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U.S. Department of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau

Universal Newborn Hearing Screening and Intervention

Reducing Loss to Follow-up after Failure to Pass Newborn Hearing Screening

New Competing Application Program Guidance

HRSA 09-142

Catalog of Federal Domestic Assistance (CFDA) No. 93.251

PROGRAM GUIDANCE

Fiscal Year 2009

Application Due Date: May 8, 2009

Release Date: March 17, 2009

Date of Issuance: March 17, 2009

Irene Forsman MS, RN

Dir., Newborn Hearing Screening Program

Division of Services for Children with Special Health Needs

Telephone: 301-443-9023

Fax: 301-443-8604

Authority: Section 399M of the PHS Act, as amended (42 USC 280g-1)

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Guidance Table of Contents

I. Funding Opportunity Description 3

1. Purpose 3

2. Background 3

II. Award Information 3

1. Type of Award 3

2. Summary of Funding 3

III. Eligibility Information 3

1. Eligible Applicants 3

2. Cost Sharing/Matching 3

3. Other 3

IV. Application and Submission Information 3

1. Address to Request Application Package 3

Application Materials and Required Electronic Submission Information 3

2. Content and Form of Application Submission 3

Application Format Requirements 3

Application Format 3

i. Application Face Page 3

ii. Table of Contents 3

iii. Application Checklist 3

iv. Budget 3

v. Budget Justification 3

vi. Staffing Plan and Personnel Requirements 3

vii. Assurances 3

viii. Certifications 3

ix. Project Abstract 3

x. Program Narrative 3

xi. Program Specific Forms 3

3. Submission Dates and Times 3

4. Intergovernmental Review 3

5. Funding Restrictions 3

6. Other Submission Requirements 3

1. Review Criteria 3

2. Review and Selection Process 3

VI. Award Administration Information 3

1. Award Notices 3

2. Administrative and National Policy Requirements 3

3. Reporting 3

VIII. Tips for Writing a Strong Application 3

APPENDIX A: HRSA’s Electronic Submission User Guide 3

Appendix B: Registering and Applying Through Grants.gov 3

APPENDIX C: MCHB Discretionary Grant Performance Measures 3

Appendix D: Program Specific Information – MCH Financial and Demographic Forms 3

I. Funding Opportunity Description

1. Purpose

The authority for this program is Title III, Sec.399M of Public Health Service Act, as amended. This announcement solicits applications for reducing the loss to follow-up of infants who have not passed a physiologic newborn hearing screening examination prior to discharge from the newborn nursery. All states, the District of Columbia, Puerto Rico, Guam, the Commonwealth of the Northern Marianas and Palau have received funds for the development and implementation of statewide universal newborn hearing screening and intervention programs beginning in the year 2000. About 95% of newborns in the USA are now screened for hearing loss in the first days of life. The goal for infants suspected of a hearing loss is to have that loss ruled out or confirmed before the infant is 3 months of age. If a hearing loss is confirmed, the infant and family should be entered into a program of early intervention as early as possible but before the infant reaches 6 months. Nationally about 20-40% of infants for whom further assessment is indicated do not return for follow-up. This funding opportunity is to initiate new activities to significantly reduce this loss to follow-up.

2. Background

Newborn hearing screening programs are not new. Beginning in 1988, HRSA’s Maternal and Child Health Bureau supported a project to demonstrate the feasibility of implementing universal statewide physiologic hearing screening of newborn infants prior to discharge from the hospital nursery in three States: Rhode Island, Utah and Hawaii. Based on the success of this program, States began to implement newborn hearing screening programs. Passage of the “Walsh” bill in 1999 allowed HRSA’s MCHB to initiate a national program of newborn hearing screening and intervention by providing funds to States for that purpose.

By 2006, all States and several jurisdictions had implemented the screening programs; however, appropriate and timely follow-up for infants who should receive further assessment continues to be a major problem for most States. While several States are reporting losses in the neighborhood of 10%, many are closer to the 40% loss range. The reasons for these differences are many and some are more amenable to change than others.

During the past two years, the Division of Services for Children with Special Health Needs (DSCSHN) has worked with the National Initiative on Child Health Quality (NICHQ) and eight States to identify points in the hearing screening and intervention system where babies and families seem to get “lost” and to identify some small changes that might prevent that from happening. For example, States piloted those changes in one hospital system or one county, and then spread successful changes to larger systems or in some instances state-wide. Applicants are expected to employ those successful small changes described in the Narrative Section below, in their statewide programs in order to compete successfully for this grant program.

HRSA is committed to ensuring access to quality health care for all. Quality care means access to services, information, materials delivered by competent providers in a manner that factor in the language needs, cultural richness, and diversity of populations served. Quality also means that, where appropriate, data collection instruments used should adhere to culturally competent and linguistically appropriate norms. For additional information and guidance, refer to the National Standards for Culturally and Linguistically Appropriate Services in Health Care published by the U.S. Department of Health and Human Services. This document is available online at http://www.omhrc.gov/CLAS.

Wherever appropriate, identify programs, training and technical assistance implemented to improve health communications to foster healing relationships across culturally diverse populations.

Wherever appropriate, describe the program’s or institution’s strategic plan, policies, and initiatives that demonstrate a commitment to providing culturally and linguistically competent health care and developing culturally and linguistically competent health care providers, faculty, staff, and program participants. This includes participation in, and, support of programs that focus on cross-cultural health communication approaches as strategies to educate health care providers serving diverse patients, families, and communities.

Wherever appropriate, provide a plan for using training to increase self-awareness of multicultural and health literacy issues and engage individuals, families, and communities from diverse social, cultural, and language backgrounds in self-managing their health care.

Wherever appropriate, describe the program or institution’s strategic plan, policies, and initiatives that demonstrate a commitment to serving the specific target population and familiarity with the culture and literacy level of the particular target group.

Wherever appropriate, describe the program’s or institution’s past performance in recruiting and retaining health care providers, faculty, staff and students with demonstrated experience serving the specific target population and familiarity with the culture of the particular target group.

Wherever appropriate, describe a plan to recruit and retain staff, health care providers, faculty, and students with demonstrated experience serving the specific target population and familiarity with the culture and literacy level of the particular target group.

Wherever appropriate, present a summary of specific training, and /or learning experiences to develop knowledge and appreciation of how culture and language influences health literacy improvement and the delivery of high quality, effective and predictably safe healthcare services.

Further Information

Additional resource information can be found on the HRSA cultural competence web page, located at http://www.hrsa.gov/culturalcompetence.

For further information, please contact the HRSA Office of Minority Health and Health Disparities.

II. Award Information

1. Type of Award

Funding will be provided in the form of a grant.

2. Summary of Funding

This program will provide funding for Federal fiscal years 2009 -2011. Approximately $500,000 is expected to be available annually to fund up to 4 applicants. Funding beyond the first year is dependent on the availability of appropriated funds for the Newborn Hearing Screening Program in subsequent fiscal years, grantee satisfactory performance, and a decision that funding is in the best interest of the Federal government.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants for this initiative are those State agencies or entities working in partnership with State agencies to fully implement the newborn hearing screening and intervention program with a focus on reducing loss to follow-up. States that are receiving newborn hearing screening funds through the Maternal and Child Health Bureau (MCHB) program with project periods ending August 31, 2009 AND States that are currently NOT receiving newborn hearing screening funds through the MCHB are eligible to apply for this opportunity.

2. Cost Sharing/Matching

No cost sharing or matching is required.

3. Other

Applications that exceed the ceiling amount of $150,000 will be considered non-responsive and will not be considered for funding under this announcement.

Any application that fails to satisfy the deadline requirements referenced in Section IV.3 will be considered non-responsive and will not be considered for funding under this announcement.

IV. Application and Submission Information

1.  Address to Request Application Package

Application Materials and Required Electronic Submission Information

HRSA is requiring applicants for this funding opportunity to apply electronically through Grants.gov. All applicants must submit in this manner unless the applicant is granted a written exemption from this requirement in advance by the Director of HRSA’s Division of Grants Policy or designee. Grantees must request an exemption in writing from , and provide details as to why they are technologically unable to submit electronically though the Grants.gov portal. Make sure you specify the announcement number for which you are seeking relief. As indicated in this guidance, HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval.

Refer to Appendix A for detailed application and submission instructions. Pay particular attention to Section 3, which provides detailed information on the competitive application and submission process.

Applicants must submit proposals according to the instructions in Appendix A, using this guidance in conjunction with Public Health Service (PHS) Application Form 5161-1. These forms contain additional general information and instructions for grant applications, proposal narratives, and budgets. These forms may be obtained from the following sites by:

(1) Downloading from http://www.hrsa.gov/grants/forms.htm

Or

(2) Contacting the HRSA Grants Application Center at:

The Legin Group, Inc.

910 Clopper Road

Suite 155 South

Gaithersburg, MD 20878

Telephone: 877-477-2123

Instructions for preparing portions of the application that must accompany Application Form 5161-1 appear in the “Application Format” section below.

2.  Content and Form of Application Submission

Application Format Requirements

See Appendix A, Section 5 for detailed application submission instructions. These instructions must be followed.

The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA, approximately 10 MB. This 80-page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard forms are NOT included in the page limit.

Applications that exceed the specified limits (approximately 10 MB, or that exceed 80 pages when printed by HRSA) will be deemed non-compliant. All non-compliant applications will be returned to the applicant without further consideration.

Application Format

Applications for funding must consist of the following documents in the following order:

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SF 424 Non Construction – Table of Contents

%  It is mandatory to follow the instructions provided in this section to ensure that your application can be printed efficiently and consistently for review.

%  Failure to follow the instructions may make your application non-compliant. Non-compliant applications will not be given any consideration and those particular applicants will be notified.

%  For electronic submissions, applicants only have to number the electronic attachment pages sequentially, resetting the numbering for each attachment, i.e., start at page 1 for each attachment. Do not attempt to number standard OMB approved form pages.

%  For electronic submissions no table of contents is required for the entire application. HRSA will construct an electronic table of contents in the order specified.

%  When providing any electronic attachment with several pages, add table of content page specific to the attachment. Such page will not be counted towards the page limit.

%  For paper submissions (when allowed), number each section sequentially, resetting the page number for each section. i.e., start at page 1 for each section. Do not attempt to number standard OMB approved form pages.

%  For paper submissions ensure that the order of the forms and attachments is as specified below.

Application Section / F / Instruction / HRSA/Program Guidelines /
Application for Federal Assistance (SF-424) / Form / Pages 1, 2 & 3 of the SF-424 face page. / Not counted in the page limit
Project Summary/Abstract / Attachment / Can be uploaded on page 2 of SF-424 - Box 15 / Required attachment. Counted in the page limit. Refer guidance for detailed instructions. Provide table of contents specific to this document only as the first page
Additional Congressional District / Attachment / Can be uploaded on page 2 of SF 424 - Box 16 / As applicable to HRSA; not counted in the page limit
HHS Checklist Form PHS-5161 / Form / Pages 1 & 2 of the HHS checklist. / Not counted in the page limit
Project Narrative Attachment Form / Form / Supports the upload of Project Narrative document / Not counted in the page limit
Project Narrative / Attachment / Can be uploaded in Project Narrative Attachment form. / Required attachment. Counted in the page limit. Refer guidance for detailed instructions. Provide table of contents specific to this document only as the first page
SF-424A Budget Information - Non-Construction Programs / Form / Page 1 & 2 to supports structured budget for the request of Non construction related funds / Not counted in the page limit
SF-424B Assurances - Non-Construction Programs / Form / Supports assurances for non construction programs / Not counted in the page limit
Disclosure of Lobbying Activities (SF-LLL) / Form / Supports structured data for lobbying activities. / Not counted in the page limit
Other Attachments Form / Form / Supports up to 15 numbered attachments. This form only contains the attachment list / Not counted in the page limit
Attachment 1-15 / Attachment / Can be uploaded in Other Attachments form 1-15 / Refer to the attachment table provided below for specific sequence. Counted in the page limit

%  To ensure that attachments are organized and printed in a consistent manner, follow the order provided below. Note that these instructions may vary across programs.