Common use of Content and Form of Application Submission Clause in Contracts

Content and Form of Application Submission. Each application must include all contents described below, in the order indicated, and in conformity with the following specifications: The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HHS, or a total file size of 10 MB. This 80-page limit includes the project abstract, project and budget narratives, attachments, letters of commitment and support, and other applicable documents. Standard forms are NOT included in the page limit. The following documents are required for a complete application: A. Standard Forms The following forms must be completed with an original signature and enclosed as part of the application:  SF 424: Official Application for Federal Assistance (see note below)  SF 424A: Budget Information Non-Construction  SF 424B: Assurances-Non-Construction Programs  SF LLL: Disclosure of Lobbying Activities  Project Site Location Form(s)  Lobbying Certification Form (HHS Checklist, 5161)  Item 15 ―Descriptive Title of Applicant’s Project.‖ Please indicate in this section the name of this cooperative agreement funding opportunity: Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges.  Check box ―C‖ to item 19, as Review by State Executive Order 12372 does not apply to these grants.  Assure that the total Federal grant funding requested is for the entire period of the grant (i.e. up to one year for Level One Establishment, from date of award up through December 31, 2014 for Level Two Establishment). B. Required Letters of Support Each applicant must submit a letter from the Governor (or the Mayor, if from the District of Columbia) officially endorsing the grant application and the proposed Cooperative Agreement. In addition, Level Two Establishment applicants must submit a letter from the Governor that expresses a commitment to establish an Exchange. Each applicant also must submit the following letters of support: (a) a letter of support from the State Medicaid Director agreeing not to duplicate efforts between the Exchange and State Medicaid office and to work with the Exchange on developing shared functionalities, and (b) a letter of support from the State Insurance Commissioner agreeing to work with the Exchange on implementation and to coordinate efforts as appropriate. States are encouraged, but not required, to submit letters from other agencies or offices that are responsible for health and human service programs for which the Exchange – in the short or long run – will facilitate applications or enrollment. C. Applicant’s Application Cover Letter A letter from the applicant must identify the:  Project Title  Applicant Name  Principal Investigator/Project Director Name (with email and phone number) D. Project Abstract Provide a summary of the application. Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the grant proposal, including the needs to be addressed, the proposed projects, and the population group(s) to be served. The abstract must be single-spaced and limited to one page in length. Place the following at the top of the abstract for the application:  Application title  Applicant organization name  Program applying under, including funding opportunity number  Project Director  Address  Congressional district(s) served  Project Director phone numbers (phone and fax)  Email address  Organizational Website address, if applicable  Category of Funding  Projected date(s) for project(s) completion The abstract narrative should include:  A brief history of the applicant organization;  A brief description of the populations served by the project;  A brief description of the proposed projects and deliverables; and  A brief description of any other relevant information, including the proposed impact of the funding.

Content and Form of Application Submission. Each application must include all contents described below, in the order indicated, and in conformity with the following specifications: The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HHS, or a total file size of 10 MB. This 80-page limit includes the project abstract, project and budget narratives, attachments, letters of commitment and support, and other applicable documents. Standard forms are NOT included in the page limit. The following documents are required for a complete application: A. Standard Forms The following forms must be completed with an original signature and enclosed as part of the application:  SF 424: Official Application for Federal Assistance (see note below)  SF 424A: Budget Information Non-Construction  SF 424B: Assurances-Non-Construction Programs  SF LLL: Disclosure of Lobbying Activities  Project Site Location Form(s)  Lobbying Certification Form (HHS Checklistchecklist, 5161)  Item 15 ―Descriptive Title of Applicant’s Project.‖ Please indicate in this section the name of this cooperative agreement funding opportunitygrant: Cooperative Agreement Agreements to Support Establishment of State-Operated Health Insurance Exchanges.  Check box ―C‖ to item 19, as Review by State Executive Order 12372 does not apply to these grants.  Assure that the total Federal grant funding requested is for the entire period of the grant (i.e. up to one year for Level One Establishment, from date of award up through December 31, 2014 for Level Two Establishment). B. Required Letters of Support Each applicant must submit a letter from the Governor (or the Mayor, if from the District of Columbia) officially endorsing the grant application and the proposed Cooperative Agreement. In addition, Level Two Establishment applicants must submit a letter from the Governor that expresses a commitment to establish an a State-operated Exchange. Each applicant also must submit the following letters of support: (a) a letter of support from the State Medicaid Director agreeing not to duplicate efforts between the Exchange and State Medicaid office and to work with the Exchange on developing shared functionalities, and (b) a letter of support from the State Insurance Commissioner agreeing to work with the Exchange on implementation and to coordinate efforts as appropriate. States are encouraged, but not required, to submit letters from other agencies or offices that are responsible for health and human service programs for which the Exchange – in the short or long run – will facilitate applications or enrollment. C. Applicant’s Application Cover Letter A letter from the applicant must identify the:  Project Title  Applicant Name  Principal Investigator/Project Director Name (with email and phone number) D. Project Abstract Provide a summary of the application. Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the grant proposal, including the needs to be addressed, the proposed projects, and the population group(s) to be served. The abstract must be single-spaced and limited to one page in length. Place the following at the top of the abstract for the application:  Application title  Applicant organization name  Program applying under, including funding opportunity number  Project Director  Address  Congressional district(s) served  Project Director phone numbers (phone and fax)  Email address  Organizational Website address, if applicable  Category of Funding  Projected date(s) for project(s) completion The abstract narrative should include:  A brief history of the applicant organization;  A brief description of the populations served by the project;  A brief description of the proposed projects and deliverables; and  A brief description of any other relevant information, including the proposed impact of the funding.