HRSA GRANT APPLICATION.PDF

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
HIV/AIDS Bureau
Division of Metropolitan HIV/AIDS Programs
Ryan White HIV/AIDS Program Part A
HIV Emergency Relief Grant Program
Funding Opportunity Number: HRSA-18-066
Funding Opportunity Type(s): Competing Continuation
Catalog of Federal Domestic Assistance (CFDA) Number: 93.914
NOTICE OF FUNDING OPPORTUNITY
Fiscal Year 2018
Application Due Date: October 30, 2017
Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!
Deadline extensions are not granted for lack of registration.
Registration in all systems, including SAM.gov and Grants.gov,
may take up to one month to complete.
Issuance Date: August 30, 2017
Steven R. Young, MSPH
Director, Division of Metropolitan HIV/AIDS Programs
Telephone: (301) 443-9091
Fax: (301) 443-5271
Email: SYoung@hrsa.gov
Authority: Public Health Service Act, Sections 2601-2610, and 2693 (42 USC 300ff-11 – 300ff-20, and
300ff-121), as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law
111-87)

EXECUTIVE SUMMARY
The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB),
Division of Metropolitan HIV/AIDS Programs (DMHAP) is accepting applications for
fiscal year (FY) 2018 Ryan White HIV/AIDS Program (RWHAP) Part A HIV Emergency
Relief Grant Program. The purpose of this program is to provide direct financial
assistance to an Eligible Metropolitan Area (EMA) or a Transitional Grant Area (TGA)
that has been severely affected by the HIV epidemic. This competition is open to Part A
jurisdictions to provide RWHAP services in the geographic service areas, as described
in Appendix B.
Eligible jurisdictions may apply for an amount up to the defined funding ceiling listed in
Appendix B, which represents a level five percent above the final FY 2017 award.
Funding Opportunity Title: Ryan White HIV/AIDS Program Part A
HIV Emergency Relief Grant Program
Funding Opportunity Number: HRSA-18-066
Due Date for Applications: October 30, 2017
Anticipated Total Annual Available $619,617,500, of which approximately
FY 2018 Funding: $9,572,100 will be used for priority
funding, and $51,208,700 will be
available for MAI funding.*
Estimated Number and Type of Award(s): Up to 52 grants
Estimated Award Amount: Varies, see Appendix B
Cost Sharing/Match Required: No
Project Period/Period of Performance: March 1, 2018 through February 28, 2019
(one (1) year)
Eligible Applicants: RWHAP Part A recipients that are
classified as an EMA or as a TGA and
continue to meet the eligibility criteria as
defined in the statute are eligible to apply
for these funds.
See Section III-1 of this notice of funding
opportunity (NOFO), formerly known as
the funding opportunity announcement
(FOA), for complete eligibility information.
*Estimated annual available funding level based on current projections.
Application Guide
You (the applicant organization/agency) are responsible for reading and complying with
the instructions included in HRSA’s SF-424 Application Guide, available online at
http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where
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instructed in this NOFO to do otherwise. A short video explaining the Application Guide
is available at http://www.hrsa.gov/grants/apply/applicationguide/.
Technical Assistance
All interested applicants are encouraged to participate in a technical assistance
(TA) webinar for this funding opportunity. The purpose of this webinar is to assist
potential applicants in preparing applications that address the requirements of this
funding notice. Participation in the pre-application TA webinar is optional.
The following technical assistance webinar has been scheduled:
Day and Date: Tuesday, September 12, 2017
Time: 2 p.m. – 4 p.m. ET
Call-In Number: 1-888-810-5901
Participant Code: 8028761
Weblink: https://hrsa.connectsolutions.com/dmhap_fy18/
The pre-application technical assistance webinar will be recorded and should be
available for viewing after September 22, 2017 at Target Center Webinar and Call
Archives.
HRSA-18-066 ii

Table of Contents
I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION ........................................................ 1
1. PURPOSE .......................................................................................................................... 1
2. BACKGROUND ................................................................................................................... 3
II. AWARD INFORMATION ...................................................................................................... 4
1. TYPE OF APPLICATION AND AWARD .................................................................................... 4
2. SUMMARY OF FUNDING ...................................................................................................... 4
III. ELIGIBILITY INFORMATION .............................................................................................. 5
1. ELIGIBLE APPLICANTS ....................................................................................................... 5
2. COST SHARING/MATCHING ................................................................................................. 6
3. OTHER .............................................................................................................................. 6
IV. APPLICATION AND SUBMISSION INFORMATION........................................................... 7
1. ADDRESS TO REQUEST APPLICATION PACKAGE .................................................................. 7
2. CONTENT AND FORM OF APPLICATION SUBMISSION ............................................................ 7
i. Project Abstract ...................................................................................................... 8
ii. Project Narrative ..................................................................................................... 8
iii. Budget ................................................................................................................... 22
iv. Budget Narrative ................................................................................................... 24
v. Attachments .......................................................................................................... 27
3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND
SYSTEM FOR AWARD MANAGEMENT ...................................................................................... 28
4. SUBMISSION DATES AND TIMES ........................................................................................ 29
5. INTERGOVERNMENTAL REVIEW ......................................................................................... 29
6. FUNDING RESTRICTIONS .................................................................................................. 29
V. APPLICATION REVIEW INFORMATION........................................................................... 31
1. REVIEW CRITERIA ............................................................................................................ 31
2. REVIEW AND SELECTION PROCESS ................................................................................... 35
3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES .............................................. 36
4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES .......................................................... 36
VI. AWARD ADMINISTRATION INFORMATION ................................................................... 36
1. AWARD NOTICES ............................................................................................................. 36
2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS .................................................. 37
3. REPORTING ..................................................................................................................... 37
VII. AGENCY CONTACTS ...................................................................................................... 38
VIII. OTHER INFORMATION .................................................................................................. 39
IX. TIPS FOR WRITING A STRONG APPLICATION ............................................................. 39
APPENDIX A ........................................................................................................................... 40
APPENDIX B ........................................................................................................................... 43
HRSA-18-00 iii

I. Program Funding Opportunity Description
1. Purpose
This notice solicits applications for the Ryan White HIV/AIDS Program (RWHAP) Part
A HIV Emergency Relief Grant Program. RWHAP Part A provides direct financial
assistance to an eligible metropolitan area (EMA) or a transitional grant area (TGA)
that has been severely affected by the HIV epidemic. Grant funds assist eligible
jurisdictions to develop or enhance access to a comprehensive continuum of high
quality, community-based care for low-income people living with HIV (PLWH) through
the provision of formula, supplemental, and Minority AIDS Initiative (MAI) funds.
RWHAP Part A recipients must provide comprehensive primary health care and support
services throughout the entire designated geographic service area. The goal is to
provide optimal HIV care and treatment for low-income, uninsured, and underserved
PLWH to improve their health outcomes. Your application must address the entire
service area, as defined in Appendix B.
Comprehensive HIV care consists of core medical services and support services that
enable PLWH and those affected by HIV to access and remain in HIV primary medical
care to improve their medical outcomes. Based on an annual assessment of the
services and gaps in the HIV care continuum within a jurisdiction, HIV Planning
Councils/Planning Bodies (PC/PB) and recipients identify specific service categories to
fund. Funded service categories should facilitate improvements at specific stages of
the HIV care continuum.
RWHAP Part A EMAs and TGAs must use grant funds to support, further develop
and/or expand systems of care to meet the needs of low income PLWH within the
EMA/TGA and strengthen strategies to reach disproportionately impacted
subpopulations. The Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB) requires EMAs/TGAs to collect data to support identification
of need, set priorities and make allocations, and validate the use of RWHAP funding.
A comprehensive application should reflect how you have used those data to develop
and expand the system of care in EMA/TGA jurisdictions.
Important Notes:
• Budget: HAB has updated the budget section. You must submit a detailed
line item budget and justification as part of the application. You may apply for
no more than the published ceiling amount in Appendix B. Please note that
your application budget that is approved, or subsequently amended, during the
award process will be your approved budget for the 2018 period of
performance. HAB no longer requires you to provide a revised budget with the
Program Submission reporting requirement.
• Work Plan: HAB has updated the Work Plan requirements. You will only be
required to submit an HIV Care Continuum Table, Service Category Plan
Table, and narratives with this NOFO. You will not submit the Implementation
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Plan Table as part of your application or as a component of your Program
Submission reporting requirement.
• Unmet Need: HAB has integrated the Unmet Need requirement in this NOFO
into the Demonstrated Need section. HAB does not require new estimates for
unmet need. Please review carefully when preparing this section of your
application.
• Clinical Quality Management (CQM): While this NOFO requires you to
address two components related to data for CQM, please note that you will be
required to submit a CQM Plan as part of the Program Submission reporting
requirement.
The following information will assist you in understanding and completing your FY
2018 application:
• Policy Clarification Notices: Information on the RWHAP and HAB Policy
Clarification Notices (PCN) are available online at
http://hab.hrsa.gov/manageyourgrant/policiesletters.html.
• Allowable Services and Service Definitions: Core medical services are
listed in Section 2604(c)(3) of the Public Health Service (PHS) Act. Support
services allowed under RWHAP Part A are limited to services that are needed
for PLWH to achieve their medical outcomes, as defined by RWHAP. The
service definitions effective for awards issued on or after October 1, 2016, are
listed in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible
Individuals and Allowable Uses of Funds.
• Core Medical Services Waiver: RWHAP Part A funds are subject to Section
2604(c) of the PHS Act, which requires that not less than 75 percent of the
funds remaining after reserving funds for administration and CQM be used to
provide core medical services. Applicants may seek a waiver of the core
medical services requirement; a waiver request must be submitted prior to
submission of the grant application, with this application, or up to four (4)
months after the budget period start date. Submission should be in accordance
with the PCN 13-07 Uniform Standard for Waiver of Core Medical Services
Requirement for Grantees Under Parts A, B, and C. You can find sample letters
to fulfill the requirements of the Core Medical Services Waiver at
https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf.
In addition, your RWHAP Part A core medical services waiver request
must include funds awarded under MAI. HAB will not consider a waiver
request that does not include MAI funds. If submitting with the
application, a core medical services waiver request should be included
as Attachment 9. The waiver request does count toward the 100-page
limit.
• Agreements and Compliance Assurances: The agreements and assurances,
found in Appendix A of this NOFO, require the signature of the chief elected
official (CEO), or the CEO’s designee. Include this document as Attachment 2.
HRSA-18-066 2

2. Background
This program is authorized by the PHS Act, Sections 2601-2610, and 2693 (42 USC
300ff-11– 300ff-20, and 300ff-121), as amended by the Ryan White HIV/AIDS Treatment
Extension Act of 2009 (Public Law 111-87). Fifty-two (52) eligible metropolitan
jurisdictions receive Part A formula, supplemental, and MAI funding through this
program.
The Centers for Disease Control and Prevention (CDC) estimated in 2015 that more
than 1.2 million people were living with HIV in the United States (U.S.) and one (1) in
seven (7) (14 percent) are not aware of their HIV status. The ultimate goal in the U.S.
is to inform all people who test positive for HIV of their status and bring them into care
in order to improve their health status, prolong their lives, and slow the spread of HIV
to end the epidemic in the U.S.
Goals to End the HIV Epidemic
To the extent possible, program activities should support four goals to end the HIV
epidemic:
1) Reduce new HIV infections;
2) Increase access to care and improve health outcomes for PLWH;
3) Reduce HIV-related health disparities and health inequities; and
4) Achieve a more coordinated national response.
To achieve these goals, recipients should take action to align their organization’s efforts,
within the parameters of the RWHAP statute and program guidance, with the following
areas of critical focus:
1) Widespread testing and linkage to care, enabling PLWH to access treatment
early;
2) Broad support for PLWH to remain engaged in comprehensive care, including
support for treatment adherence; and
3) Universal viral suppression among PLWH.
HIV Care Continuum
Identifying and linking PLWH to HIV primary care with initiation and long-term
maintenance of life saving antiretroviral treatment (ART) are important public health
steps toward the elimination of HIV in the United States. The continuum of interventions
that begins with outreach and testing and concludes with HIV viral suppression is
generally referred to as the HIV care continuum. The HIV care continuum includes the
diagnosis of HIV, linkage to HIV medical care, lifelong retention in HIV medical care,
appropriate prescription of ART, and, ultimately, HIV viral suppression.
The difficult challenge of executing these lifesaving steps is demonstrated by the data
from the Centers for Disease Control and Prevention (CDC), which estimate that only
54.7 percent of individuals diagnosed with HIV, who may be in or out of care, in the
United States have HIV viral suppression. Data from the 2015 Ryan White HIV/AIDS
Program Services Report (RSR) indicate that there are better outcomes in RWHAP-
funded agencies; approximately 83.4 percent of individuals who received RWHAP-
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funded HIV primary care achieving viral suppression. Such findings emphasize the
importance of supporting effective interventions for linking HIV-positive individuals into
care, retaining them in care, and helping them adhere to their effective combination
ART.
RWHAP recipients are encouraged to assess the outcomes of their programs along the
HIV care continuum. Recipients should work with their community and public health
partners to improve outcomes across the continuum, so that individuals are linked to
and engaged in care and started on ART as early as possible. HAB requests that
recipients use the RWHAP performance measures at their local level to assess the
efficacy of their programs and identify and eliminate gaps along the HIV care
continuum.
The HIV care continuum measures also align with the Common Indicators for HHS-
funded HIV Programs and Services. RWHAP recipients and providers are required to
submit data through the RSR. Through the RSR submission, HAB collects the data
elements to calculate six of the seven Common Indicators for the entire RWHAP.
Minority AIDS Initiative
As established in Section 2693 of the PHS Act, the MAI is intended to address the
disproportionate impact of HIV and to address the disparities in access, treatment, care,
and outcomes for racial and ethnic minorities, including Black/African Americans,
Alaska Natives, Hispanic/Latinos, American Indians, Asian Americans, Native
Hawaiians, and Pacific Islanders.
The purpose of the RWHAP Part A MAI is to “improve HIV-related health outcomes to
reduce existing racial and ethnic health disparities” (Section 2693 of the PHS Act). As
such, MAI funds provide direct financial assistance to RWHAP Part A recipients to
develop or enhance access to high quality, community-based HIV core medical and
support services for low-income minority PLWH and their families. You may target MAI
funds to any new/emerging minority populations identified in this application.
II. Award Information
1. Type of Application and Award
Type of applications sought: Competing Continuation
HRSA will provide funding in the form of a grant.
2. Summary of Funding
HRSA expects $619,617,500 to be available to fund fifty-two (52) recipients.
Approximately $9,572,100 will be used for priority funding, and $51,208,700 will be
available for MAI funding. You may apply for no more than the published ceiling amount
in Appendix B. HRSA established ceiling amounts based on current funding with a five
percent increase to accommodate fluctuations in formula and supplemental funding.
The actual amount available will not be determined until enactment of the final FY 2018
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appropriation. This program announcement is subject to the appropriation of funds, and
is a contingency action taken to ensure that, should funds become available for this
purpose, HRSA can process applications and award funds in a timely manner. The
project period is March 1, 2018, through February 28, 2019, (one (1) year). HRSA will
send notification of awards to the CEO or to the delegated administrative agency
responsible for dispersing RWHAP Part A funds.
The RWHAP Part A provides non-discretionary formula grants that include MAI funds,
and discretionary supplemental awards. These funds assist eligible areas in developing
or enhancing access to a comprehensive continuum of high quality, community-based
care for low-income PLWH within the EMA/TGA, and strengthening strategies to reach
minority populations. HRSA awards two-thirds of the funds available for EMAs and
TGAs according to a formula based on the number of living cases of HIV/AIDS in the
EMAs and TGAs. HRSA awards the remaining funds as discretionary supplemental
awards based on the demonstration of additional need by the eligible EMAs and TGAs,
and as MAI funding. HRSA determines MAI awards based on the number of minorities
living with HIV and AIDS in a jurisdiction. If determined eligible for priority funding,
HRSA will calculate the additional amount awarded, and that amount will be included in
the final award.
Eligible jurisdictions may apply for an amount up to the funding ceiling listed in Appendix
B. If the RWHAP Part A award calculation results in an amount less than the budget
submitted with your application, your budget will be proportionally reduced across all
budget categories to reflect the actual award amount. If your award calculation results
in an amount greater than the budget submitted with the application, you will be
required to submit a revised budget prior to the Notice of Award being issued.
Establishing realistic ceiling amounts ensures that there will be an approved project
budget in place at the beginning of the project period.
Please note that the U.S. Secretary of Health and Human Services (Secretary) may
reduce the amounts of grants under the RWHAP Part A to an EMA/TGA for a FY, if with
respect to such grants for the second preceding FY, the subdivision fails to prepare
audits in accordance with the procedures of Section 7502 of Title 31, United States
Code. See Section 2682(a) of the PHS Act.
All HRSA awards are subject to the Uniform Administrative Requirements, Cost
Principles and Audit Requirements in 45 CFR part 75.
Please see Policy Clarification Notice 15-01 Treatment of Costs under the 10%
Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with
the Frequently Asked Questions for information regarding the statutory ten (10) percent
limitation on administrative costs.
III. Eligibility Information
1. Eligible Applicants
Eligibility for RWHAP Part A grants is based in part on the number of confirmed AIDS
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cases within a statutorily specified “metropolitan area.” The Secretary uses the Office of
Management and Budget’s (OMB) census-based definitions of a Metropolitan Statistical
Area (MSA) in determining the geographic boundaries of a RWHAP metropolitan area.
HHS utilizes the OMB geographic boundaries that were in effect when a jurisdiction was
initially funded under RWHAP Part A. For all newly eligible areas, the boundaries are
based on current OMB MSA boundary definitions.
RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to
meet the status as an eligible area as defined in statute are eligible to apply for these
funds. For an EMA, this is more than 2,000 cases of AIDS reported and confirmed
during the most recent five (5) calendar years, and for a TGA, this is at least 1,000, but
fewer than 2,000 cases of AIDS reported and confirmed during the most recent five (5)
calendar years for which such data are available. In addition, for three (3) consecutive
years, recipients must not have fallen below both the required incidence levels already
specified, and required prevalence levels (cumulative total of living cases of AIDS
reported to and confirmed by the Director of CDC, as of December 31 of the most recent
calendar year for which such data are available). For an EMA, the required prevalence
is 3,000 living cases of AIDS. For a TGA, the required prevalence is 1,500 or more
living cases of AIDS. However, for a TGA with, as of the end of the most recent fiscal
year, not more than five (5) percent of the total amount from grants awarded to the area
under Part A unobligated, the required prevalence is at least 1,400 (and fewer than
1,500) living cases of AIDS.
This competition is open to eligible Part A jurisdictions to provide comprehensive
primary health care and support services for low income, uninsured and underserved
PLWH in their service areas as listed in Appendix B.
2. Cost Sharing/Matching
Cost sharing/matching is not required for this program.
3. Other
Applications that exceed the ceiling amount will experience delays in receiving a funding
award under this notice.
Any applicant that fails to satisfy the deadline requirements referenced in Section IV.4
will experience delays in receiving a funding award under this notice.
Maintenance of Effort – The RWHAP Part A recipient must agree to maintain
EMA/TGA political subdivision expenditures for HIV-related core medical services and
support services at a level equal to the FY preceding the FY for which the grant
recipient is applying to receive a RWHAP Part A grant. See Section 2605(a)(1)(B) of
the PHS Act. Core medical services and support services are defined in Section
2604(c)(3) and 2604(d) of the legislation. Part A recipients must document they have
met the maintenance of effort (MOE) requirement (see Attachment 11).
NOTE: Multiple applications from an organization are not allowable.
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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.
IV. Application and Submission Information
1. Address to Request Application Package
HRSA requires you to apply electronically through Grants.gov. You must use the SF-
424 application package associated with this NOFO following the directions provided at
http://www.grants.gov/applicants/apply-for-grants.html.
Effective December 31, 2017 - You must use the Grants.gov Workspace to complete
the workspace forms and submit your application workspace package. After this date,
you will no longer be able to use PDF Application Packages.
HRSA recommends that you supply an email address to Grants.gov on the grant
opportunity synopsis page when assessing the notice of funding opportunity (NOFO)
(also known as “Instructions” on Grants.gov) or application package. This allows
Grants.gov to email organizations that supply an email address in the event the NOFO
is changed and/or republished 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 Find Grant
Opportunities page for all information relevant to desired opportunities.
2. Content and Form of Application Submission
Section 4 of HRSA’s SF-424 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 Application Guide except
where the NOFO instructs you to do otherwise. You must submit the application in the
English language and must be in the terms of U.S. dollars (45 CFR § 75.111(a)).
See Section 8.5 of the Application Guide for the Application Completeness Checklist.
Application Page Limit
The total size of all uploaded files may not exceed the equivalent of 100 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 application
package do not count in the page limitation. Indirect Cost Rate Agreement and 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.
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Applications must be complete, within the specified page limit, and validated by
Grants.gov under the correct funding opportunity number prior to the deadline.
Applicants that fail to meet this requirement will experience delays in receiving
funding under this notice.
Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification
1) The prospective recipient certifies, by submission of this proposal, that neither it
nor its principals is 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 the prospective recipient is unable to attest to the statements in this
certification, an explanation shall be included in Attachment 14: Other
Relevant Documents.
See Section 4.1 viii of HRSA’s SF-424 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
Application Guide (including the budget, budget narrative, staffing plan and personnel
requirements, assurances, certifications, and abstract), please include the following:
i. Project Abstract
See Section 4.1.ix of HRSA’s SF-424 Application Guide. Your abstract should be
limited to one page and include the following information in this order:
• A general overview of the HIV epidemic in the EMA/TGA, including
epidemiologic, demographic and geographic information. You may present
this information as a table.
• A description of the comprehensive system of care in the entire EMA/TGA,
including the available core medical and support services funded by RWHAP
Part A and by other sources, where services are located, and how clients
access those services, including services for disproportionately impacted
subpopulation(s) supported by MAI funds.
• The overall viral suppression rate for the EMA/TGA. Use readily available and
validated data and indicate whether it represents data for Ryan White eligible
clients only, or is population-based. Also, if available and appropriate, provide
any meaningful subpopulation data that highlights disparities in this outcome
measure.
ii. Project Narrative
This section provides a comprehensive framework and description of all aspects of
the proposed project. It should be succinct, self-explanatory and well organized so
that reviewers can understand the proposed project.
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Successful applications will contain the information below. Please use the
following section headers for the narrative:
 INTRODUCTION -- Corresponds to Section V’s Review Criterion #1
This section must briefly describe how the EMA or TGA will utilize RWHAP Part A
grant funds in support of a comprehensive continuum of high-quality care and
treatment for PLWH in the RWHAP Part A service area, as defined in Appendix B.
 NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1
The purpose of this section is to demonstrate the severity of the HIV epidemic
in the EMA/TGA, using quantifiable data on HIV epidemiology, co-morbidities,
complexity of providing care, service needs of emerging populations, past
unmet need estimates, and unique service delivery challenges as required and
cited in Section 2603(b)(2)(B) of the PHS Act.
A. Demonstrated Need
The Demonstrated Need section includes statutorily required Epidemiological
Overview, Comorbidities, and Complexities of Providing Care sub-sections.
Since 2003, unmet need has been defined as the number of individuals with
HIV in a jurisdiction who are aware of their HIV status and are not in care.
HAB continues to consider the best approach to developing a new framework
and methodology for accurately estimating unmet need based on current HIV
treatment guidelines. No new unmet need estimates are required. For this
NOFO, unmet need elements (as specified in Section 2603(b)(2)(B) of PHS
Act) are captured in the Epidemiologic Overview, and Complexities of
Providing Care sub-sections below. You may use your past unmet need
estimate to help inform planning, resource allocation and work plan
development for this application.
HAB will target supplemental funds to those eligible areas where epidemiologic
data demonstrate that HIV infection prevalence rates are increasing, where
there is documented demonstrated need and service gaps, and where there is
a demonstrated disproportionate impact on vulnerable populations.
1) Epidemiologic Overview
An epidemiologic overview provides a description of the demonstrated
need for HIV care in the population of an area in terms of socio-
demographic, geographic, behavioral, and clinical characteristics of
persons newly diagnosed with HIV, PLWH, and persons at higher risk for
infection. Understanding the populations affected by HIV provides the
basis for setting priorities, identifying appropriate interventions and
services, allocating funding to HIV prevention and care services,
maintaining service standards, and evaluating programs and policies.
The epidemiologic overview should focus on the most recent year for
which data are available; when presenting trends, a minimum of three (3)
HRSA-18-066 9

years of data are recommended.
a) Provide a summary of the HIV epidemic in your EMA/TGA geographic
area.
b) Describe the socio-demographic characteristics of: (1) persons newly
diagnosed, (2) PLWH, and (3) persons at higher risk for HIV infection in
the service area. Include the following, as available in the geographical
region of the jurisdiction:
i. Demographic data (e.g., race, age, sex, transmission category,
current gender identity)
ii. Socioeconomic data (e.g., percentage of federal poverty level (FPL),
income, education, health insurance status, language barriers, etc.)
c) Describe the relative rates of increase in HIV diagnosed cases within new
and emerging populations, as well as the most disproportionally impacted
subpopulations.
i. Include information on how you identified emerging populations, any
unique challenges, and estimated costs to the RWHAP Part A, if
applicable.
ii. Describe the increasing need for HIV-related services based on the
relative increase of HIV cases.
2) Co-occurring Conditions
Using the list below, provide quantitative evidence (e.g., incidence,
prevalence, and estimates) describing the conditions co-occurring with HIV in
the EMA/TGA in a table format (Attachment 4) and document the data
sources used. The table must include:
a) Hepatitis C virus
b) Sexually transmitted infection rates, including syphilis, gonorrhea, and
chlamydia
c) Mental illness
d) Substance use disorder
e) Homelessness
f) Former incarceration
3) Complexities of Providing Care
a) If the EMA/TGA experienced a reduction in RWHAP Part A formula
funding last year, provide a narrative that addresses both the impact and
response to the funding reduction, as follows:
i. Impact: The specific services that were eliminated or reduced, and by
how much; and
ii. Response: Any cost containment measures implemented, (e.g.,
waiting lists, client cost sharing, or other measures); PC/PB response
to the reduction in formula funding; and any transitional planning for
clients receiving services that were either eliminated or reduced.
HRSA-18-066 10

b) Provide, in a table format, current estimates on poverty and health care
coverage status of PLWH in your jurisdiction. Include the following
information, as available:
i. The number and percentage of PLWH who are enrolled in Medicaid,
Medicare, and other health care coverage;
ii. The number and percentage of PLWH who are uninsured; and
iii. The number and percentage of PLWH living at or below 138 percent
and 400 percent of the 2017 FPL. Also, include the percentage of
FPL used to determine RWHAP eligibility in the jurisdiction.
c) Discuss any relevant factors that limit access to health care, including
geographic variation, adequacy of health insurance coverage, and
language barriers. Also, include a description of any service gaps,
especially for PLWH who are not in care, and how these service gaps will
be addressed with FY 2018 RWHAP Part A funding.
B. Early Identification of Individuals with HIV/AIDS (EIIHA)
The purpose of this section is to describe the data and information associated with
ensuring that individuals who are unaware of their HIV status are identified,
informed of their status, referred to supportive services, and linked to medical care
if HIV positive. The goals of the EIIHA initiative are to present a strategy for: (1)
identifying individuals with HIV who do not know their HIV status, (2) making such
individuals aware of such status, and enabling such individuals to use the health
and support services, and (3) reducing barriers to routine testing and disparities in
access and services among affected subpopulations and historically underserved
communities. See Section 2602(b)(4)(D)(vi) of the PHS Act.
1) Describe the planned EMA/TGA EIIHA activities for the 2018 project period.
Include the following information:
a) The primary activities that will be undertaken, including system level
interventions (e.g., routine testing in clinical settings, expanding partner
services);
b) Major collaborations with other programs and agencies, including HIV
prevention and surveillance programs; and
c) The anticipated outcomes of the RWHAP’s overall EIIHA strategy.
2) Describe any planned efforts to remove legal barriers, including state laws
and regulations, to routine HIV testing.
3) Select three (3) distinct target populations for the 2018 project period EIIHA
Plan. For each selected target population describe:
a) Why you chose the target population and how the epidemiological data,
social determinants of health, or other data supports that decision;
b) Specific challenges or opportunities for working with the target population;
and
c) The specific strategies that will be utilized with the target populations.
HRSA-18-066 11

C. AIDS Pharmaceutical Assistance (i.e., Local Pharmaceutical Assistance
Program) – Not Scored
Only complete this section if requesting funds for a Local Pharmaceutical
Assistance Program (LPAP) that will be newly funded in the 2018 project period.
The purpose of this section is to describe the need for an LPAP, including a
description of the systems and activities required to effectively operate an LPAP.
The RWHAP Part A needs assessment must determine that the State/Territory’s
AIDS Drug Assistance Program (ADAP) does not adequately address the
medication assistance needs of clients in the jurisdiction (e.g., existence of an
ADAP waiting list, restrictive ADAP financial eligibility criteria, or a limited ADAP
formulary). The needs assessment must also demonstrate that other resources
are inadequate to meet the medication needs of clients residing in the jurisdiction.
The National Monitoring Standards and LPAP letter of clarification sent August 29,
2013, outline the systemic requirements necessary to comply with the LPAP
service category definition. Implementation of an LPAP requires the development
of a drug distribution system that includes, but is not limited to: client enrollment
and eligibility determination process that includes screening for ADAP and LPAP
eligibility with rescreening at a minimum every six months; an LPAP advisory
board; uniform benefits for all enrolled clients; compliance with RWHAP
requirement of payor of last resort; and a drug formulary approved by the local
advisory committee/board. An LPAP may not be used to provide short-term or
emergency medication assistance. Please refer to the RWHAP Part A National
Monitoring Standards and PCN 16-02 Ryan White HIV/AIDS Program Services:
Eligible Individuals and Allowable Uses of Funds for a complete list of LPAP
requirements.
If you are planning to fund LPAP for the first time in the 2018 project period,
describe the following:
1) The need for an LPAP in detail; include how the ADAP, other RWHAP funded
service categories, and other resources (e.g., pharmaceutical assistance
programs, patient assistance programs, local/state funded medication
assistance programs) are failing to meet the jurisdiction’s medication needs.
2) How the LPAP will be coordinated with the ADAP.
3) The client enrollment and eligibility process, including how the payor of last
resort requirement is ensured.
4) The LPAP advisory board composition. Describe the process and timeframe
for development of the LPAP advisory board.
5) How the recipient ensures that the LPAP follows the most recent HHS
HIV/AIDS Clinical Guidelines.
6) The mechanism to ensure “best price” for medications (e.g., 340B Drug
Pricing Program and/or Prime Vendor Program).
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 METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 & #4
A. Impact of the Changing Health Care Landscape
The availability of health care coverage options may impact RWHAP service needs
and how services are provided in jurisdictions.
1) Provide an overall description of health care coverage options available to
PLWH in the jurisdiction.
a) Explain how coverage options in the jurisdiction impact access to direct
health care services and health outcomes.
2) Describe how changes in the health care landscape affects the following:
a) Service provision and the complexity of providing care to PLWH in the
EMA/TGA.
b) Changes in RWHAP Part A allocations, including activities related to
health insurance premium and cost sharing assistance.
B. Planning Responsibilities
Sections 2602(b)(4)(D), 2602(b)(4)(F), and 2602(b)(4)(G) and (H) of the PHS Act
require PCs to determine the priority for RWHAP allowable services and service
allocations of RWHAP Part A funds every year. To fulfill this responsibility,
EMA/TGA PCs set service priorities and allocate RWHAP Part A funds based on
the size, demographics, and needs of people living with or affected by HIV, with
particular focus on individuals who know their HIV status but are not in care. The
RWHAP Part A PCs are also responsible for evaluating the efficiency of the
recipient in distributing funds to service providers.
PCs analyze information to develop an in-depth understanding of the current HIV
epidemic and its impact on the service area. PCs review needs assessment data,
HIV epidemiologic data, and co-occurring conditions data. The review includes
service utilization data related to complexity of providing care, including service
availability and unit cost per service, as well as service needs of emerging
populations. The purpose of these data reviews is to guide decisions about HIV-
related services and resources in the EMA/TGA. Additionally, planning and
implementation of the RWHAP Part A is driven by overall comprehensive planning
and the recently developed Integrated HIV Prevention and Care Plan, including the
Statewide Coordinated Statement of Need, CY 2017- 2021 as a roadmap for
relevant goals, objectives, and strategies for delivering RWHAP Part A services
along the HIV continuum of care.
Please see the December 4, 2013 letter to Transitional Grant Areas and Planning
Councils Moving Forward for expectations and responsibilities of PBs.
1) Planning and Resource Allocation
The purpose of this section is to document the existence of a functioning
planning process in the EMA/TGA that is consistent with RWHAP and
HRSA/HAB program requirements. Such a planning process is imperative
for effective local and state decision making to develop systems of
HRSA-18-066 13

prevention and care that are responsive to the needs of persons at risk for
HIV infection and PLWH. Both HRSA and CDC support activities that
facilitate collaboration and/or develop a joint planning body to address
prevention and care. Community engagement is an essential component for
planning comprehensive, effective HIV prevention and care programs in the
United States.
The composition of the PC must reflect the demographics of the HIV
epidemic in the EMA/TGA and be representative of various required
categories of membership as cited in Sec. 2602(b)(1-2) of the PHS Act. PC
members must be trained regarding their legislatively mandated
responsibilities and other competencies necessary for full participation in
collaborative decision-making. PCs are encouraged to educate members
about service issues related to the prevention of domestic and sexual
violence as part of their ongoing training. PCs should also consider
recruiting members who are knowledgeable about these issues.
a) Description of the Community Input Process
Describe the overall community input process and how it informs the PC
priority setting and resource allocation process for the jurisdiction and
include a summary of how that process was conducted. Also include a
discussion of how the Integrated HIV Prevention and Care Plan informs
that process. Specifically, address:
i. How PLWH were involved in the planning and allocation processes
and how their priorities were considered in the process;
ii. How the input of the community was considered and whether the
community input process adequately addressed any funding
increases or decreases in the RWHAP Part A award;
iii. How MAI funding was considered during the planning process to
enhance services to minority populations;
iv. How data were used in the priority setting and allocation processes
to increase access to core medical services, ensure access to
services for women, infants, children, and youth (WICY) and to
reduce disparities in access to HIV care in the EMA/TGA; and
v. Any significant changes in the prioritization and allocation process
from 2017 to 2018 project periods and the rationale for making
those changes.
2) Administrative Assessment
The RWHAP authorizing legislation mandates (2602(b)(4)(E)) that EMA/TGA
PCs assess the efficiency of the administrative mechanism to rapidly allocate
funds to the areas of greatest need within the EMA/TGA (2602(b)(4)(E)).
Include in your application a narrative that describes the results of the PC’s
assessment of the administrative mechanism in terms of the following:
a) Assessment of grant recipient activities to ensure timely
allocation/contracting of funds and payments to contractors; and
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b) The RWHAP Part A jurisdiction’s response to any deficiencies identified by
the PC and the status of your corrective actions in response to
administrative assessment findings.
3) Letter of Assurance from Planning Council Chair(s) or Letter of
Concurrence from Planning Bodies
Provide a letter of assurance signed by the PC chair(s) or a letter of
concurrence signed by PB leadership as Attachment 6. The letter must
address the following:
a) How the 2017 project period Formula, Supplemental, and MAI funds
awarded to the EMA/TGA are being expended according to the priorities
established by the PC or PB;
b) How all 2017 project period Conditions of Award relative to the PC or PB
have been addressed;
c) How the PC or PB determined the 2018 project period priorities, and how
the PC or PB used the approved process for establishing those priorities;
and
d) That ongoing, annual membership training occurred, including the
date(s).
4) Resource Inventory
RWHAP Part A EMA/TGA planning efforts should expand the availability of
services, reduce duplication of services, coordinate with all other public
funding for HIV, and bring newly diagnosed PLWH into care or engage
PLWH who know their status but are not presently in HIV care. RWHAP Part
A planning efforts should also consider service needs not currently being met
(defined as service gaps).
a) Coordination of Services and Funding Streams
i. Provide, in a table format as Attachment 5, a jurisdictional HIV
resources inventory, that includes: (1) public funding sources for
HIV prevention, care, and treatment services in the jurisdiction
(RWHAP Parts B-D and F, federal/state and local); (2) the dollar
amount and the percentage of the total available funds in the 2017
project period for each funding source; and 3) how the resources
are being used (i.e., services delivered). You may use the resource
inventory table submitted with your Integrated HIV Prevention and
Care Plan if it includes all information requested as Attachment 5.
ii. Provide a narrative description identifying any needed resources
and/or services in the jurisdiction that are not being provided and
the steps taken to secure them.
 WORK PLAN -- Corresponds to Section V’s Review Criteria #2 & #4
The purpose of this section is to provide tables and a narrative summary
describing the EMA/TGA service provision during the 2018 project period. It
should describe how RWHAP Part A funded services are utilized to impact the
HIV care continuum. The EMA/TGA system of HIV care should be consistent
HRSA-18-066 15

with HRSA’s goals of increasing access to services and decreasing HIV health
disparities among affected subpopulations and historically under-served
communities.
Under RWHAP Part A, MAI formula funding provides core medical and related
support services to improve access and reduce disparities in health outcomes.
The services have to be consistent with the epidemiologic data.
Similar to other components of the RWHAP, the goal of the MAI is improved
health outcomes among racial and ethnic minorities living with HIV as
demonstrated by viral suppression. MAI funds must be used to deliver services
designed to address the unique barriers and challenges faced by hard-to-reach,
disproportionately impacted individuals within the EMA/TGA.
A. HIV Care Continuum Table and Narrative
1) HIV Care Continuum Table
Based on either your HIV care continuum submitted with your Integrated HIV
Prevention and Care Plan or on more recent data, please develop an HIV
Care Continuum Table. The table is comprised of the stages of the HIV care
continuum, baseline indicators for each stage, the desired target outcome to
be achieved during the project period, and the RWHAP-funded service
categories to help support achieving the desired outcome. The target
outcome must be developed based on one of the seven common indicators
for HHS funded HIV programs and services or one of the HAB Core
Performance Measures that correspond to each stage of the HIV care
continuum. You must express the baseline and target indicators as a
numerator and denominator as well as a percentage. List the service
categories funded by the RWHAP Part A that will aid in achieving the desired
target outcomes in the last column of the HIV Care Continuum Table. Submit
as Attachment 7.
2) HIV Care Continuum Narrative:
a) Describe how you currently utilize the HIV care continuum in planning,
prioritizing, targeting, and monitoring available resources in response
to the needs of PLWH in the jurisdiction.
b) Describe how you evaluate efforts to impact the HIV care continuum in
the jurisdiction.
B. Funding for Core and Support Services
RWHAP Part A funds are subject to Section 2604(c) of the PHS Act, which
requires that RWHAP Part A recipients expend 75 percent of RWHAP Part A
funds remaining after reserving funds for administration and CQM on core
medical services for individuals with HIV who are identified and eligible under the
RWHAP.
1) Service Category Plan
Please provide a Service Category Plan in table format as described below
that utilizes core medical and support service categories as prioritized and
HRSA-18-066 16

funded by the PC or through local community planning processes. The plan
should consist of both RWHAP Part A and MAI funds. Please indicate if
you submitted a core medical services waiver for the 2018 project
period (either approved or pending) prior to submission of this
application. Allocations in the Service Category Plan should match
the submitted waiver. The Service Category Plan must also correlate with
the budget and budget narrative section of the application.
a) Service Category Plan Table
The Service Category Plan Table illustrates how you fund RWHAP
Part A and MAI core medical and support services in the EMA/TGA.
It is comprised of service categories, priority number, funding amount,
unduplicated clients served, service unit definition, service units, and
target populations (MAI only) for the 2017 and 2018 project periods.
For every service category funded by RWHAP Part A in the
jurisdiction, provide in table format the following (submit as
Attachment 8):
i. RWHAP Part A
(a) 2017 project period service categories with priority number,
allocated funding amount, and number of projected unduplicated
clients to be served per the 2017 project period Implementation
Plan submitted with the 2017 Program Terms Report, service unit
definitions, and service units. Include total dollar amounts and
percentages of expenditures for core and support services.
(b) 2018 project period service categories with priority number,
anticipated funding amount, anticipated number of unduplicated
clients to be served, service unit definitions, and service units.
Include total dollar amounts and percentages of expenditures for
core and support services.
ii. MAI
(a) 2017 project period service categories with priority number,
allocated funding amount, and number of projected unduplicated
clients to be served per the 2017 project period Implementation
Plan submitted with the 2017 Program Terms Report, service unit
definitions, and service units. Include total dollar amounts and
percentages of expenditures for core and support services and
subpopulations.
(b) 2018 project period service categories with priority number,
anticipated funding amount, anticipated number of unduplicated
clients to be served, service unit definitions, and service units.
Include total dollar amounts and percentages of expenditures for
core and support services and subpopulations.
b) Service Category Plan Narrative
For populations experiencing health inequities, based upon the 2018
project period Service Category Plan, describe MAI initiatives that
impact positive health outcomes along the HIV care continuum.
HRSA-18-066 17

c) Core Medical Services Waiver (if applicable – not scored)
You must provide a separate allocation table that is reflective of the
results of the priority setting and resource allocation process, only if
you submit a core medical services waiver with this application.
The allocation table must be consistent with the waiver request.
Include the allocation table and the core medical services waiver
request as Attachment 9.
 RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review
Criterion # 2
In lieu of a narrative for this section, HAB suggests providing the information in
table format with the following headers: Challenges/Barriers, Proposed
Resolutions, Intended Outcomes, Current Status for implementing both the
RWHAP Part A overall, and the HIV care continuum.
Please consider the following when completing your table:
• Challenges and barriers identified in the larger context of implementing the
RWHAP Part A (e.g., changes in the health care landscape, community
engagement, barriers for populations experiencing inequities in health
outcomes, etc.);
• Proposed resolutions that have been encountered in integrating the HIV
care continuum into planning and implementing the RWHAP Part A (e.g.,
test to care, and retention strategies) and approaches that will be used to
resolve such challenges;
• Intended outcomes once the proposed resolution is implemented; and
• Current status of implementing the proposed resolution.
 EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to
Section V’s Review Criterion # 3
A. Clinical Quality Management (CQM)
Section 2604(h)(5) of the PHS Act requires the establishment of a CQM program.
After HRSA makes the awards, you will be required to submit an updated clinical
quality management plan as a component of the Program Submission reporting
requirement. That plan will describe all aspects of your CQM program including
infrastructure, priorities, performance measures, quality improvement activities,
action plan with a timeline and responsible parties, and evaluation of the CQM
program.
Please describe:
1) How performance measure data are analyzed to evaluate for disparities in
care, and actions taken in the last grant year to eliminate disparities; and
2) How CQM data have been used to improve and/or change service delivery in
the jurisdiction, including strategic long-range service delivery planning.
HRSA-18-066 18

You can find more information about the HRSA RWHAP expectations for CQM
programs in:
• PCN 15-02 Clinical Quality Management and Frequently Asked Questions
• HIV/AIDS Bureau Performance Measures
• Department of Health and Human Services HIV/AIDS Medical Practice
Guidelines
• HIV/AIDS Bureau RWHAP Part A Monitoring Standards (RWHAP Part A
specific, Universal Monitoring Standards, and Frequently Asked
Questions)
• Part A Manual
 ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review
Criterion # 5
A. Grant Administration
The purpose of this section is to demonstrate the extent to which the CEO or
designee in the EMA/TGA has met the legislative requirements to disburse
funds quickly, closely monitor their use, and ensure the RWHAP is the payor of
last resort. RWHAP stresses the importance of timely obligation of RWHAP
funds. Timely obligation of RWHAP funds ensures that services can be
provided as rapidly as possible, and decreases the possibility that unobligated
funds will remain at the end of the program year. Please refer to Section
2603(c)(1), (2), and (3) of the PHS Act regarding the RWHAP Part A formula
and supplemental unobligated balance (UOB) requirement as well as PCN 12-
02 Part A and Part B Unobligated Balances and Carryover. The UOB
requirement does not apply to MAI funds. If the recipient reports
unobligated formula funds of five (5) percent or less, HRSA does not
impose penalties, although a future year award may be subject to an
offset.
Note: UOB Penalties
If the UOB of a formula award exceeds five (5) percent, two penalties are
imposed:
• The future year award is reduced by the amount of the UOB, less the
amount of approved carryover; and
• The grant recipient is not eligible for a future year supplemental award.
Note, that like all other recipients with a UOB, the amount of the UOB not
covered by a waiver for carryover is subject to an offset.
Supplemental Funds
Under the RWHAP legislation, the Secretary has flexibility regarding the imposition
of penalties for UOBs. Supplemental funds cannot be carried over, but are subject
to offset. If a grant recipient has a UOB of supplemental funds, the recipient
remains eligible for a future year RWHAP Part A award, including supplemental
funds.
HRSA-18-066 19

1) Program Organization
a) Provide a description of how RWHAP Part A funds are administered
within the EMA/TGA with reference to the staff positions, including
program and fiscal staff, described in the budget narrative and the
program organizational chart provided in Attachment 10. The
narrative should describe the local agency responsible for the grant
and identify the entity responsible for administering the RWHAP Part
A, including the department, unit, staffing levels (full-time equivalent
staff [FTE], including any vacancies), fiscal agents, PC/PB staff, and
in-kind support staff. Describe the approaches to fill vacant staff
positions that are essential for delivery, oversight, and monitoring of
the RWHAP Part A and MAI services/activities.
b) If you administer the RWHAP Part A funds by a contractor or fiscal
agent, describe the staffing, fiscal agent scope of work or services to
be provided, and how you will evaluate the performance of the scope
of work or services being provided.
2) Grant Recipient Accountability
HRSA/HAB holds recipients accountable for the expenditure of funds awarded
under RWHAP Part A and expects recipients to monitor subrecipient fiscal
and programmatic compliance. Recipients are also required to have on file a
copy of each subrecipient’s procurement document (contracts), and fiscal,
program, and site visit reports. Also see the requirements outlined in the
Uniform Administrative Requirements, Cost Principles, and Audit
Requirement for HHS Awards (45 CFR part 75) - Subrecipient Monitoring and
Management (45 CFR § 75.351 and 352) and National Monitoring Standards.
a) Monitoring - Provide a narrative that describes the following:
i. The three most common program and fiscal subrecipients’ monitoring
findings for the 2017 project period, and the process and timeline for
corrective actions;
ii. The process for ensuring subrecipient compliance with the single
audit requirement in Subpart F of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirement for HHS
Awards (45 CFR part 75) (45 CFR part 75);
iii. If there were findings in any subrecipient single audit or program-
specific audit reports, describe what you have done to ensure that
subrecipients have taken appropriate corrective action. Corrective
actions may include, but are not limited to, HRSA/HAB sponsored
technical assistance and training requests from the grant recipient of
record.
b) Third Party Reimbursement
The RWHAP is the payor of last resort and you must vigorously
pursue alternate sources of payments. You must certify eligibility
every twelve (12) months/annually and recertify eligibility at least
every six (6) months (see PCN 13-02, Clarifications on Ryan White
Program Client Eligibility Determinations and Recertifications
HRSA-18-066 20

Requirements). Recipients and subrecipients are required to use
effective strategies to coordinate between RWHAP Part A and third
party payers who are ultimately responsible for covering the cost of
services provided to eligible or covered persons. Subrecipients
providing Medicaid eligible services must be Medicaid certified.
Provide a narrative that describes the following:
i. The process used to ensure that subrecipients are pursuing third
party reimbursement; also describe the contract language or other
mechanism to ensure that this takes place;
ii. The process to conduct screening and eligibility to ensure the
RWHAP is the payor of last resort; and
iii. How you monitor and track the source and use of any program
income earned at both the recipient and subrecipient levels.
c) Fiscal Oversight - Provide a narrative that describes the following
information:
i. The process used by program and fiscal staff to coordinate activities,
ensuring adequate reporting, reconciliation, and tracking of program
expenditures (e.g., meeting schedule, information sharing regarding
subrecipient expenditures, UOB, and program income);
ii. The process used to separately track formula, supplemental, MAI,
and carryover funds, including information on the data systems
utilized; and
iii. The process for reimbursing subrecipients, from the time a
voucher/invoice is received, to payment.
B. Maintenance of Effort (MOE)
The RWHAP legislation requires RWHAP Part A recipients to maintain, as a
condition of award, EMA/TGA political subdivision expenditures for HIV-related
core medical services and support services at a level equal to the FY preceding
the FY for which the recipient is applying to receive a RWHAP Part A grant.
Core medical services and support services are defined in Section 2604(c)(3)
and 2604(d) of the PHS Act and PCN 16-02 Ryan White HIV/AIDS Program
Services: Eligible Individuals & Allowable Uses of Funds. RWHAP Part A
recipients must document that they have met the MOE requirement.
You must submit the following information as Attachment 11:
1) A table that identifies the baseline aggregate for actual non-federal EMA/TGA
political subdivision expenditures for HIV-related core medical and support
services during your most recently completed FY prior to the application
deadline and an estimate for your next fiscal year; and
2) A description of the process and elements used to determine the amount of
expenditures in the MOE calculations.
HRSA-18-066 21

NARRATIVE GUIDANCE
To ensure that you fully address the review criteria, this table provides a crosswalk
between the narrative language and where each section falls within the review
criteria.
Narrative Section Review Criteria
Introduction (1) Need
Needs Assessment (1) Need
• Demonstrated Need
• Early Intervention of
Individuals with HIV/AIDS
Methodology (2) Response and (4) Impact
• Impact of Funding
• Coordination of Services
and Funding Streams
• Planning Responsibilities
Work Plan (2) Response and (4) Impact
• Funding for Core and
Support Services
• FY 2018 HIV Care
Continuum Table
• MAI Narrative
Resolution of Challenges (2) Response
Evaluation and Technical Support (3) Evaluative Measures
Capacity
• Clinical Quality Management
Organizational Information (5) Resources/Capabilities
• Grant Administration
Budget and Budget Narrative (6) Support Requested – the budget section
should include sufficient justification to allow
reviewers to determine the reasonableness
of the support requested.
iii. Budget
See Section 4.1.iv of HRSA’s SF-424 Application Guide. Please note the directions
offered in the SF-424 Application Guide may differ from those offered by Grants.gov.
Please 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 approves the application for funding, you will have a well-
organized plan, and carefully following the approved plan can avoid audit issues
during the implementation phase.
HRSA-18-066 22

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.
In addition, the RWHAP Part A HIV Emergency Relief Grant Program requires the
following:
Completion of Sections A, B, and F of the SF-424A Budget Information – Non-
Construction Programs form. In Section B, the three required columns are:
(1) Administrative
(2) CQM
(3) HIV Services
Caps on expenses: RWHAP Part A grant administration costs (including PC or PB
support) may not exceed ten (10) percent of the grant award. The aggregate total
of administrative expenditures for subrecipients, including all indirect costs, may not
exceed ten (10) percent of the aggregate amount of all subawards. Please see
Policy Clarification Notice 15-01 Treatment of Costs under the 10% Administrative
Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with the
Frequently Asked Questions for information regarding the statutory ten (10) percent
limitation on administrative costs.
Recipients are allowed to allocate up to five (5) percent of the total grant award or
$3,000,000 (whichever is less), for CQM activities.
Line Item Budget
In order to evaluate your adherence to RWHAP Part A legislative budget
requirements, you must submit a separate program-specific line item budget. To
reduce the burden of recipient reporting that previously required multiple post-award
budget revisions, you must submit a budget that does not exceed the ceiling amount
listed for the service area in Appendix B. In addition, the total amount requested on
the SF-424A and the total amount listed on the line item budget must match. The
budget allocations on the line item budget must relate to the activities proposed in the
project narrative, including the work plan.
You should submit the line item budget in table format. It should list separately by
funding type (Part A and MAI), the program cost categories: Administrative, CQM,
and HIV Services across the top and object class categories (i.e., Personnel, Fringe
Benefits, Travel, Equipment, Supplies, Contractual, Other, and Indirect Charges) in a
column down the left-hand side. The MAI component of your budget must not
exceed five percent of your FY 2017 MAI award.
When completing the line item budget submit an overall summary table and a
separate table for each of the cost categories: Administrative, CQM, and HIV
Services. If the EMA/TGA is administrated by a contractor or fiscal agent, you should
HRSA-18-066 23

clearly detail the costs for administering the grant in the line item budget. You must
also show a separate PC Support budget and narrative.
Each of the specific line item budget tables (and corresponding budget narrative)
should describe and justify how every item with a cost associated under each object
class category makes a contributing impact and supports the overall RWHAP Part A
HIV service delivery system.
Upload the line item budgets as Attachment 13.
NOTE: HRSA recommends that the budgets be converted or scanned into PDF
format for submission. Do not submit Excel spreadsheets.
Salary Rate Limitation - The Consolidated Appropriations Act, 2017 (P.L. 115-31),
Division H, § 202 states, “None of the funds appropriated in this title shall be used to
pay the salary of an individual, through a grant or other extramural mechanism, at a
rate in excess of Executive Level II.” As of January 8, 2017, the Executive Level II
salary limitation is now $187,000. Please see Section 4.1.iv Budget – Salary
Limitation of HRSA’s SF-424 Application Guide for additional information. Note that
these or other salary limitations may apply in FY 2018, as required by law.
iv. Budget Narrative
See Section 4.1.v. of HRSA’s SF-424 Application Guide. The budget narrative
should be presented by funding type (Part A and MAI), and divided by the three
RWHAP Part A cost categories: Administrative, CQM, and HIV Services.
Descriptions for each object class categories (i.e., Personnel, Fringe Benefits, Travel,
Equipment, Supplies, Contractual, Other, and Indirect Charges) must be specific to
the each cost category. The MAI component of your budget must not exceed five
percent of your FY 2017 MAI award.
The RWHAP Part A HIV Emergency Relief Grant Program requires the following cost
categories:
1) Administrative Costs are costs associated with the administration of the
RWHAP Part A grant. By law, no more than ten (10) percent of the RWHAP
Part A budget can be spent on administrative costs. You should allocate staff
activities that are administrative in nature to administrative costs. Costs
associated with grant administration and PC support or PB support are all
subject to the ten (10) percent limit on costs associated with administering the
award. Recipients must determine the amounts necessary to cover all
administrative and program support activities. The RWHAP Part A recipient
must also ensure adequate funding for PC mandated functions within the
administrative line item. PC support should cover reasonable and necessary
costs associated with carrying out legislatively mandated functions.
If a RWHAP Part A grant recipient has contracted with an entity to provide
statewide or regional RWHAP management and fiscal oversight (i.e., the entity
is acting on behalf of the recipient), the cost of that contract, exclusive of
subawards to providers, would count toward the recipient’s ten (10) percent
HRSA-18-066 24

administrative cap. Providers that have contracted to provide healthcare
services for the lead agency are considered to be subrecipients of the
recipient and are subject to the aggregate ten (10) percent administrative cap
for subrecipients.
The aggregate total of administrative expenditures for subrecipients, including all
indirect costs, may not exceed ten (10) percent of the aggregate amount of all
subawards. Subrecipient administrative activities include:
• Usual and recognized overhead activities, including established indirect
rates for agencies;
• Management oversight of specific programs funded under the RWHAP;
and
• Other types of program support such as quality assurance, quality control,
and related activities (exclusive of RWHAP CQM).
As a reminder: All indirect costs charged by the subrecipient are considered an
administrative cost subject to the ten (10) percent aggregate limit.
For further guidance on the treatment of costs under the ten (10) percent
administrative limit, refer to PCN 15-01 Treatment of Costs under the 10%
Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D and
Frequently Asked Questions.
2) CQM Costs are costs required to maintain a CQM program to assess the
extent to which services are consistent with the current HHS guidelines for the
treatment of HIV and to develop strategies to improve access to and quality of
services. Examples of CQM costs include:
• Implementation of CQM program;
• Continuous Quality Improvement activities;
• Data collection for CQM purposes (collect, aggregate, analyze, and
report on measurement data);
• Recipient CQM staff training/TA (including travel and registration) - this
includes HRSA sponsored or HRSA approved training; and
• Training of subrecipients on CQM.
For further guidance on CQM, refer to PCN 15-02 Clinical Quality
Management Policy Clarification Notice.
3) HIV Services costs are associated with the provision of core medical and
support services to RWHAP eligible clients. Core medical and support services
are important to assist in the diagnosis of HIV infection, linkage to care for HIV
positive individuals, retention in care, and the provision of HIV treatment. To be
an allowable cost under the RWHAP, all services must relate to HIV diagnosis,
care, and support, and must adhere to established HIV clinical practice
standards consistent with HHS treatment guidelines. In addition, all providers
HRSA-18-066 25

must be appropriately licensed and in compliance with state and local
regulations. Recipients are required to work toward the development and
adoption of service standards for all RWHAP-funded services.
For further guidance on core medical and support services, refer to PCN 16-02
Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses
of Funds.
a) Core Medical Services Costs (At least 75 percent of the award – minus
amounts for administrative costs, including planning/evaluation – must be used
to provide core medical services. You may seek a waiver to this requirement.)
- Core medical services are inclusive of those services identified in the MAI
section above plus the service categories as described by HAB PCN 16-02
Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable
Uses of Funds.
b) Support Services Costs –Support services as described in HAB PCN
16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and
Allowable Uses of Funds are those services needed by PLWH to achieve
optimal HIV medical outcomes.
Object Class Category Details
The narrative should explain how the line items listed support the overall service
delivery system and include justification for any of the following applicable object
class categories: Personnel, Fringe Benefits, Travel, Equipment, Supplies,
Contractual, Construction, Other, and Indirect Charges. For employees who are
less than one (1) FTE on the award, please identify all funding sources outside of
RWHAP Part A funding for Personnel and Fringe Benefits costs.
Personnel: All costs must include the name and position title. The annual
salary, program FTE and program salary subtotal must be listed for each
personnel with adequate justification clearly explaining how the roles impact the
RWHAP Part A HIV service delivery system. Please list personnel separately by
position title and the name of the individual for each position title, or note if
position is vacant. Descriptions must be specific to the cost category. A general
description for personnel repeated across the categories is not acceptable.
HRSA will consider a general personnel description across categories as non-
responsive.
Contractual: Provide a clear explanation of the purpose of each contract, how
you estimated the costs, and the specific contract deliverables. List the amounts
allocated for personnel or services contracted to outside providers for all HIV
services (subrecipients). Show the amount allocated to any activities that are not
conducted “in-house” on the Contractual line. Subrecipients providing services
under this award must adhere to the same requirements as the recipient. All
RWHAP Part A legislative requirements, the requirements outlined in 45 CFR
part 75, and program expectations that apply to recipients also apply to
subrecipients. Your organization is accountable for your subrecipients’
HRSA-18-066 26

performance of the project, program, activity, and appropriate expenditure of
funds under the award.
v. Attachments
Please 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: Staffing Plan, Job Descriptions, and Biographical Sketches for
Key Personnel (required; see Section 4.1.vi. of the HRSA’s SF-424 Application
Guide).
Attachment 2: FY 2018 Agreements and Compliance Assurances, Certifications
(required)
Submit the RWHAP Part A Grant Program FY 2018 Agreements and
Compliance Assurances signed by the CEO or the CEO’s designee (see
Appendix A).
Attachment 3: HIV/AIDS Demographic Table (required)
Attachment 4: Co-occurring Conditions Table (required)
Attachment 5: Coordination of Services and Funding Streams Table (required)
Provide in table format a jurisdictional HIV resources inventory, that
includes: (1) public and private funding sources for HIV prevention, care,
and treatment services in the jurisdiction; (2) the dollar amount and the
percentage of the total available funds in the 2017 project period for each
funding source; (3) how the resources are being used (e.g., services
delivered).
Attachment 6: Letter of Assurance from Planning Council Chair/Letter of
Concurrence from Planning Body (required)
Attachment 7: HIV Care Continuum Table (required)
Attachment 8: Service Category Plan Tables (required)
Attachment 9: Core Medical Services Waiver Request and
Allocation Table (if applicable)
Attachment 10: Program Organizational Chart (required)
Provide a one-page illustration that depicts the organizational
structure of the program.
HRSA-18-066 27

Attachment 11: Maintenance of Effort Documentation (required)
Provide a baseline aggregate for actual non-federal EMA/TGA political
subdivision expenditures for HIV-related core medical and support services
during the most recently completed FY prior to the application deadline and
an estimate for the next fiscal year using a table similar to the one below.
Also include a description of the process and elements used to determine the
amount of expenditures in the MOE calculations. [See Section 2605(a)(1)(B)
of the PHS Act. Core medical services and support services are defined in
Section 2604(c)(3) and 2604(d) of the legislation and HRSA/HAB service
definitions distributed to all recipients.] HRSA will enforce statutory MOE
requirements through all available mechanisms.
NON-FEDERAL EXPENDITURES
FY Prior to Application (Actual) Current FY of Application (Estimated)
Actual prior FY non-federal Estimated current FY non-federal
EMA/TGA political subdivision EMA/TGA political subdivision
expenditures for HIV-related core expenditures for HIV-related core
medical and support services. medical and support services.
Amount: $_____________ Amount: $______________
Attachment 12: Federally Negotiated Indirect Cost Rate Agreement (if
applicable, not counted in the page limit).
Attachment 13: Line Item Budget (required)
Attachment 14: Letters of Agreement, Memorandum of Understanding,
Intergovernmental Agreements, and Other Relevant Documents (optional)
Include here any other documents that are relevant to the application,
including letters of support that are dated and specifically indicate a
commitment to the project/program (in-kind services, dollars, staff, space,
equipment, etc.). Any other support letters can be listed on one page.
3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number and
System for Award Management
You must obtain a valid DUNS number, also known as the Unique Entity Identifier, for
your organization/agency and provide that number in the application. You must also
register with the System for Award Management (SAM) and continue to maintain active
SAM registration with current information at all times during which you have an active
HRSA-18-066 28

federal award or an application or plan under consideration by an agency (unless the
applicant is an individual or federal agency that is exempted from those requirements
under 2 CFR § 25.110(b) or (c), or has an exception approved by the agency under 2
CFR § 25.110(d)).
HRSA may not make an award to an applicant until the applicant has complied with all
applicable DUNS and SAM requirements and, if an applicant has not fully complied with
the requirements by the time HRSA is ready to make an award, HRSA may determine
that the applicant is not qualified to receive an award and use that determination as the
basis for making an award to another applicant.
If you have already completed Grants.gov registration for HRSA or another federal
agency, confirm that the registration is still active and that the Authorized Organization
Representative (AOR) has been approved.
The Grants.gov registration process requires information in three separate systems:
• Dun and Bradstreet (http://www.dnb.com/duns-number.html)
• System for Award Management (SAM) (https://www.sam.gov)
• Grants.gov (http://www.grants.gov/)
For further details, see Section 3.1 of HRSA’s SF-424 Application Guide.
If you fail to allow ample time to complete registration with SAM or Grants.gov,
you will not be eligible for a deadline extension or waiver of the electronic
submission requirement.
4. Submission Dates and Times
Application Due Date
The due date for applications under this NOFO is October 30, 2017, at 11:59 p.m.
Eastern Time.
See Section 8.2.5 – Summary of emails from Grants.gov of HRSA’s SF-424 Application
Guide for additional information.
5. Intergovernmental Review
The RWHAP Part A Emergency Relief Grant Program is a program subject to the
provisions of Executive Order 12372, as implemented by 45 CFR part 100. See
Executive Order 12372 in the HHS Grants Policy Statement.
See Section 4.1 ii of HRSA’s SF-424 Application Guide for additional information.
6. Funding Restrictions
You may request funding for a project period up to one (1) year, using the ceiling
amount provided in Appendix B.
HRSA-18-066 29

In addition to the general Funding Restrictions included in Section 4.1 of the SF-424
Application Guide, RWHAP Part A funds cannot be used for the following purposes:
• Cash payment to intended recipients of RWHAP services;
• Construction (minor alterations and renovations to an existing facility to make it
more suitable for the purpose of the program are allowable with prior HRSA
approval);
• International travel;
• Pre-exposure prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP)
medications or the related medical services. (See the June 22, 2016 RWHAP
and PrEP program letter);
• Syringe Services Programs (SSPs). Some aspects of SSPs are allowable with
HRSA's prior approval and in compliance with HHS and HRSA policy;
• Payment for any item or service to the extent that payment has been made (or
reasonably can be expected to be made), with respect to that item or service,
under any state compensation program, insurance policy, federal or state
benefits program, or any entity that provides health services on a prepaid basis,
(except for a program administered by or providing the services of the Indian
Health Service); and
• Development of materials designed to promote or encourage, directly,
intravenous drug use or sexual activity, whether homosexual or heterosexual.
Please see PCN 15-01 and Frequently Asked Questions for information regarding the
statutory ten (10) percent limitation on administrative costs.
You can find other non-allowable costs in 45 CFR part 75 – Subpart E Cost Principles.
The General Provisions in Division H of the Consolidated Appropriations Act, 2017 (P.L.
115-31) apply to this program. Please see Section 4.1 of HRSA’s SF-424 Application
Guide for additional information. Note that these or other restrictions will apply in FY
2018, as required by law.
You are required to have the necessary policies, procedures and financial controls in
place to ensure that your organization complies with all legal requirements and
restrictions applicable to the receipt of federal funding including statutory restrictions on
use of funds for lobbying, executive salaries, gun control, abortion, etc. Like those for
all other applicable grants requirements, the effectiveness of these policies, procedures
and controls is subject to audit.
All program income generated as a result of RWHAP Part A awarded funds is
considered additive and must be used for otherwise allowable costs to further the
objectives of the RWHAP Part A HIV Emergency Relief Grant Program. For RWHAP
Part A, allowable costs are limited to core medical services, support services, CQM and
administrative expenses [Section 2604(a)(2) of the PHS Act]. Program income may be
utilized for elements of the program that are otherwise limited by statutory provisions,
such as administrative and CQM activities that might exceed statutory caps, or unique
HRSA-18-066 30

services that are needed to maintain a comprehensive program approach, but that
would still be considered allowable under the award. (See PCN 15-03, Clarifications
Regarding the Ryan White HIV/AIDS Program and Program Income).
You can find post-award requirements for program income at 45 CFR § 75.307. Per 45
CFR § 75.305 (b)(5), to the extent available, you must disburse funds available from
program income before requesting grant funds.
V. Application Review Information
1. Review Criteria
HRSA has instituted procedures for assessing the technical merit of applications to
provide for an objective review of applications and to assist you in understanding the
standards against which each application will be judged. HRSA has developed critical
indicators for each review criterion to assist you in presenting pertinent information
related to that criterion and to provide the reviewer with a standard for evaluation. See
the review criteria outlined below with specific detail and scoring points.
These criteria are the basis upon which the reviewers will evaluate and score the merit
of the application. The entire proposal is considered during objective review.
Review criteria are used to review and rank applications. The RWHAP Part A has six
review criteria:
Criterion 1: NEED (66 points) – Corresponds to Section IV’s ii, Project Narrative:
Introduction, Needs Assessment, Demonstrated Need, including the Epidemiologic
Overview, Social Determinants of Health and Co-occurring Conditions, and
Complexities of Providing Care and associated attachments. Note: This section
includes EIIHA, which is worth 33 points, per Section 2602(b)(4)(D)(vi) of the PHS Act.
The extent to which the application demonstrates the problem and associated
contributing factors to the problem.
A. Demonstrated Need (33 points): Provides a description of the demonstrated
needs of PLWH, both those in care and not in care. The needs assessment provides
information on the size, geographic distribution, and the socio-demographics of the HIV
population within the EMA/TGA. It also provides information on strategies for reducing
barriers to accessing care as well as services targeted to individuals who are aware of
and those unaware of their HIV status.
1) Epidemiological Profile (10 points)
a) Provides a clear and comprehensive description of the HIV epidemic in the
EMA/TGA geographic area.
b) Clarity and completeness of the HIV Demographic Table(s) (Attachment 3),
including use of the most recent data available and clearly cited sources of
data.
HRSA-18-066 31

c) Clearly describes any increases in rates of HIV cases within emerging
populations, how emerging populations were identified, and justifies the need
for HIV-related services.
2) Co-occurring Conditions (10 points)
The strength of the table that quantifies the co-occurring conditions discussed in
this section and clearly cites the data sources used (Attachment 4).
3) Complexities of Providing Care (13 points)
a) Demonstrates a thorough understanding of both the impact and response to
funding reduction (if applicable). Provides a clear and comprehensive
description of any cost containment measures implemented, (e.g., waiting
lists, client cost sharing, or other measures); PC or community PB response
to the reduction in formula funding; and any transitional planning for clients
receiving services that were either eliminated or reduced.
b) Provides comprehensive estimates on poverty and health care coverage of
PLWH in table format.
c) Demonstrates a thorough understanding of relevant factors that limit access
to health care, including geographic variation, and language barriers, and
services gaps related to PLWH who have fallen out of care.
B. Early Identification of Individuals with HIV/AIDS (EIIHA) (33 points)
1) EIIHA Plan (12 points)
The strength and clarity of the EIIHA Plan that includes the following:
a) Primary activities which will be undertaken, including system level
interventions (e.g., routine testing in clinical settings, expanding partner
services);
b) Major collaborations with other programs and agencies, including HIV
prevention and surveillance programs; and
c) Anticipated outcomes of the program’s overall EIIHA strategy.
2) Clarity and completeness of plans to address legal barriers, including state laws
and regulations, to routine HIV testing. (3 points)
3) Appropriateness of the description of three (3) distinct target populations, which
includes a clear explanation of the following: (18 points)
a) Why the target populations were chosen and how the epidemiological data,
social determinants of health or other data supports that decision;
b) Specific challenges or opportunities presented by the target populations; and
c) Specific strategies to be utilized with the target populations.
Criterion 2: RESPONSE (16 points) – Corresponds to Section IV. ii. Project Narrative:
Methodology/Planning Responsibilities, Work Plan/Funding for Core and Support
Services, Resolution of Challenges, and associated attachments.
The extent to which the proposed project responds to the “Purpose” included in the
program description. The strength of the proposed goals and objectives and their
relationship to the identified project. The extent to which the activities (scientific or
HRSA-18-066 32

other) described in the application are capable of addressing the problem and
attaining the project objectives.
A. Methodology (5 points)
1) Strength and clarity of the Community Input Process description that includes
PLWH and community involvement, MAI needs, and utilization of data in
priority setting and resource allocation.
2) Completeness of description of any significant changes in the prioritization and
allocation processes from 2017 to 2018 project periods and clarity of rationale
for making those changes.
3) Clarity and completeness of “Coordination of Service Streams” (Attachment 5)
and the narrative identifying any needed resources and/or services in the
jurisdiction, which are not provided, and the feasibility of the proposed steps to
secure them.
4) Completeness of the description for the assessment of the recipient’s process
to ensure timely allocation/contracting and payments to contractors, and
recipient’s response to any deficiencies identified.
5) Letter of Assurance from Planning Council Chair(s) or Letter of Concurrence
from Planning Bodies (Attachment 6) fully addressed and provided evidence
that 2017 project period funding was expended according to PC priorities, PC
approved a process for determining 2018 project period priorities and evidence
of annual membership training.
B. Work Plan (9 points)
1) Funding for Core Medical and Support Services
a) Service Category Plan (Attachment 8)
i. The clarity and completeness of the table that illustrates how RWHAP
Part A and MAI core medical and support services are funded in the
EMA/TGA as evidenced by the inclusion of complete data on service
categories, priority number, funding amount, unduplicated clients,
service unit definition, service units, and target populations (for MAI
services only) for 2017 and 2018 project periods.
b) Service Category Plan Narrative
i. The strength and clarity of the MAI initiatives and their impact on health
outcomes along the continuum of care.
C. Resolution of Challenges (2 points)
The strength and feasibility of approaches to resolve challenges and barriers
identified throughout the application (e.g., changing health care landscape,
community engagement), as well as challenges encountered in integrating the HIV
care continuum into planning and implementing the RWHAP Part A grant.
HRSA-18-066 33

Criterion 3: EVALUATIVE MEASURES (2 points) – Corresponds to Section IV. ii.
Project Narrative: Evaluation and Technical Support Capacity/CQM
The strength and effectiveness of the method proposed to monitor and evaluate the
project results. Evidence that the evaluative measures will be able to assess: 1) to
what extent the program objectives have been met, and 2) to what extent these can be
attributed to the project.
1) Fully describes how performance data are used to evaluate disparities in care,
and the strength of the actions taken in the last grant year to eliminate disparities.
2) Clearly describes how CQM data are used to improve and/or change service
delivery in the jurisdiction.
Criterion 4: IMPACT (5 points) – Corresponds to Section IV. ii. Project Narrative:
Methodology/Impact of Funding, Work Plan/HIV Care Continuum Table, and
associated attachments.
1) The strength and completeness of the HIV Care Continuum Table depicting:
a) How RWHAP services will be used to address gaps along the HIV care
continuum (Attachment 7);
b) How the HIV care continuum is currently utilized in planning, prioritizing,
targeting, and monitoring available resources; and
c) The efforts made to impact the HIV care continuum and how they are
evaluated in the jurisdiction.
2) Demonstrates a thorough understanding of how changes in the health care
landscape, including, but not limited to service provision, changes in allocations,
and health care coverage options, affect health outcomes of PLWH in the
EMA/TGA.
Criterion 5: RESOURCES/CAPABILITIES (6 points) – Corresponds to Section IV. ii.
Project Narrative: Organizational Information/Grant Administration and associated
attachments.
The extent to which project personnel are qualified by training and/or experience to
implement and carry out the project. The capabilities of the applicant organization and
the quality and availability of facilities and personnel to fulfill the needs and
requirements of the proposed project.
1) Program Organization (2 points)
a) The completeness and appropriateness of the Staffing Plan, Job Descriptions
and Biographical Sketches for Key Personnel (Attachment 1) and Program
Organizational Chart (Attachment 10) that demonstrates capacity of the
department, unit, staffing levels (FTEs, including any vacancies), fiscal and/or
management agents, planning and evaluation bodies, and in-kind support
staff necessary to carry out the project.
HRSA-18-066 34

2) Recipient Accountability (4 points)
a) Monitoring
The strength and completeness for the description of the FY 2017
subrecipients’ most common findings, corrective actions to address findings,
and compliance with single audit requirements.
b) Third Party Reimbursement
The strength and completeness of the process used to ensure RWHAP is the
payor of last resort by vigorously pursuing alternate sources of payment,
tracking source and use program income earned at recipient and
subrecipient levels, and conducting annual RWHAP eligibility determinations
and recertifications.
c) Fiscal Oversight
The strength and effectiveness of the process used to ensure adequate
reporting, timely payment, reconciliation, and tracking of program
expenditures separately by formula, supplemental, MAI, and carryover funds.
Criterion 6: SUPPORT REQUESTED (5 points) – Corresponds to Section IV. ii.
Project Narrative: Organizational Information/MOE, Budget and associated
attachments.
The reasonableness of the proposed budget for the project period in relation to the
objectives, the complexity of the activities, and the anticipated results.
1) The extent to which costs, as outlined in the budget, are reasonable given the
scope of work, and aligned with demonstrated need and the Service Category
Table.
2) The extent to which the budget reflects that key personnel have adequate time
(FTEs) devoted to the project and allocated to appropriate budget categories.
2. Review and Selection Process
The independent review process provides an objective evaluation to the individuals
responsible for making award decisions. The highest ranked applications receive
consideration for award within available funding ranges. In addition to the ranking
based on merit criteria, HRSA approving officials may also apply other factors in award
selection, (e.g., geographical distribution), if specified below in this NOFO. HRSA may
also consider assessment of risk and the other pre-award activities described in Section
3, below.
Funding Priority
This program includes a funding priority for some applicants as authorized by section
2603(b)(2)(C) of the PHS Act. HAB will determine the funding factor as outlined below.
Section 2603(b)(2)(C) of the PHS Act directs the Secretary to provide funds to areas to
address the decline or disruption of services related to the decline in the amount of
formula funding. HRSA sets aside a portion of the Part A supplemental funding to
award priority funds in conformance with this statutory requirement. Applicants that
HRSA-18-066 35

received greater than a 20 percent loss in their RWHAP Part A formula award when
comparing their FY 2006 award to their FY 2018 award are eligible for and will receive
priority funding.
3. Assessment of Risk and Other Pre-Award Activities
HRSA may elect not to fund applicants with management or financial instability that
directly relates to the organization’s ability to implement statutory, regulatory or other
requirements (45 CFR § 75.205).
HRSA reviews applications receiving a favorable objective review for other
considerations that include past performance, as applicable, cost analysis of the
project/program budget, assessment of your management systems, ensuring continued
applicant eligibility, and compliance with any public policy requirements, including those
requiring just-in-time submissions. HRSA may ask you to submit additional
programmatic or administrative information (such as an updated budget or “other
support” information) or to undertake certain activities (such as negotiation of an indirect
cost rate) in anticipation of an award. However, even at this point in the process, such
requests do not guarantee that HRSA will make an award. Following review of all
applicable information, HRSA’s approving and business management officials will
determine whether HRSA can make an award, if special conditions are required, and
what level of funding is appropriate.
Award decisions are discretionary and are not subject to appeal to any HRSA or HHS
official or board.
Effective January 1, 2016, HRSA is required to review and consider any information
about your organization that is in the Federal Awardee Performance and Integrity
Information System (FAPIIS). You may review and comment on any information about
your organization that a federal awarding agency previously entered. HRSA will
consider any of your comments, in addition to other information in FAPIIS, in making a
judgment about your organization’s integrity, business ethics, and record of
performance under federal awards when completing the review of risk posed as
described in 45 CFR § 75.205 HHS Awarding Agency Review of Risk Posed by
Applicants.
HRSA will report to FAPIIS a determination that an applicant is not qualified (45 CFR §
75.212).
4. Anticipated Announcement and Award Dates
HRSA anticipates issuing/announcing awards prior to the start date of March 1, 2018.
VI. Award Administration Information
1. Award Notices
HRSA will issue the Notice of Award prior to the start date of March 1, 2018. See
HRSA-18-066 36

Section 5.4 of HRSA’s SF-424 Application Guide for additional information.
2. Administrative and National Policy Requirements
See Section 2.2 of HRSA’s SF-424 Application Guide.
3. Reporting
The reporting activities are authorized in 45 CFR part 75 and title XXVI of the PHS Act,
42 U.S.C. 300ff-64. RWHAP award recipients must comply with Section 6 of HRSA’s
SF-424 Application Guide and the following reporting and review activities:
1) Program Terms Report and Program Submission. The RWHAP Part A
recipient must submit a Program Terms Report and Program Submission to HRSA
90 days after the final award is issued. The CQM Plan is included within the
Program Submission reporting requirement. HRSA will provide further information
in the award notice.
2) Estimated Unobligated Balance (UOB). The recipient must submit an estimate
of anticipated UOB and an estimate of anticipated carryover funding to HRSA no
later than December 31, 2018. HRSA will provide further information in the award
notice.
3) RWHAP Part A & MAI Final Expenditure Report. The recipient must submit a
RWHAP Part A & MAI Final Expenditure Report no later than 90 days after the end
of the 2018 budget period. HRSA will provide further information in the award
notice.
4) Annual Progress Report. The recipient must submit an Annual Progress Report
no later than 90 days after the end of the 2018 budget period. HRSA will provide
further information in the award notice.
5) Carryover Request. If applicable, the RWHAP Part A recipient must submit a
Carryover Request no later than 30 days after the FFR submission deadline.
HRSA will provide further information in the award notice.
6) Ryan White HIV/AIDS Program Services Report (RSR). Acceptance of this
award indicates that you assure that you will comply with data requirements of the
RSR and that you will mandate compliance by each of your subrecipients. The
RSR captures information necessary to demonstrate program performance and
accountability. All RWHAP core medical and support service providers are
required to submit client level data as instructed in the RSR manual. Please refer
to the Ryan White HIV/AIDS Program Client Level Data website at
http://hab.hrsa.gov/manageyourgrant/clientleveldata.html for additional information.
Further information will be provided in the award notice.
HRSA-18-066 37

VII. Agency Contacts
You may request additional information regarding business, administrative, or fiscal
issues related to this NOFO by contacting:
Olusola Dada
Grants Management Specialist
Division of Grants Management Operations, OFAM
Health Resources and Services Administration
5600 Fishers Lane, Mailstop 10SWH03
Rockville, MD 20857
Telephone: (301) 443-0195
Email: ODada@hrsa.gov
You may request additional information regarding the overall program issues and/or TA
related to this NOFO by contacting:
Steven R. Young, MSPH
Director, Division of Metropolitan HIV/AIDS Programs
Attn: HIV/AIDS Bureau
Health Resources and Services Administration
5600 Fishers Lane, Room 09W12
Rockville, MD 20857
Telephone: (301) 443-9091
Fax: (301) 443-5271
Email: SYoung@hrsa.gov
You may need assistance when working online to submit your application forms
electronically. Always obtain a case number when calling for support. For assistance
with submitting the application in Grants.gov, contact Grants.gov 24 hours a day, 7 days
a week, excluding federal holidays at:
Grants.gov Contact Center
Telephone: 1-800-518-4726 (International Callers, please dial 606-545-5035)
Email: support@grants.gov
Self-Service Knowledge Base: https://grants-
portal.psc.gov/Welcome.aspx?pt=Grants
Successful applicants/recipients may need assistance when working online to submit
information and reports electronically through HRSA’s Electronic Handbooks (EHBs).
For assistance with submitting information in HRSA’s EHBs, contact the HRSA Contact
Center, Monday-Friday, 8 a.m. to 8 p.m. ET, excluding federal holidays at:
HRSA Contact Center
Telephone: (877) 464-4772
TTY: (877) 897-9910
Web: http://www.hrsa.gov/about/contact/ehbhelp.aspx
HRSA-18-066 38

VIII. Other Information
Technical Assistance
You are encouraged to participate in a TA webinar for this funding opportunity. The
technical assistance webinar is scheduled for Tuesday, September 12, 2017 from 2
p.m. - 4 p.m. Eastern Time. The purpose of this webinar is to assist potential
applicants in preparing applications that address the requirements of this funding
notice. Participation in a pre-application TA webinar is optional.
The following TA webinar has been scheduled:
Day and Date: Tuesday, September 12, 2017
Time: 2 p.m. – 4 p.m. ET
Call-In Number: 1-888-810-5901
Participant Code: 8028761
Weblink: https://hrsa.connectsolutions.com/dmhap_fy18/
The pre-application technical assistance webinar will be recorded and should be
available for viewing after September 22, 2017 at Target Center Webinar and Call
Archives.
IX. Tips for Writing a Strong Application
See Section 4.7 of HRSA’s SF-424 Application Guide.
HRSA-18-066 39

Appendix A
FY 2018 AGREEMENTS AND COMPLIANCE ASSURANCES
Ryan White HIV/AIDS Program
Part A HIV Emergency Relief Grant Program
I, the Chief Elected Official of the Eligible Metropolitan Area or Transitional Grant Area
, (hereinafter referred to as the EMA/TGA) assure that:
Pursuant to Section 2602(a)(2) 1, 2
The EMA/TGA will establish a mechanism to allocate funds and a Planning Council that
comports with section 2602(b).
Pursuant to Section 2602(a)(2)(B)
The EMA/TGA has entered into intergovernmental agreements with the Chief Elected
Officials of the political subdivisions in the EMA/TGA that provide HIV-related health
services and for which the number of AIDS cases in the last 5 years constitutes not less
than 10 percent of the cases reported for the EMA/TGA.
Pursuant to Section 2602(b)(4)
The EMA/TGA Planning Council will determine the size and demographics of the population
of individuals with HIV/AIDS, as well as the size and demographics of the estimated
population of individuals with HIV/AIDS who are unaware of their HIV status; determine the
needs of such population, and develop a comprehensive plan for the organization and
delivery of health and support services. The plan must include a strategy with discrete
goals, a timetable, and appropriate funding, for identifying individuals with HIV/AIDS who do
not know their HIV status, making such individuals aware of their HIV status, and enabling
such individuals to use the health and support services. The strategy should particularly
address disparities in access and services among affected subpopulations and historically
underserved communities.
Pursuant to Section 2603(c)
The EMA/TGA will comply with statutory requirements regarding the timeframe for obligation and
expenditure of funds, and will comply with any cancellation of unobligated funds.
Pursuant to Section 2603(d)
The EMA/TGA will make expenditures in compliance with priorities established by the
Planning Council/Planning Body.
Pursuant to Section 2604(a)
The EMA/TGA will expend funds according to priorities established by the Planning
Council/Planning Body, and for core medical services, support services, and administrative
expenses only.
1 All statutory references are to the Public Health Service Act, unless otherwise specified.
2 TGAs are exempted from the requirement related to Planning Councils, but must provide a process for
obtaining community input as described in section 2609(d)(1)(A) of the PHS Act. TGAs that have currently
operating Planning Councils are strongly encouraged to maintain that structure.
HRSA-18-066 40

Pursuant to Section 2604(c)
The EMA/TGA will expend not less than 75 percent of service dollars for core medical
services, unless waived by the Secretary.
Pursuant to Section 2604(f)
The EMA/TGA will, for each of such populations in the eligible area use, from the grants
made for the area under Section 2601(a) for a FY, expend not less than the percentage
constituted by the ratio of the population involved (infants, children, youth, or women in such
area) with HIV/AIDS to the general population in such area of individuals with HIV/AIDS,
unless a waiver from this provision is obtained.
Pursuant to Section 2604(g)
The EMA/TGA has complied with requirements regarding the Medicaid status of providers,
unless waived by the Secretary.
Pursuant to Section 2604(h)(2), Section 2604(h)(3), Section 2604(h)(4)
The EMA/TGA will expend no more than 10 percent of the grant on administrative costs
(including Planning Council or planning body expenses), and in accordance with the
legislative definition of administrative activities, and the allocation of funds to subrecipients
will not exceed an aggregate amount of 10 percent of such funds for administrative
purposes.
Pursuant to Section 2604(h)(5)
The EMA/TGA will establish a CQM Program that meets HRSA requirements, and that
funding for this program shall not exceed the lesser of five percent of program funds or $3
million.
Pursuant to Section 2604(i)
The EMA/TGA will not use grant funds for construction or to make cash payments to
recipients.
Pursuant to Section 2605(a)
With regard to the use of funds,
a. funds received under Part A of Title XXVI of the Act will be used to supplement, not
supplant, state funds made available in the year for which the grant is awarded to
provide HIV related services to individuals with HIV disease;
b. during the period of performance, political subdivisions within the EMA/TGA will
maintain at least their prior FY’s level of expenditures for HIV related services for
individuals with HIV disease;
c. political subdivisions within the EMA/TGA will not use funds received under Part A in
maintaining the level of expenditures for HIV related services as required in the
above paragraph; and
d. documentation of this MOE will be retained.
Pursuant to Section 2605(a)(3)
The EMA/TGA will maintain appropriate referral relationships with entities considered key
points of access to the health care system for the purpose of facilitating EIS for individuals
diagnosed as being HIV positive.
Pursuant to Section 2605(a)(5)
HRSA-18-066 41

The EMA/TGA will participate in an established HIV community based continuum of care, if
such continuum exists within the EMA/TGA.
Pursuant to Section 2605(a)(6)
Part A funds will not be used to pay for any item or service that can reasonably be expected
to be paid under any state compensation program, insurance policy, or any Federal or
state health benefits program (except for programs related to the Indian Health Service)
or by an entity that provides health services on a prepaid basis.
Pursuant to Section 2605(a)(7)(A)
Part A funded HIV primary medical care and support services will be provided, to the
maximum extent possible, without regard to a) the ability of the individual to pay for such
services or b) the current or past health conditions of the individuals to be served.
Pursuant to Section 2605(a)(7)(B)
Part A funded HIV primary medical care and support will be provided in settings that are
accessible to low-income individuals with HIV disease.
Pursuant to Section 2605(a)(7)(C)
A program of outreach services will be provided to low-income individuals with HIV disease
to inform them of such services.
Pursuant to Section 2605(a)(8)
The EMA/TGA has participated in the Statewide Coordinated Statement of Need (SCSN)
process initiated by the state, and the services provided under the EMA/TGA’s
comprehensive plan are consistent with the SCSN.
Pursuant to Section 2605(a)(9)
The EMA/TGA has procedures in place to ensure that services are provided by appropriate
entities.
Pursuant to Section 2605(a)(10)
The EMA/TGA will submit audits every 2 years to the lead state agency under Part B of Title
XXVI of the PHS Act.
Pursuant to Section 2605(e)
The EMA/TGA will comply with the statutory requirements regarding imposition of charges
for services.
Pursuant to Section 2681(d)
Services funded will be integrated with other such services, programs will be coordinated
with other available programs (including Medicaid), and that the continuity of care and
prevention services of individuals with HIV is enhanced.
Pursuant to Section 2684
No funds shall be used to fund AIDS programs, or to develop materials, designed to
promote or encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual.
Signature Date
HRSA-18-066 42

Appendix B
Geographic Service Areas
Applications must propose to serve the entire service area, as defined here in
Appendix B.
The “Funding Ceiling” column identifies the total funding available for the delivery of
comprehensive primary healthcare and support services for low income, uninsured and
underserved PLWH for each service area. Funding requests must not exceed the
published funding ceiling amount. Please note that this amount includes MAI funding.
The MAI component of your budget must not exceed five percent of your FY 2017 MAI
award.
EMA City State Funding Service area
Ceiling
Atlanta EMA Atlanta GA $26,806,415 Barrow County, Bartow
County, Carroll County,
Cherokee County, Clayton
County, Cobb County,
Coweta County, DeKalb
County, Douglas County,
Fayette County, Forsyth
County, Fulton County,
Gwinnett County, Henry
County, Newton County,
Paulding County, Pickens
County, Rockdale County,
Spalding County, and
Walton County
Baltimore EMA Baltimore MD $17,859,446 Anne Arundel County,
Baltimore City, Baltimore
County, Carroll County,
Harford County, Howard
County, and Queen Anne's
County
Boston EMA* Boston MA $15,629,834 MA: Bristol County, Essex
County, Middlesex County,
Norfolk County, Plymouth
County, Suffolk County, and
Worcester County
NH: Hillsborough County,
Rockingham County, and
Strafford County
HRSA-18-066 43

Chicago EMA Chicago IL $28,823,062 Cook County, DeKalb
County, DuPage County,
Grundy County, Kane
County, Kendall County,
Lake County, McHenry
County, and Will County
Dallas EMA Dallas TX $18,234,544 Collin County, Dallas
County, Denton County,
Ellis County, Henderson
County, Hunt County,
Kaufman County, and
Rockwall County
Detroit EMA Detroit MI $10,213,475 Lapeer County, Macomb
County, Monroe County,
Oakland County, St. Clair
County, and Wayne County
Fort Lauderdale Fort FL $16,623,315 Broward County
EMA Lauderdale
Houston EMA Houston TX $23,912,765 Chambers County, Fort
Bend County, Harris
County, Liberty County,
Montgomery County, and
Waller County
Los Angeles EMA Los Angeles CA $45,723,215 Los Angeles County
Miami EMA Miami FL $27,963,028 Miami-Dade County
Nassau-Suffolk EMA Mineola NY $5,895,963 Nassau County and Suffolk
County
New Haven EMA New Haven CT $5,982,648 Fairfield County and New
Haven County
New Orleans EMA New Orleans LA $8,304,396 Jefferson Parish, Orleans
Parish, Plaquemines Parish,
St. Bernard Parish, St.
Charles Parish, St. James
Parish, St. John the Baptist
Parish, and St. Tammany
Parish
New York EMA New York NY $103,813,259 Bronx County, Kings
County, New York County,
Putnam County, Queens
County, Richmond County,
Rockland County, and
Westchester County
Newark EMA Newark NJ $13,466,992 Essex County, Morris
County, Sussex County,
HRSA-18-066 44

Union County, and Warren
County
Orlando EMA Orlando FL $10,190,328 Lake County, Orange
County, Osceola County,
and Seminole County
Philadelphia EMA* Philadelphia PA $24,023,303 PA: Bucks County, Chester
County, Delaware County,
Montgomery County, and
Philadelphia County
NJ: Burlington County,
Camden County, Gloucester
County, and Salem County
Phoenix EMA Phoenix AZ $9,675,916 Maricopa County and Pinal
County
San Diego EMA San Diego CA $11,971,876 San Diego County
San Francisco EMA San CA $16,601,550 Marin County, San
Francisco Francisco County, and San
Mateo County
San Juan EMA San Juan PR $11,871,640 Aguas Buenas Municipality,
Barceloneta Municipality,
Bayamón Municipality,
Canóvanas Municipality,
Carolina Municipality,
Cataño Municipality, Ceiba
Municipality, Comerío
Municipality, Corozal
Municipality, Dorado
Municipality, Fajardo
Municipality, Florida
Municipality, Guaynabo
Municipality, Humacao
Municipality, Juncos
Municipality, Las Piedras
Municipality, Loíza
Municipality, Luquillo
Municipality, Manatí
Municipality, Morovis
Municipality, Naguabo
Municipality, Naranjito
Municipality, Río Grande
Municipality, San Juan
Municipality, Toa Alta
Municipality, Toa Baja
Municipality, Trujillo Alto
Municipality, Vega Alta
Municipality, Vega Baja
HRSA-18-066 45

Municipality, and Yabucoa
Municipality
Tampa-St. Tampa FL $10,808,521 Hernando County,
Petersburg EMA Hillsborough County, Pasco
County, and Pinellas County
Washington, DC Washington DC $34,143,157 District of Columbia
EMA* MD: Calvert County,
Charles County, Frederick
County, Montgomery
County, and Prince
George's County
VA: Alexandria City,
Arlington County, Clarke
County, Culpeper County,
Fairfax City, Fairfax County,
Falls Church City, Fauquier
County, Fredericksburg City,
King George County,
Loudoun County, Manassas
City, Manassas Park City,
Prince William County,
Spotsylvania County,
Stafford County, and
Warren County
WV: Berkeley County, and
Jefferson County
West Palm Beach West Palm FL $8,020,040 Palm Beach County
EMA Beach
*Service area crosses state lines
HRSA-18-066 46

Current TGA City State Funding Service area
Recipient Ceiling
Austin TGA Austin TX $5,072,729 Bastrop County, Caldwell
County, Hays County,
Travis County, and
Williamson County
Baton Rouge TGA Baton Rouge LA $4,833,636 Ascension Parish, East
Baton Rouge Parish, East
Feliciana Parish, Iberville
Parish, Livingston Parish,
Pointe Coupee Parish, St.
Helena Parish, West Baton
Rouge Parish, and West
Feliciana Parish
Bergen-Passaic Paterson NJ $4,333,040 Bergen County and Passaic
TGA County
Charlotte-Gastonia Charlotte NC $6,545,685 NC: Anson County,
TGA* Cabarrus County, Gaston
County, Mecklenburg
County, and Union County
SC: York County
Cleveland-Lorain- Cleveland OH $4,910,542 Ashtabula County,
Elyria TGA Cuyahoga County, Geauga
County, Lake County, Lorain
County, and Medina County
Columbus TGA Columbus OH $4,761,097 Delaware County, Fairfield
County, Franklin County,
Licking County, Madison
County, Morrow County,
Pickaway County, and
Union County
Denver TGA Denver CO $8,217,030 Adams County, Arapahoe
County, Denver County,
Douglas County, and
Jefferson County
Fort Worth TGA Fort Worth TX $4,708,143 Hood County, Johnson
County, Parker County, and
Tarrant County
Hartford TGA Hartford CT $3,413,321 Hartford County, Middlesex
County, and Tolland County
HRSA-18-066 47

Indianapolis TGA Indianapolis IN $4,579,120 Boone County, Brown
County, Hamilton County,
Hancock County, Hendricks
County, Johnson County,
Marion County, Morgan
County, Putnam County,
and Shelby County
Jacksonville TGA Jacksonville FL $6,335,214 Clay County, Duval County,
Nassau County, and St.
Johns County
Jersey City TGA Jersey City NJ $5,428,884 Hudson County
Kansas City TGA* Kansas City MO $4,534,522 MO: Cass County, Clay
County, Clinton County,
Jackson County, Lafayette
County, Platte County, Ray
County, and Johnson
County
KS: Leavenworth County,
Miami County, and
Wyandotte County
Las Vegas TGA* Las Vegas NV $6,444,707 NV: Clark County, and Nye
County
AZ: Mohave County
Memphis TGA* Memphis TN $7,136,376 TN: Fayette County, Shelby
County, and Tipton County
AR: Crittenden County
MS: DeSoto County,
Marshall County, Tate
County, and Tunica County
Middlesex- New NJ $2,983,423 Hunterdon County,
Hunterdon- Brunswick Middlesex County, and
Somerset TGA Somerset County
Minneapolis–St. Minneapolis MN $6,198,211 MN: Anoka County, Carver
Paul TGA* County, Chisago County,
Dakota County, Hennepin
County, Isanti County,
Ramsey County, Scott
County, Sherburne County,
Washington County, and
Wright County
WI: Pierce County and St.
Croix County
HRSA-18-066 48

Nashville TGA Nashville TN $4,815,165 Cannon County, Cheatham
County, Davidson County,
Dickson County, Hickman
County, Macon County,
Robertson County,
Rutherford County, Smith
County, Sumner County,
Trousdale County,
Williamson County, and
Wilson County
Norfolk TGA* Norfolk VA $6,231,884 VA: Chesapeake City,
Gloucester County,
Hampton City, Isle of Wight
County, James City County,
Mathews County, Newport
News City, Norfolk City,
Poquoson City, Portsmouth
City, Suffolk City, Virginia
Beach City, Williamsburg
City, and York County
NC: Currituck County
Oakland TGA Oakland CA $7,523,617 Alameda County and Contra
Costa County
Orange County TGA Santa Ana CA $6,643,556 Orange County
Portland TGA* Portland OR $4,267,956 OR: Clackamas County,
Columbia County,
Multnomah County,
Washington County, and
Yamhill County
WA: Clark County
Riverside-San San CA $8,180,902 Riverside County and San
Bernadino TGA Bernadino Bernardino County
Sacramento TGA Sacramento CA $3,534,323 El Dorado County, Placer
County, and Sacramento
County
HRSA-18-066 49

Saint Louis TGA* St. Louis MO $6,589,620 MO: Franklin County,
Jefferson County, Lincoln
County, St. Charles County,
St. Louis City, St. Louis
County, and Warren County
IL: Clinton County, Jersey
County, Madison County,
Monroe County, and St.
Clair County
San Antonio TGA San Antonio TX $5,580,924 Bexar County, Comal
County, Guadalupe County,
and Wilson County
San Jose TGA San Jose CA $3,292,407 Santa Clara County
Seattle TGA Seattle WA $7,528,149 Island County, King County,
and Snohomish County
*Service area crosses state lines
HRSA-18-066 50