Capital Assistance for Disaster Response and Recovery Efforts (CADRE)

Capital Assistance for Disaster Response and Recovery Efforts (CADRE) is sponsored by Health Resources & Services Administration (HRSA). These grants support infrastructure upgrades that improve care delivery in communities.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES # Bureau of Primary Health Care # Office of Policy and Program Development # Capital Assistance for Disaster Response and Recovery Efforts (CADRE) # Funding Opportunity Number: HRSA-20-097 # Funding Opportunity Type(s): New # Assistance Listings (CFDA) Number: 93. 224 # NOTICE OF FUNDING OPPORTUNITY # Application Due Date in Grants.

gov: April 6, 2020 # Supplemental Information Due Date in HRSA EHBs: May 6, 2020 Ensure your SAM. gov and Grants. gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration. Registration in all systems, including SAM. gov and Grants.

gov, may take up to 1 month to complete. Issuance Date: March 5, 2020 Public Health Analyst, Office of Policy and Program Development Telephone: (301) 594-4300 Contact: https://www. hrsa.

gov/about/contact/bphc. aspx Authority: Additional Supplemental Appropriations for Disaster Relief Act, 2019 (PL 116-20) Title XVIII, and section 330 of the Public Health Service Act, as amended (42 U.S.C. 254b), HRSA-20-097 i The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Capital Assistance for Disaster Response and Recovery Efforts (CADRE).

The purpose of this funding opportunity is to assist health centers with at least one service delivery site in areas declared by the Federal Emergency Management Agency to have been impacted by Hurricanes Florence and Michael, Typhoon Mangkhut, Super Typhoon Yutu, and wildfires and earthquakes occurring in calendar year 2018; and tornadoes and floods occurring in calendar year 2019 in those areas for which a major disaster or emergency has been declared under Section 401 or 501 of the Robert T.

Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170 and 5191) to: • Respond and recover from emergency and/or disaster impacts, and/or • Increase the capacity and capability to respond to and/or recover from future emergencies and/or disasters and support continuity of access to high quality primary care services for underserved and vulnerable populations.

Funding Opportunity Title: Capital Assistance for Disaster Response and Recovery Efforts (CADRE) Funding Opportunity Number: HRSA-20-097 Due Date for Applications – Grants. gov: April 6, 2020 (11:59 p. m.

ET) Due Date for Applications – HRSA EHBs--— HRSA Electronic Handbooks (EHBs) Anticipated Total Annual Available Estimated Number and Type of Award(s): Approximately 225 awards Estimated Award Amounts: Track 1 - Equipment Only: Up to $100,000 per award to support the purchase of moveable equipment for one or more eligible service-delivery sites.

Track 2 - Minor Construction-Related: Up to $250,000 per award to support alteration/renovation and/or construction/expansion activities with or without equipment at up to three eligible service-delivery sites. Track 3 – Major Construction-Related: Up to $1,000,000 per HRSA-20-097 ii award for alteration/renovation and/or construction/expansion activities, with or without equipment, at one eligible service delivery site.

Cost Sharing/Match Required: No Period of Performance: September 1, 2020 through August 31, 2023 (3 years) Eligible Applicants: Existing health centers receiving Health Center Program operational support (under sections 330(e), (g), (h), and/or (i)) at the time of application and at the time of award. As further explained in Section III.

1 of this notice of funding opportunity (NOFO), the health center also must have at least one service delivery site located in a disaster-impacted area within its approved health center scope of project (as indicated on Form 5B: Service Sites). See Appendix A for a list of disaster-impacted areas.

HRSA-20-097 iii You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide, available online at http://www. hrsa. gov/grants/apply/applicationguide/sf424guide.

pdfhttps://www. hrsa. gov/s ites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.

pdf , except where instructed in this NOFO to do otherwise. The Health Resources and Services Administration (HRSA) will offer technical assistance to applicants seeking CADRE funding. Technical assistance will provide an overview of these instructions and an opportunity for applicants to ask questions on the application process and CADRE objectives.

Visit the CADRE technical assistance webpage at https:// bphc. hrsa. gov/program-opportunities/funding-opportunities/cadre for details about live and recorded events, frequently asked questions, example documents, and other resources.

See Agency Contacts for where to direct program, application system, and budget questions. HRSA-20-097 iv I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION ................................

......................... 1 1. PURPOSE ................................................................................................

.......................... 1 2. BACKGROUND ................................................................................................

................... 1 II. AWARD INFORMATION ................................................................................................

....... 1 1. TYPE OF APPLICATION AND AWARD ................................................................

.................... 1 2. SUMMARY OF FUNDING ................................................................................................

...... 2 III. ELIGIBILITY INFORMATION ................................................................

............................... 3 1. ELIGIBLE APPLICANTS ................................................................................................

....... 3 2. COST SHARING /M ATCHING ................................................................................................

. 3 3. O THER ................................................................................................

.............................. 3 IV. APPLICATION AND SUBMISSION INFORMATION ................................

........................... 4 1. ADDRESS TO REQUEST APPLICATION P ACKAGE ................................................................

.. 4 2. CONTENT AND FORM OF APPLICATION SUBMISSION ................................

............................ 4 i. Project Abstract ................................................................................................

...... 5 ii. Project Narrative ................................................................................................

..... 5 iii. Budget ................................................................................................

..................... 8 iv. Budget Narrative ................................................................................................

..... 8 v. Project-Specific Forms ................................................................

........................... 9 vi. Attachments ........................................................................................................

12 3. DUN AND BRADSTREET D ATA UNIVERSAL N UMBERING SYSTEM (DUNS) NUMBER AND SYSTEM FOR AWARD M ANAGEMENT ...................................................................................... 13 4.

SUBMISSION DATES AND TIMES ........................................................................................ 14 5. I NTERGOVERNMENTAL REVIEW .........................................................................................

14 6. FUNDING RESTRICTIONS .................................................................................................. 14 V.

APPLICATION REVIEW INFORMATION........................................................................... 15 1. REVIEW CRITERIA ............................................................................................................

15 2. REVIEW AND SELECTION PROCESS ................................................................................... 17 3.

ASSESSMENT OF RISK AND O THER PRE -A WARD ACTIVITIES .............................................. 17 VI. AWARD ADMINISTRATION INFORMATION ....................................................................

18 1. AWARD NOTICES ............................................................................................................. 18 2.

ADMINISTRATIVE AND N ATIONAL POLICY REQUIREMENTS .................................................. 18 3. REPORTING .....................................................................................................................

24 VII. AGENCY CONTACTS....................................................................................................... 25 VIII.

OTHER INFORMATION ................................................................................................... 26 APPENDIX A: FEMA DESIGNATED DISASTER AND EMERGENCY DECLARATIONS AND IMPACTED AREAS ................................................................................................................. 27 APPENDIX B: ALLOWABLE AND UNALLOWABLE COSTS ...............................................

32 HRSA-20-097 1 # I. Program Funding Opportunity Description This notice announces the opportunity to apply for funding under the Capital Assistance for Disaster Response and Recovery Efforts (CADRE).

The purpose of this funding is to assist health centers with at least one service delivery site in areas declared by the Federal Emergency Management Agency (FEMA 1) to have been impacted by Hurricane Florence, Hurricane Michael, Typhoon Mangkhut, Super Typhoon Yutu, wildfires, and earthquakes occurring in calendar year 2018; and/or tornadoes or floods occurring in calendar year 2019 in those areas for which a major disaster or emergency has been declared under Section 401 or 501 of the Robert T.

Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170 and 5191) to: • Respond and recover from emergency and/or disaster impacts and/or; Increase the capacity and capability to respond to and/or recover from future emergencies and/or disasters; and Support the continuity of access to high quality primary care services for underserved and vulnerable populations.

A list of FEMA-declared emergency and/or disaster events is available in Appendix A. This funding opportunity is authorized by Additional Supplemental Appropriations for Disaster Relief Act, 2019, P. L.

116-20, and section 330 of the Public Health Service Act, as amended (42 U.S.C. 254b). In calendar years 2018 and 2019, the United States and its territories endured multiple natural disasters, including hurricanes, typhoons, wildfires, earthquakes, tornadoes, and floods.

These natural disasters resulted in loss of life, injury, and costly damage to infrastructure and property. This funding opportunity supports the critical role that health centers play in responding to and recovering from natural disasters by supporting continuity of essential primary health care services for these underserved communities. 1.

Type of Application and Award Type(s) of applications sought: New HRSA will provide funding in the form of a grant. > 1The Federal Emergency Management Agency ( FEMA ) coordinates the federal government’s role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror. www.

fema. gov . HRSA will provide approximately $79,000,000 to fund an estimated 225 awards across the three available tracks (equipment, minor construction-related, major construction-related).

You may use CADRE funding at an existing or a proposed new site within the identified disaster-impacted area(s). You may submit one application to request funding through only one of the following funding tracks: Track Activities Estimated Purchase of moveable equipment.

Approximately $10,000,000 Up to $100,000 for approximately 100 awards Minor Construction-Related Alteration/renovation 4,and/or construction/expansion 5 activities with or without equipment. Approximately $19,000,000 Up to $250,000 for approximately 75 awards Up to three service-delivery sites Major Construction-Related Alteration/renovation, and/or construction/expansion activities with or without equipment.

Up to $1,000,000 for approximately 50 awards One site-specific project HRSA may adjust the total number of awards for each track based on the number and quality of applications received and reviewed for each track. The period of performance is September 1, 2020 through August 31, 2023 (3 years). Equipment-only activities include the purchase of moveable equipment items with a useful life of more than one year.

Moveable equipment includes non-expendable equipment items that can be readily shifted from place to place without requiring a change in the utilities or structural characteristics of the space. Can support any number of eligible service delivery sites, as moveable equipment purchases are not site-specific.

Alteration/renovation can consist of activities to modernize, improve, and/or reconfigure the interior arrangements of an existing facility; permanently affixing equipment (e.g., heating, ventilation, and air-conditioning (HVAC) units; exterior generators; lighting); work to improve and/or replace exterior envelope; work to improve accessibility (such as sidewalks and ramps) and/or life safety requirements in an existing facility.

Work outside of the building is limited to improvements to the building entry for handicapped accessibility, generator concrete pads, and other minor ground disturbance.

Construction/expansion activities can include the construction of a new stand-alone structure and/or associated work required to expand a structure to increase the total square feet of a facility and/or the installation of a permanently affixed modular or prefabricated building and/or significant site work such as new parking lots or storm water structures.

If a proposed facility expansion project also includes alteration/renovation to the existing structure, this falls under construction/expansion activities. HRSA-20-097 3 All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75 . # III.

Eligibility Information You must meet all of the following eligibility requirements for consideration for funding under this announcement. a) You are an existing health center receiving Health Center Program operational support (under sections 330(e), (g), (h), and/or (i)) at the time of application and at the time of award.

b) You have at least one service delivery site located in a FEMA declared disaster-impacted area within your approved health center scope of project (as indicated on your Form 5B: Service Sites) See Appendix A for a list of disaster-impacted areas. Cost sharing/matching is not required for this program. HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.

4 and the requirement relating to direct operation of the service delivery site as described in Section III. 1 non-responsive and will not consider it for funding under this notice. You may not propose a project that will be located at a sub-recipient or contractor site.

NOTE: Multiple applications from an organization are not allowable. 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, HRSA 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. Additions to Current Scope of Project You may propose to change your Health Center Program scope of project to add a new service delivery site within the FEMA declared disaster-impacted area as part of the CADRE funding opportunity. 6 You may not use CADRE funds to propose the addition of administrative-only sites.

If you propose a project at a new site not currently in your approved scope of project, you must complete the Add Site Checklist as part of the > 6Refer to Policy Information Notice (PIN) 2008-01: Defining Scope of Project and Policy for Requesting Changes available at https://bphc. hrsa. gov/programrequirements/policies/pin200801.

html and Policy Information Notice (PIN) 2007-09: Service Area Overlap: Policy and Process at > https://bphc. hrsa. gov/programrequirements/policies/pin200709.

html application process for HRSA review and approval as part of your application. Any site additions for applications submitted for the Equipment-Only track will be limited to proposing only new mobile medical van site(s). CADRE funding may not supplant other resources (federal, state, local, or private funds).

You may not propose construction-related activities associated with a project or connected activity (e.g., installation of utilities, demolition) that starts before the CADRE award date, September 1, 2020. Proposed CADRE-funded projects must be separate and distinct from any other construction projects. See Appendix B for further details regarding allowable and unallowable costs.

# IV. Application and Submission Information 1. Address to Request Application Package HRSA requires you to apply electronically.

HRSA encourages you to apply through Grants. gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www. grants.

gov/applicants/apply-for-grants. html . The NOFO is also known as “Instructions” on Grants.

gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including modifications and/or republications of the NOFO on Grants. gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application.

Please note you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities. 2. Content and Form of Application Submission Section 4 of HRSA’s SF-424 Two-Tier Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract.

You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.

111(a)). See Section 9. 5 of the Application Guide for the Application Completeness Checklist.

The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Indirect Cost Rate Agreement and HRSA-20-097 5 proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit. Applications must be complete, within the specified page limit, and validated by Grants.

gov under the correct funding opportunity number prior to the deadline to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification 1) You, on behalf of the applicant organization certify, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75. 371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C.

3321). 3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 6-11: Other Relevant Documents. See Section 4.

1 viii of HRSA’s SF-424 Two-Tier Application Guide for additional information on all certifications. Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Two-Tier Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following: See Section 5. 1.

ix of HRSA’s SF-424 Two-Tier Application Guide . Proposal Cover Page (EHBs) Successful applications will contain the information below. Enter information within the following section headers for the cover page: Choose one of the following tracks: o Track 1 - Equipment-Only; o Track 2 - Minor Construction-Related; or o Track 3 - Major Construction-Related 1.

NEED -- Corresponds to Section V’s Review Criterion(a) #1-NEED a) Describe how the emergency and/or disaster event(s) impacted your community, organization and/or your patient population. b) Describe the health center infrastructure/capital needs to support its response and recovery efforts, and/or to increase its capacity or capability to address future emergencies and/or disasters.

HRSA-20-097 6 c) Describe the infrastructure/capital needs to support the health center’s ability to ensure continuity of access to high quality primary health care services. 2. RESPONSE -- Corresponds to Section V’s Review Criterion(a) #2 - RESPONSE a) Provide a comprehensive, consolidated description of the proposed project(s).

b) Describe how the proposed project(s) will support the health center in its efforts to respond to future emergencies or disasters and/or recover from the emergency and/or disaster event. c) Describe how the proposed project(s) will support the health center to ensure current and/or future continuity of access to high quality primary health care services. 3.

IMPACT -- Corresponds to Section V’s Review Criterion(a) #3 - IMPACT a) Describe how the proposed project(s) will support the health center to increase its capacity and/or capability to respond to and/or recover from future emergencies and/or disasters, and support continuity of access to high quality primary health care services.

b) Identify the number of patients the proposed project(s) will support in the health center’s effort to ensure a current and/or future continuity of access to high quality primary health care services. 4.

RESOURCES/CAPABILITIES -- Corresponds to Section V’s Review Criterion(a) #4-RESOURCES/CAPABILITIES a) Describe the administrative structure and oversight for the proposed project, including: o The expertise and experience of key staff responsible for managing/overseeing the project and previous/similar projects, and the individual(s) (name and title); o The expertise and experience in acquisition strategies, policies, and procedures that comply with federal procurement requirements; and o Any other funds needed and available to support the project.

b) Provide a timeline to support completing the project(s) within the identified budget and specified period of performance, including key milestones (i.e., planning, design, securing permits and/or variances, environmental and historic perseveration process, and contracting process). HRSA-20-097 7 c) Describe the status of securing the proposed project site, where applicable.

o If you are adding a new site or mobile unit site, describe how this site will ensure current and/or future continuity of access to high quality primary health care services in the disaster-impacted areas. o If the site is leased, provide a letter of consent from the landlord to implement the project and acknowledges Federal Interest via attachment (see Leasehold Improvements section in VI.

Award Administration Information for more details). For leased sites, provide details regarding the length of lease and its appropriateness for the funding requested, e.g., the length of the lease extends for a minimum of five (5) years from the project period end date (current period, including option year(s), if needed).

d) Describe how additional operational costs (including utilities, daily maintenance and repair, and long-term capital reinvestment) resulting from the proposed project will be supported within the existing or projected operational budget for the health center. 5.

SUPPORT REQUESTED – Corresponds to Section V’s Criterion(a) #5-SUPPORT REQUESTED a) Attach a budget justification for each proposed project as instructed in the Project-Specific Forms that provides a clear, detailed description for each cost classification (as outlined in Appendix B).

b) For Funding Track 1: Equipment Only projects, provide a complete and reasonable equipment list (in EHBs in the Project-Specific Forms) that aligns with the goals and objectives of the proposed project.

c) For Funding Track 2: Minor Constructions-related and Funding Track 3: Major Construction-related projects: For Alteration/Renovation and/or Construction/Expansion activities: o Provide a Project Description and budget justification that are consistent with the construction work shown on the schematic drawing and site plan documentation provided for the proposed project.

o Submit drawings depicting the spaces to be added and/or improved as well as other proposed actions for the project. o Provide a complete and reasonable equipment list (in EHBs in the Project-Specific Forms) that aligns with the goals and objectives of the proposed project. HRSA-20-097 8 This table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Any attachments referenced in a narrative section may be considered during the objective review. Narrative Sectio n *Review Criteria Response (including Project Description on Project Cover Page for all project types) Resources/Capabilities (4) Resources/Capabilities Budget Presentation (Budget Forms, Budget Narrative, and Project Budget Justification(s)) See Section 4. 1.

iv of HRSA’s SF-424 Two-Tier Application Guide. Note: the directions offered in the SF-424 Application Guide may differ from those offered by Grants. gov. Follow the instructions included in the Application Guide and the additional budget instructions provided below.

A budget that follows the Application Guide will ensure that, if HRSA selects the application for funding, you will have a well-organized plan and by carefully following the approved plan can avoid audit issues during the implementation phase. Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity.

Total Project or Program Costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable. The Further Consolidated Appropriations Act, 2020 (P. L.

116-94), Division A, § 202 does not apply to this program. See Section 5. 1.

v. of HRSA’s SF-424 Two-Tier Application Guide . In addition, the CADRE funding opportunity requires the following: A.

Budget Information for Construction (Consolidated Budget) – Standard Form SF-424C (EHBs) – Required for all applications Complete the SF-424C (in EHBs) as presented for the proposed project. This budget should reflect the total project or program costs of the entire project proposed. See instructions in Appendix B for further details on completing the SF-424C.

HRSA-20-097 9 B. Funding Sources (EHBs) – Required for all applications Identify the total cost associated with the CADRE project proposed and describe all public, private or other sources of funding, including governmental agencies, or other grant funds or proposed debt.

Identify the status of obtaining the full funding needed to undertake the project (e.g., whether the funds are secured, expected, or forthcoming including the date, the source, and amount). C. Assurances – Required for all applications Complete Application Form SF-424D Assurances – Construction Programs provided with the application package.

v. Project-Specific Forms A. Project Qualification Criteria (EHBs) – Required for each project You will provide information to assure that the project is eligible under this funding.

B. Project Cover Page (EHBs) – Required for each project You must describe each proposed project including the project description, site information, project timeline, and attachments as applicable.

• Site Information – Required for Alteration/Renovation and/or Construction/Expansion activities : Provide details regarding the improved project square footage (total square feet of new construction/expansion and/or the alteration/renovation area), as applicable.

• Project Description – Required for each proposed project: Provide a detailed description for the proposed project: o Describe the specific scope of activities, such as:  Purchases of clinical and/or non-clinical moveable equipment items.  Creation of a new stand-alone structure.  Expansion of an existing structure to increase the total square footage.

 Improvement and/or reconfiguration of the interior arrangements of an existing facility.  Installation of permanently affixed equipment.  Modifications and/or repairs to the building exterior (including windows).

 Heating, ventilation, and air-conditioning (HVAC) modifications (including the installation of climate control and duct work).  Electrical upgrades and/or plumbing work. o Identify the project activities in terms of dimensions, square footage, and clinical and non-clinical area(s) to be impacted.

o Describe the proposed method of construction such as design/build, construction management at risk, by the applicant’s own forces, or whether a third party construction manager will be used. HRSA-20-097 10 o Identify whether the planned construction procurement will occur through competitive bid or other method.

• Project Timeline – Required for all projects: Provide a project timeline that identifies the person or entity accountable in your organization for the implementation and oversight of the project, and the number of months for each of the applicable milestones within the 3-year (36 months) period of performance: o Obtaining required permits and/or variances o Meeting Federal environmental and historic preservation requirements o Solicitation of bids and awarding of contracts, alteration/renovation or construction period, o Expected project completion date Describe the status of the proposed project, including any steps accomplished to date, as applicable.

7 C. Budget Information for Construction (Project Budget) – Standard Form SF-424C (EHBs) – Required for each project Complete the SF-424C as presented for each proposed project. See instructions in Appendix B for further details on completing the SF-424C.

D. Form 5B: Service Sites (EHBs) – Required for each project Propose a project at either an existing site in your current Health Center Program scope of project, or propose to add a new site within the designated disaster-impacted area. E.

Equipment List (EHBs) – Required for all projects with equipment purchases Provide a complete and reasonable equipment list (clinical and non-clinical) that aligns with the goals and objectives of the proposed project. NOTE: Equipment purchases supported all or in part by CADRE funding must be maintained, tracked, and disposed of in accordance with 45 CFR Part 75.

While title to the equipment vests with the awardee, the Federal government retains interest in the equipment purchased with Federal funds in accordance with 45 CFR Part 75. F.

Add Site Check List (EHBs) – Required for proposed new sites Applicants proposing to add a site not currently included in your current Health Center Program scope of project must complete the Add Site Checklist for HRSA review and approval as part of your application.

The purchase of a new mobile > 7Proposed alteration/renovation and construction/expansion activities associated with the project or connected activities (e.g., site grading, installation of utilities, demolition) may not start before the award date. Conditions of the grant award must be met, and lifted through a Notice of Award prior to physical activities commencing.

medical van will require you to add a new site within the designated disaster-impacted area. Applications submitted for the Equipment-Only track will be limited to the addition of a mobile medical van site. G.

Other Requirements for Sites (EHBs) – Required for Alteration/Renovation and/or Construction/Expansion activities • Site Control and Federal Interest Identify whether the property is owned or leased.

If the applicant has a title to the property, the applicant must: Attach a plot plan survey,  Attach the title or opinion from counsel describing the applicant’s interest in the site, and certifying the estate or interest is legal and valid, and  Identify potential issues with the site control, e.g., procurement issues, property ownership not at arm’s length.

If the applicant is leasing the project space, the applicant must document in writing that the property owner:  Agrees to the renovation of the property and consent to the language outlined within the Leasehold Improvements section, whether as a provision of a new lease or an amendment to an existing lease, agreed to by both the recipient and lessor/property owner,  Acknowledges Federal Interest in the property, and  Agrees to file a Notice of Federal Interest (NFI) in the land records of the local jurisdiction before the project begins (if applicable).

(See the Leasehold Improvements section in VI. Award Administration Information for more information on the expectations associated with lease agreements.) • Cultural Resource Assessment and Historic Preservation Considerations For alteration/renovation projects, you must respond to each of the following questions:  Is the project facility 50 years or older?

 Does the overall proposed project include a) any renovation/modification to the exterior of the facility (including the installation of new signage), or b) ground disturbance activities (including installation of permanent access ramps, utility work, installation of curb cuts, fencing, and parking)?  Does the project involve alteration/renovation to a project facility that is architecturally, historically, or culturally significant?

 Is the site located on Native American, Alaskan Native, Native Hawaiian, or equivalent culturally significant lands? HRSA-20-097 12 Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit.

Indirect cost rate agreements and proof of non-profit status (if applicable) will not count toward the page limit. You must clearly label each attachment .

Attachment 1: Budget Justification – Required for all projects Provide a budget justification for each proposed project that provides a concise cost estimate, showing quantities, unit prices and total cost for each line item/costs classification in the budget, as well as a breakout of Federal and Non-Federal costs for each line item. Detail information provided in the Funding Sources Form.

Identify the specific sources of other funding and the status of obtaining funding (e.g., whether the funds are secured, expected, or forthcoming, including the date, source, and amount) and describe the plan for securing the balance of the funds that are neither secured nor committed. See sample budget justification: https://bphc. hrsa.

gov/sites/default/files/bphc/programopportunities/fundingopportu nities/capital-development/samplebudgetjust2. pdf Attachment 2: Environmental Information Document (EID) Checklist - Required for Alteration/Renovation and/or Construction/Expansion activities Provide a completed EID checklist for the project. See: https://bphc.

hrsa. gov/sites/default/files/bphc/programopportunities/pdf/environment al-info-doc-2019. pdf Attachment 3: Floor Plans/Schematic Drawings/Site Plan – Required for Alteration/Renovation and/or Construction/Expansion activities Provide a floor plan drawn to scale for the proposed project, including proposed exam rooms, waiting area, etc. Documents must include rough dimensions and room labels for major project components.

Drawings should clearly identify the proposed project components, as well as distinguishing improved space from unaffected space. Where the project or a related component of the work will require activities outside of a building, provide a site plan for the proposed project showing the general layout and location of the existing site conditions.

The plan should clearly diagram the location of the project and indicate the uses and structures proposed for the parcel of land. As applicable, include locations and details on any proposed work or connected activity. Where a project includes only interior renovation of an existing facility, provide a site plan or key plan showing the space(s) to be renovated and the functional relationship within the building.