable amount of time to
implement these policies. Successful non-incumbent applicants will be asked to
negotiate this timeline with ACL individually after awards are made.
ACL's Conflict of lnterest: Identification, Remedy, and Removal guidance found
here: https://acl.gov/programs/senior-medicare-patrol/managing-conflicts-interest-
ship-smp-and-mippa-programs. This guidance was developed to provide technical
assistance to the SMP, SHIP, and Medicare Improvements for Patients and
Providers Act (MIPPA) programs and their community-based partners on how to
avoid actual and perceived conflicts of interest and mitigate risk.
3. Monitor and assess SMP results through operational and quality measures. ACL
requires SMP projects to use the SMP data system, known as the SMP Information and
Reporting System (SIRS), to collect, track, assess, and measure program performance
data. SIRS data is summarized annually in a report titled Performance Data for the Senior
Medicare Patrol Projects. Recent reports are available on ACL's website:
https://acl.gov/programs/protecting-rights-and-preventing-abuse/senior-medicare-patrol-
smp
Page 7 of 42

---

Applicants must describe plans to comply with SMP reporting requirements including:
1. Timely data entry of SMP activities into SIRS, including one-on-one interactions with
beneficiaries, group education and outreach events, media education and outreach events,
SMP team members, and SMP team member activities.
2. Participation in quality assurance activities:
1. Successful applicants must participate in an SMP Customer Satisfaction Survey
which requires evaluation of both one-on-one interactions and group education
events. To satisfy this requirement, SMPs will be asked to:
▪ Ensure proper collection and reporting of beneficiary information, so ACL
may conduct post-service satisfaction surveys of a random sample of SMP
clients.
▪ Periodically administer pre- and post- surveys at group education events,
as requested by ACL. Each SMP project will be surveyed twice annually.
2. Describe any additional quality assessment activities proposed outside the
required surveys described above.
3. Ongoing performance management, including regular assessment of progress
toward goals and objectives, growth areas and obstacles, and strategies for
performance improvement on the SMP performance measures listed below, as
well as any other applicant-identified measures of success. Applicants are
expected to provide a plan to continually assess gaps in program reach in order to
strengthen provided services.
Performance Measure
Definition
(PM)
1.TOTAL NUMBER OF
Total number of individuals who spent time on the SMP program,
ACTIVE SMP TEAM
including SMP-paid, in-kind paid, and volunteer team members
MEMBERS
2. TOTAL NUMBER OF Total number of hours contributed by team members while
SMP TEAM MEMBER performing SMP work and receiving training to perform SMP work,
HOURS including time spent by SMP-paid, in-kind paid, and volunteer team
members
3. NUMBER OF GROUP Total number of community outreach events, education activities,
OUTREACH AND and presentations to educate beneficiaries, family members,
EDUCATION EVENTS caregivers, and others about SMP services and detecting healthcare
fraud, errors, and abuse
4. ESTIMATED
NUMBER OF PEOPLE
REACHED THROUGH Total estimated number of people reached as a result of SMP group
GROUP OUTREACH outreach and education activities
AND EDUCATION
EVENTS
Page 8 of 42

---

5. NUMBER OF
INDIVIDUAL Total number of individual interactions between SMP team
INTERACTIONS WITH, members and beneficiaries, family members, caregivers, or others
OR ON BEHALF OF, A for the purpose of discussing or gathering information about
MEDICARE potential health care fraud, errors, or abuse
BENEFICIARY
6. COST AVOIDANCE
ON BEHALF OF
Healthcare expenditures for which the government, a beneficiary,
MEDICARE, MEDICAID,
or other entity was relieved of responsibility for payment
BENEFICIARIES, OR
OTHERS
Actual and expected Medicare recoveries from criminal actions,
7. EXPECTED settlements, civil judgments, or over payments that resulted from
MEDICARE the referral. Includes recoveries associated with a project's referral
RECOVERIES that resulted in the opening of an investigation or where the SMP
made a meaningful contribution to an existing investigation
Actual and expected Medicare recoveries from criminal actions,
8. ADDITIONAL settlements, civil judgments, or over payments that resulted from
EXPECTED MEDICARE the referral. Includes recoveries associated with a project's referral
RECOVERIES to an existing investigation where the SMP's information validated
existing information
Actual and expected Medicaid recoveries from criminal actions,
9. EXPECTED settlements, civil judgments, or over payments that resulted from
MEDICAID the referral. Includes recoveries associated with a project's referral
RECOVERIES that resulted in the opening of an investigation or where the SMP
made a meaningful contribution to an existing investigation
Actual and expected Medicaid recoveries from criminal actions,
10. ADDITIONAL settlements, civil judgments, or over payments that resulted from
EXPECTED MEDICAID the referral. Includes recoveries associated with a project's referral
RECOVERIES to an existing investigation where the SMP's information validated
existing information
11. ACTUAL SAVINGS
Amount of money recouped to beneficiaries
TO BENEFICIARIES
Amount of money recouped to an entity other than Medicare,
12. OTHER SAVINGS
Medicaid, or a beneficiary
4. Position SMP to nimbly and effectively respond to changes in the programmatic
landscape. Applicants must propose a plan to adapt to changes in the programmatic
landscape, such as the increasing Medicare beneficiary population, changes in the
geographic distribution of beneficiaries, changes in public health need, varied beneficiary
needs by age, and traditionally underserved populations that may need additional
Page 9 of 42

---

assistance understanding how to prevent, detect, and report Medicare fraud, errors, and
abuse. Specifically, applicants must:
1. Identify any anticipated changes in the programmatic landscape and explain how
these changes will be addressed by the SMP project;
2. Address readiness to nimbly and effectively shift as unanticipated changes in the
programmatic landscape are identified;
3. Describe the target populations to be served, including:
1. Identifying the target populations and the reasons why the applicant has
chosen to target the specific populations;
2. Addressing barriers in access or provision of program services to the
target populations; and
3. Detailing proposed innovative and collaborative methods to reach the
target populations.
Statutory Authority
The statutory authority for the grant under this program announcement is contained in the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 (PL 104-191); (Catalog of
Federal Domestic Assistance 93.048) and Older Americans Act, Title 42 U.S.C.
II. Award Information
Funding Instrument Type:
CA (Cooperative Agreement)
Estimated Total Funding:
$1,100,000
Expected Number of Awards:
1
Award Ceiling:
$1,100,000
Per Budget Period
Award Floor:
$0
Per Budget Period
Length of Project Period:
24-month project period with two 12-month budget periods
Additional Information on Project Periods and Explanation of 'Other'
III. Eligibility Information
1. Eligible Applicants
Domestic public or private non-profit entities, including state governments; county
governments; city or township governments; special district governments; public and state
contro11ed institutions of higher education; Native American tribal governments (Federally
recognized); Native American tribal organizations (other than Federa11y recognized tribal
Page 10 of 42

---

governments); nonprofits having a 501(c)(3) status with the IRS, other than institutions of
higher education; Nonprofits without 501(c)(3) status with the IRS, other than institutions of
higher education; or private institutions of higher education.
2. Cost Sharing or Matching
Cost Sharing / Matching Requirement:
No
For awards that do not require matching or cost sharing by statute, recipients are not
expected to provide cost sharing or matching. However, recipients are allowed to voluntarily
propose a commitment of non-federal resources. If an applicant decides to voluntarily contribute
non-federal resources towards project costs and the costs are accepted by ACL, the non-federal
resources will be included in the approved project budget. The applicant will be held accountable
for all proposed non-federal resources as shown in the Notice of Award (NOA). A recipient's
failure to meet the voluntary amount of non-federal resources that was accepted by ACL as
part of the approved project costs and that was identified in the approved budget in the
NOA, may result in the disallowance of federal funds. Recipients will be required to report
these funds in the Federal Financial Reports.
3. Responsiveness and Screening Criteria
Application Responsiveness Criteria
Applications that do not meet the following responsiveness criteria will be administratively
eliminated and will not be reviewed. The successful SMP applicant will be an organization that
meets the following basic evaluation criteria:
1. Demonstrated expertise in implementation through collaboration and work with
volunteers to achieve program objectives;
2. Technological capacity to implement the SMP web-based data collection, management
tracking, and reporting system, known as SIRS; and
3. Organizational capacity to provide statewide virtual and in-person SMP program
coverage.
Application Screening Criteria
All applications will be screened to assure a level playing field for all applicants. Applications
that fail to meet the three screening criteria described below will not be reviewed and will
receive no further consideration.
In order for an application to be reviewed, it must meet the following screening requirements:
1. Applications must be submitted electronically via http://www.grants.gov; by 11:59 p.m.,
Eastern Time, by the due date listed in section IV.3 Submission Dates and Times.
2. The Project Narrative section of the Application must be double-spaced, sized 8 ½" x 11"
with l" margins on both sides, and a standard font size of not less than 11, preferably
Times New Roman or Arial.
3. The Project Narrative must not exceed 20 pages. Project Narratives that exceed 20 pages
will have the additional pages removed and only the first 20 pages of the Project
Narrative will be provided to the merit reviewers for funding consideration. NOTE: The
Page 11 of 42

---

Project Work Plan, Letters of Commitment, and Vitae of Key Project Personnel are not
counted as part of the Project Narrative for purposes of the 20-page limit.
Applicants seeking late submission approval must provide authenticated verification from
http://www.grants.gov indicating system problems existed at the time of submission. For
example, applicants will be required to provide an http://www.grants.gov submission error
notification and/or tracking number to substantiate missing the application deadline.
IV. Application and Submission Information
1. Address to Request Application Package
Application materials can be obtained from https://www.grants.gov or
https://www.acl.gov/grants/applying-grants.
Please note, ACL requires applications for all announcements to be submitted electronically
through http://www.grants.gov in Workspace. Grants.gov Workspace is the standard way for
organizations and individuals to apply for federal grants in Grants.gov. An overview and training
on Grants.gov Workspace can be found here at:
https://www.grants.gov/web/grants/applicants/workspace-overview.html
The Grants.gov registration process can take several days. If your organization is not currently
registered, please begin this process immediately. For assistance with https://www.grants.gov,
please contact them at support@grants.gov or 800-518-4726 between 7:00 a.m. and 9:00 p.m.
Eastern Time.
• At the https://www.grants.gov website, you will find information about submitting an
application electronically through the site, including the hours of operation. ACL strongly
recommends that you do not wait until the application due date to begin the application
process because of the time involved to complete the registration process.
• All applicants must have a UEI and be registered with the System for Award
Management (SAM, www.sam.gov) and maintain an active SAM registration until the
application process is complete, and should a grant be made, throughout the life of the
award. Effective June 11, 2018, when registering or renewing your registration, you must
submit a notarized letter appointing the authorized Entity Administrator. Please be sure to
read the FAQs located at www.sam.gov to learn more. Applicants should allot sufficient
time prior to the application deadline to finalize a new, or renew an existing registration.
This action should allow you time to resolve any issues that may arise. Failure to comply
with these requirements may result in your inability to submit your application or receive
an award. Maintain documentation (with dates) of your efforts to register or renew at
least two weeks before the deadline. See the SAM Quick Guide for Grantees at:
SAM.GOV Quick Start Guide for Financial Assistance Registrations.
Note: Once your SAM registration is active, allow 24 to 48 hours for the information to be
available in Grants.gov before you can submit an application through Grants.gov. This action
should allow you time to resolve any issues that may arise. Failure to comply with these
requirements may result in your inability to submit your application or receive an award.
• Note: Failure to submit the correct EIN Suffix can lead to delays in identifying your
organization and access to funding in the Payment Management System.
Page 12 of 42

---

• Effective October 1, 2010, HHS requires all entities that plan to apply for and ultimately
receive federal grant funds from any HHS Operating/Staff Division
(OPDIV/STAFFDIV) or receive subawards directly from the recipients of those grant
funds to:
1. Register in SAM prior to submitting an application or plan;
2. Maintain an active SAM registration with current information at all times during which it
has an active award or an application or plan under consideration by an OPDIV; and
3. Provide its UEI number in each application or plan to submit to the OPDIV.
Additionally, all first-tier subaward recipients must have a UEI number at the time the subaward
is made.
• The Federal Government will transition from the DUNS Number to the New Unique
Entity Identifier. As of April of 2022, the federal government stopped using the DUNS
number to uniquely identify entities. At that point, entities doing business with the federal
government will use a Unique Entity Identifier (SAM) created in SAM.gov. It is entered
on the SF-424. It is a unique, nine-digit identification number, which provides unique
identifiers of single business entities.
• You must submit all documents electronically, including all information included on the
SF424 and all necessary assurances and certifications. In accordance with the Federal
Government’s efforts to reduce reporting burden for recipients of federal financial
assistance, the general certification and representation requirements contained in the
Standard Form 424B (SF-424B) – Assurances – Non-Construction Programs, and the
Standard Form 424D (SF-424D) – Assurances – Construction Programs, have been
standardized federal-wide. Effective January 1, 2020, the updated common certification
and representation requirements will be stored and maintained within SAM.
Organizations or individuals applying for federal financial assistance as of January 1,
2020, must validate the federally required common certifications and representations
annually through SAM located at SAM.gov.
• After you electronically submit your application, you will receive an automatic
acknowledgment from https://www.grants.gov that contains https://www.grants.gov
tracking number. The Administration for Community Living will retrieve your
application form from https://www.grants.gov.
U.S. Department of Health and Human Services
Administration for Community Living
Rebecca Kinney
Center for Innovation and Partnership
Phone Number: (202) 795-7375
Email: rebecca.kinney@acl.hhs.gov
2. Content and Form of Application Submission
Letter of Intent
Number of Days from Publication 21
Page 13 of 42

---

03/03/2026
Applicants are requested, but not required, to submit a letter of intent to apply for this funding
opportunity to assist ACL in planning for the application independent review process. The
purpose of the letter of intent is to allow our staff to estimate the number of independent
reviewers needed and to avoid potential conflicts of interest in the review. Letters of intent
should be sent to:
U.S. Department of Health and Human Services
Administration for Community Living
Rebecca Kinney
Office of Healthcare Information and Counseling
Washington, D.C. (202) 795-7375
Email: rebecca.kinney@acl.hhs.gov
Project Narrative
Project Narrative must be double-spaced, sized 8 ½" x 11" with 1" margins on both sides, and a
standard font size of not less than 11, preferably Times New Roman or Arial. Smaller font sizes
to fill in the Standard Forms and Sample Formats can be used. The suggested length for the
Project Narrative is 10 to 20 pages; 20 pages is the maximum length allowed. Project
Narratives that exceed 20 pages will have the additional pages removed and only the first 20
pages of the Project Narrative will be provided to the merit reviewers for funding consideration.
The Project Work Plan, Letters of Commitment, and Vitae of Key Personnel are not counted as
part of the Project Narrative for purposes of the 20-page limit, but all other sections noted
below are included in the limit.
The Project Narrative is the most important part of the application since it will be used as the
primary basis to determine whether the project meets the minimum requirements for grants
under the authorizing statutes. The Project Narrative should provide a clear and concise
description of the proposed SMP project. ACL recommends that the project narrative include
the following components as part of the 20-page limit:
• Summary/Abstract
• Problem Statement
• Goal(s) and Objective(s)
• Proposed Intervention
• Special Target Populations and Organizations
• Outcomes
• Project Management Evaluation
• Dissemination
• Organizational Capability
Summary/Abstract
Include a brief - no more than 265 words maximum - description of the proposed project,
including: goal(s), objectives, outcomes, and products to be developed. Detailed instructions for
Page 14 of 42

---

completing the summary/abstract are included in the "Instructions for Completing the Project
Summary/Abstract."
Problem Statement
Describe, in both quantitative and qualitative terms, the nature and scope of the particular
problem or issue the proposed intervention is designed to address, including how the project
will potentially affect older adults and/or people with disabilities, identified state-specific
marginalized communities, their families and caregivers, and the health care and social services
systems.
Goals and Objectives
Describe the project's goal(s) and major objectives. Unless the project involves multiple
complex interventions, ACL recommends proposing only one overall goal. The proposed
project goal(s) and objectives should be reflective of the priority activities discussed in SMP
Strategic Program Objectives (see Section I).
Proposed Intervention
Provide a clear and concise description of the proposed intervention to address the problem
described in the "Problem Statement." Describe the rationale for using the particular
intervention, including factors such as: "lessons learned" for similar projects previously tested
in the targeted community(ies) or in other areas of the country; factors in the larger
environment that have created the "right conditions" for the intervention (e.g., existing social or
economic factors to take advantage of, etc.). Also note any anticipated major barriers, and how
the proposed intervention will address those barriers.
Be sure to describe the role and makeup of any planned strategic partnerships in implementing
the intervention, including other organizations, supporters, and/or consumer groups. This
section should also provide a detailed plan for the management and operation of the SMP
project. Plans must address the key elements discussed in Section I - "SMP Mission and
Strategic Program Objectives," including:
1. Provide group education and one-on-one assistance to Medicare beneficiaries on a
statewide basis.
2. Recruit, train, and retain a sufficient and effective workforce ready to provide high
quality education and one-on-one support.
3. Monitor and assess SMP results through operational and quality measures.
4. Position SMP to nimbly and effectively respond to changes in the programmatic
landscape.
Special Target Populations and Organizations
Describe plans to involve organizations in a meaningful way in the planning and implementation
of the proposed project. This section should also describe whether the proposed intervention will
target commonly underserved populations and, if so, how.
Outcomes
Clearly identify the measurable outcome(s) that will result from the project. (NOTE: ACL will
not fund any project that does not include measurable outcomes). This section should also
Page 15 of 42

---

describe how the project's findings might benefit the field at large (e.g., how the findings could
help other organizations throughout the nation to address the same or similar problems). List
measurable outcomes in the work plan grid ("Project Work Plan-Sample Template") under
"Measurable Outcomes" in addition to any discussion included in the narrative along with a
description of how the project might benefit the field at large.
A "measurable outcome" is an observable end-result that describes how a particular
intervention benefits consumers. It demonstrates the functional status, mental well-being,
knowledge, skill, attitude, awareness, or behavior. It can also describe a change in the degree to
which consumers exercise choice over the types of services they receive or whether they are
satisfied with the way a service is delivered. Additional examples include: a change in the
responsiveness or cost-effectiveness of a service delivery system; a new model of support or
care that can be replicated in the aging network; new knowledge that can contribute to the field
of aging; a measurable increase in community awareness; or a measurable increase in persons
receiving services. A measurable outcome is not a measurable "output", such as: the number of
clients served; the number of training sessions held; or the number of service units provided.
The focus of this section is describing what outcome(s) will be produced by the project. Use the
Evaluation section noted below to describe how the outcome(s) will be measured and reported.
Applications will be scored on the clarity and nature of proposed outcomes, not on the number
of outcomes cited. It is appropriate for a project to have only ONE outcome that it is trying to
achieve through the intervention reflected in the project's design.
As discussed in Section 1 under "SMP Mission and Strategic Program Objectives," ACL
utilizes the SIRS data system to collect data, track, and measure a number of program
outcomes. ACL will use program data contained in the SMP data system to assess SMP project
progress in reaching SMP Strategic Program Objectives. Hence, applicant's plans should
discuss expected outcomes and link these outcomes to the project priorities and activities
provided in the "Proposed Intervention" upon which the outcomes are based.
Project Management
Clearly delineate the roles and responsibilities of project staff, consultants, and partner
organizations, and how they will contribute to achieving the project's objectives and outcomes.
It should specify the key staff with day-to-day responsibility for key tasks such as leadership of
project; monitoring the project's ongoing progress; preparation of reports; and communications
with other partners and ACL. It should also describe the approach that will be used to monitor
and track progress on the project's tasks and objectives.
Evaluation
Describe the method(s), techniques and tools that will be used to: 1) determine whether the
proposed intervention achieved its anticipated outcome(s), and 2) document the "lessons
learned" - both positive and negative - from the project that will be useful in replicating the
intervention, if it proves successful.
In addition, describe a plan for evaluating the effectiveness of the proposed SMP project in
achieving project outcomes. As discussed, ACL utilizes SIRS to collect data, track, assess, and
measure program outcomes. In addition, ACL will use data to assess SMP project progress in
Page 16 of 42

---

reaching SMP Strategic Program Objectives. Hence, applicant plans must discuss priorities,
activities, and staff capacity to capture project performance data accurately and timely.
Dissemination
Describe the method that will be used to disseminate the project's results and findings in a
timely manner and in easily understandable formats. Recipients could include parties interested
in using the results of the project to inform practice, service delivery, program development,
and/or policymaking; especially those parties who would be interested in replicating the
project.
Dissemination examples should include sharing information with ACL, the National SMP
Resource Center, fellow SMP projects, and other national, state, and local partner
organizations.
Budget Narrative/Justification
The Budget Narrative/Justification can be provided using the format included in the document,
“Budget Narrative/Justification – Sample Format.” Applicants are encouraged to pay particular
attention to this document, which provides an example of the level of detail sought. A detailed
Budget Narrative/Justification for year 1 of the grant funding is required.
Work Plan
The Project Work Plan should reflect and be consistent with the Project Narrative and Budget. It
should include a statement of the project’s overall goal, anticipated outcome(s), key objectives,
and the major tasks / action steps that will be pursued to achieve the goal and outcome(s). For
each major task / action step, the work plan should identify timeframes involved (including start-
and end-dates), and the lead person responsible for completing the task. Please use the “Project
Work Plan - Sample Template” format as a reference and resource, if desired.
Letters of Commitment from Key Participating Organizations and Agencies
Include confirmation of the commitments and key activities/work (not just lending support to the
application) to the project (should it be funded) made by key collaborating organizations and
agencies in this part of the application. Any organization that is specifically named to have a
significant role in carrying out the project should be considered an essential collaborator. For
applications submitted electronically via http://www.grants.gov, signed letters of commitment
should be scanned and included as attachments. Applicants unable to scan the signed letters of
commitment may email them to Rebecca Kinney at rebecca.kinney@acl.hhs.gov. In your email,
be sure to include the funding opportunity number and your agency name in the subject line.
3. Unique Entity Identifier and System for Award Management (SAM)
The Grants.gov registration process can take several days. If your organization is not currently
registered, please begin this process immediately. For assistance with https://www.grants.gov,
please contact them at support@grants.gov or 800-518-4726 between 7:00 a.m. and 9:00 p.m.
Eastern Time.
• At the https://www.grants.gov website, you will find information about submitting an
application electronically through the site, including the hours of operation. ACL strongly
Page 17 of 42

---

recommends that you do not wait until the application due date to begin the application
process because of the time involved to complete the registration process.
• All applicants must have a UEI number and be registered with the System for Award
Management (SAM, www.sam.gov) and maintain an active SAM registration until the
application process is complete, and should a grant be made, throughout the life of the
award. Effective June 11, 2018, when registering or renewing your registration, you must
submit a notarized letter appointing the authorized Entity Administrator. Please be sure to
read the FAQs located at www.sam.gov to learn more. Applicants should allot sufficient
time prior to the application deadline to finalize a new, or renew an existing registration.
This action should allow you time to resolve any issues that may arise. Failure to comply
with these requirements may result in your inability to submit your application or receive
an award. Maintain documentation (with dates) of your efforts to register or renew at
least two weeks before the deadline. See the SAM Quick Guide for Grantees at:
SAM.GOV Quick Start Guide for Financial Assistance Registrations.
Note: Once your SAM registration is active, allow 24 to 48 hours for the information to be
available in Grants.gov before you can submit an application through Grants.gov. This action
should allow you time to resolve any issues that may arise. Failure to comply with these
requirements may result in your inability to submit your application or receive an award.
• Note: Failure to submit the correct EIN Suffix can lead to delays in identifying your
organization and access to funding in the Payment Management System.
• Effective October 1, 2010, HHS requires all entities that plan to apply for and ultimately
receive federal grant funds from any HHS Operating/Staff Division
(OPDIV/STAFFDIV) or receive subawards directly from the recipients of those grant
funds to:
1. Register in SAM prior to submitting an application or plan;
2. Maintain an active SAM registration with current information at all times during which it
has an active award or an application or plan under consideration by an OPDIV; and
3. Provide its UEI number in each application or plan to submit to the OPDIV.
Additionally, all first-tier subaward recipients must have a UEI number at the time the subaward
is made.
• The Federal Government will transition from the DUNS Number to the New Unique
Entity Identifier. As of April of 2022, the federal government stopped using the DUNS
number to uniquely identify entities. At that point, entities doing business with the federal
government will use a Unique Entity Identifier (SAM) created in SAM.gov. They will no
longer have to go to a third-party website to obtain their identifier. This transition allows
the government to streamline the entity identification and validation process, making it
easier and less burdensome for entities to do business with the federal government. If
your entity is registered in SAM.gov today, your Unique Entity ID (SAM) has already
been assigned and is viewable in SAM.gov. This includes inactive registrations. The
Unique Entity ID is currently located below the DUNS Number on your entity
registration record. Remember, you must be signed in to your SAM.gov account to view
entity records. To learn how to view your Unique Entity ID (SAM) go to this help article.
Page 18 of 42

---

• You must submit all documents electronically, including all information included on the
SF424 and all necessary assurances and certifications. In accordance with the Federal
Government’s efforts to reduce reporting burden for recipients of federal financial
assistance, the general certification and representation requirements contained in the
Standard Form 424B (SF-424B) – Assurances – Non-Construction Programs, and the
Standard Form 424D (SF-424D) – Assurances – Construction Programs, have been
standardized federal-wide. Effective January 1, 2020, the updated common certification
and representation requirements will be stored and maintained within SAM.
Organizations or individuals applying for federal financial assistance as of January 1,
2020, must validate the federally required common certifications and representations
annually through SAM located at SAM.gov.
• After you electronically submit your application, you will receive an automatic
acknowledgment from https://www.grants.gov that contains https://www.grants.gov
tracking number. The Administration for Community Living will retrieve your
application form from https://www.grants.gov.
4. Submission Dates and Times
Number Of Days from Publication 60
04/13/2026
Date for Informational Conference Call:
Applications that fail to meet the application due date will not be reviewed and will receive no
further consideration. You are strongly encouraged to submit your application a minimum of 3-5
days prior to the application closing date. Do not wait until the last day in the event you
encounter technical difficulties, either on your end or, with http://www.grants.gov. Grants.gov
can take up to 48 hours to notify you of a successful submission.
In addition, if you are submitting your application via Grants.gov, you must (1) be designated by
your organization as an Authorized Organization Representative (AOR) and (2) register yourself
with Grants.gov as an AOR. Details on these steps are outlined at the following Grants.gov web
page: http://www.grants.gov/web/grants/register.html.
After you electronically submit your application, you will receive from Grants.gov an automatic
notification of receipt that contains a Grants.gov tracking number. (This notification indicates
receipt by Grants.gov only)
If you are experiencing problems submitting your application through Grants.gov, please contact
the Grants.gov Support Desk, toll free, at 1-800-518-4726. You must obtain a Grants.gov
Support Desk Case Number and must keep a record of it.
If you are prevented from electronically submitting your application on the application deadline
because of technical problems with the Grants.gov system, please contact the person listed under
For Further Information Contact in section VII of this notice and provide a written explanation of
the technical problem you experienced with Grants.gov, along with the Grants.gov Support Desk
Case Number. ACL will contact you after a determination is made on whether your application
will be accepted.
Page 19 of 42

---

Note: We will not consider your application for further review if you failed to fully register
to submit your application to Grants.gov before the application deadline or if the technical
problem you experienced is unrelated to the Grants.gov system.
If for any reason (including submitting to the wrong funding opportunity number or making
corrections/updates) an application is submitted more than once prior to the application due date,
ACL will only accept your last validated electronic submission, under the correct funding
opportunity number, prior to the Grants.gov application due date as the final and only acceptable
application
Unsuccessful submissions will require authenticated verification from http://www.grants.gov
indicating system problems existed at the time of your submission. For example, you will be
required to provide an http://www.grants.gov submission error notification and/or tracking
number in order to substantiate missing the cut off date.
Grants.gov (http://www.grants.gov) will automatically send applicants a tracking number and
date of receipt verification electronically once the application has been successfully received and
validated in http://www.grants.gov.
5. Intergovernmental Review
This program is not subject to Executive Order (E.O.) 12372, Intergovernmental Review of
Federal Programs.
6. Funding Restrictions
The following activities are not fundable:
• Construction and/or major rehabilitation of buildings
• Basic research (e.g. scientific or medical experiments)
• Continuation of existing projects without expansion or new and innovative approaches
Note: A recent Government Accountability Office (GAO) report has raised considerable
concerns about grantees and contractors charging the Federal Government for additional meals
outside of the standard allowance for travel subsistence known as per diem expenses. Executive
Orders on Promoting Efficient Spending (E.O. 13589) and Delivering Efficient, Effective and
Accountable Government (E.O. 13576) have been issued and instruct Federal agencies to
promote efficient spending. Therefore, if meals are to be charged in your proposal, applicants
should understand such costs must meet the following criteria outlined in the Executive Orders
and HHS Grants Policy Statement:
• Meals are generally unallowable except for the following:
o For subjects and patients under study (usually a research program);
o Where specifically approved as part of the project or program activity, e.g., in
programs providing children’s services (e.g. Head Start);
o When an organization customarily provides meals to employees working beyond
the normal workday, as a part of a formal compensation arrangement,
o As part of a per diem or subsistence allowance provided in conjunction with
allowable travel; and
o Under a conference grant, when meals are necessary and integral part of a
conference, provided that meal costs are not duplicated in participants' per diem
Page 20 of 42

---

or subsistence allowances. (Note: conference grant means the sole purpose of the
award is to hold a conference.)
The following updated sections 2 CFR 200.216 “Prohibition on certain telecommunications and
video surveillance services or equipment” became effective on or after August 13, 2020.
Recommended Actions for any recipient that has received a loan, grant, or cooperative
agreement on or after August 13, 2020:
• Develop a compliance plan to implement 2 CFR 200.216 regulation.
• Develop and maintain internal controls to ensure that your organization does not expend
federal funds (in whole or in part) on covered equipment, services or systems.
• Determine through reasonable inquiry whether your organization currently uses “covered
telecommunication” equipment, services, or systems and take necessary actions to
comply with the regulation as quickly as is feasibly possible.
7. Other Submission Requirements
Letters of intent should be emailed to:
Rebecca Kinney
rebecca.kinney@acl.hhs.gov
US Department of Health and Human Services
Administration for Community Living
Office of Healthcare Information and Counseling
Washington, DC
V. Application Review Information
1. Criteria
Applicants must document all source material. If any text, language and/or materials are from
another source, the applicant must make it clear the material is being quoted and where the text
comes from. The applicant must also cite any sources when they obtain numbers, ideas, or other
material that is not their own. If the applicant fails to comply with this requirement, regardless of
the severity or frequency of the plagiarism, the reviewers shall reduce their scores accordingly
even to the degree of issuing no points at all. Applications are scored by assigning a maximum of
100 points across five criteria:
1. Project Relevance & Current Need (10 points)
2. Approach (40 points)
3. Budget (10 points)
4. Project Impact (25 points)
5. Organizational Capacity (15 points)
Project Relevance & Current Need
Maximum Points: 10
Page 21 of 42

---

1. Does the proposal provide a detailed description in both quantitative and qualitative
terms, of the nature and scope of the health care fraud control problems or issues within
the state or territory that the proposed plan is designed to address? (3 points)
2. Does the application include a focus on those with greatest economic and social need to
continually ensure that program services are accessible and that beneficiaries' needs are
being met? (3 points)
3. Does the problem statement include a description of the demographics of the
population(s) to be served and a discussion of potential barriers to program access? (4
points)
Approach
Maximum Points: 40
Strategic Program Objective 1 (10 points)
Provide group education and one-on-one assistance to Medicare beneficiaries on a statewide
basis, with a specific emphasis on those in Pennsylvania with the greatest economic and social
need.
1. Does the applicant demonstrate knowledge of the geographic service area and its
populations of greatest economic and social need, including barriers to program access
and strategies specifically designed to overcome these barriers? (3 points)
2. Does the proposal include a detailed description of how statewide program coverage will
be implemented? (2 points)
3. Does the applicant thoroughly describe plans to provide one-on-one assistance, group
education, and media outreach, as well as any plans to build on existing partnerships and
the development of new partnerships to establish a strong network to deliver SMP
services? (3 points)
4. Has the applicant described how they will ensure that program services will be accessible
to all Medicare beneficiaries in their state/territory including those that have been
historically hard-to-reach? (2 points)
Strategic Program Objective 2 (10 points)
Recruit, train, and retain a sufficient, effective, and representative workforce equipped to
provide high quality education and inquiry resolution.
1. Does the proposal include a description of plans to recruit, train, retain, and manage a
team of volunteers, paid staff, and in-kind partners throughout the state? (4 points)
2. Does the proposed plan include an approach for implementing and managing the
Volunteer Risk and Program Management (VRPM) policies and procedures as outlined
by ACL? (2 points)
3. Does the proposal detail a training plan to equip all team members with the information
necessary to perform SMP work in a culturally appropriate and accessible manner? (2
points)
4. Does the application target partnerships with groups focusing on those with greatest
economic and social need to continually ensure that program services are accessible and
that beneficiaries' needs are being met? (2 points)
Strategic Objective 3 (10 points)
Monitor and assess SMP results through operational and quality measures.
Page 22 of 42

---

1. Does the proposal include plans to monitor and assess ongoing SMP results through
operational and quality measures? (3 points)
2. Does the proposal include plans to ensure timely data entry of SMP activities into SIRS?
(2 points)
3. Does the applicant include plans for ongoing performance management, including regular
assessment of progress toward goals and objectives, growth areas and obstacles, and
strategies for performance improvement based on the SMP performance measures? (3
points)
4. Does the application include a plan to continually assess gaps in program reach to
strengthen provided services? (2 points)
Strategic Objective 4 (5 points)
Position SMP to respond nimbly and effectively to changes in the programmatic landscape.
1. Does the proposal include plans to position SMP to nimbly and effectively respond and
react to unanticipated changes in the programmatic landscape? (3 points)
2. Does the applicant identify target populations to be served and innovative methods to
reach those populations? (2 points)
Work Plan (5 points)
1. Is the project work plan clear, comprehensive, and for the appropriate time frame? Does
it include key task leaders, roles of staff/partners, and feasible timeframes for the
accomplishment of tasks presented? (3 points)
2. Does the work plan include specific goals and tasks that are linked to measurable
outcomes? (2 points)
Budget
Maximum Points: 10
1. Is the budget justified with respect to the adequacy and reasonableness of resources
requested? Is the time commitment of the proposed director and other key project
personnel sufficient to assure proper direction, management, and timely completion of
the project? Does the budget include funding for program services that ensure
accessibility to those in greatest economic and social need for services? (6 points)
2. Did the applicant provide a clear budget justification for Budget Year 1? Are strategies
clearly outlined under each without duplication? Are budget line items clearly delineated
and consistent with work plan objectives? (4 points)
Project Impact
Maximum Points: 25
1. Does the proposal clearly identify the measurable program outcome(s) that will result
from the project? Are the expected outcomes linked to the priorities of the SMP Strategic
Program Objectives? (10 points)
2. Does the proposal include measurable outcomes that follow the provided definition, as
opposed to simply including measurable outputs? (5 points)
3. Does the proposal contain a plan for evaluating the effectiveness of the proposed
activities in achieving project outcomes? Does the plan discuss the method(s) to be used
Page 23 of 42

---

to disseminate the project's results to the National SMP Resource Center and the SMP
network? (5 points)
4. Does the proposal include measurement of impact targeting those in greatest economic
and social need? (5 points)
Organizational Capacity
Maximum Points: 15
1. Are the roles and responsibilities of project staff, contractors and key partners delineated,
including how they will contribute to implementation of the proposed project? Do the
brief vitae of the proposed project director, key staff, and consultants reflect the
background, experience, and other qualifications required to carry out designated SMP
roles and responsibilities, particularly project direction, team member management, data
tracking and reporting, and SMP outreach and education? (5 points)
2. Do letters of commitment document roles of key partners, including strategies to reach
identified target populations and the specific role, commitment, and resources/activities
in support of the project's effort from each collaborating organization? (5 points)
3. Has the applicant demonstrated capability to manage a statewide program? Has the
organization demonstrated that they are fiscally stable? (5 points)
2. Review and Selection Process
3. Anticipated Announcement Award Date
Award notices to successful applicants will be sent out prior to the project start date.
The anticipated project period start date for this announcement is: 06/01/2026
VI. Award Administration Information
1. Award Notices
Successful applicants will receive an electronic Notice of Award. The Notice of Award is the
authorizing document from the U.S. Administration for Community Living authorizing official,
Office of Grants Management. Acceptance of this award is signified by the drawdown of funds
from the Payment Management System. Unsuccessful applicants are generally notified within 30
days of the final funding decision and will receive a disapproval letter via e-mail. Unless
indicated otherwise in this announcement, unsuccessful applications will not be retained by the
agency and will be destroyed.
2. Administrative and National Policy Requirements
The award is subject to HHS Administrative Requirements, which can be found in 45 CFR Part
75 and the Standard Terms and Conditions, included in the Notice of Award as well as
implemented through the HHS Grants Policy Statement.
If you receive an award, you must follow all applicable nondiscrimination laws. You agree to
this when you register in SAM.gov. You must also submit an Assurance of Compliance (HHS-
690). To learn more, see the HHS Office for Civil Rights website.
A standard term and condition of award will be included in the final notice of award; all
applicants will be subject to a term and condition that applies the terms of 48 CFR section 3.908
Page 24 of 42

---

to the award and requires the grantees inform their employee in writing of employee
whistleblower rights and protections under 41 U.S.C. 4712 in the predominant native language of
the workforce.
Applicants may follow their own procurement policies and procedures when contracting with
Project Funds, but You must comply with the requirements of 2 C.F.R. §§ 200.317-200.326.
Additionally, when using Project Funds to procure supplies and/or equipment, applicants are
encouraged to purchase American-manufactured goods to the maximum extent practicable.
American-manufactured goods are those products for which the cost of their component parts
that were mined, produced, or manufactured in the United States exceeds 50 percent of the total
cost of all their components. For further guidance regarding what constitutes an American
manufactured good (also known as a domestic end product), see 48 C.F.R. Part 25.
As of October 1, 2024, 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards updated to a new version. The eCFR is currently
updating its site with the newly adopted content. Until that time, the links below to 2 CFR 200
will not include the changes. If you need to see specific changes while they complete that work,
see 78 FR 78608.
Also as of October 1, 2024, HHS adopted several provisions in the new 2 CFR 200 that affect
your application. These new provisions supersede those previously used in 45 CFR 75. The
changes include:
Indirect costs
De minimis rate
If you use the de minimis rate to calculate indirect costs:
• When you calculate this rate, you will now use 15% of modified total direct costs
(MTDC) rather than 10%. See 2 CFR 200.414(f).
• Additionally, when you calculate MTDC, you can now use up to $50,000 of subawards
and subcontracts rather than $25,000. See 2 CFR 200.1.
Training awards
If your application is for a training award, your indirect cost rate remains capped at 8% of
MTDC. However, when calculating MTDC , you can now use up to $50,000 of subawards and
subcontracts rather than $25,000. See 2 CFR 200.1.
Budget
When planning your budget, HHS now uses the definitions for equipment and supplies in 2 CFR
200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s
capitalization level or $10,000 and the threshold for supplies to below that amount.
All changes
HHS adopted all the following superseding provisions on October 1, 2024:
• 2 CFR 200.1, Definitions, Modified Total Direct Cost.
• 2 CFR 200.1, Definitions, Equipment.
Page 25 of 42

---

• 2 CFR 200.1, Definitions, Supplies.
• 2 CFR 200.313(e), Equipment, Disposition.
• 2 CFR 200.314(a), Supplies.
• 2 CFR 200.320, Methods of procurement to be followed.
• 2 CFR 200.333, Fixed amount subawards.
• 2 CFR 200.344, Closeout.
• 2 CFR 200.414(f), Indirect (F&A) costs.
• 2 CFR 200.501, Audit requirements.
3. Reporting
Reporting frequency for performance and financial reports, as well as any required form or
formatting and the means of submission will be noted within the terms and conditions on the
Notice of Award.
4. FFATA and FSRS Reporting
The Federal Financial Accountability and Transparency Act (FFATA) requires data entry at the
FFATA Subaward Reporting System (http://www.FSRS.gov) for all sub-awards and sub-
contracts issued for $30,000 or more as well as addressing executive compensation for both
grantee and sub-award organizations.
For further guidance please follow this link to access ACL’s Terms and Conditions:
https://www.acl.gov/grants/managing-grant#
VII. Agency Contacts
Project Officer
First Name:
Rebecca
Last Name:
Kinney
Phone:
202-795-7375
Office:
Office of Healthcare Information and Counseling (OHIC)
Grants Management Specialist
First Name:
Rasheed
Last Name:
Williams
Phone:
(xxx)-xxx-xxxx
Office:
Office of Grants Management: Rasheed.Williams@acl.hhs.gov
Page 26 of 42

---

VIII. Other Information
The Paperwork Reduction Act of 1995 (P.L. 104-13)
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The project description and
Budget Narrative/Justification is approved under OMB control number 0985-0018. Public
reporting burden for this collection of information is estimated to average 10 hours per response,
including the time for reviewing instructions, gathering and maintaining the data needed and
reviewing the collection information.
Appendix
Accessibility Provisions for All Grant Application Packages and Funding Opportunity
Announcements
Should you successfully compete for an award, recipients of federal financial assistance (FFA)
from HHS will be required to complete an HHS Assurance of Compliance form (HHS 690) in
which you agree, as a condition of receiving the grant, to administer your programs in
compliance with federal civil rights laws that prohibit discrimination on the basis of race, color,
national origin, age, sex and disability, and agreeing to comply with federal conscience laws,
where applicable. This includes ensuring that entities take meaningful steps to provide
meaningful access to persons with limited English proficiency; and ensuring effective
communication with persons with disabilities. The HHS Office for Civil Rights provides
guidance on complying with civil rights laws enforced by HHS. See https://www.hhs.gov/civil-
rights/for-individuals/nondiscrimination/index.html.
• Recipients of FFA must ensure that their programs are accessible to persons with limited
English proficiency. HHS provides guidance to recipients of FFA on meeting their legal
obligation to take reasonable steps to provide meaningful access to their programs by
persons with limited English proficiency. Please see https://www.hhs.gov/civil-
rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-
guidance/index.html and https://www.lep.gov. For further guidance on providing
culturally and linguistically appropriate services, recipients should review the National
Standards for Culturally and Linguistically Appropriate Services in Health and Health
Care at https://minorityhealth.hhs.gov.
• Recipients of FFA also have specific legal obligations for serving qualified individuals
with disabilities. Please see
http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.
• HHS funded health and education programs must be administered in an environment free
of sexual harassment. Please see https://www.hhs.gov/civil-rights/for-
individuals/special-topics/harassment/index.html;
https://www2.ed.gov/about/offices/list/ocr/docs/shguide.html; and
https://www.eeoc.gov/sexual-harassment.
• Recipients of FFA must also administer their programs in compliance with applicable
federal religious nondiscrimination laws and applicable federal conscience protection and
associated anti-discrimination laws. Collectively, these laws prohibit exclusion, adverse
treatment, coercion, or other discrimination against persons or entities on the basis of
their consciences, religious beliefs, or moral convictions. Please see
Page 27 of 42

---

https://www.hhs.gov/conscience/your-protections-against-discrimination-based-on-
conscience-and-religion/index.html.
• Please contact the HHS Office for Civil Rights for more information about obligations
and prohibitions under federal civil rights laws at https://www.hhs.gov/ocr/about-
us/contact-us/index.html or call 1-800-368-1019 or TDD 1-800-537-7697.
If you receive an award, HHS may terminate it if any of the conditions in 2 CFR 200.340(a)(1)-
(4) are met. No other termination conditions apply.
Instructions for Completing Required Forms
This section provides step-by-step instructions for completing the four (4) standard Federal
forms required as part of your grant application, including special instructions for completing
Standard Budget Forms 424 and 424A. Standard Forms 424 and 424A are used for a wide
variety of Federal grant programs, and Federal agencies have the discretion to require some or
all of the information on these forms. ACL does not require all the information on these
Standard Forms. Accordingly, please use the instructions below in lieu of the standard
instructions attached to SF 424 and 424A to complete these forms.
a. Standard Form 424
1. Type of Submission: (REQUIRED): Select one type of submission in accordance with
agency instructions.
• Preapplication
• Application
• Changed/Corrected Application – If ACL requests, check if this submission is to change
or correct a previously submitted application.
2. Type of Application: (REQUIRED) Select one type of application in accordance with agency
instructions.
• New
• Continuation
• Revision
3. Date Received: Leave this field blank.
4. Applicant Identifier: Leave this field blank
5a Federal Entity Identifier: Leave this field blank
5b. Federal Award Identifier: For new applications leave blank. For a continuation or revision
to an existing award, enter the previously assigned Federal award (grant) number.
6. Date Received by State: Leave this field blank.
7. State Application Identifier: Leave this field blank.
8. Applicant Information: Enter the following in accordance with agency instructions:
a. Legal Name: (REQUIRED): Enter the name that the organization has registered with the
System for Award Management (SAM), formally the Central Contractor Registry. Information
Page 28 of 42

---

on registering with SAM may be obtained by visiting the Grants.gov website
(https://www.grants.gov) or by going directly to the SAM website (www.sam.gov).
b. Employer/Taxpayer Number (EIN/TIN): (REQUIRED): Enter the Employer or Taxpayer
Identification Number (EIN or TIN) as assigned by the Internal Revenue Service. In addition, we
encourage the organization to include the correct suffix used to identify your organization in
order to properly align access to the Payment Management System.
c. Organizational UEI (REQUIRED): If your entity is registered in SAM.gov today, your
Unique Entity ID (SAM) has already been assigned and is viewable in SAM.gov. This includes
inactive registrations. The Unique Entity ID is currently located below the DUNS Number on
your entity registration record. Remember, you must be signed in to your SAM.gov account to
view entity records.
d. Address: (REQUIRED) Enter the complete address including the county.
e. Organizational Unit: Enter the name of the primary organizational unit (and department or
division, if applicable) that will undertake the project.
f. Name and contact information of person to be contacted on matters involving this
application: Enter the name (First and last name required), organizational affiliation (if affiliated
with an organization other than the applicant organization), telephone number (Required), fax
number, and email address (Required) of the person to contact on matters related to this
application.
9. Type of Applicant: (REQUIRED) Select the applicant organization “type” from the
following drop down list.
A. State Government B. County Government C. City or Township Government D. Special
District Government E. Regional Organization F. U.S. Territory or Possession G. Independent
School District H. Public/State Controlled Institution of Higher Education I. Indian/Native
American Tribal Government (Federally Recognized) J. Indian/Native American Tribal
Government (Other than Federally Recognized) K. Indian/Native American Tribally Designated
Organization L. Public/Indian Housing Authority M. Nonprofit with 501C3 IRS Status (Other
than Institution of Higher Education) N. Nonprofit without 501C3 IRS Status (Other than
Institution of Higher Education) O. Private Institution of Higher Education P. Individual Q. For-
Profit Organization (Other than Small Business) R. Small Business S. Hispanic-serving
Institution T. Historically Black Colleges and Universities (HBCUs) U. Tribally Controlled
Colleges and Universities (TCCUs) V. Alaska Native and Native Hawaiian Serving Institutions
W. Non-domestic (non-US) Entity X. Other (specify)
10. Name of Federal Agency: (REQUIRED) Enter U.S. Administration for Community Living
11. Catalog of Federal Domestic Assistance Number/Title: The CFDA number can be found
on page one of the Program Announcement.
12. Funding Opportunity Number/Title: (REQUIRED) The Funding Opportunity Number and
title of the opportunity can be found on page one of the Program Announcement.
13. Competition Identification Number/Title: Leave this field blank.
Page 29 of 42

---

14. Areas Affected by Project: List the largest political entity affected (cities, counties, state
etc.)
15. Descriptive Title of Applicant’s Project: (REQUIRED) Enter a brief descriptive title of the
project (This is not a narrative description).
16. Congressional Districts Of: (REQUIRED) 16a. Enter the applicant’s Congressional District,
and 16b. Enter all district(s) affected by the program or project. Enter in the format: 2 characters
State Abbreviation – 3 characters District Number, e.g., CA-005 for California 5th district, CA-
012 for California 12th district, NC-103 for North Carolina’s 103rd district. If all congressional
districts in a state are affected, enter “all” for the district number, e.g., MD-all for all
congressional districts in Maryland. If nationwide, i.e. all districts within all states are affected,
enter US-all. See the below website to find your congressional district:
https://www.house.gov/
17. Proposed Project Start and End Dates: (REQUIRED) Enter the proposed start date and
final end date of the project. If you are applying for a multi-year grant, such as a 3 year
grant project, the final project end date will be 3 years after the proposed start date. In
general, all start dates on the SF424 should be the 1st of the month and the end date of the last
day of the month of the final year, for example 7/01/2014 to 6/30/2017. The Grants Officer can
alter the start and end date at their discretion.
18. Estimated Funding: (REQUIRED) If requesting multi-year funding, enter the full amount
requested from the Federal Government in line item 18.a., as a multi-year total. For example and
illustrative purposes only, if year one is $100,000, year two is $100,000, and year three is
$100,000, then the full amount of federal funds requested would be reflected as $300,000. The
amount of matching funds is denoted by lines b. through f. with a combined federal and non-
federal total entered on line g. Lines b. through f. represents contributions to the project by the
applicant and by your partners during the total project period, broken down by each type of
contributor. The value of in-kind contributions should be included on appropriate lines, as
applicable.
NOTE: Applicants should review cost sharing or matching principles contained in Subpart C of
45 CFR Part 75 before completing Item 18 and the Budget Information Sections A, B and C
noted below.
All budget information entered under item 18 should cover the total project period. For sub-item
18a, enter the federal funds being requested. Sub-items 18b-18e is considered matching funds.
For ACL programs that have a cost-matching requirement (list here), the dollar amounts entered
in sub-items 18b-18f must total at least 1/3 of the amount of federal funds being requested (the
amount in 18a). For a full explanation of ACL’s match requirements, see the information in the
box below. For sub-item 18f (program income), enter only the amount, if any, that is going to be
used as part of the required match. Program Income submitted as match will become a part of the
award match and recipients will be held accountable to meet their share of project expenses even
if program income is not generated during the award period.
There are two types of match: 1) non-federal cash and 2) non-federal in-kind. In general, costs
borne by the applicant and cash contributions of any and all third parties involved in the project,
including sub-grantees, contractors and consultants, are considered matching funds. Examples
Page 30 of 42

---

of non-federal cash match includes budgetary funds provided from the applicant agency’s
budget for costs associated with the project. Generally, most contributions from sub-contractors
or sub-grantees (third parties) will be non-federal in-kind matching funds. Volunteered time and
use of third party facilities to hold meetings or conduct project activities may be considered in-
kind (third party) donations.
NOTE: Indirect charges may only be requested if: (1) the applicant has a current indirect cost
rate agreement approved by the Department of Health and Human Services or another federal
agency; or (2) the applicant is a state or local government agency. State governments should
enter the amount of indirect costs determined in accordance with HHS requirements. If indirect
costs are to be included in the application, a copy of the approved indirect cost agreement
or cost allocation plan must be included with the application. Further, if any sub-
contractors or sub-grantees are requesting indirect costs, a copy of the latest approved
indirect cost agreements must also be included with the application, or reference to an
approved cost allocation plan.
19. Is Application Subject to Review by State Under Executive Order 12372 Process?
Please refer to IV. Application and Submission Information, 4. Intergovernmental Review to
determine if the ACL program is subject to E.O. 12372 and respond accordingly.
20. Is the Applicant Delinquent on any Federal Debt? (Required) This question applies to the
applicant organization, not the person who signs as the authorized representative. If yes, include
an explanation on the continuation sheet.
21. Authorized Representative: (Required) To be signed and dated by the authorized
representative of the applicant organization. Enter the name (First and last name required) title
(Required), telephone number (Required), fax number, and email address (Required) of the
person authorized to sign for the applicant. A copy of the governing body’s authorization for
you to sign this application as the official representative must be on file in the applicant’s office.
(Certain federal agencies may require that this authorization be submitted as part of the
application.)
Standard Form 424A
NOTE: Standard Form 424A is designed to accommodate applications for multiple grant
programs; thus, for purposes of this ACL program, many of the budget item columns and rows
are not applicable. You should only consider and respond to the budget items for which
guidance is provided below. Unless otherwise indicated, the SF 424A should reflect a multi-
year budget.
Section A - Budget Summary
Line 5: Leave columns (c) and (d) blank. Enter TOTAL Federal costs in column (e) and total
non federal costs (including third party in-kind contributions and any program income to be used
as part of the grantee match) in column (f). Enter the sum of columns (e) and (f) in column (g).
Section B - Budget Categories
Column 1: Enter the breakdown of how you plan to use the Federal funds being requested by
object class category.
Page 31 of 42

---

Column 2: Enter the breakdown of how you plan to use the non-Federal share by object class
category.
Column 5: Enter the total funds required for the project (sum of Columns 1 and 2) by object
class category.
Section C - Non-Federal Resources
Column A: Enter the federal grant program.
Column B: Enter in any non-federal resources that the applicant will contribute to the project.
Column C: Enter in any non-federal resources that the state will contribute to the project.
Column D: Enter in any non-federal resources that other sources will contribute to the project.
Column E: Enter the total non-federal resources for each program listed in column A.
Section D - Forecasted Cash Needs
Line 13: Enter Federal forecasted cash needs broken down by quarter for the first year only.
Line 14: Enter Non-Federal forecasted cash needs broken down by quarter for the first year.
Line 15: Enter total forecasted cash needs broken down by quarter for the first year.
Note: This area is not meant to be one whereby an applicant merely divides the requested
funding by four and inserts that amount in each quarter but an area where thought is given as to
how your estimated expenses will be incurred during each quarter. For example, if you have
initial startup costs in the first quarter of your award reflect that in quarter one or you do not
expect to have contracts awarded and funded until quarter three, reflect those costs in that
quarter.
Section E – Budget Estimates of Federal Funds Needed for Balance of the Project (i.e.
subsequent years 2, 3, 4 or 5 as applicable).
Column A: Enter the federal grant program
Column B (first): Enter the requested year two funding.
Column C (second): Enter the requested year three funding.
Column D (third): Enter the requested year four funding, if applicable.
Column E (forth): Enter the requested year five funding, if applicable.
Section F – Other Budget Information
Line 21: Enter the total Indirect Charges
Line 22: Enter the total Direct charges (calculation of indirect rate and direct charges).
Line 23: Enter any pertinent remarks related to the budget.
Separate Budget Narrative/Justification Requirement
Applicants requesting funding for multi-year grant programs are REQUIRED to provide
a combined multi-year Budget Narrative/Justification, as well as a detailed Budget
Page 32 of 42

---

Narrative/Justification for each year of potential grant funding. A separate Budget
Narrative/Justification is also REQUIRED for each potential year of grant funding
requested.
For your use in developing and presenting your Budget Narrative/Justification, a sample format
with examples and a blank sample template have been included in these Attachments. In your
Budget Narrative/Justification, you should include a breakdown of the budgetary costs for all of
the object class categories noted in Section B, across three columns: Federal; non-Federal cash;
and non-Federal in-kind. Cost breakdowns, or justifications, are required for any cost of $1,000
or for the thresholds as established in the examples. The Budget Narratives/Justifications should
fully explain and justify the costs in each of the major budget items for each of the object class
categories, as described below. Non-Federal cash as well as, sub-contractor or sub-grantee
(third party) in-kind contributions designated as match must be clearly identified and explained
in the Budget Narrative/Justification The full Budget Narrative/Justification should be included
in the application immediately following the SF 424 forms.
Line 6a: Personnel: Enter total costs of salaries and wages of applicant/grantee staff. Do not
include the costs of consultants, which should be included under 6h Other.
In the Justification: Identify the project director, if known. Specify the key staff, their titles,
and time commitments in the budget justification.
Line 6b: Fringe Benefits: Enter the total costs of fringe benefits unless treated as part of an
approved indirect cost rate.
In the Justification: If the total fringe benefit rate exceeds 35% of Personnel costs, provide a
breakdown of amounts and percentages that comprise fringe benefit costs, such as health
insurance, FICA, retirement, etc. A percentage of 35% or less does not require a breakdown but
you must show the percentage charged for each full/part time employee.
Line 6c: Travel: Enter total costs of all travel (local and non-local) for staff on the project.
NEW: Local travel is considered under this cost item not under Other. Local transportation (all
travel which does not require per diem is considered local travel). Do not enter costs for
consultant's travel - this should be included in line 6h.
In the Justification: Include the total number of trips, number of travelers, destinations,
purpose (e.g., attend conference), length of stay, subsistence allowances (per diem), and
transportation costs (including mileage rates).
Line 6d: Equipment: Enter the total costs of all equipment to be acquired by the project. For all
grantees, "equipment" is nonexpendable tangible personal property having a useful life of more
than one year and an acquisition cost of $5,000 or more per unit. If the item does not meet the
$5,000 threshold, include it in your budget under Supplies, line 6e.
In the Justification: Equipment to be purchased with federal funds must be justified as
necessary for the conduct of the project. The equipment must be used for project-related
functions. Further, the purchase of specific items of equipment should not be included in the
submitted budget if those items of equipment, or a reasonable facsimile, are otherwise available
to the applicant or its subrecipient.
Page 33 of 42

---

Line 6e: Supplies: Enter the total costs of all tangible expendable personal property (supplies)
other than those included on line 6d.
In the Justification: For any grant award that has supply costs in excess of 5% of total direct
costs (Federal or Non-Federal), you must provide a detailed break down of the supply items
(e.g., 6% of $100,000 = $6,000 – breakdown of supplies needed). If the 5% is applied against $1
million total direct costs (5% x $1,000,000 = $50,000) a detailed breakdown of supplies is not
needed. Please note: any supply costs of $10,000 or less regardless of total direct costs does not
require a detailed budget breakdown (e.g., 5% x $200,000 = $10,000 – no breakdown needed).
Line 6f: Contractual: Regardless of the dollar value of any contract, you must follow your
established policies and procedures for procurements and meet the minimum standards
established in the Code of Federal Regulations (CFR’s) mentioned below. Enter the total costs
of all contracts, including (1) procurement contracts (except those which belong on other lines
such as equipment, supplies, etc.). Note: The 33% provision has been removed and line item
budget detail is not required as long as you meet the established procurement standards. Also
include any awards to organizations for the provision of technical assistance. Do not include
payments to individuals on this line. Please be advised: A subrecipient is involved in financial
assistance activities by receiving a sub-award and a subcontractor is involved in procurement
activities by receiving a sub-contract. Through the recipient, a subrecipient performs work to
accomplish the public purpose authorized by law. Generally speaking, a sub-contractor does not
seek to accomplish a public benefit and does not perform substantive work on the project. It is
merely a vendor providing goods or services to directly benefit the recipient, for example
procuring landscaping or janitorial services. In either case, you are encouraged to clearly
describe the type of work that will be accomplished and type of relationship with the lower tiered
entity whether it be labeled as a subaward or subcontract.
In the Justification: Provide the following three items – 1) Attach a list of contractors
indicating the name of the organization; 2) the purpose of the contract; and 3) the estimated
dollar amount. If the name of the contractor and estimated costs are not available or have not
been negotiated, indicate when this information will be available. The Federal government
reserves the right to request the final executed contracts at any time. If an individual contractual
item is over the small purchase threshold, currently set at $100K in the CFR, you must certify
that your procurement standards are in accordance with the policies and procedures as stated in
45 CFR Part 75 for states, in lieu of providing separate detailed budgets. This certification
should be referenced in the justification and attached to the budget narrative.
Line 6g: Construction: Leave blank since construction is not an allowable costs for this
program.
Line 6h: Other: Enter the total of all other costs. Such costs, where applicable, may include, but
are not limited to: insurance, medical and dental costs (i.e. for project volunteers this is different
from personnel fringe benefits), non-contractual fees and travel paid directly to individual
consultants, postage, space and equipment rentals/lease, printing and publication, computer use,
training and staff development costs (i.e. registration fees). If a cost does not clearly fit under
another category, and it qualifies as an allowable cost, then rest assured this is where it belongs.
Note: A recent Government Accountability Office (GAO) report number 11-43, has raised
considerable concerns about grantees and contractors charging the Federal government for
Page 34 of 42

---

additional meals outside of the standard allowance for travel subsistence known as per diem
expenses. If meals are to be charged towards the grant they must meet the following criteria
outlined in the Grants Policy Statement:
Meals are generally unallowable except for the following:
For subjects and patients under study(usually a research program);
Where specifically approved as part of the project or program activity, e.g., in programs
providing children’s services (e.g., Headstart);
When an organization customarily provides meals to employees working beyond the normal
workday, as a part of a formal compensation arrangement;
As part of a per diem or subsistence allowance provided in conjunction with allowable travel;
and
Under a conference grant, when meals are a necessary and integral part of a conference,
provided that meal costs are not duplicated in participants’ per diem or subsistence allowances
(Note: the sole purpose of the grant award is to hold a conference).
In the Justification: Provide a reasonable explanation for items in this category. For example,
individual consultants explain the nature of services provided and the relation to activities in the
work plan or indicate where it is described in the work plan. Describe the types of activities for
staff development costs.
Line 6i: Total Direct Charges: Show the totals of Lines 6a through 6h.
Line 6j: Indirect Charges: Enter the total amount of indirect charges (costs), if any. If no
indirect costs are requested, enter "none." Indirect charges may be requested if: (1) the applicant
has a current indirect cost rate agreement approved by the Department of Health and Human
Services or another federal agency; or (2) the applicant is a state or local government agency.
State governments should enter the amount of indirect costs determined in accordance with
DHHS requirements. An applicant that will charge indirect costs to the grant must enclose a
copy of the current rate agreement. Indirect Costs can only be claimed on Federal funds, more
specifically, they are to only be claimed on the Federal share of your direct costs. Any unused
portion of the grantee’s eligible Indirect Cost amount that are not claimed on the Federal share of
direct charges can be claimed as un-reimbursed indirect charges, and that portion can be used
towards meeting the recipient match.
Line 6k: Total: Enter the total amounts of Lines 6i and 6j.
Line 7: Program Income: As appropriate, include the estimated amount of income, if any,
you expect to be generated from this project that you wish to designate as match (equal to the
amount shown for Item 15(f) on Form 424). Note: Any program income indicated at the
bottom of Section B and for item 15(f) on the face sheet of Form 424 will be included as part of
non-Federal match and will be subject to the rules for documenting completion of this pledge. If
program income is expected, but is not needed to achieve matching funds, do not include that
portion here or on Item 15(f) of the Form 424 face sheet. Any anticipated program income that
will not be applied as grantee match should be described in the Level of Effort section of the
Program Narrative.
Page 35 of 42

---

c. Standard Form 424B – Assurances (required)
This form contains assurances required of applicants under the discretionary funds programs
administered by the Administration for Community Living. Please note that a duly authorized
representative of the applicant organization must certify that the organization is in compliance
with these assurances.
d. Certification Regarding Lobbying (required)
This form contains certifications that are required of the applicant organization regarding
lobbying. Please note that a duly authorized representative of the applicant organization must
attest to the applicant’s compliance with these certifications.
Proof of Nonprofit Status (as applicable)
Non-profit applicants must submit proof of non-profit status. Any of the following constitutes
acceptable proof of such status:
• A copy of a currently valid IRS tax exemption certificate.
• A statement from a State taxing body, State attorney general, or other appropriate State
official certifying that the applicant organization has a non-profit status and that none of
the net earnings accrue to any private shareholders or individuals.
• A certified copy of the organization’s certificate of incorporation or similar document
that clearly establishes non-profit status.
Indirect Cost Agreement
Applicants that have included indirect costs in their budgets must include a copy of the current
indirect cost rate agreement approved by the Department of Health and Human Services or
another federal agency. This is optional for applicants that have not included indirect costs in
their budgets.
Budget Narrative/Justification- Sample Format
NOTE: Applicants requesting funding for a multi-year grant program are REQUIRED to provide
a detailed Budget Narrative/Justification for EACH potential year of grant funding requested.
Non-
Non-
Object
Federal
Federal
Federal
Class TOTAL Justification
Funds In-
Category Cash
Kind
Federal
Project Director (name) = .5 FTE @ $95,401/yr
Personnel $47,700 $0 $71,254 = $47,700
$23,554
Non-Fed Cash
Page 36 of 42

---

Officer Manager (name) = .5FTE @ $47,108/yr
= $23,554
Total
71,254
Federal
Fringe on Project Director at 36.65% = $17,482
FICA (7.65%)
Health (25%)
Dental (2%)
Life (1%)
Unemployment (1%)
Fringe $17,482 $8,632 $0 $26,114
Non-Fed Cash
Benefits
Fringe on Office Manager at 36.65% = $8,632
FICA (7.65%)
Health (25%)
Dental (2%)
Life (1%)
Unemployment (1%)
Federal
Local travel: 6 TA site visits for 1 person
Mileage: 6RT @ .585 x 700 miles
$2,457
Lodging: 15 days @ $110/day
$1,650
Per Diem: 15 days @ $40/day
$600
$4,707 $2,940 $0 $7,647
Travel
Total
$4,707
Non-Fed Cash
Travel to National Conference in (Destination)
for 3 people
Airfare 1 RT x 3 staff @ $500
$1,500
Page 37 of 42

---

Lodging: 3 days x 3 staff @ $120/day
$1,080
Per Diem: 3 days x 3 staff @ $40/day
$360
Total
$2,940
No Equipment requested OR:
Call Center Equipment
Installation =
$5,000
Equipment $10,000 $0 $0 $10,000
Phones =
$5,000
Total
$10,000
Federal
2 desks @ $1,500
$3,000
2 chairs @ $300
$600
2 cabinets @ $200
$400
Non-Fed Cash
Supplies $3,700 $5,670 $0 $9,460 2 Laptop computers
$3,000
Printer cartridges @ $50/month
$300
Consumable supplies (pens, paper, clips etc…)
@ $180/month
$2,160
Total
$9,460
(organization name, purpose of contract and
estimated dollar amount)
Contract with AAA to provide respite services:
Contractual $30,171 $0 $0 $30,171
11 care givers @ $1,682 =
$18,502
Page 38 of 42

---

Volunteer Coordinator =
$11,669
Total
$30,171
If contract details are unknown due to contract
yet to be made provide same information listed
above and:
A detailed evaluation plan and budget will be
submitted by (date), when contract is made.
Federal
2 consultants @ $100/hr for 24.5 hours each =
$4,900
Printing 10,000 Brochures @ $.05 =
$500
Local conference registration fee (name
conference) = $200
Other $5,600 $0 $5,880 $11,480
Total
$5,600
In-Kind
Volunteers
15 volunteers @ $8/hr for 49 hours =
$5,880
21.5% of salaries and fringe =
Indirect $20,934
$20,934 $0 $0 $20,934
Charges
IDC rate is attached.
TOTAL $40,866 $ 5,880 $187,060
$140,294
Budget Narrative/Justification - Sample Template
NOTE: Applicants requesting funding for a multi-year grant program are REQUIRED to provide
a detailed Budget Narrative/Justification for EACH potential year of grant funding requested.
Object Class Federal Non-Federal Non-Federal In-
TOTAL Justification
Category Funds Cash Kind
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Page 39 of 42

---

Contractual
Other
Indirect Charges
TOTAL
Project Work Plan - Sample Template
NOTE : Applicants requesting funding for a multi-year grant program are REQUIRED to
provide a Project Work Plan for EACH potential year of grant funding requested.
Goal:
Measurable Outcome(s):
* Time Frame (Start/End Dates by Month in Project Cycle)
Major Objectives Key Tasks Lead Person 1 2 3 4 5 6 7 8 9 10 11 12
1.
2.
3.
4.
5.
6.
NOTE: Please do note infer from this sample format that your work plan must have 6 major
objectives. If you need more pages, simply repeat this format on additional pages.
Page 40 of 42

---

Instructions for Completing the Project Summary/ Abstract
• All applications for grant funding must include a Summary/Abstract that concisely
describes the proposed project. It should be written for the general public.
• To ensure uniformity, limit the length to 265 words or less, on a single page with a font
size of not less than 11, doubled-spaced.
• The abstract must include the project's goal(s), objectives, overall approach (including
target population and significant partnerships), anticipated outcomes, products, and
duration. The following are very simple descriptions of these terms, and a sample
Compendium abstract.
Goal(s) - broad, overall purpose, usually in a mission statement, i.e. what you want to do, where
you want to be.
Objective(s) - narrow, more specific, identifiable or measurable steps toward a goal. Part of the
planning process or sequence (the "how") to attain the goal(s).
Outcomes - measurable results of a project. Positive benefits or negative changes, or measurable
characteristics among those served through this funding (e.g., clients, consumers, systems,
organizations, communities) that occur as a result of an organization's or program's activities.
These should tie directly back to the stated goals of the funding as outlined in the funding
opportunity announcement. (Outcomes are the end-point)
Products - materials, deliverables.
• A model abstract/summary is provided below:
The Delaware Division of Services for Aging and Adults with Physical Disabilities (DSAAPD),
in partnership with the Delaware Lifespan Respite Care Network (DLRCN) and key
stakeholders will, in the course of this two-year project, expand and maintain a statewide
coordinated lifespan respite system that builds on the infrastructure currently in place. The goal
of this project is to improve the delivery and quality of respite services available to families
across age and disability spectrums by expanding and coordinating existing respite systems in
Delaware. The objectives are: 1) to improve lifespan respite infrastructure; 2) to improve the
provision of information and awareness about respite service; 3) to streamline access to respite
services through the Delaware ADRC; 4) to increase availability of respite services. Anticipated
outcomes include: 1) families and caregivers of all ages and disabilities will have greater options
for choosing a respite provider; 2) providers will demonstrate increased ability to provide
specialized respite care; 3) families will have streamlined access to information and satisfaction
with respite services; 4) respite care will be provided using a variety of existing funding sources
and 5) a sustainability plan will be developed to support the project in the future. The expected
products are marketing and outreach materials, caregiver training, respite worker training, a
Respite Online searchable database, two new Caregiver Resource Centers (CRC), an annual
Respite Summit, a respite voucher program and 24/7 telephone information and referral services.
Instructions for Completing the "Supplemental Information for the SF-424" Form
1. Project Director.
Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on
matters involving this application. Items marked with an asterisk (*) are mandatory.
Page 41 of 42

---

2. Novice Applicant.Select "Not Applicable To This Program."
Page 42 of 42