Catalog of Federal Domestic Assistance No: 93.259

HRSA-03-088

Program Guide and Application Instructions
for
FY 2003 Grant Applications

DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION

OFFICE OF RURAL HEALTH POLICY (ORHP)
5600 Fishers Lane, Room 9A-55
Rockville, Maryland 20857
301/443-0835

APPLICATION SUBMISSION INSTRUCTIONS

ALL RURAL ACCESS TO EMERGENCY DEVICES GRANT PROGRAM APPLICATIONS ARE DUE JUNE 18, 2003. TO BE CONSIDERED ON TIME, APPLICATIONS MUST BE OFFICIALLY POSTMARKED BY 11:59 PM JUNE 18, 2003 SO THEY MAY RECEIVE A THOUGHTFUL AND FAIR REVIEW. POSTMARKED MEANS OFFICIAL POST OFFICE CANCELLATION MARK, FEDERAL EXPRESS SHIPPING RECEIPT FORM, UNITED PARCEL SERVICE RECEIPT OR OTHER CARRIER THAT OFFICIALLY RECORDS THE PICK-UP OR DROP-OFF TIME OF A PACKAGE. PRIVATE POSTAGE METER CANCELLED PACKAGES WILL NOT BE ACCEPTED UNLESS THE PACKAGE ARRIVES ON OR BEFORE THE DUE DATE. APPLICATIONS THAT MISS THE JUNE 18, 2003 DEADLINE WILL BE RETURNED TO THE APPLICANT WITHOUT REVIEW.

A COMPLETED APPLICATION SHOULD BE SIGNED IN BLUE INK, AND THE ORIGINAL SHOULD BE IDENTIFIED BY AN "ORIGINAL" STAMP, OR OTHER MEANS OF NOTATION, AFTER DUPLICATION. TO FACILITATE THE REVIEW PROCESS, THE APPLICATION MUST NOT BE BOUND OR STAPLED.

PLEASE SUBMIT THE SIGNED ORIGINAL APPLICATION AND TWO COPIES OF THE APPLICATION TO THE FOLLOWING ADDRESS:

HRSA GRANTS APPLICATION CENTER
ATTENTION: GRANTS MANAGEMENT OFFICER
HRSA-03-088
901 RUSSELL AVENUE, SUITE 450
GAITHERSBURG, MD 20879

hrsagac@hrsa.gov
1-877-477-2123

EACH APPLICANT WILL RECEIVE A CARD VERIFYING RECEIPT OF THE APPLICATION AND THE TEMPORARY APPLICATION NUMBER ASSIGNED TO THE PROPOSAL. PLEASE NOTE THAT ONLY HARD COPY SUBMISSIONS OF APPLICATIONS WILL BE ACCEPTED FOR THIS FUNDING CYCLE.

TABLE OF CONTENTS

PART ONE: PROGRAM GUIDE

1. INTRODUCTION
2. BACKGROUND
3. PROGRAM PURPOSE
4. PROGRAM REQUIREMENTS
5. ELIGIBLE APPLICANTS
NOTE TO CURRENT RAED GRANTEES
6. OBTAINING ASSISTANCE
7. NOTIFYING YOUR STATE EMS OFFICE AND STATE OFFICE OF RURAL HEALTH
8. GRANT AWARDS AND FISCAL ISSUES
9. FUNDING PREFERENCE AND PRIORITY
10. GEOGRAPHIC CONSIDERATION IN FUNDING
11. REVIEW PROCESS AND REVIEW CRITERIA
12. PAGE LIMITATION FOR APPLICATIONS
13. ASSURANCES AND PUBLIC POLICY REQUIREMENTS
14. REPORTS
15. PUBLIC HEALTH IMPACT STATEMENT
16.

URCES

PART TWO: APPLICATION INSTRUCTIONS

A. INTRODUCTION
B. FORMATTING YOUR APPLICATION
C. APPLICATION TEMPLATE
1. FACE PAGE - STANDARD FORM 424
2. TABLE OF CONTENTS: THIS TEMPLATE WITH PAGE NUMBERS
3. PROJECT ABSTRACT
4. BUDGET FORMS AND SPREADSHEET
5. PROJECT NARRATIVE AND BUDGET
6. FUNDING PREFERENCE AND PRIORITY STATEMENTS
7. OFFICE OF RURAL HEALTH POLICY GRANTEE HISTORY
8. PROOF OF NON-PROFIT OR PUBLIC STATUS
9. ASSURANCES (STANDARD FORM 424B)
10. CERTIFICATION FORMS
11. DISCLOSURE OF LOBBYING ACTIVITIES FORM
12. CHECKLIST FORM
13. APPENDICES

APPENDIX I: DEFINITIONS
APPENDIX II: SAMPLES OF COMPLETED BUDGET FORMS (see Acrobat file or the application kit.

PART ONE: PROGRAM GUIDE

1. INTRODUCTION

This document serves as the program guide for the Rural Access to Emergency Devices (RAED) Grant Program. The instructions in this guide, in conjunction with the generic instructions for the application form PHS-5161-1, must be used to apply for funds from this program.

2. BACKGROUND

The grant program described in this document, the Rural Access to Emergency Devices Grant Program, is authorized by Public Health Improvement Act Title IV - Cardiac Arrest Survival, Public Law 106-505 (November 13, 2000), Subtitle B - Rural Access to Emergency Devices, 42 U.S.C. § 254c. The Catalog of Federal Domestic Assistance Number for this grant program is 93.259.

The law states that the purpose of the Rural Access to Emergency Devices Grant Program is to "(1) purchase automated external defibrillators that have been approved, or cleared for marketing by the Food and Drug Administration; and (2) to provide defibrillator and basic life support training in automated external defibrillator usage through the American Heart Association, the American Red Cross, or other nationally recognized training courses."

3. PROGRAM PURPOSE

As established in Title IV of the Public Health Improvement Act, the overall goals for the Rural Access to Emergency Devices Grants are to: (1) place automatic external defibrillators (AEDs) in eligible rural areas; (2) purchase AEDs for these areas; and (3) train first responders and the lay public in the proper usage of AEDs. Ideally, the RAED Grant Program provides a mechanism around which State Offices of Rural Health and State EMS Offices may collaborate to improve rural and frontier emergency care. This collaboration should form the basis for future joint endeavors in infrastructure development for rural and frontier EMS and trauma systems, especially for integrating emergency care considerations into other Office of Rural Health Policy grant program applications. The program also seeks to create or increase collaboration with rural emergency care providers and rural health care systems by extending the "chain of survival" with early defibrillation and cardiopulmonary resuscitation (CPR) into areas that have difficulty accessing care in a timely and efficient manner.

Some anticipated outcomes of the RAED program could include:

• recognition of the integral role rural first responders have in access to care in light of geographical isolation;
• achieving economies of scale through bulk purchasing of AEDs either through competitive bidding process or pre-negotiated state contract arrangements;
• extending "chain of survival" to rural and frontier areas;
• enhancing the recognition of a sudden cardiac event and use of lay person CPR in rural communities.

The Rural Access to Emergency Devices Grant Program provides approximately $12,500,000 for fiscal year (FY) 2003 in grants for the purchase, placement and training in the use of automated external defibrillators and related activities in eligible rural areas.

For the purpose of this grant program, the RAED program will be administered through an integrated community partnership. A community partnership is a formal organizational arrangement among a consortium consisting of first responders (e.g., EMS, law enforcement and fire departments) and local for and non-profit entities that may include, but are not limited to, long-term care facilities, rural health clinics, Federally Qualified Health Centers, Indian Health Service clinics and tribal EMS services, post offices, libraries and other civic centers, athletic facilities (i.e., high school playing fields where a town may gather for games), senior citizen and child day care facilities, faith-based organizations and schools. The Office of Rural Health Policy defines a community partnership as at least a multi-county consortium of eligible entities as prescribed in the authorizing legislation:

An applicant must be part of a State-wide, regional or multi-county consortium of rural community organizations applying as a community partnership. Each community partnership must have a designated lead applicant as the grantee of record and to act as the fiscal agent for the partnership. In order to qualify as a State-wide community partnership, all eligible counties do not have to be included but a State-level office must be the lead applicant.

4. PROGRAM REQUIREMENTS

All community partnerships funded under this grant program must meet the following requirements:

1. The community partnership organizational relationship is formal. Formal in this case means explicit and/or legal. Each member of the community partnership must sign a Memorandum of Agreement or other formal collaborative agreement. Organizations from at least three counties must be part of the community partnership.
2. All members of the community partnership must be trained and certified in the use of AEDs. Such certification must remain valid throughout the entire project period.
3. The community partnership and/or its members must attempt to solicit either in-kind funding or cash contributions to the program. While in-kind funding or cash contributions are not mandatory in order to be funded, they are a sign of strong community support. If obtained, these resources must be identified in the budget section of the grant application.
4. All members demonstrate a strong and measurable commitment to the community partnership and propose how collaboration gained from this project will impact future joint planning activities (i.e., mutual aid agreements, training exercises, etc.).
5. The community partnership has created a governing body that includes representation for all organizations and ensures that the governing body, rather than an individual member, will make financial and programmatic decisions (i.e., determining AED placement locations). Providers of care should be represented on the governing body.
6. The lead applicant has considered the public accountability that flows from the community partnership to its member organizations and from the organizations to the communities they serve. In the application, the lead applicant describes the environment in which it and its members function and the justification for the investment of public funds in its activities. The applicant must address how its work benefits the local community and, where appropriate, demonstrates the role of lay public in public access defibrillation.
7. The lead applicant has identified a permanent program director or has established an interim program director at the time of application. If hiring a permanent program director is contingent upon the grant award, the permanent program director should be in place within six months of grant award.
8. Applicants must have financial management systems in place and have the capacity to manage the project. The applicant organization must: 1.) be able to exercise administrative and programmatic direction over the grant project; 2.) have the administrative and accounting capabilities to manage the grant funds; and 3.) have permanent staff who can ensure that the intent of the grant is carried out for the entire partnership. This will include responsibility for hiring and managing the grant project staff. Further, the applicant organization must have an Employer Identification Number from the Internal Revenue Service and an Internal Revenue Service letter or a letter from an appropriate State agency of non-profit status, if applicable. Proof of organizational viability, elaborating on the above three factors, must be included with the grant application.
9. Training costs should be no less than 20%, and no more than 40%, of the total grant award. An exception to this rule is if the lead applicant can document that in-kind training is already in place that would benefit the entire community partnership. An example of such in-kind training would be that already provided through, or sponsored by, a rural health network or regional EMS office. AED training must be from the American Heart Association, the American Red Cross, or other nationally recognized training courses. Training may take place in an urban area if done through a contract. Otherwise, the training entity may be a formal partner of the community partnership in an eligible rural area. Training funds may also be used for 9-1-1-dispatcher training on AEDs so that quality pre-hospital care may be rendered until EMS arrives. It is the responsibility of the grantee, not the Federal Government, for the AEDs purchased to be of a current model, FDA approved and maintained in proper working order. Furthermore, the Federal Government is not responsible for replacement of original AEDs purchased through this grant program.
10. Each community partnership must describe the source of information used for their needs assessment (i.e., average response and/or transport times, epidemiological data, etc.). Applicants are strongly encouraged to use national, state and local data to substantiate and document the need for placement of AEDs in their community partnership's service area. Applicants are also strongly encouraged to include, to the extent possible, current response and transport times for EMS providers in their community partnership's service area. Mileage to the nearest definitive care facility is also helpful. Your county (if available) and State Department of Health are useful sources of information in obtaining epidemiological data to strengthen your application.
11. Grantees will be expected to participate in an evaluation of the program at the conclusion of the grant period. Specific details on what data should be collected and reported for the annual project report for FY 2002 grantees will be released at the ORHP All-Programs Grantee Meeting during August 17-22, 2003. This meeting will be held at the Grand Hyatt Hotel in Washington, DC. This meeting is not intended for new FY 2003 grantees as this will occur before the start of the official project period. Details on the grantee meeting for new FY 2003 grantees will be released in Spring 2004.

Each community partnership must have a lead applicant. An applicant must be a multi-county, regional or State-wide consortium of rural community organizations applying as a community partnership. Each community partnership must have a designated lead applicant to apply as the grantee of record and act as a fiscal agent for the partnership. The role of the lead applicant will be to apply for this program on behalf of the entities in their community partnership and to disseminate grant funding to them if awarded. This can happen two ways. Under the first option, a group of eligible entities would join together and apply as a regional or multi-county consortium. One of the eligible entities within that consortium would have to be identified as the lead applicant. The second option would be for State-wide applicants. In this case, the State EMS Office or State Office of Rural Health would apply as the lead applicant on behalf of the eligible entities within the state.

Applicants must be public or nonprofit entities that are located in a rural area or rural Zip Code of an otherwise urban county (see listing included in application kit). All services must be provided in a rural county or Zip Code. The lead applicant, which applies on behalf a community partnership, must be a public or non-profit private entity. Applications from profit-making organizations will not be accepted. Applicants must meet one of the two criteria listed below:

1. If a community partnership applies under the first option as a regional or multi-county consortium, all of the eligible entities in the community partnership must be located in a rural area or in a rural Zip Code of an urban county and all services must be provided in eligible rural areas. If the applicant is owned by or affiliated with an urban entity or health system, the rural component may still apply as long as the rural entity can directly receive and administer the grant funds in eligible rural areas.
2. If a community partnership applies under the second option as a State-wide consortium, the lead applicant may be located in an urban area as many state capitals are classified by the U.S. Census Bureau as Metropolitan Statistical Areas. All of the eligible entities (other than the lead applicant) in the community partnership must be located in an eligible rural area and the lead applicant must demonstrate how funding, training and other technical assistance will be provided to those areas.

A list of eligible rural areas is provided in the application packet. The same listings are also available on the Office of Rural Health website. Eligible rural counties can be found at (ftp://ftp.hrsa.gov/ruralhealth/sectionI.pdf) and Rural-Urban Commuting Area Zip Codes can be found at (ftp://ftp.hrsa.gov/ruralhealth/sectionII.pdf) and each listing is sorted by State.

In addition to eligible rural areas in the 50 States, applicants can be located in the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Territories of the Virgin Islands, Guam, American Samoa, the Compact Free Association Jurisdictions of the Republic of the Marshall Islands, the Republic of Palau and the Federated States of Micronesia.

The utilization of a State-level office as a collaborator of State-wide resources and organizations will lead to enhanced exchange of placement methodologies and strategic planning for infrastructure sustainability. In addition, broad participation best ensures strong community support, enhanced economies of scale for bulk purchasing of AEDs and maximum coordination of resources to include medical direction and a tiered EMS response following AED use. This will help to ensure the most efficient use of grant funding to support purchase and placement of AEDs in rural communities and efforts to train eligible entities in the use of the equipment. All community partnerships applying as one State-wide entity will receive a floor amount of $50,000 to encourage broad partnerships and adequate coordination with State-level offices.

The State EMS Office is a logical lead applicant to disseminate funding to individual entities within the partnership given their statutory role in medical direction and regulation. The State EMS Office can ensure maximum coordination and integration of automated external defibrillators (AEDs) into existing EMS systems. Collaboration with State Offices of Rural Health is strongly encouraged as part of a State-wide community partnership. State Offices of Rural Health should be consulted about public access AED placement sites for those areas that lack EMS services or when they are located too far away to be of practical benefit to a patient when early defibrillation is needed. This consultation is essential to complement the rather regulatory nature of State EMS Offices. Should the State EMS Office be unable to act as the lead applicant, other State-level offices eligible to accept Federal grant funding may be the lead applicant. These include the State Office of Rural Health or a division within the State health department. All lead applicants will qualify for an 8% administration fee based on the direct cost of the program.

The composition and size of a community partnership in this grant program will be left to each lead applicant. This is intended to give maximum flexibility to the applicant so that the scope and composition best reflect local resources resulting in the strongest possible community partnership. The Office of Rural Health Policy has a vested interest in promoting larger community partnerships. This is not to exclude those entities with limited resources applying as smaller community partnerships (e.g., multi-county). Rather, the best advocacy and strongest partnerships are envisioned to result from collaboration gained in larger partnerships. It is expected that all smaller, eligible community partnerships who express interest in participating in a State-wide community partnership be included in such to prevent a competition or selection of interested entities.

Interested entities can form a community partnership through letters of commitment or memoranda of agreement that should be included as an appendix to the grant application. The partnership, as evidenced through the letters of commitment, should provide documentation about issues related to governance and disbursement of funds by the grantee, including which entity will act as the lead applicant for the grant. The lead applicant must provide the name for the community partnership as it corresponds to PHS Form 424. The roles and responsibilities of each member of a community partnership must be clearly defined and each must contribute significantly to the goals of the project. The local community must be involved in project decision-making and committed to the goals of the partnership.

6. OBTAINING ASSISTANCE

The Rural Access to Emergency Devices Grant Program is funded and administered by the Office of Rural Health Policy (ORHP). Requests for technical or programmatic information on this announcement should be directed to the Office of Rural Health Policy, Room 9A-55, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857, telephone number (301) 443-0835. Applicants may also call to obtain technical and programmatic assistance by contacting one of the following ORHP staff members by either email or phone at the above number:

Information or technical assistance regarding business, budget or financial issues should be directed to the Office of Grants Management, Health Resources and Services Administration, HIV/AIDS Bureau, Room 11-A-16, 5600 Fishers Lane, Rockville, MD. 20857, telephone number (301) 443-0829 or (301) 443- 1913:

Technical assistance conference calls will be provided on the three following dates to community partnerships writing grant applications:

Please use (888) 340-6895 to call in. An operator will answer and ask for a pass code and call leader. The pass code is "AED" and the leader will be Evan Mayfield from the Office of Rural Health Policy. You will hear a short beep that will indicate that you have been patched through to the call-in session. Please give your name, location and organization you are representing before asking a question so that everyone may be properly identified. This will assist us in compiling a list of participants on the call and allow those interested in expanding their community partnership to do so by taking note of other participants within their State and contact them following the call. For all technical assistance calls, instant replay of each call will be available for participants for one week following each call by calling (800) 925-3897.

7. NOTIFYING YOUR STATE EMS OFFICE AND STATE OFFICE OF RURAL HEALTH

The letter of intent due date is close of business on May 5, 2003. The letter of intent should include only the lead applicant's name, organizational names of those within their proposed community partnership, proposed number of AEDs to be requested and a statement of intent to apply for grant funding under this program. It may be mailed to the Office of Rural Health Policy at 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857, or faxed to (301) 443-2803. While not mandatory, applicants are strongly encouraged to fax or mail a copy of a letter of intent to their State Office of Rural Health and their State EMS Office. A list of State Offices of Rural Health and State EMS Offices is included with the application kit.

Upon receiving a grant award, a letter from the community partnership to the State EMS Office and State Office of Rural Health is expected. This notification, which is separate from that required by the Public Health System Impact Statement, applies in cases where a community partnership does not include either, or both of the State Offices listed. Most States have laws that require the State EMS Office, or their representative, to know where AEDs are placed. This notification is necessary to ensure that: (1.) AEDs will be placed in a tiered response system; (2.) all AEDs will be registered; (3.) data reporting communication for medical direction will follow use of AEDs; and (4.) each community partnership will prepare a list of properly trained individuals to operate AEDs pursuant to its State laws.

In those cases where the State Office of Rural Health, or other office within a Department of Health, is the lead applicant of a State-wide community partnership, the above notification to the State EMS Office must still take place.

Both the State EMS Office and State Office of Rural Health can provide technical assistance on the strongest linkages between stakeholders when forming community partnerships and placement of AEDs during the grant writing period. Because many rural areas rely upon volunteer first response services, and experience longer response times, public access defibrillation placement is an important consideration of any grant application. The primary goal of a State Office of Rural Health is to provide expertise in matters relating to access and rural health care infrastructure development, and thus, is invaluable when making public access defibrillation placement decisions. The State Offices of Rural Health are a valuable source of information on State-wide activities that may be important to your project. Also, they can provide technical assistance to applicants and have been provided with information that enables them to provide application development assistance.

8. GRANT AWARDS AND FISCAL ISSUES

1. NUMBER, SIZE, AND DURATION OF PROJECTS: HRSA estimates that approximately 50 awards will be made to community partnerships, in collaboration with State EMS Offices in FY 2003. State EMS Offices are strongly encouraged to consult with their State Office of Rural Health. It is anticipated that applications will be State-wide in size. The amount awarded to grantees will vary based on the quality of applications from each partnership, percent rural population in a state and the total rural population in each state. All such factors will be considered in addition to a program base amount of $50,000 per State-wide application. The duration of all awards shall consist of a three-year project period with 12 month budget periods and non-competing second and third year budget periods. The FY 2002 average amount of funding, across 49 total grant awards, was approximately $238,000. All awards are contingent upon availability of funds.
2. LIMITATIONS ON THE USE OF GRANT FUNDS: Generally, funds should be used to support salaries and contractual services. The grantee must ensure that grant funds for staff and contracted professional services (e.g., attorneys, accountants, MIS specialists, etc.) are used for the benefit and development of the network as a whole. No funds can be used for the purchase, construction or renovation of facilities. Funds may not be used to purchase vehicles.
3. COST PARTICIPATION: Cost participation serves as one important indicator of community and organization commitment to the project. It also increases the likelihood that the project will continue after Federal grant support has ended. Cost participation may be in the form of cash or in-kind contributions (e.g., equipment, personnel, building space, indirect costs). Cash and in-kind contributions must be addressed in the budget forms and in the narrative budget justification. While matching funds at the local level are not required, they are encouraged if possible as a demonstration of community participation and commitment to this program. Instructions for preparing a budget are found later in this document. (See Part Two: Application Instructions)
4. COST PRINCIPLES: If a grant award is made, all funds identified as dedicated to the project (including cost participation) will be subject to the applicable Federal cost principles, audit, and reporting requirements. The Cost Principles governing non-profit organizations are found in OMB Circular A-122 (non-profits), OMB Circular A-102 (State and Local Governments), or OMB Circular A-110 (Institutions of Higher Education, Hospitals and Other Non-Profit Organizations). These documents can be found on the Internet at: http://www.whitehouse.gov/omb/circulars/.
5. GRANTEES MEETING: FY 2002 grantees are required to allocate funds for sending 1-2 representatives to an annual 1-2 day meeting of all grantees during August 17-22, 2003 at the Grand Hyatt Hotel in Washington, DC. Details of subsequent grantee meetings for FY 2003 grantees will be released near the end of the first budget period.

Applicants must demonstrate that existing levels of institutional and other non-Federal support are not reduced or supplanted by the availability of these grant funds. These funds may not be used for the same purpose for which another Federal grant has been awarded. Grant funds may be used only for the purposes described in the approved application.

9. FUNDING PREFERENCE AND PRIORITY

Funding Preference
Funding preference will be awarded to rural community partnerships that propose a community partnership that is State-wide in scope. Applicants must specifically request this preference and must describe how it will meet the test of a State-wide partnership, meaning a State-level governmental agency is the lead applicant of such a partnership and achieves an equitable distribution of organizations and resources among eligible rural counties within the State. Funding preference will move approved applicants carrying the preference ahead of those applicants without the preference. Applications that do not request or receive a funding preference will be given full and equitable consideration during the review process. However, all applications that request and are eligible to receive a funding preference will be funded before applications in the funding line that do not have a funding preference.

Funding Priority
Funding priority gives an application 5 additional points during the scoring process of approved applications. Applicants must specifically request funding priority for either one or both and describe how they will meet each criteria.

The RAED Grant Program provides a funding priority to any qualified applicant that specifically requests the preference and can demonstrate the following:

1. Include emergency first response entities (i.e., EMS, law enforcement and fire departments) that are currently operating without AEDs (additional 5 points)
2. Designate the State Office of Emergency Medical Services as the lead applicant (additional 5 points).

To receive a funding preference and/or priority, you must request it. Further, you must identify the type of preference for which you are eligible, and demonstrate your eligibility as instructed in Part Two of the Application Instructions.

10. GEOGRAPHIC CONSIDERATION IN FUNDING

The Office of Rural Health Policy seeks to expand the RAED Grant Program into geographic areas not currently served by the program. Consequently, the Office will consider geographic location when deciding which approved applications to fund.

11. REVIEW PROCESS AND REVIEW CRITERIA

1. REVIEW PROCESS: Staff will review competing applications for completeness and compliance with all program and administrative requirements. Applications are deemed non-compliant if they are incomplete, improperly formatted, longer than the specified page limit (40 pages), inadequately developed, or otherwise unsuitable for peer review. Non-compliant applications are returned to the applicant without further consideration.
   An Objective Review Committee (ORC) reviews all compliant applications. The ORC evaluates and scores each application and makes a funding recommendation to the Director, Office of Rural Health Policy. The Director makes a final decision on funding based on the level of funds available, funding preferences and priorities, responsiveness to the goals of the program and geographic considerations. Applicants will be notified by September 1, 2003 of the outcome of the review process. All applicants will receive a Final Narrative Evaluation Report that indicates the strengths and weaknesses of the ORC.
2. REVIEW CRITERIA: All applications will be reviewed against the standard criteria listed below. Each criterion is assigned a maximum number of points that can be awarded by reviewers. Based upon the Objective Review Committee's assessment of the proposed project, applicants may receive a score ranging from 0 to 110 points. A description of the elements that are included within each criterion is provided in Section 5, "Project Narrative and Budget," of the Application Instructions on pages 23-28.
1. Need for the Proposed Commnity Partnership
1. Description of Need
2. Description of Community Partnership Capability
2. Project Delivery Plan
1. Organizational Structure
2. Project Goals, Strategies, Activities, Responsible Agents and Completion Milestones
3. AED Placement Plan
4. Detailed Training Plan
3. Budget
1. Budget Justification Narrative
4. Sustainability Plan
5. Evaluation

The entire application may not exceed 40 pages in length, including the abstract, project and budget narratives, face page, forms, attachments and appendices. Letters of commitment and support do not count towards the page limit. Pages must be numbered consecutively. Applications that exceed the 40-page limit will not be reviewed or returned.

13. ASSURANCES AND PUBLIC POLICY REQUIREMENTS

Applicants are required to sign certain certifications and assurances as part of the Federal application process. These materials and instructions for completion are found in the Application Instructions.

14. REPORTS

1. AUDIT: Grantees are subject to the requirements of OMB Circular A-133. Grantees that expend more than $300,000 in Federal funds per their fiscal year are required to complete an audit in compliance with OMB Circular A-133 regulations. Information on the scope, frequency and other aspects of the audits can be found on the Internet at www.whitehouse.gov/omb/circulars.
2. ANNUAL PERFORMANCE REPORT: Grantees are required to submit an annual program performance report to document their progress during the year. This report is part of the non-competing continuation application that is required for continued grant support. Instructions for preparing and submitting this report will be automatically sent to grantees in the non-competing continuation application kit and via email distribution.
3. PAYMENT MANAGEMENT SYSTEM QUARTERLY REPORT (PMS 272): This report must be submitted quarterly. The reports identify cash expenditures against the authorized funds for the grant. Failure to submit the report may result in the inability to access grant funds.
4. FINANCIAL STATUS REPORT: A financial status report is required within 90 days of the end of each grant year. The report is an accounting of expenditures under the project that year. The report must not show unliquidated obligations and must indicate the exact balance of unobligated funds.
5. FINAL PROGRAM PERFORMANCE REPORT: A final programmatic report must be submitted within 90 days of the end of the grant project period. Grantees will be notified in writing by the Office of Rural Health Policy concerning substance, format and delivery date of this report.

The RAED Grant Program is subject to Public Health System Reporting Requirements as approved under OMB No. 0937-0195. Under these requirements, community-based, non-government applicants (that is, where no local government or State run health organization is the applicant), must prepare and submit a Public Health Impact Statement. The statement is intended to provide timely information to State and local health officials. Community-based and non-government applicants must submit the following information to the head of your State and local health agencies in the areas affected by the project no later than the Federal application receipt deadline date of June 18, 2003.

1. A copy of the face page of the application (Standard Form 424)
2. A summary of the project, not to exceed one page, which provides:
   • A description of the project and population to be served
   • A estimate of the proposed number of AEDs to be purchased and how many people are expected to need training within the community partnership
   • A description of the coordination planned with appropriate State and local health agencies (ranging from required notification of AED placement to the State EMS Office to a State-level office agreeing to be the lead applicant and/or fiscal agent of a State-wide community partnership).

Several sources offer data and information that will help you in preparing the application:

In addition to these data sources, grantees are encouraged to visit websites for the National Association of State EMS Directors (http://www.nasemsd.org), National Association of EMS Physicians (http://www.naemsp.org), National Association of EMS Educators (http://www.naemse.org), National Rural Health Association (http://www.NRHArural.org), The Foundation Center (http://www.thefdncenter.org/) and Grantmakers in Health (http://www.gih.org).

PART TWO: APPLICATION INSTRUCTIONS

A. INTRODUCTION

This section provides detailed instructions for preparing your application and completing the forms and other materials required by the Form PHS-5161-1. These instructions include a template for the application (see page 17 of this document). This template specifies the order in which materials are to be presented in the application and a detailed outline for you to follow in preparing the narrative description of your project. The outline for your project narrative should correspond with the criteria that will be used for scoring your application. Please follow the template and the specific instructions for each part of the application. Failure to do so may result in an incomplete application or loss of points in the review process.

B. FORMATTING YOUR APPLICATION

Applications must be legible with no less than a one-inch margin at the top and no less than half-inch margins on the sides and bottom. The print for all narrative materials must be no smaller than Courier 12-point or a 12-pitch font. The narrative material can be single-spaced if you wish. Charts must be prepared in no smaller than 10-pitch fonts.

The entire application must be no more than 40 pages, including all forms, budget and program narratives, supporting documents and appendices. This does not include letters of commitment from entities within a community partnership which do not count against the page limit. (Note: If a cover letter is submitted, it will be counted against the 40 page limit, even if it is not numbered.)

Pages must be numbered consecutively from the beginning of the Template to the end and may be handwritten.

A completed application should be signed in blue ink. The original copy should be identified using an "ORIGINAL" stamp or some other means of notation. Applicants are to use binder clips or rubber bands to secure the application pages. Please do not staple or bind the original application or the two copies enclosed with your application.

C. APPLICATION TEMPLATE

The application should consist of the following 14 sections presented in order:

1. Face Page (Standard Form 424)

2. Table of Contents

3. Project Abstract

4. Budget Forms (Standard Form 424A) and Budget Spreadsheet

5. Project Narrative and Budget

1. Need for the Proposed Project and the Network
1. Description of Need
2. Description of Community Partnership Capability
2. Project Delivery Plan
1. Organizational Structure
2. Goals, Strategies, Activities, Responsible Agents and Completion Milestones
3. AED Placement Plan
4. Detailed Training Plan
3. Budget
1. Budget Justification Narrative
4. Project Evaluation
5. Sustainability Plan
1. Continuing the Program After the Grant Ends

6. Funding Preference and/or Priority Statement(s)

7. Office of Rural Health Policy History

8. Proof of Non-Profit Status

9. Assurances (Standard Form 424B)

10. Certification Forms

11. Disclosure of Lobbying Activities

12. Checklist Form

13. Appendices (Letters of Commitment)

Template Instructions

1. Face Page - Standard Form 424

The first numbered page of your application is the Face Page or Standard Form 424, Application For Federal Assistance. Below are instructions for completing the form:

2. Table of Contents: This Template with Page Numbers

This template (Items 1 through 13) is the Table of Contents for your application. Your Table of Contents will list items 1 (Face Page) through 13 (Appendices) and show the page number where each item is found in your application. A page number must be given for each item. Under Item 5, "Project Narrative and Budget," there are sub-headings for various components of the narrative. These sub-headings must also be a part of your Table of Contents. They must appear under Section 5 with page numbers shown for each sub-heading. This will allow reviewers to refer quickly to specific parts of the Project Narrative and Budget.

3. Project Abstract

The Project Abstract must be single-spaced and must not exceed one page. It should include a brief description of the proposed grant project including the needs to be addressed, the proposed services, the population group(s) to be served and the organizations comprising the community partnership. The abstracts of funded projects are used for press releases and to notify Congressional Districts if a constituent is awarded.

4. Budget Forms and Spreadsheet

The budget forms (SF 424A) that come with the application packet and the budget spreadsheet for all three years of the budget should be included in this section of the application. For a sample budget spreadsheet, see Appendix II. The budget narrative should remain under Section 6, Criterion 3.

1. Budget Information and Instructions for Completing the SF424A
1. Budget Information (Standard Form 424A): This form has been provided in single-sided format for Rural Health Network Development Grant applicants. It is a separate item in the application kit (do not use the double-sided format found with Form PHS-5161-1). Also, please follow the instructions found here rather than the information in Form PHS 5161-1.
   SF 424A: Section A - Budget Summary
   Line 1, Column a: Enter Rural Access to Emergency Devices Program
   Line 1, Column b: Enter 93.259
   Line 1, Columns c and d: Leave blank (not applicable for new applications)
   Line 1, Columns e and f: Enter the Project Costs from Federal and non-Federal Sources
   Line 1, Column g: Enter the total for Columns e and f.
   Line 2-4: Leave blank.
   Line 5, Columns e, f, and g: Enter totals for these columns.
   
   SF 424A: Section B - Budget Categories
   Line 6, Column 1: Enter the amount of Federal support requested for each Object Class Category. The amount on Line 6, Column k, should be the same as the amount in Section A, Line 5, Column e, and Block 15a of the Face Page.
   Line 6, Item j. (Indirect Costs): These are the costs incurred that are not readily identifiable with a particular project or program, but are essential to the operations of the organization. Indirect costs will be allowed only if the applicant organization has a negotiated indirect cost rate approved by a Federal Agency. The applicant must submit a copy of its most current rate agreement to substantiate the request. Indirect costs are included in the total amount requested. ORHP requests that Indirect Cost be voluntarily limited to 5% of total project costs for the community partnership so that the maximum benefit of each grant award may be used towards life saving devices.
   Line 6, Column 3: (Non-Federal Contributions): Distribute the amount shown in Section A, Line, 5, Column f, among the Object Class Categories (this includes both cash and in-kind contributions from all non-Federal sources). Insert the total for this column on Line k.
   Line 6, Column 5: Enter the totals for Columns 1 and 3 for each Object Class Category. The amount on Line k, Column 5 should be the same as the amount on Line 15, Column g on the Face Page Form (SF 424).
   Line 7, Column 1: Enter the amount of estimated program income for the first twelve-month period. This is the same amount that appears on the Face Page, Block 15f.
   SF 424A: Section C - Non-Federal Resources
   Line 8, Column a: Enter Rural Access to Emergency Devices Grant Program
   Line 8, Columns b, c, and d: Enter the value of cash and in-kind contributions contributed by the applicant, State and other sources and insert the total(s) on Line 12. These figures correspond with those on the Face Page, Blocks 15 b, c, d, and e.
   Line 12, Column e: Enter the total of Columns b, c, and d. This amount should be the same as that shown in Section A, Line 5, Column f.
   SF 424A: Section D - Forecasted Cash Needs
   This section does not apply. Leave this section blank.
   SF 424A: Section E - Budget Estimates of Federal Funds Needed For Balance of the Project
   Line 16, Column a: Insert Rural Access to Emergency Devices Grant Program
   Line 16, Column b: Insert the dollars requested for the second budget period, including Indirect Costs, if appropriate.
   Line 16, Column c: Insert the dollars requested for the third and final budget period, including appropriate Indirect Costs.
   Line 20, Column b: Insert the figure on line 16 for the second budget period.
   Line 20, Column c: Insert the amount on line 16 for the third budget period.
   Note: Columns d and e are blank since the maximum length of a grant is three years.
   SF 424A: Section F - Other Budget Information
   Line 21 (Direct Charges): Leave this item blank. The information will be provided in your detailed budget justification as described below.
   Line 22 (Indirect Charges): Specify the type of Indirect Cost Rate that has been negotiated with a Federal agency, if applicable. Indirect Costs are only allowed if a rate has been approved by a Federal agency.
   Line 23 (Remarks): Leave blank. Remarks should be included in the Budget Justification Narrative section.
2. Budget Justification Narrative
   1. Applicants must provide justification for all items in the budget and explain the relevance of each cost to the overall goals of the project. All items in the budget must be addressed. The details and justifications must be presented for each year of the proposed project.
      Personnel: Each position (Project Director, Secretary, etc) should be itemized and compensation shown for each position.
      Fringe Benefits: Describe how the fringe benefits are calculated for the proposed personnel.
      Equipment: Per 45 CFR Part 74.2, equipment is tangible non-expendable personal property, including exempt property, charged directly to the award having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. However, consistent with recipient policy, lower limits may be established. The RAED Grant Program will consider any durable items with an acquisition amount greater than $1,000, and life expectancy of at least one year, as meeting this definition. This is to allow for classification of AEDs under this definition.
      List every item of equipment and describe its purpose in relation to the project. Also, applicants are advised that they are required to get at least three price quotations.
      Supplies: Please itemize and explain the expendable items required for the project. These would include, among other items, computer equipment and peripheral supplies.
      Travel: Explain the need for all requested travel, including numbers of people involved, duration of trips, destinations, importance to project, etc. Remember to include funds for two people to attend one grantee meeting per year in Washington, D.C.
      Contractual Costs: Explain the need for all proposed contractual arrangements and how they relate to the project.
      Program Income: All income generated from the use of grant funds must be reported. Any program income generated must be expended before grant funds.
      Other: Please itemize and explain any other expenses not captured in any other budget category.

5. Project Narrative and Budget

The Project Narrative is used to explain the proposed area, population served, community involvement and anticipated community benefits. In this section you should also outline the structure of the community partnership and the methods that will be used to select and distribute the AEDs to the identified organizations. If this is not a State-wide partnership, the applicant must explain how the community will interact with the State. You should address all of the areas listed below in a clearly defined way.

These are the criteria that the application reviewers will use to rate your application. The maximum review points that can be earned for each item are shown below. Should you find an item where the information needed is not available, please explain the circumstances. Up to 5 points may be deducted from the total score if the application does not conform to these requirements.

1. Need for the Proposed Community Partnership - 30 Points
   The applicant must demonstrate the need for Federal funding to support the request for AED equipment and training.
1. Description of Need - 15 Points
1. Unmet Health Needs of the Target Population: The target population and its unmet health needs must be described and documented in this section. Demographic data should be used whenever possible to document the unmet needs. Local data is particularly important, but often needs to be complimented by State data, and sometimes by national information. The population to be served must be identified. The population description may include information about the incidence and prevalence of specific conditions, such as cardiovascular disease and mortality, or about the age or socioeconomic status of the target population. Information about local or state EMS response times, specifically those for cardiac arrest and /or heart attack should be included if available. If there are no existing records of response time, a plan on how these times will be obtained should be included.
2. Access Barriers to Needed Services: Please discuss the relevant barriers to health care in the service area that the project hopes to overcome. In some instances there is a general problem of access to particular health services in the community (i.e. EMS, primary care etc.). In other cases, needed services may be available in the community, but not to all who need them. In many rural communities, shortages of health care personnel are important access issues. Any geographic, financial, cultural, linguistic, workforce, or other direct barriers to access should be discussed.
3. Description and Map of the Service Area: Every grant award will impact an area that is geographically bounded in some way. There may be important physical features to the landscape that are important for reviewers to understand. This section describes the area to be served and must include a map of the area to be used as a reference by reviewers. The map does not have to be "tailor made" for this application. It can be simply a copy or portion of an existing map, altered by hand if necessary. To the extent possible, the may should include locations of both existing and proposed placement of AEDs and proximity to stabilizing or definitive care.

 

2. Description of Community Partnership Capability - 15 Points
1. Applicant Management Information: The applicant must describe how the capabilities of a community partnership will be utilized to address the problems described above. The lead applicant organization should be described in this section, with an emphasis on its ability to manage the project network, to administer grant funds, and deliver the services proposed for the project. The applicant's history in providing and managing the relevant services should be discussed. Evidence of success with other similar projects, particularly collaborative endeavors, should be provided when applicable.
2. Management Review Form: The Management Review form included in the application kit must be completed and inserted here. The purpose of this form is to document some of the applicant's financial and management systems. It is used as one tool to evaluate organizational capability to manage Federal funds.
3. Identification of Community Partnership Members: Evidence of the ability to deliver services and otherwise meet the needs of the project should be presented here for each organization participating in the community partnership.
4. History of Community Partnership and Collaborative Activities: The history of how the proposed community partnership has developed should be presented in this section. How did the network come together and decide to make and support this application? Does this application represent the community partnership's first collaboration, or does the partnership have a history of working together in the past? Evidence of any prior efforts by local, State executive, legislative, or other efforts undertaken to increase the number of AEDs in the community partnership service area should be included here. The applicant should describe how their proposal would support, but not duplicate, any prior efforts. If the applicant believes no prior efforts have been undertaken, then a description on how funds would support the creation of new initiatives should be included.
5. Letters of Commitment from Community Partnership Members: Each letter should commit that particular community partnership member explicitly to the role assigned to it. The ability of each community partnership member to fulfill its role should have been established in section A.2.c. All letters of commitment should be included at the end of the application as an appendix.
2. Project Delivery Plan - 40 Points
   Now that the applicant has described the need for the proposed project and the community partnership's capability to meet the need, this section describes the project delivery plan to meet the need.
1. Organizational Structure - 10 points
   The applicant describes the organizational structure of the rural community partnership and the delegation of appropriate authority to provide adequate oversight and management to ensure collaboration among the participants. The roles and responsibilities of each member of the community partnership and the relative contribution of each to the project goals and activities are clearly defined. The process to be used for gaining collaboration across all relevant agencies in the public and private sectors, including the entities comprising the community partnership is defined. The Fiscal Agent for grant funds is described. The applicant provides descriptions of the qualifications of key project staff involved in ensuring completion of project goals and outcomes.
2. Chart of Project Goals, Strategies, Activities, Responsible Agents and Completion Milestones - 10 points
   These are the components of a project plan. A goal is something that is to be accomplished by the proposed project. If the grant is received and if its implementation is successful, the result may be thought of as the goal fulfilled. Community partnerships may state a single goal or multiple goals. Applicants should indicate, if accomplished, how significant the realization of the goal(s) will be for the target population and for others in the community. A strategy is a plan to accomplish a goal, or a portion of a goal. An activity is an action step toward completion of a strategy. Responsible agents are persons or organizations that are responsible for completing activities. Completion dates are deadlines by which goals, strategies and activities are to be completed by responsible agents. Outcomes and/or process measures are used to determine whether a goal, a strategy or an activity has been achieved. Using these measures, the applicant should identify a process for periodic feedback and program modification as necessary.
   The applicant should include a chart that identifies the responsible partnership agency that is responsible for accomplishing each goal, strategy and activity, and by what date. A timeline must be included. The chart should be explained in this section and in agreement with the Budget Narrative. Any information included in this chart must also be explained in the narrative part of this section.
   The chart below is illustrative. Some applicants may develop a different but equally effective format. For example, some applicants have included sub-goals, or objectives. Only charts may be generated in 10 pitch fonts.

Goals	Objectives	Activities	Anticipated Outputs or Outcomes	How Measured	Performance Period	Resposible Organization/ Person
1.	A. B.	a. b. c.
2.	A.	a.

The applicant provides an accompanying narrative that describes how the goals and activities outlined in the matrix will be accomplished. The narrative should include a description of how the proposed grant-funded activities would further the community partnership's strategic plan. If a community partnership has not yet developed a strategic plan, the matrix and narrative should include details for how the applicant intends to develop a strategic plan. This includes the allocation of appropriate resources in the application budget to accomplish this task.
3. AED Placement Plan - 10 points
   The applicant provides a detailed plan for the proposed placement of AEDs, including an accessibility plan for the AEDs. The sites should represent fair geographical, organizational (e.g., first response verses public access placement) and efficient resource allocation. When considering AED placement locations in your proposed service area, please consider: rural eligibility, average age of population, number of AEDs nearby, presence of an established 911 dispatching system, 24/7 availability, average response time of AED to potential call locations, training resources in the community and the number of lay persons or health care personnel already trained in AED usage.
4. Detailed Training Plan - 10 points
   The applicant should include a detailed training plan. There should be a clear relationship between the plan and the needs outlined in the budget requested. The plan should include the following information:
   • Description and name of the identified and approved CPR and AED training entity. This description should include what nationally recognized training program the course follows, where the training will occur, when it will occur during the grant period, or how often if multiple groups within an entity need be trained. The cost of the training course(s) should be provided in the budget section.
   • Description of State laws pertaining to the allowable usage of AEDs including State protocols of AED care and legal oversight.
   • Date when the applicant's State EMS Office would be notified of AED placement to ensure optimal integration of grant-funded efforts with established local EMS system efforts. This should also include notification to local 911 dispatching centers, if equipped with 9-1-1, so that these centers are aware of new AED placement locations and are prepared to direct laypersons in AED use until EMS arrives on scene.
   • Description of proposed AED maintenance schedule.
3. Budget - 20 Points
   1. General Information
      The applicant provides required budget forms and a budget narrative that are appropriate and adequate to accomplish the stated project goals, action steps, and expected outputs and outcomes as described in the project narrative and matrix. The budget should be reasonable, allocates Federal funds for allowable purposes, and should address:
      • AED purchasing, including brand and model information.
      • Training and maintenance costs.
      • Data reporting costs.
      • Description of budget and accounting processes to be used.
      This section is the location for the narrative justification of your budget and the completed Budget Forms (SF 424A), which are described below.

4. Sustainability Plan - 5 Points
   1. General Information
      Discuss planning on how these funds will be the seed for continuing to purchase and place AEDs in areas serviced by the proposed community partnership. This planning should identify:
      • Mechanism for periodic/ongoing planning and assessment of member and community needs
      • How the community partnership plans to meet its long-range leadership and staffing needs
      • Alternative sources of community partnership revenue, including an approach for soliciting in-kind or matching funding
      • How the community partnership plans to build financial reserves (i.e., acquiring funds to meet both longer-term operational needs)
      • How the community partnership plans to acquire sustained financial commitment from its members and to support ongoing partnership activities

5. Evaluation - 5 Points
   1. General Information
      • The applicant proposes appropriate output and outcome measures for the goals, objectives, and activities described in the project matrix and narrative
      • The applicant explains any assumptions made in developing the project matrix and outlines anticipated outputs and outcomes
      • The applicant describes the process by which data for these measures will be collected and analyzed, including an approach for evaluating the community partnership's progress towards its proposed outputs and outcomes in collaboration with its State EMS Office and/or State Office of Rural Health
      • The applicant describes a continuous self-evaluation plan that would measure, monitor, and improve the community partnership's progress toward identified goals and objectives