INDIAN HEALTH
GRANT PROGRAM
GRANT APPLICATION GUIDANCE
Grant Project Period: January 1, 2016 – December 31, 2017
Application Due: October 19, 2015
MINNESOTA DEPARTMENT OF HEALTH
OFFICE OF RURAL HEALTH AND PRIMARY CARE
July 2015
(for Electronic Submission requirement)
Indian Health Grant Program
Minnesota Department of Health - Office of Rural Health and Primary Care
2015 GRANT APPLICATION GUIDANCE
NEW GRANT PROCESS
For the first time, MDH will solicit, award and manage this grant program electronically, using
WebGrants@MDH. We are excited about this opportunity to add efficiency and consistency to
the management of our grants. It is our hope that every step of the grant process will be clear
and easy to navigate. All required forms and documents will include instructions. You will have
the ability to edit individual forms, save your progress and return later. Please read all
instructions carefully.
INFORMATION ABOUT ELECTRONIC SUBMISSION
To submit an application for this grant, you must first register in the electronic system,
WebGrants@MDH. Your profile includes your personal contact information and information
about your organization. It will be used for all grant communication, so make sure it is accurate
and up-to-date. Remember your password, as you will be responsible for updating and
maintaining your profile. Step-by-step instructions and definitions are available in the
"Instructions" page, a link on the "Main Menu" page.
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All individuals associated with an application, i.e. the person entering the information,
the authorized person who will sign forms, etc., must register with this system before
starting an application.
Once registered, go to the "Funding Opportunities" page and click on the appropriate
grant program.
Complete all electronic forms. Fields with a red star (*) are required and must be
completed or the form cannot be completed. The system will prompt you when a required
field is incomplete.
The system will remember your additions and changes as long as you click "Save" to
save your work. You can begin filling out fields, save changes, close the forms, and
return to the "My Applications" page at a later date. To reopen a saved form for editing,
click "Edit."
In addition to completing electronic forms, you will be required to attach or “upload”
documents for this application. Attachments should be in commonly used software
formats (e.g. Word, PDF, etc.). Instructions for attaching documents are within the form
called "Community Clinic Grant Attachments."
While additional documentation may be attached, only attach documents that are highly
relevant to the specific scope and purpose of your proposed project.
Signatures from authorized individuals are required on some forms, and should be
submitted electronically. See the instructions within the forms where a signature is
required.
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Once all fields on a form are completed, make sure to "Mark as Complete" to prepare the
form for final submission.
After all information is entered, attached, saved and marked as complete, you may submit
the application. You will receive confirmation via the email address you entered when
you registered. You will be able to review and print the submitted application on the "My
Applications" page.
The deadline for submission is automated, and cannot be changed. Attempts to enter an
application after the deadline will not be allowed by the system. Plan accordingly.
If you have any questions, please feel free to contact Deb Jahnke at 800-366-5424 or 651-2013845 or debra.jahnke@state.mn.us.
2016-2017 INDIAN HEALTH GRANT APPLICATION GUIDANCE
A full version of the Application Guidance may be downloaded from the 2016-2017 Indian
Health Grant Program Funding Opportunity in WebGrants@MDH or from the Office of Rural
Health and Primary Care website at
http://www.health.state.mn.us/divs/orhpc/funding/index.html#indian
PROGRAM DESCRIPTION
Per Minnesota Statute 145A.14, the purpose of the Indian Health Grant Program is to provide
assistance to eligible applicants to establish, operate or subsidize clinic facilities and services to
furnish health services for American Indians who reside off reservations. For purposes of the
grant, “resides off reservation” means persons not living on Indian land who are members of an
organized tribe, band or other group of aboriginal people of the United States, having a treaty
relationship with the federal government and who are regarded as American Indians by the group
in which they claim membership. Eligible applicants include nonprofit organizations,
governmental or tribal entities. The Indian Health Grant Program is a two-year grant.
FUNDING LEVELS
The total funding available for the Indian Health Grant Program for the two-year program period
is $348,000. The maximum awards amount for the two-year program period will be $100,000.
Proposed grant project budgets should not exceed the maximum award amount. The Minnesota
Department of Health (MDH) expects to award approximately 4-5 grants.
FUNDING CYCLE
Grant awards are provided for two years: January 1, 2016-December 31, 2017. However, the
final six months of funding for July 1, 2017 to December 31, 2017 will be contingent upon
favorable legislative action on the state budget request for the Fiscal Years 2018/2019 biennium
period.
APPLICATION DEADLINE
Applications must be submitted into WebGrants@MDH by 11:59 PM on October 19, 2015. The
application deadline for submission is automated, and cannot be changed. Attempts to enter an
application after the deadline will not be allowed by the system.
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OTHER REQUIREMENTS
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Applications must be submitted via the electronic grants management system,
WebGrant@MDH, prior to the stated deadline.
Mailed, faxed or emailed applications will not be accepted.
It is recommended that you review these instructions, the Scoring Criteria and Program
Statutes (at the end of this Application Guidance.)
Narrative portions of the application must be in 12-point font, single spaced with
one-inch margins.
Narrative pages must include the name of the applicant and be numbered consecutively.
Applications must include all required components relevant to the applicant
organization’s status – Tribal/Indian Health Services, Nonprofit or Government.
SELECTION AND NOTIFICATION
A review committee will be established to make award recommendations to the Commissioner
of Health. Reviewers may include staff from MDH, staff from other state agencies and
individuals from other organizations that represent a broad range of professionals with
experience in grant writing and review. Reviewers will be required to identify any conflicts of
interest and will not review a proposal if they have a direct relationship with the applicant. The
Commissioner has final authority on grant awards.
Applicants will be notified of award decision by mail in November 2015. An award summary
will be posted on the MDH website after grant contracts are finalized.
REPORTING REQUIREMENTS
Grantees will be expected to provide quarterly narrative progress reports during the grant project
and annual final summary reports at the end of each year in the project period. Financial reports
with invoices for grant expenditure reimbursements must include supporting documentation for
proof of expenditures and are due with the narrative reports. Reimbursements will not be
processed until the narrative progress report is received.
REQUIRED APPLICATION COMPONENTS
Each application must contain the following items:
 Grant Application Face Page Form
 Signature Page Form (accepts electronic signature)
 Project Budget Form
 Biographical Sketch Forms for Grant Project Staff
 Due Diligence Review Form (nonprofits only)
 Grant Feedback Form (optional)
 Grant Attachments (upload documents not provided as forms)
o Governing Board Resolution
o Copy of 501(c)3 IRS determination letter (nonprofits only)
o Financial Statements, IRS 990 or Certified Financial Audit (nonprofits only)
o Project Narrative
o Budget Justification Narrative
o Letters of Support (optional)
o Other Supporting Documents (optional)
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GRANT APPLICATION FACE PAGE
This form is available in the application within WebGrants@MDH.
SIGNATURE PAGE
This form is available in the application within WebGrants@MDH and accepts an electronic
signature.
PROJECT BUDGET FORM
This form is available in the application within WebGrants@MDH. The total budget request
should be the two-year project period. The cost items included in the Grant Funds Requested
column are those that will be supported by grant funds. Non-grant funds are not required but may
be provided to offer grant reviewers a better understanding of the total cost of the grant project.
The budget should be specific to the grant project described in the applicant's project narrative
and is not intended to represent the organization's total budget.
BIOGRAPHICAL SKETCH FORMS
This form is available in the application within WebGrants@MDH. A form should be completed
for each staff person relevant to the grant project.
DUE DILIGENCE REVIEW FORM (Nonprofit Organizations only)
It is the policy of the State of Minnesota to make grants to nongovernmental organizations that
are financially stable enough to carry out the purpose of the grant. Before awarding a grant of
over $25,000 to a nongovernmental organization, Minnesota state agencies must review the Due
Diligence Review Form (formerly the Accounting System and Financial Capability
Questionnaire) and assess a recent financial statement from that organization. Items of
significant concern must be discussed with the grant applicant and resolved to the satisfaction of
state agency staff before a grant is awarded.
GRANT FEEDBACK FORM (optional)
This form is available in the application within WebGrants@MDH.
GRANT ATTACHMENTS
This section of the application is a WebGrants@MDH form that allows applicants to upload
documents that are not provided as fillable forms. The attachments are as follows:
Governing Board Resolution Attachment
A signed Governing Board Resolution authorizing the submission of an Indian Health Grant
application must be attached. The resolution certifies the organization may apply for this grant
program, will comply with the statutory requirements and may enter into a grant contract with
the State of Minnesota. Applicants should plan accordingly with their Governing Board to pass
the resolution prior to the application deadline. The resolution form is attached to the Funding
Opportunity as a PDF. It may be downloaded, completed, scanned and uploaded into the
appropriate section of the application.
Copy of 501(c)3 IRS Determination Letter Attachment (nonprofits only)
Private nonprofit organizations must submit proof of nonprofit status. This is not applicable to
government or tribal organization applicants.
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Financial Documents, IRS 990, or Certified Financial Audit Attachment (nonprofits
only)
It is the policy of the State of Minnesota to make grants to nongovernmental organizations that
are financially stable enough to carry out the purpose of the grant. Before awarding a grant of
over $25,000 to a nongovernmental organization, Minnesota state agencies must review the Due
Diligence Review Form (formerly the Accounting System and Financial Capability
Questionnaire) and assess a recent financial statement from that organization. Items of
significant concern must be discussed with the grant applicant and resolved to the satisfaction of
state agency staff before a grant is awarded.
Nonprofit organizations must submit the one of the following, based on annual income levels, for
the previous full accounting period (12 months):
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Organizations with annual income of under $50,000 or who have not been in
existence long enough to have completed IRS Form 990 or an audit must submit the
most recent board-reviewed internal financial statements
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Organizations with annual income over $50,000 and under $750,000 must submit
the most recent IRS Form 990 or a Certified Financial Audit
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Organizations with annual income over $750,000 must submit the most recent
Certified Financial Audit (applicants submitting an audit need not provide duplicate
copies with the two copies of the pre-application)
Project Narrative Attachment
The Project Narrative should follow the following format: 14-page limit, 12-point font, one-inch
margins, page numbers and include all required components in the order specified.
I. Applicant Information
A. Eligibility Status
1. Brief description of the organizational history, mission and goals.
2. Brief description of organization’s current programs and services.
3. Brief description of the clinic’s geographic service area (you may upload a
map as a separate attachment).
4. Brief description of the organization’s target population.
II. Project Description and Collaboration
A. Problem Statement: Describe the priority problem or problems experienced by the
American Indian community that will be addressed by the proposed grant project.
B. Project Need: Provide data and documentation to support the existence and severity
of the problem described in the problem statement.
C. Project Description: The proposed project should address the problem described in
the problem statement. Please include the following:
1. A description of the population to be served.
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2. An overview of what will be done in the project and how it will be done (as
reflected in more detail in the Work Plan) to provide a broader picture of how
activities are accomplished.
3. Specific information about the project’s target population and how many
patients (in numbers) will benefit from the project.
4. If the project has been funded before under this grant program, applicants
should describe progress made in prior years, e.g. what were the goals and
were they met?
D. Collaboration: Provide an explanation of how the project is supported by the
American Indian community and other community partners. Letters of support are
strongly encouraged.
III. Project Work Plan (This section works well in table format.)
A. Project Goal(s)
A goal is a restatement of a public health problem in a way that describes what
conditions will prevail if the problem is resolved or reduced. A goal is long term
and not necessarily measurable, but it clearly establishes a connection between
public health problems/priorities and the applicant’s intentions. Goal statements
are optional but may help the applicant formulate measurable objectives. One goal
statement is sufficient.
For example, an applicant may find during its community assessment that
American Indian women experienced a high-risk birth rate exceeding state
averages. Based on this finding and other related data, an organization might
establish the following goal: To reduce American Indian infant mortality due to
high-risk birth.
B. Objectives for Each Project Goal
Include objectives for each stated goal. Objectives are tangible, measurable and
achievable outcomes specific to what the proposed grant project is intending to
accomplish. Objectives are generally client-centered with the focus on the
targeted population and not on organization activities. Objectives that use a
number or percentage as an ending outcome should include the current base level
number or percentage so that the intended change is clear. It is expected that the
grant project and objectives will be achieved within the grant period.
Objectives pertain to what will happen within the target population, not what the
clinic will “do” (which are activities within the work plan). Objectives contain
four common elements:
1.
An indicator (how the problem will change)
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A target (a “who” or a “what,” generally the client)
3.
A time frame (when), and
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The amount of measurable change expected in the indicator, or the target.
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A common format for objectives is as follows:
By ,
(when?)
of
, will
(% or # of change) (what population) (indicator – do
what/change how)
For example:
By
December 31, 2016 , 97% (from 86.5% in 2013) of American Indian
(when?)
(% of change)
(who/what)
Women will initiate prenatal care before the third trimester of pregnancy.
(indicator)
C. Activities for Each Project Objective (includes timeline and staff responsible)
Activities are detailed descriptions of how the objectives will be accomplished.
Activities are organization-centered (vs. client-centered objectives) and should
document the person responsible for each activity and a time period in which the
activity will be completed. Activities may be documented within a table format,
or by statements such as the following format:
The _____ will
(who?)
(what? how much? activity?)
by ______.
(when?)
For example:
The Maternal-Child Health Nurse will provide free pregnancy tests
(who at the agency?)
(what activity?)
for 60 American Indian women by March 31, 2016.
(how much?)
(when?)
Budget Justification Narrative Attachment
Prepare a Budget Justification for the two-year grant project not exceeding 6 typewritten pages.
The budget justification should include an explanation for each of the cost items for EACH year
for which grant funds are being requested on the Project Budget Form. The format should be an
itemization of Year One and Year Two together within each cost item.
Explanations for each cost item should include:
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Details on how the budgeted cost items were calculated.
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A rationale of how the item relates to the objectives and activities listed in the Work
Plan.
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How any remaining costs not funded by the grant may be funded.
The following examples provide illustrations of the type of information necessary. Examples for
each cost item are not included. Not all examples are fully formatted.
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Example A: Salary and Fringe
For each year of the project period, provide the position title, total salary and FTE based on
2,080 hours/year spent by the position in activities funded by this special project, the rationale
for this calculation, the dollar amount of the Community Clinic Grant funds budgeted for
positions, and the relationship to objectives/activities.
Example A Salary and Fringe :
YEAR ONE
Registered Nurse
0.75 FTE @ $29,572 = $22,179.00
Secretary
0.2 FTE @ $16,500 = $ 3,300.00
Fringe Benefits (19%) = $4,841.01
Fringe benefits include (example: life/health insurance, FICA, unemployment and
worker's compensation insurance coverage).
Year One Total = $30,320.01
YEAR TWO (followed by same Year One format, breakdown and total).
Rationale: Registered Nurse is assigned 75% to the project; estimated percentage of
secretary’s time is based on actual experience during previous grant period. The majority
of the nurse’s time will address Objective __, “initiate prenatal care before the third
trimester of pregnancy.” Her time will include pregnancy testing and health and nutrition
education for expectant mothers.
Example B: Travel
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For each year, provide the number of miles of travel planned for project activities as well
as the rate of reimbursement per mile. Mileage reimbursement paid by Community Clinic
Grant funds cannot exceed the Federal IRS mileage reimbursement rate unless otherwise
negotiated directly with the State of Minnesota.
Other travel expenses supported by grant funds will be reimbursed to the grantee in the
same manner and in no greater amount than provided in the current "Commissioner's
Plan" promulgated by the Commissioner of Minnesota Management and Budget
("MMB"). The plan may be found at
http://www.mn.gov/mmb/search/?query=Commissioners+Plan
Out-of state travel is discouraged and must be approved specifically by the MDH grant
manager.
The rationale for travel costs should specify how the travel will support the activities and
objectives.
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Example C: Contracted Services
For each year, provide the name of the contractor, the components or services to be
provided by contractor, and cost per service, client, etc.
Contracted Services Example:
XYZ Laboratory –
Laboratory services for diabetes testing and pregnancy testing = $500
Total = $500
Example D: Equipment and Supplies
For each year, provide an actual cost of equipment and/or supplies to be purchased with grant
funds. Purchases of these items should be previously outlined in the activities of the Work Plan
and the rationale should show how the equipment and/or supplies will directly support the
objectives.
Letters of Support Attachment(s)
Letters of support from the American Indian community being served by the project are strongly
encouraged.
Other Supporting Document Attachment(s)
Applicants may submit additional information to support the application, such as service area
maps, evidence of community support, etc.
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Application Scoring Criteria
The following is a guide used by grant reviewers to score Indian Health Grant applications.
A.
All legal and procedural conditions of eligibility are met.
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B.
Organization is a governmental, tribal or nonprofit entity.
Proposed services are for Indian persons not residing on Indian land who are members of
an organized tribe having a treaty relationship with the federal government and who are
regarded as Indians by the group in which they claim membership.
Application was received by the stated deadline.
Application Face Sheet is completed.
Application Signature Page Form is completed.
Project Budget Form encompasses the two years of the project period and is completed.
Biographical Sketches are included for each staff relevant to the grant project.
Non-profit organizations have included a completed Due Diligence Review Form.
Governing Board Resolution is completed, signed and uploaded.
Non-profit organizations have uploaded proof of nonprofit status.
Non-profit organizations have uploaded the appropriate financial documents.
A Project Narrative with Work Plan is completed and uploaded.
A Budget Justification Narrative including justification for both years of the grant period
is completed and uploaded.
Evidence that proposed activity will positively affect identified priority community
health problems in a cost-effective manner.
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The Indian community has been clearly identified by numbers and geography and has
been included in the community assessment process.
The proposal includes an identified community health problem, goals, objectives and
activities for the proposed grant project.
The objectives are written in the correct format per the Grant Application Guidance,
client-centered and measurable.
The activities include staff assignment and a defined timeline for completion.
There is a clear relationship between the identified community health problems and the
goals, objectives and activities presented in the proposal.
There is evidence that the proposed activities will improve population health status and
are culturally acceptable.
The proposed project budget expenditures are clearly connected to program objectives
and activities.
Funding from other sources, specific to the proposed grant project, have been identified.
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C.
Evidence of coordinated planning, community support and integration of projects
with other community resources.
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There is evidence of support for the proposed project from the Indian Community.
o Does the planning process show involvement of the Indian community as
participants?
o Are there indications of support from affected members/organizations in the Indian
community?
o Are there indications of support from other health and social service organizations
serving the Indian community?
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Program Statutes
Minnesota Statute 145A.14 Special grants.
Subd. 2.
Indian health grants. (a) The commissioner
may make special grants to establish, operate, or subsidize
clinic facilities and services to furnish health services for
American Indians who reside off reservations.
(b) Applicants must submit for approval a plan and budget
for the use of the funds in the form and detail specified by the
commissioner.
(c) Applicants must keep records, including records of
expenditures to be audited, as the commissioner specifies.
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