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HomeMy WebLinkAboutUS Department of Health and Human Services-Healthy Start Initiative Eliminating Disparities in Perinatal Health_D-19-790.pdf CO Hall of Records, Room 301 County of Fresno 2281 Tulare Street ;`9 Fresno,California Board of Supervisors 93721-2198 '$'6 0 Telephone:(559)600-3529 S� Minute Order Toll Free:1-800-742-1011 FRE www.co.fresno.ca.us September 5, 2023 Present: 5- Supervisor Steve Brandau, Vice Chairman Nathan Magsig, Supervisor Buddy Mendes, Supervisor Brian Pacheco, and Chairman Sal Quintero Agenda No. 32. Public Health File ID: 23-0472 Re: Retroactively approve and authorize the Director of the Department of Public Health's previous submission of an application to the U.S. Department of Health and Human Services, Maternal and Child Health Bureau,for Healthy Start Initiative: Eliminating Disparities in Perinatal Health grant funds, for the period of April 1, 2019 to March 31,2024($4,885,000); approve and authorize the Chairman to retroactively accept the Notice of Awards Authorization from the U.S. Department of Health and Human Services for the Healthy Start Initiative: Eliminating Disparities in Perinatal Health, effective April 1, 2019 to March 31,2024($4,885,000); and retroactively approve and authorize the Director of Public Health's execution of the Federal Assurances and Certifications for the application APPROVED AS RECOMMENDED Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero County of Fresno Page 32 C O �. "CaBoard Agenda Item 32 o le,6 o FRE`'� DATE: September 5, 2023 TO: Board of Supervisors SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health SUBJECT: Retroactive Approval of Submission of Application and Notice of Awards from the U.S Department of Health and Human Services for Healthy Start Initiative: Eliminating Disparities in Perinatal Health RECOMMENDED ACTION(S): 1. Retroactively approve and authorize the Director of the Department of Public Health's previous submission of an application to the U.S. Department of Health and Human Services, Maternal and Child Health Bureau,for Healthy Start Initiative: Eliminating Disparities in Perinatal Health grant funds,for the period of April 1, 2019 to March 31, 2024 ($4,885,000). 2. Approve and authorize the Chairman to retroactively accept the Notice of Awards Authorization from the U.S. Department of Health and Human Services for the Healthy Start Initiative: Eliminating Disparities in Perinatal Health, effective April 1,2019 to March 31, 2024 ($4,885,000). 3. Retroactively approve and authorize the Director of Public Health's execution of the Federal Assurances and Certifications for the application. There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will retroactively approve the Department of Public Health's (Department)submission of the application for Federal Healthy Start funding ($4,885,000)and retroactively accept the Notice of Awards (NoA)to continue the Babies First program for five years to reduce disparities in infant mortality and adverse perinatal outcomes. The Babies First program provides outreach, education, and home visitation services to low-income mothers and their families.This item is countywide. ALTERNATIVE ACTION(S): There are no viable alternative actions.The Healthy Start funding has been utilized by DPH since 2019. Should your Board not approve the recommended action, the Department would not be able to accept current and previous already expended grant funds from the U.S. Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA)and DHHS HRSA may require the County to repay the Federal funds expended since 2019 ($2,787,616). RETROACTIVE AGREEMENT: The recommended actions are retroactive to April 1, 2019. The Department conducted an internal review on current grants and discovered the DHHS application and NoA was not presented to the Board in FY 2019-20 for the full grant term of April 1, 2019 to March 31, 2024. The Department attributes this error to staffing oversight, and safeguards have been put in place to make sure this does not occur in the future. County of Fresno Page 1 File Number.23-0472 File Number:23-0472 FISCAL IMPACT: There is no increase in Net County Cost associated with the recommended actions. The DHHS approved a competitive grant allocation to Fresno County in the amount of$950,000 for April 1, 2019 through March 31, 2020 for the Babies First program. Future allocations through March 31, 2024 were allocated in the amount of$980,000 per year. DHHS allocated an additional $15,000 for the FY 2023-24 to purchase Mother and Infant Supply Kits. The Federal government allows an indirect cost recovery of 10% of total direct costs. The Department's indirect cost rate for FY 2023-24 is 18.314%. The 8.314% difference will be covered by Health Realignment. Sufficient appropriations and estimated revenues were included in the Department's Org 5620 FY 2019-23 Adopted Budgets and is included in the Department's Org 5620 FY 2023-24 Recommended Budget. DISCUSSION: On March 25, 2014, the Board approved the retroactive submission of the application to DHHS for Health Start funding for the grant period of June 1, 2014 to May 31, 2019 ($3,750,000). On August 19, 2014,the Board approved a retroactive revenue agreement with DHHS for the extension of the FY 2013-14 Healthy Start grant by approving DHHS allocation of$287,500 from June 1, 2014 to August 31, 2014 due to the final determination of grantees to be awarded for the 2014-19 grant period had not been made, therefore, DHHS authorized a NoA to extend the project through August 31, 2014. On December 2, 2014, the Board approved the retroactive Notice of Award (NoA)from DHHS for the Healthy Start funding from September 1, 2014 through May 31, 2019 ($3,532,933). In the final term of the Healthy Start funding in FY 2018-19, the Department completed a new grant application on November 26, 2018 and received the new NoA on March 18, 2019 for terms April 1, 2019 through March 31, 2024. DHHS continued to reimburse the services provided by the Department's Babies First program as DHHS did not require a signed document be returned from the County. Every project applying for funding is required to address the five approaches of Healthy Start: improve women's health, promote quality services, strengthen family resilience, achieve collective impact, and increase accountability through quality improvement, performance monitoring, and evaluation. Core services include Outreach, Case Management/Care Coordination, Health Education, Interconception Care and Depression Screening and Referral, all of which are provided by Babies First and Maternal, Child and Adolescent Health (MCAH) programs. Services and strategies will be implemented to achieve the grant benchmarks and align with existing community services to sustain community level change within the community system of care. Approval of the recommended actions will approve the DHHS Healthy Start funding allocations to the Department's Babies First program to continue addressing significant disparities in perinatal health. The Department's Babies First program has been receiving the Healthy Start funding since 1997 and was required to compete for continued funding prior to the expiration of the FY 2014-19 grant term cycle. The FY 2019-24 application was submitted on November 26, 2018. Since April 1, 2019, Babies First has provided services to 462 pregnant and parenting women/teens and 390 children. Nurse case managers and trained health education assistants completed a total of 3,549 home visits, field visits or telehealth visits, 2,584 phone calls, and 6,241 texts. Every pregnant, postpartum women, infant and child served is assessed at least quarterly and screened for depression, intimate partner violence and developmental delays. Babies First has continued to meet the community's needs by implementing new grant activities to improve perinatal health outcomes and reduce infant mortality by meeting several program objectives. These objectives include increasing the percentage of participants with health insurance and a reproductive life plan. Babies First also hopes to reduce the percentage of pregnancies conceived within 18 months of a previous birth and increase the percentage of participants who engage in safe sleep behaviors, breastfeed, receive screenings for perinatal depression and intimate partner County of Fresno page 2 File Number.23-0472 File Number:23-0472 violence and abstain from cigarette smoking during pregnancy. Approval of the recommended actions will also accept the terms of the grant, which specify that the County must comply with DHHS's Grants Policy Statements, including if County fails to comply with the remarks, terms, conditions, or reporting requirements, this may result in a draw down restriction being placed on the County's Payment Management System account or denial of future funding. REFERENCE MATERIAL: BAI #44, December 2, 2014 BAI #42, August 19, 2014 BAI #26, March 25, 2014 ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk- DHHS Healthy Start Funding Application for FY 2019-24 On file with Clerk- Notice of Award Authorization with DHHS FY 2019-24 On file with Clerk- Federal Assurances and Certification CAO ANALYST: Ron Alexander County of Fresno Page 3 File Number.23-0472 D-19-790 WORKSPACE FORM 1GRA'N S.GO6 GFtANTS.COv'� SUPPORT@GRANTS.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package.This form can be completed in its entirety ofiline using Adobe Reader.You can save your form by clicking the"Save"button and see any errors by clicking the"Check For Errors"button.In-progress and completed forms can be uploaded at any time to Grants.gov using the Workspace feature. When you open a form,required fields are highlighted in yellow with a red border.Optional fields and completed fields are displayed in white.If you enter invalid or incomplete information in a field,you will receive an error message.Additional instructions and FAQs about the Application Package can be found in the Granls.gov Applicants lab. OPPORTUNITY&PACKAGE DETAILS: Opportunity Number: HRSA-19-049 Opportunity Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opportunity Package ID PKGO0245324 CFDA Number: 93.926 CFDA Description: Healthy Start Initiative Competition ID: HRSA-19-049 Competition Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opening Date: Closing Date: 11/2W2018 ` Agency: Health Resources and Services Administration Contact Information: Contact Benita Baker, MS at (301)443-0543 or email MCHBHealthyStart@hrsa.gov WORKSPACEAPPLICANTA Workspace ID: t4S00220665 Application Filing Name: Fresno DPH Healthy Start 2019-24 DUNS: 5561976550000 Organization: FRESNO, COUNTY OF Form Name: Application for Federal Assistance (SF-424) Form Version: 2.1 Requirement: Mandatory Download Date/Time: Nov 26, 2018 07:59:36 PM EST — — ----- ----- Form State: No Errors OMB Number:4040-0004 Expiration Dale:12/31/2019 Application for Federal Assistance SF-424 1.Type of Submission: 2.Type of Application: If Revision,select appropriate letter(s): ❑Preapplicalion New ®Application ®Continuation Other(Specify): Changed/Corrected Application Revision 4.Applicant Identifier: Comp a ed by ran s.gov upon submisslon. 5a.Federal Entity Identifier: 5b.Federal Award Identifier: H4914CO0150 State Use Only: 6.Dale Received by Slate: 7.Slate Application Identifier: 8.APPLICANT INFORMATION: a.Legal Name: County of Fresno b.Employer/Taxpayer Identification Number(EIN/TIN): c,Organizational DUNS: 94-6000512 15561976550000 d.Address: Slreetl: PO Box 11867 Street2: City: Fresno County/Parish: State: CA: California Province: 'Country: USA: UNITED STATES 'Zip/Postal Code: 93775-1867 e.Organizational Unit: Department Name: Division Name: f.Name and contact information of person to be contacted on matters involving this application: Prefix: First Name: Ah Middle Name: 'Last Name: Fang Suffix: Title: Health Educator Organizational Affiliation: Fresno County Department of Public Health Telephone Number. 5596003330 Fax Number: 5594554705 Email: ahvang@fresnocountyca.gov Application for Federal Assistance SF-424 '9.Type of Applicant 1:Select Applicant Type: B: county Government Type of Applicant 2:Select Applicant Type: Type of Applicant 3:Select Applicant Type: Other(specify): 10,Name of Federal Agency: Health Resources and Services Administration 11.Catalog of Federal Domestic Assistance Number: 93.926 CFDA Title: Healthy Start initiative 12.Funding Opportunity Number: IIRSA-19-049 'Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 13.Competition Identification Number: HRSA-19-049 Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 14.Areas Affected by Project(Cities,Counties,States,etc.): HSmap2019-2024.pdf I I Add Attachment I Delete Attachment ViewAttachmenl 15.Descriptive Title of Applicant's Project: Babies First: Eliminating Disparities in Perinatal Health Attach supporting documents as specified in agency instructions. Add Attachments I Delete Attachments View Attachments Application for Federal Assistance SF-424 16.Congressional Districts Of: 'a.Applicant CA-016 'b.Program/Project cx-016 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Deleie Allachria L Via::Attachment 17.Proposed Project: a.Start Dale: 04/01/2019 'b.End Dale: 03/30/2029 16.Estimated Funding(S): a.Federal 950,000.00 b.Applicant 0.001 c.State 0.00 d.Local 479,252.00 e.Other 2,019,099.00 f. Program Income 0.00 'g.TOTAL 3,448,351.00 "19.Is Application Subject to Review By State Under Executive Order 12372 Process? ® a.This application was made available to the Stale under the Executive Order 12372 Process for review on 11/26/2018 b.Program is subject to E.O.12372 but has not been selected by the State for review. c.Program is not covered by E.O.12372. '20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) Yes ©No If"Yes",provide explanation and attach Add Attachmienl Delete Allaci inenl View Allachmerd 21."By signing this application,I certify(1)to the statements contained in the list of certifications"and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) IN ""IAGREE The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific Instructions. Authorized Representative: Prefix: 'First Name: David Middle Name: Last Name: Pomaville Suffix: 'Title: Director 'Telephone Number: 5596003200 Fax Number: 5596001667 ville@fresnocountyca.gov Email: rdporn, Signature of Authorized Representative: lCompleted by Grants.gov upon submission. Dale Signed: Completed by Grants.gov upon submission. WORKSPACE FORM 1G '- GRANTS.COV` SUPPORT@GRANRANTS.GO.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package.This form can be completed in its entirely offline using Adobe Reader.You can save your form by clicking the"Save"button and see any errors by clicking the"Check For Errors"button.In-progress and completed forms can be uploaded at any time to Granls.gov using the Workspace feature. When you open a form,required fields are highlighted in yellow with a red border.Optional fields and completed fields are displayed in white.If you enter invalid or incomplete information in a field,you will receive an error message.Additional instructions and FAQs about the Application Package can be found in the Granls.gov Applicants lab. OPPORTUNITY&PACKAGE DETAILS: Opportunity Number: HRSA-19-049 Opportunity Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opportunity Package ID: PK000245324 CFDA Number: 93.926 CFDA Description: Healthy start Initiative Competition ID: HRSA-19-049 Competition Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opening Dale: Closing Date: 11/27/2018 Agency: Health Resources and Services Administration Contact Information: contact Benita Baker, MS at (301)443-0543 or email 14CHBHealthyStart@hrsa.gov WORKSPACEAPPLICANT& DETAILS: Workspace ID: WS00220665 Application Filing Name: Fresno DPH Healthy start 2019-24 DUNS: 5561976550000 Organization: FRESNO, COUNTY OF Form Name: Budget Information for Non-Construction Programs (SF-424A) Form Version: 1.0 Requirement: Mandatory Download Date/Time: Nov 27, 2018 06:09:25 PM EST Form State: No Errors BUDGET INFORMATION-Non-Construction Programs OMB Number:4040.0006 Expiration Dale:o11311201g SECTION A-BUDGET SUMMARY Grant Program Catalog or Federal Function or Domestic Assistance Estimated Unabllgatad Funds Now or Revised Budget Activity Number Federal Non-Federal Federal Non-Federal Total (a) (b) (c) (d) (a) (g) 1 EliolnaGing 9].926 $ o.00 S - o.00 $ 9so,000.DD $ S 950,000.00 Dlapariclaa !n 9oclna Gal Ilvalth 2 N/A 97.926 700,000.00 900,000.00 3. N/A 97.926 9BO,OD0.00 960.000.00 4 N/A 9].926 9e0,000.00 9a0,000.00 S. Totals $�$ 0$ $ $ Standard Form 424A(Rev.7-97) Prescribed by 01018(Circular A-102)Page 1 SECTION B-BUDGET CATEGORIES 6.Object Class Categories GRANT PROGRAM,FUNCTION OR ACTIVITY Tolal (1) (2) (3) (4) (5) elLminating e/A a/A u/A DiapatLtL— in eoeinstel H—Lth a.Personnel $ 7s7,s77.oa $ 762,691.00 $ 762,691.00 $ 762,091.00 ; 1,991,fi30,00 b.Fringe Benefits 259,]71.00 36i,7a7.00 264,797,00 264,787.00 1,057,692.00 c.Travel 19,619.00 19,x7a.00 19,270.00 19,230.00 n,7oo.co d.Equipment 926.00 926.00 926.00 2,77a.00 e.Supplies 7,7s1,00 10,102.00 10,162.00 10,192.00 7a,399.00 f.Contractual xx6,7oo.0o z17,400.ao 277,400.0o z77,9o0.00 9z6,90a.00 g.Construction 0 0 0 h.Other 7,796.00 7,211.00 7.211.00 7,211.00 39,029.00 I.Total Direct Charges(sum of 6a•6h) e7o,Ix7.ao a9e,9z7.oa e9e,az7.ea 098,427.00 $ 7,s6s,609.00 ),IndirectCharges 79,sv.00 01.573.00 81,s13.00 e1,s77.oa $ 7x4,792,00 k.TOTALS(sum of6i and 6j) $ 9so,000.oa $ 9ea,000.00 $ 99o,oao.00 $ 9eo,0oo.ao $ I,o9o,000.oa 7.Program Income $O Is ===$ ===$ 5 Authorized for Local Reproduction Slandaid Form 424A(Rev.7-97) Prescribed by OMB(Circular A-102) Page to SECTION C-NON-FEDERAL RESOURCES (a)Grant Program (b)Applicant (c)State (d) Other Sources (e)TOTALS B Eliminating DlaparLtisa in Portnatal H-1th $ 479,252.OD $ $ 2,019,099.0015 2,498,351.00 12.TOTAL(sum of lines 6-11) $ a79,2s2.DD S �$ 2,019,099.00 S E 2,490,351.0. SECTION D-FORECASTED CASH NEEDS Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4lh Quarter 13.Federal $ 9so,aoo.Do $ 237,50o.0o $ 237.....00 $ 2]7,500.005 237,50040 14.Non-Federal $ 2,499,351.00 624,590.00 iSl,s96.v0 624,506.00 624,507.00 15,TOTAL(sum of lines 13 and 14) $ 3,6ie,ssl.D10 S 042,089.0. $ a62,0e0.00 $1 062,0o8.0o $ esx,oe7.00 SECTION E-BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a)Grant Program FUTURE FUNDING PERIODS YEARS (b)Fir3t (c)Second (d)Third (e)Fourth 16. Eliminating Dlep—itiea in Parivatal Health $ 950.000,00 $ 900,000.00 $ 9a0,v00,00 $ 96o,000.00 17. 19. 20.TOTAL(sum of lines 16-19) S 950,000.00 $ 980,Doo.oD $ 99o.000.00 5 9ao,00o.00 SECTION F-OTHER BUDGET INFORMATION 21.Direct Charges: 22.Indirect Charges: 23.Remarks: Authorized for Local Reproduction Standard Form 424A(Rev.7.97) Pre5cribed by OMB(Circular A-102)Page 2 Agreement Between the County of Fresno and U.S. Department of Health and Human Services Agreement Name: U.S. Department of Health and Human Services— Healthy Start Initiative: Eliminating Disparities in Perinatal Health Fund/Subclass: 0001/10000 Organization: 56201748 Revenue Account#: 4380 WORKSPACE FORM )GRAN S.GOe '— GRANTS.COV'� SUPPORT@GRANTS.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package.This form can be completed in its entirely offline using Adobe Reader.You can save your form by clicking the"Save"button and see any errors by clicking the"Check For Errors"button.In-progress and completed forms can be uploaded at any time to Grants.gov using the Workspace feature. When you open a form,required fields are highlighted in yellow wilh a red border.Optional fields and completed fields are displayed in white.If you enter invalid or incomplete information in a field,you will receive an error message.Additional instructions and FAQs about the Application Package can be found in the Granls.gov Applicants tab. OPPORTUNITY&PACKAGE DETAILS: Opportunity Number: HRSA-19-049 Opportunity Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opportunity Package ID ,PK000245324 CFDA Number: 93.926 CFDA Description: Healthy Start Initiative Competition ID: HRSA-19-049 Competition Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opening Date: Closing Date: 11/27/2018 Agency: Health Resources and Services Administration Contact Information: Contact Benita Baker, MS at (301)443-0543 or email 6rCHBHealthyStart@hrsa.gov WORKSPACE Workspace ID: WS00220665 Application Filing Name: Fresno DPH Healthy Start 2019-24 DUNS: 5561976550000 Organization: FRESNO, COUNTY OF Form Name: Application for Federal Assistance (SF-424) Form Version: 2.1 Requirement: Mandatory Download Date/Time: Nov 26, 2018 07:59:36 PM EST Form State: No Errors FORM ACTIONS: OMB Number:4040-00o4 Expiration Dale:1 2/3 112 01 9 Application for Federal Assistance SF-424 1.Type of Submission: 2.Type of Application: 'If Revision,select appropriate letter(s): Preapplication New ®Application ®Continuation Other(Specify): Changed/Corrected Application Revision _ � 4.Applicant Identifier: Comp a.d by ranfs.gov upon submisslon. 5a.Federal Entity Identifier: 5b.Federal Award Identifier: H49MC00150 State Use Only: 6.Dale Received by Slate: 7.State Application Identifier: S.APPLICANT INFORMATION: a.Legal Name: County of Fresno b.Employer/Taxpayer Identification Number(EINrrIN): c.Organizational DUNS: 9 4-6 0 0 0 512 15561976550000 d.Address: Streetl: 1P0 Sox 11867 Sfreel2: City: Fresno County/Parish: Slate: CA: California Province: 'Country: USA: UNITED STATES 'Zip/Postal Code: 93775-1867 e.Organizational Unit: Department Name: Division Name: f.Name and contact information of person to be contacted on matters involving this application: Prefix: First Name: Ah Middle Name: Last Name: yang Suffix: Title: Health Educator Organizational Affiliation: Fresno County Department of Public Health 'Telephone Number- 15596003330 Fax Number: 5594554705 Email: ahvang@fresnocountyca.gov Application for Federal Assistance SF-424 1 9.Type of Applicant 1:Select Applicant Type: 8: County Government Type of Applicant 2:Select Applicant Type: Type of Applicant 3:Select Applicant Type: Other(specify): 10.Name of Federal Agency: Healch Resources and Services Administration 11.Catalog of Federal Domestic Assistance Number: 93.926 CFDA Title: Healthy Start Initiative 12.Funding Opportunity Number: IIRSA-19-049 Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 13.Competition Identification Number: HRSA-19-049 Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 14.Areas Affected by Project(Cities,Counties,States,etc.): xsmap2ol9-2029.odf Acid Attachment I Delete Attachment View Attachment 15,Descriptive Title of Applicant's Project: Babies First: Eliminating Disparities in Perinatal Health Attach supporting documents as specified in agency instructions. Add Attachments Delete Attachments View Attachments Application for Federal Assistance SF-424 16.Congressional Districts Of: a.Applicant CA-016 'b.Program/Project cA-016 Attach an additional list of ProgramlProject Congressional Districts if needed. Add Attachment Delete Allachment Viaw Atlachme ri 17.Proposed Project; a.Stan Date; 09/01/2019 `b.End Dale: 03/30/2029 18.Estimated Funding(5): a.Federal 950,000.00 b.Applicant 0.001 c.State 0.001 d.Local 479,252,001 e,Other 2,019,099,00 f. Program Income 0.001 'g.TOTAL 3,448,351.00 19.Is Application Subject to Review By State Under Executive Order 12372 Process? a.This application was made available to the Stale under the Executive Order 12372 Process for review on 11/26/2018 b.Program is subject to E.O.12372 but has not been selected by the Slate for review. c.Program is not covered by E.O.12372. •20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) IE]Yes ®No If"Yes",provide explanation and attach Add Allachment Delete Allachment View Allachment 21.'By signing this application,I certify(1)to the statements contained in the list of certifications"and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) IN""I AGREE "The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: First Name: David Middle Name: Last Name: Pomaville Suffix: Title: Director Telephone Number. 5596003200 Fax Number: 5596001687 'Email: ldpomaville@fresnocountyca.gov •Signature of Authorized Representative: completed by Grants.gov upon submission. 'Date Signed: completed by Grants.gov upon submission. WORKSPACE FORM 16 CFiANTS.GOV- SUPPORT@GRANRANTS.GO.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package.This form can be completed in its entirely oftline using Adobe Reader.You can save your form by clicking the"Save"button and see any errors by clicking the"Check For Errors"button.In-progress and completed forms can be uploaded at any time to Granls.gov using the Workspace feature. When you open a form.required fields are highlighted in yellow with a red border.Optional fields and completed fields are displayed in white.If you enter invalid or incomplete information in a field,you will receive an error message.Additional instructions and FAQs about the Application Package can be found in the Granls.gov Applicants lab. :OPPORTUNITY DETAILS. Opportunity Number: HRSA-19-049 Opportunity Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opportunity Package ID: PK000245324 CFDA Number: 93.926 CFDA Description: Healthy Start Initiative Competition ID: HRSA-19-049 Competition Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opening Dale: Closing Date: 11/27/2018 Agency: Health Resources and Services Administration Contact Information: Contact Benita Baker, MS at (301)443-0543 or email 14CHBHealthyStart0hrsa.gov WORKSPACEAPPLICANT& DETAILS: Workspace ID: WS00220665 Application Filing Name: Fresno DPH Healthy Start 2019-24 DUNS: 5561976550000 Organization: FRESNO, COUNTY OF Form Name: Budget Information for Non-Construction Programs (SF-424A) Form Version: 1.0 Requirement: Mandatory Download DatelTime: Nov 27, 2018 06:09:25 PM EST Form State: No Errors FORM ACTIONS: BUDGET INFORMATION-Non-Construction Programs OMB Number:4040.0006 Expiration Dale:01/3 112 01 9 SECTION A•BUDGET SUMMARY Grant Program Catalog of Federal Function or Domestic Assistance Estimated UnD611galed Funds Now or Revised Budget Activity Number Federal Non-Federal Federal Non-Federal Total (a) (b) (c) (d) (a) to (g) 1 clminacing 97.926 $ o.00 S o.o0 5 9so,DDD.Da $ lnpariciaa In P—inntal Naalch 2 900�000.00 900,000.00 3. 91 '926 9a0,OD0.00 980,000.00 4 N/A 97.926 9e0,000.00 9B0,000.00 5. Totals 3 S S 0 5 5 Standard form 424A(Rev.7.97) Prescribed by OMB(Circular A-102)Page 1 SECTION B-BUDGET CATEGORIES 6,Object Class Categories GRANT PROGRAM.FUNCTION OR ACTIVITY Tolal (1) (2) (a) (4) (5) elimins Clnq I1/A I1/A 11/A olaparl[lva in pacinctnl Ha ol[h a.Personnel $ ]5],5]7.00$ ]62,691.00 $ 362,691.00 $ 3G2,691.00 $ 1,aa1,fi10.00 b.Fringe Benefits 259,371.00 x6a,7a7.00 26a,797.00 264,7e7.00 1,057,fi93.00 c.Travel 19,610.00 19,x]0.00 19,270.00 19.2 0.00 71,300.eo d.Equipment 9x6.00 926.00 9x6.00 2,178.00 e.Supplies 7,7s3.00 lo,l9x.00 la,laz.00 1o,lez.00 3a,299.00 f.Contractual zxc,7ao.00 x33,aoo.ao z]],aoo.00 x3],aoo.00 9z6,9oo.00 g.Construction h.Other 3,396.00 7,zu.ao 7,2u.ao 7,u1.00 xs,oz9.ao i.Total Direct Charges(sum of 6a•6h) H7o,]z7.oa1 e90,427.aa e9a,ax7.va 099,427.00 $ 7,565,608.00 (.Indirect Charges 79,67].ao al,s7].vo e1,s73.00 e1,s7].vo S 3za,39z.00 k.TOTALS(sum of6i and 6j) $ 9sv,vvo.00$ 9eo,000.00 $ 9oo,aoa.oa $ 9ao,000,00 $ 3,a9o,aoo.ao 7.Program Income Is 0$ ===$ L�---- S $ Authorized for Local Reproduction Slandard Foim 424A(Rev.7.97) Prescribed by OMB(CiroWar A-102) Page to SECTION C-NON-FEDERAL RESOURCES (a)Grant Program (b)Applicant (c)State (d) Other Sources r (e)TOTALS 8. ciiminating Dlaparltlea in➢arinatal Health $ 479,252.00 $ $ 2,019,099.00 $ 3,198,351.as 10. 0 11. 0 12.TOTAL(sum of lines B-11) $ 179,2s2.00 is $ 2,019,099.00 5 2,1➢a,1s1.0o SECTION D-FORECASTED CASH NEEDS Total for 1st Year 1st Quarter 2nd Quarter srd Quarter 4th Quarter 13.Federal $ 950,000.00 § 237,500.00 $ 221,500.00 $ 237,500.00 $ 237,500,00 14,Non-Federal 31 2,49B,7s1.oo 624,see.oa 624,590.0. 624,500.00 621,507.00 15.TOTAL(sum of lines 13 and 14) $1 3,449,ss1.o0 5 862,000.00 $ esz,oe0.0o $ 6,2,088.00 $r- 862,007,00 SECTION E•BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a)Grant Program FUTURE FUNDING PERIODS YEARS (b)Firzt (c)Second (d)Third 101 Fourth 16. Elinlnating Diaparleiaa In➢erinatal Ilaalth $ 950,000.00 $ 9eo,goo.oo $1 9e0,00o.e0 17. -� 18. 19. 20.TOTAL(sum of lines 16-19) $ 950,000.00 $ 980,000.00 $ 900,aa0.0o 5 980,eDe.00 SECTION F-OTHER BUDGET INFORMATION 21.Direct Charges: 22.Indirect Charges: 23.Remarks: Authorized for Local Reproduction Slandard Form 424A(Rev.7.97) Prescribed by OMB(CircularA-102) Page 2 Agreement Between the County of Fresno and U.S. Department of Health and Human Services Agreement Name: U.S. Department of Health and Human Services— Healthy Start Initiative: Eliminating Disparities in Perinatal Health Fund/Subclass: 0001/10000 Organization: 56201748 Revenue Account#: 4380 1.DATE ISSUED: 2.PROGRAM CFDA:93.926 114 Irltarvum of Hmnh s14 Hxun Susicca 03118/2019 3.SUPERSEDES AWARD NOTICE dated: <@HRSA excapl Ihnt any additions or restrictions provlously Imposed ra train In all.cl unless specifically rescinded. 4a.AWARD NO,: 4b.GRANT NO.: 5.FORMER GRANT H<,eh Fe>ovr«Band scnl<er Admmlrb,ren 2 H49MC00150-19-00 H49MC00150 NO.: NOTICE OF AWARD 6.PROJECT PERIOD: AUTHORIZATION(Legislation/Regulation) Public Health Service Act,Section 751 FROM:07/01/2001 THROUGH:0 3/3 112 0 2 4 Public Health Service Act:Title III,Part D,Section 330H;42 U.SC. 254c-8 7,BUDGET PERIOD: Public Health Service Act,Title III,Part D,§330H(42 U.S.C.254c- FROM:04/01/2019 THROUGH:03/31/2020 8),as amended by the Healthy Start Reauthorization Act of 2007 (P.L.110-339) 8.TITLE OF PROJECT(OR PROGRAM):ELINIMINATING DISPARITIES IN PERINATAL HEALTH 9.GRANTEE NAME AND ADDRESS: 10.DIRECTOR:(PROGRAM DIRECTOMPRINCIPAL COUNTY OF FRESNO INVESTIGATOR) PO BOX 11867 Ain Vang Fresno,CA 93775-1867 COUNTY OF FRESNO DUNS NUMBER; PO BOX 11867 556197655 Fresno,CA 93775 11.APPROVED BUDGET:(Excludes Direct Assistance) 12.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: [X]Grant Funds Only a.Authorized Financial Assistance This Period $950,000,00 ( ] Total project costs including grant funds and all other financial participation b.Less Unobllgaled Balance from Prior Budget Periods a.Salaries and Wages: $353,537.00 i.Additional Authority $0.00 b.Fringe Benefits: S259,331.00 ii,Offset $0.00 c.Total Personnel Costs: $612,868.00 c.Unawarded Balance of Current Year's Funds $0.00 d.Consultant Costs: $0.00 d.Less Cumulative Prior Awards(s)This Budget $0.00 e.Equipment: $0.00 Period f. Supplies: $7,753.00 e.AMOUNT OF FINANCIAL ASSISTANCE THIS $950,000.00 g.Travel: $19,610.00 ACTION h.Construction/Alteration and Renovation: $0.00 13.RECOMMENDED FUTURE SUPPORT:(Subject to the a ailability of funds and satisfactory progress of project) I. Other: $3,396.00 YEAR TOTAL COSTS j. Consorlium/Contractual Costs: $226,700.00 20 $980,000.00 k. Trainee Related Expenses: $0.00 21 $980,000.00 22 $980,000.00 1. Trainee Stipends: WOO 23 $980,000.00 m Trainee Tuition and Fees: $0.00 14.APPROVED DIRECT ASSISTANCE BUDGET:(In lieu of cash) n.Trainee Travel: $0.00 a.Amount of Direct Assistance $0.00 o.TOTAL DIRECT COSTS: $870,327.00 b.Less Unawarded Balance of Current Year's Funds SO.00 p.INDIRECT COSTS(Rate:%of S&W/TADC): $79.673.00 c.Less Cumulative Prior Awards(s)This Budget Period $0.00 q.TOTAL APPROVED BUDGET: $950,000.00 d.AMOUNT OF DIRECT ASSISTANCE THIS ACTION $0.00 I.Less Non-Federal Share: $0.00 ii.Federal Share: $950,000.00 15.PROGRAM INCOME SUBJECT TO 45 CFR 75,307 SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING ALTERNATIVES: A=Addition S=Deduction C=Cost Sharing or Matching D=Other [A] Estimated Program Income:SO.00 16,THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO,AND AS APPROVED BY HRSA,IS ON THE ABOVE TITLED PROJECT AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a.If..gmnl program Icglslallon chad nbova.Is.The grant program mgulall.n cited above.c.This it-W nolica including leans and conditions.II any.holed holow under REMARKS.d.45 CFR Part 75 as applicable.In Iha oven{Ihoro are conflicting or olhanoise Incan5witnt pallatas,pplicah1c to Ilia grant.Ilia above order of placedelim shall pl-rid.Acceplanco of Iha grant lawns and conditions Is acknor.IcdpaO by the granlao Mlan funds nra drawn or olhcrwiso obtained from Iho grant paymonl syslam. REMARKS:(Other Terms and Conditions Attached[X]Yes [)No) This grant is under expanded authority. Please refer to the contact section tar the new Grants Management Specialist. Electronically signed by Shonda Gosnel/,Grants Management Officer on:03/18/2019 17.OBJ.CLASS:41.51 118.CRS-EIN:1946000512A3 19,FUTURE RECOMMENDED FUNDING:$0.00 SUBPROGRAM SUB FY-CAN CFDA DOCUMENT NO. AMT.FIN.ASST. AMT.DIR.ASST. CODE ACCOUNT CODE 19-389BO20 93.926 19H49MC00150 $946,028.00 $0.00 19-HIS-ERED 17-3898020 93.926 19H49MC00150 $3,972.00 $0.00 WA 19-HIS-ERED I'agc 1 ^l�ormaaon,lywro torlacr NASA chon;ecr eonlelrel C77 a51•+717�B era;a a oar Er1ieoe AJyrlha rcroan ruadcr urea 7e Aecafr famelnrarm a.'ren,aruRy SOB cenrdr,nl accarrible ll7ldl varrronir uverlaElo Douro llRSA ElacaoncllantlCCMr ayau naetl rr�ora NOTICE OF AWARD(Continuation Sheet) Date Issued:3118/2019 2:17:51 Pfvl Award Number:2 1149M000150-19-00 HRSA Electronic Handbooks (EHBs) Registration Requirements The Project Director of the grant(listed on this NoA)and the Authorizing Official of the grantee organization are required to register(if not already registered)within HRSA's Electronic Handbooks(EHBs).Registration within HRSA EHBs is required only once for each user for each organization they represent.To complete the registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this NoA.After you have completed the initial registration steps(i.e.,created an individual account and associated it with the correct grantee organization record),be sure to add this grant to your portfolio.This registration in HRSA EHBs is required for submission of noncompeting continuation applications.In addition,you can also use HRSA EHBs to perform other activities such as updating addresses, updating email addresses and submitting certain deliverables electronically.Visit hops://grants3.hrsa.govi2010/WebEPSExternal/Interface/common/accesscontrol/login.aspx to use the system.Additional help is available online and/or from the HRSA Call Center at 877-Go4-HRSA/877-464-4772. Terms and Conditions Failure to comply with the remarks,terms,conditions,or reporting requirements may result in a draw down restriction being placed on your Payment Management System account or denial of future funding. Grant Specific Term(s) 1. This award is governed by the post-award requirements cited in Subpart D-Post Federal Award Requirements,standards for program and fiscal management of 45 CFR Part 75 except when the Notice of Award indicates in the"Remarks"section that the grant is included under "Expanded Authority".These recipients may take the following actions without prior approval of the Grant Management Office: Section 75.308 c(2)(d)(1)Incur pre-award costs up to 90 calendar days before the award.See also 75.458. Section 75.308 c(2)(d)(2)Initiate a one-time extension of the period of performance by up to 12 months unless one or more of the conditions outlined in paragraphs(d)(2)(i)through(iii)of this section apply.For one-time extensions,the recipient must notify the HHS awarding agency in writing with(lie supporting reasons and revised period of performance at least 10 calendar days before the end of the period of performance specified in the Federal award.This notification must be submitted through the Electronic Handbooks(EHB).This one-time extension may not be exercised merely for the purpose of using unobligated balances. Section 75.308 c(2)(d)(3)Carry forward unobligated balances to subsequent periods of performance. Except for funds restricted on a Notice of Award,grantee organizations are authorized to carry over unobligated grant funds up to the lesser of 25%or S250,000 of the amount awarded for that budget period remaining at the end of that budget period.If the unobligated balance is in excess of 25%of the total amount awarded,or$250,000,whichever is less,and the grantee wishes to carry the funds forward,the grantee must obtain prior approval from the Grants Management Office. The grantee must notify the Grants Management Office when it has elected to carry over unobligated balances under Expanded Authority and the amount to be carried over.The notification must be provided under item 12,'Remarks",on the initial submission of the Federal Financial Report(FFR). For all other Post Award request refer Standard Term 5 below. 2. Healthy Start funds may not be used for entertainment costs.Trips and/or activities for Healthy Start clients must relate to both the goal of reducing infant mortality and the approved project objectives 3. Fund raising costs are unallowable.Healthy Start funds,e.g.,staff salary,contract personnel,consultants or costs for items to be sold or raffled,may not be used for fund raising activities. 4. The replacement of,or significant change in the responsibilities of senior project staff,including the project director,project manager,and chief financial officer,must have prior approval from the Grants Management Officer.The grantee must obtain prior approval from the awarding office for changes in scope,direction,type of service delivery or training,and rebudgeting of Healthy Start funds. 5. This action reflects a new document number.Please refer to this number when contacting the Payment Management System or submitting drawdown requests.Reporting on the FFR(Federal Financial Report)SF 425-Federal Cash Transaction Report(FCTR)should reflect this number for all disbursements related to this project period. 6. Effective December 26,2014,all references to OMB Circulars for the administrative and audit requirements and the cost principles that govern Federal monies associated with this award are superseded by the Uniform Guidance 2 CFR 200 as codified by NHS at 45 CFR 75. 7. The funds for this award are sub-accounted in the Payment Management System(PMS)and will be in a P type(sub accounted)account. This type of account allows recipients to specifically identify the individual grant for which they are drawing funds and will assist HRSA in monitoring the award.If your organization previously received a grant under this program,it was in a G type(cash pooled)account designated by a PMS Account Number ending in G or G1.Now that this grant is sub accounted the PMS Account Number will be changed to reflect either P or P1.For example,if the prior year grant was in payee account number 2AAG it will now be in 2AAP.Similarly,if the prior year grant was in payee account 2AAG1,the grant will be in payee account 2AAP1.The P sub account number and the sub account code (provided on page 1 of(his Notice of Award)are both needed when requesting grant funds. You may use your existing PMS username and password to check your organizations P account access.If you do not have access, complete a PMS Access Form(PMS/FFR Form)found at:httl):Hwvoro.cfpm.i)sc.gov/grant_rccil)icnUgrantee_forms.aspx and send it to the Page 2 NOTICE OF AWARD(Continuation Sheet) Datc Issued:3/18/2019 2:17:51 I'M Award Number:2 1149MC00150.19-00 fax number indicated on the bottom of the form.If you have any questions about accessing PMS,contact the PMS Liaison Accountant as identified at:htip://k-Nm.dpm.l)sc.gov/contacts/conlacis.,Ispx. 8. All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement:http://wtivw.hrsa.gov/grants/hhsgrantspolicy.pdf 9. This Notice of Award provides the offset of an unobligaled balance in the amount of$3.972 from the 4/l/2017-3/31/2018 budget period to the current budget period.Please be advised Thal if the final resolution of the audit determines that the unobligaled balance of Federal Funds is incorrect,HRSA is not obligated to make additional Federal Funds available to cover the shortfall. Program Specific Term(s) 1. The management Team,including key personnel,must reflect the cultural diversity of the Community to be served. 2. Each project is expected to establish a plan to recover,to the maximum extent feasible,third party revenues to which it is entitled for services provided;garner all other available Federal,slate,local,and private funds;and charge beneficiaries according to their ability to pay for services without creating a barrier to those services.Where third-party payors,including Government agencies,are authorized or are under legal obligation to pay all or a portion of charges for health care services,"all such sources must be billed for covered services, and every effort must be made to obtain payment.Each service provider receiving Federal funds,either directly or indirectly,must have a procedure to identify all persons served who are eligible for third-party reimbursement." 3. All MCHB discretionary grant projects are expected to incorporate a carefully designed and well-planned evaluation protocol capable of demonstrating and documenting measurable progress toward achieving the slated goals.The measurement of progress toward goals should focus on systems,health and performance indicators,rather than solely on the intermediate process measures. 4. In accordance with the requirements of the"Government Performance and Results Act(GPRA)of 1993"(Public Law 103-62),MCHB has established measurable goals for Federal programs that can be reported as part of the budgetary process,thus linking funding decisions with performance.Performance measures and data elements for all MCHB-funded grant programs including Healthy Start have been finalized.As previously communicated all Healthy Start projects are expected to participate in the MCHB reporting requirements system. 5. Grantees must use the DHSPS screening tools,must report aggregate level data on a monthly basis to DHSPS,and report progress on benchmarks in the MCHB Discretionary Grants Information System. 6. Grantees are required to participate in the National Evaluation of Healthy Start Programs and respond to request for information from the Division and the HS EPIC Center.Participation in the evaluation includes data collection activities,e.g.HSMEDS 7. HRSA reserves the right to reduce base awards for grantees that consistently maintain unobligated balance greater than 5100,000. 8. A grantee can propose to include an evidence-based home visiting model as part of their Healthy Start(HS)program as long as each component of the program addresses the four HS approaches,and the evidence-based model allows for the HS program to collect the data included in(lie HS screening tools.That is,the requirements of any curriculum or model chosen do not supersede the requirements of HS. 9. HRSA reserves the right to reduce funding if,after receiving Technical Assistance,grantee cannot fulfil the requirements of the grant.i.e. progress on benchmarks,number of participants served. 10. Grantees are to budget for up to 3 persons each to attend mandatory regional meetings,and the Healthy Start convention. Standard Term(s) 1. Recipients must comply with all terms and conditions outlined in their grant award,including grant policy terms and conditions outlined in applicable Department of Health and Human Services(HHS)Grants Policy Statements,and requirements imposed by program statutes and regulations and HHS grant administration regulations,as applicable;as well as any requirements or limitations in any applicable appropriations acts. 2. All discretionary awards issued by HRSA on or after October 1,2006,are subject to the HHS Grants Policy Statement(HHS GPS)unless otherwise noted in the Notice of Award(NoA).Parts I through III of the HHS GPS are currently available at hnp://www.hrsa.gov/grants/hhsgrantspolicy.pdf.Please note that the Terns and Conditions explicitly noted in(he award and the HHS GPS are in effect. 3. "This[projecUpublication/program/website](is/was]supported by the Health Resources and Services Administration(HRSA)of the U.S. Department of Health and Human Services(HHS)as part of an award totaling$XX with xx percentage financed with non-governmental sources.The contents are those of the author(s)and do not necessarily represent the official views of,nor an endorsement,by FIRS&HHS or the U.S.Government." Recipients are required to use this language when issuing statements,press releases,requests for proposals, bid solicitations,and other Page 3 NOTICE OF AWARD(Continuation Shea) Date Issued:3/18/2019 2:17:51 PM Award Number:2 1149MC00150-19-00 HRSA-supported publications and forums describing projects or programs funded in whole or in part with HRSA funding.Examples of HRSA-supported publications include,but are not limited to,manuals,toolkits,resource guides,case studies and issues briefs. 4. Recipients and sub-recipients of Federal funds are subject to the strictures of the Medicare and Medicaid anti-kickback statute(42 U.S.C. 1320a-7b(b)and should be cognizant of the risk of criminal and administrative liability under this statute,specifically under 42 U.S.C. 1320 7b(b)Illegal remunerations which stales,in part,that whoever knowingly and willfully:(A)Solicits or receives(or offers or pays)any remuneration(including kickback,bribe,or rebate)directly or indirectly,overtly or covertly,in cash or in kind,in return for referring(or to induce such person to refer)an individual to a person for the furnishing or arranging for the furnishing of any item or service,OR(B)In return for purchasing,leasing,ordering,or recommending purchasing,leasing,or ordering,or to purchase,lease,or order,any goods,facility, services,or item....For which payment may be made in whole or in part under subchapter XIII of this chapter or a State health care program, shall be guilty of a felony and upon conviction thereof,shall be fined not more than S25,000 or imprisoned for not more than five years,or both. 5. Items that require prior approval from the awarding office as indicated in 45 CFR Part 75(Note:75(d)HRSA has not waived cost-related or administrative prior approvals for recipients unless specifically staled on this Notice of Award]or 45 CFR Part 75 must be submitted as a Prior Approval action via Electronic Handbooks(EHBs).Only responses to prior approval requests signed by the GMO are considered valid.Grantees who lake action on the basis of responses from other officials do so at their own risk.Such responses will not be considered binding by or upon the HRSA. In addition to the prior approval requirements identified in Part 75,HRSA requires grantees to seek prior approval for significant rebudgeling of project costs.Significant rebudgeling occurs when,under a grant where the Federal share exceeds$100,000,cumulative transfers among direct cost budget categories for the current budget period exceed 25 percent of the total approved budget(inclusive of direct and indirect costs and Federal funds and required matching or cost sharing)for that budget period or$250,000,whichever is less. For example,under a grant in which the Federal share for a budget period is$200,000,if the total approved budget is$300,000,cumulative changes within that budget period exceeding$75,000 would require prior approval).For recipients subject to 45 CFR Part 75,this requirement is in lieu of that in 45 CFR 75 which permits an agency to require prior approval for specified cumulative transfers within a grantee's approved budget.(Note,even if a grantee's proposed rebudgeting of costs falls below the significant rebudgeting threshold identified above,grantees are still required to request prior approval,if some or all of the rebudgeting reflects either a change in scope,a proposed purchase of a unit of equipment exceeding$25,000(if not included in the approved application)or other prior approval action identified in Part 75 unless HRSA has specifically exempted the grantee from the requirement(s).] 6. Payments under this award will be made available through the DHHS Payment Management System(PMS).PMS is administered by the Division of Payment Management,Financial Management Services,Program Support Center,which will forward instructions for obtaining payments.Inquiries regarding payments should be directed to:ONE-DHHS Help Desk for PMS Support at 1-877-614-5533 or PMSSupport@psc.hhs.gov.For additional information please visit the Division of Payment Management Website at https://pms.psc.gov/. 7. The DHHS Inspector General maintains a toll-free hotline for receiving information concerning fraud,waste,or abuse under grants and cooperative agreements.Such reports are kept confidential and callers may decline to give their names if they choose to remain anonymous.Contact:Office of Inspector General,Department of Health and Human Services,Attention:HOTLINE,330 Independence Avenue Southwest,Cohen Building,Room 5140,Washington,D.C.20201,Email:Htips@os.dhhs.gov or Telephone:1-800-447-8477(1- 800-HHS-TIPS). 8. Submit audits,if required,in accordance with 45 CFR Part 75,to:Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jefferson, IN 47132 PHONE:(310)457-1551,(800)253-0696 loll free https://harvester.census.gov/facweb/default.aspx/. 9. EO 13166,August 11,2000,requires recipients receiving Federal financial assistance to take steps to ensure that people with limited English proficiency can meaningfully access health and social services.A program of language assistance should provide for effective communication between the service provider and the person with limited English proficiency to facilitate participation In,and meaningful access to,services.The obligations of recipients are explained on the OCR website at HFIS Limited English Proficiency(LEP), 10, This award is subject to the requirements of Section 106(g)of the Trafficking Victims Protection Act of 2000,as amended(22 U.S.C. 7104).For the full text of the award term,go to: liltps://wrovw.hrsa.gov/siles/defaulUfiles/hrsa/grants/manage/trafficking-in-p(irsons.l)df.If you are unable to access this link,please contact the Grants Management Specialist identified in this Notice of Award to obtain a copy of the Term. 11. The Consolidated Appropriations Act,2017,Division H,§202,(P.L,115-31)enacted May 5,2017,limits the salary amount that may be awarded and charged to HRSA grants and cooperative agreements to the Federal Executive Pay Scale Level II rate set at$189,600, effective January,2018.This amount reflects an individual's base salary exclusive of fringe benefits.An individual's institutional base salary is the annual compensation that the recipient organization pays an individual and excludes any income an individual may be permilted to earn outside the applicant organization duties.HRSA funds may not be used to pay a salary in excess of this rate.This salary limitation also applies to sub-recipients under a HRSA grant or cooperative agreement.The salary limitation does not apply to payments made to consultants under this award although,as with all costs,those payments must meet the lest of reasonableness and be consistent with recipient's institutional policy.None of the awarded funds may be used to pay an individual's salary at a rate in excess of the salary Page 4 NOTICE OF AWARD(Cominuation Shaer) Dare Issued:3/18/2019 2:17:51 PM Award Number:2 I149M000150.19-00 limitation.Note:an individual's base salary,per se,is NOT constrained by the legislative provision for a limitation of salary.The rate limitation simply limits the amount that may be awarded and charged to HRSA grants and cooperative agreements. 12. To serve persons most in need and to comply with Federal law,services must be widely accessible.Services must not discriminate on the basis of age,disability,sex,race,color,national origin or religion.The HHS Office for Civil Rights provides guidance to grant and cooperative agreement recipients on complying with civil rights laws that prohibit discrimination on these bases.Please see Iriip://wv.,w.hlis.gov/civil-rigliIs/for-individuals/index.hIm1.HHS also provides specific guidance for recipients on meeting their legal obligation under Title VI of the Civil Rights Act of 1964.which prohibits discrimination on the basis of race,color or national origin in programs and activities that receive Federal financial assistance(P.L.88-352,as amended and 45 CFR Part 75).In some instances a recipient's failure to provide language assistance services may have the effect of discriminating against persons on the basis of their national origin.Please see htip://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-profciency/index.hlmI to learn more about the Title VI requirement for grant and cooperative agreement recipients to lake reasonable steps to provide meaningful access to their programs and activities by persons with limited English proficiency. 13. Important Notice:The Central Contractor registry(CCR)has been replaced.The General Services Administration has moved the CCR to the System for Award Management(SAM)on July 30,2012.To learn more about SAM please visit htlps://www.sam,gov. It is Incumbent that you,as the recipient,maintain the accuracylcurrency of your information in the SAM at all times during which your entity has an active award or an application or plan under consideration by HRSA,unless your entity is exempt from this requirement under 2 CFR 25.110.Additionally,this term requires your entity to review and update the information at least annually after the initial registration, and more frequently if required by changes in your information.This requirement(lows down to subrecipienls.Note:SAM information must be updated at least every 12 months to remain active(for both grantees and sub-recipients).Grants.gov will reject submissions from applicants with expired registrations.It is advisable that you do not wait until the last minute to register in SAM or update your information. According to the SAM Quick Guide for Grantees(System for Award Management User Guide),an entity's registration will become active after 3-5 days.Therefore,check for active registration well before the application deadline. 14. In any grant-related activity in which family,marital,or household considerations are,by statute or regulation,relevant for purposes of determining beneficiary eligibility or participation,grantees must treat same-sex spouses,marriages,and households on the same terms as opposite-sex spouses,marriages,and households,respectively.By"same-sex spouses,"HHS means individuals of the same sex who have entered into marriages that are valid in the jurisdiction where performed,including any of the 50 stales,the District of Columbia,or a U.S.territory or in a foreign country,regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage.By "same-sex marriages,"HHS means marriages between two individuals validly entered into in the jurisdiction where performed,including any of the 50 states,the District of Columbia,or a U.S.territory or in a foreign country,regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage.By"marriage,"HHS does not mean registered domestic partnerships,civil unions or similar formal relationships recognized under the law of the jurisdiction of celebration as something other than a marriage.This term applies to all grant programs except block grants governed by 45 CFR part 96 or 45 CFR Part 98,or grant awards made under titles IV-A, XIX,and XXI of the Social Security Act;and grant programs with approved deviations. 15. §75.113 Mandatory disclosures. Consistent with 45 CFR 75.113,applicants and non-federal entities must disclose,in a timely manner,in writing to the HHS awarding agency,with a copy to the HHS Office of Inspector General(OIG),all information related to violations of federal criminal law involving fraud, bribery,or gratuity violations potentially affecting the federal award.Sub recipients must disclose,in a timely manner,in writing to the prime recipient(pass through entity)and the HHS OIG,all information related to violations of federal criminal law involving fraud,bribery,or gratuity violations potentially affecting the federal award.Disclosures must be sent in writing to the awarding agency and 10 the HHS DIG at the following address: Department of Health and Human Services Health Resources and Services Administration Office of Federal Assistance Management Division of Grants Management Operations 5600 Fishers Lane,Mailstop 10SWH-03 Rockville,MD 20879 AND U.S.Department of Health and Human Services Office of Inspector General Attn:Mandatory Grant Disclosures,Intake Coordinator 330 Independence Avenue,SW,Cohen Building Room 5527 Washington,DC 20201 Fax:(202)205-0604(Include:"mandatory Grant Disclosures"in subject line)or Email:A4andatoryGranleeDisclosures@oig.hhs.gov Failure to make required disclosures can result in any of the remedies described in 45 CFR 75,371.Remedies for noncompliance, Page 5 NOTICE Of AWARD(Continuation Sheet) Date Issued:3/18/2019 2:17:51 PM Award Number:2 1149MC00150.19-00 including suspension or debarment(See 2 CFR parts 180&376 and 31 U.S.C.3321).The recipient must include this mandatory disclosure requirement in all sub-awards and contracts under this award. Non-Federal entities that have received a Federal award including the term and condition outlined in Appendix XII are required to report certain civil,criminal,or administrative proceedings to\vww.sam.gov.Failure to make required disclosures can result in any of the remedies described in§75.371.including suspension or debarment.(See also 2 CFR parts 180 and 376,and 31 U.S.C.3321). Recipient integrity and performance matters,If the total Federal share of the Federal award is more than$500,000 over the period of performance,Appendix XII to CFR Pail 200 is applicable to this award. Reporting Requirement(s) 1. Due Date:Within 90 Days of Award Issue Date The grantee must submit a Performance Report within 90 days after receipt of the NoA.This report should include completing the financial forms,project abstract,grant summary and performance measures.The performance report must be submitted using the Electronic Handbook(EHB). 2. Due Date:Annually(Budget Period)Beginning:Budget Start Date Ending:Budget End Date,due Quarter End Date after 90 days of reporting period, The grantee must submit an annual Federal Financial Report(FFR).The report should reflect cumulative reporting within the project period and must be submitted using the Electronic Handbooks(EHBs).The FFR due dates have been aligned with the Payment Management System quarterly report due dates,and will be due 90,120,or 150 days after the budget period end dale,Please refer to the chart below for the specific due dale for your FFR: • Budget Period ends August—October.FFR due January 30 • Budget Period ends November—January:FFR due April 30 • Budget Period ends February—April:FFR due July 30 • Budget Period ends May—July:FFR due October 30 Failure to comply with these reporting requirements will result in deferral or additional restrictions of future funding decisions. Contacts NoA Email Address(es): Name Role Email David Pomaville Authorizing Official dpomaville@fresnocounlyca.gov Ah Vang Point of Contact ahvang@fresnocounlyca.gov Michael Chu Business Official mchu@fresnocountyca.gov Ali Vang Program Director ahvang@co.fresno.ca.us Note:NoA emailed to these address(es) Program Contact: For assistance on programmatic issues,please contact Michael Muni at: 5600 Fishers Ln Rockville,MD,20852-1750 Email:mmuni@hrsa.gov Phone:(301)443-2052 Division of Grants Management Operations: For assistance on grant administration issues,please contact Ernsley Charles at: HRSA/OFAM 5600 Fishers Ln RM 1ON146A Rockville,MD,20852-1750 Email:ECharles@hrsa.gov Phone:(301)443-8329 Fax:(301)443-6343 Page 6 1.DATE ISSUED: 2.PROGRAM CFDA:93.926 U.S. 0320-SUPERSEDES SUPERSEDES AWARD NOTICE dated; y except that any additions or roslilcllona provi-ly hnposed remain in ellact unless:padlically rescinded. Health Rnowces and Seeriees Adn,iriabalion 4a,AWARD NO.: 4b.GRANT NO.: 5.FORMER GRANT 5 H49MC00150.20-00 H49MC00150 NO.: NOTICE OF AWARD 6.PROJECT PERIOD: AUTHORIZATION(Legislation/Regulation) FROM:07/01/2001 THROUGH:03/31/2024 Public Health Service Act,Section 751 Public Health Service Act:Title III,Part D,Section 330H;42 U.SC. 254c-8 7.BUDGET PERIOD: Public Health Service Act,Title III,Part D,§330H(42 U.S.C.254C- FROM:04/01/2020 THROUGH:03/31/2021 8),as amended by the Healthy Start Reauthorization Act of 2007 (P.L.110-339) 8.TITLE OF PROJECT(OR PROGRAM):ELINIMINATING DISPARITIES IN PERINATAL HEALTH 9.GRANTEE NAME AND ADDRESS: 10.DIRECTOR:(PROGRAM DIRECTOR/PRINCIPAL COUNTY OF FRESNO INVESTIGATOR) PO BOX 11867 Ah Vang Fresno,CA 93775-1867 COUNTY OF FRESNO DUNS NUMBER: PO BOX 11867 556197655 Fresno,CA 93775-1867 11.APPROVED BUDGET:(Excludes Direct Assistance) 12.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: [X]Grant Funds Only a.Authorized Financial Assistance This Period $960,000.00 ( ] Total project costs including grant funds and all other financial participation b.Less Unobligaled Balance from Prior Budget Periods a.Salaries and Wages: $362.691.00 i,Additional Authority $0.00 b.Fringe Benefits: S264,787.00 ii.Offset 50.00 c.Total Personnel Casts: S627,478.00 c.Unawarded Balance of Curren)Year's Funds $0.00 d.Consultant Costs: $0.00 d.Less Cumulative Prior Awards(s)This Budget $0.00 e. Equipment: $926.00 Period f. Supplies: $10,182.00 e.AMOUNT OF FINANCIAL ASSISTANCE THIS $980,000.00 g.Travel: $19,230.00 ACTION h.Construction/Alteration and Renovation: $0.00 13.RECOMMENDED FUTURE SUPPORT:(Subject to the a ailability,of funds and satisfactory progress of ro ecl i. Other: $7.211.00 YEAR TOTAL COSTS j. Consortium/Contractual Costs: $233,400.00 21 $980,000.00 k. Trainee Related Expenses: $0•00 22 $980,000.00 23 $980,000.00 I. Trainee Stipends: $0.00 m Trainee Tuition and Fees: $0.00 14.APPROVED DIRECT ASSISTANCE BUDGET:(In lieu of cash) a.Amount of Direct Assistance $0.00 n.Trainee Travel: $0.00 b.Less Unawarded Balance of Current Year's Funds $0.00 o.TOTAL DIRECT COSTS: $898,427.00 c.Less Cumulative Prior Awards(s)This Budget Period $0.00 p.INDIRECT COSTS(Rate:%of S&W/TADC): $81,573.00 d.AMOUNT OF DIRECT ASSISTANCE THIS ACTION $0.00 q.TOTAL APPROVED BUDGET: $980,000.00 I.Less Non-Federal Share: $0.00 it.Federal Share: $980,000.00 15,PROGRAM INCOME SUBJECT TO 45 CFR 75.307 SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING ALTERNATIVES: A=Addition B=Deduction C=Cost Sharing or Matching D=Other [A] Estimated Program Income:$0.00 16.THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO,AND AS APPROVED BY HRSA,IS ON THE ABOVE TITLED PROJECT AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a.The grant plogrmn legislation cited above.b.The grant pragram regulntlo tiled above.n.This award notice Including terms and conditions,if any,noted below under REMARKS.d.45 CFR Pan 75 as appllcabte.In Iho avant there are con111c11n0 or otherwise ineonsislelll po1111-5 nppllcable to the grant.Ilia above order of precedence shall prevail.Acceptance of the grant leans and conditions Is ..kno.lodgod by the gmmoo when runds are drawn or nther vi li obtained from the grant paymani system. REMARKS:(Other Terms and Conditions Attached[X]Yes []No) This grant is under expanded authority. Electronically signed by Shonda Gosnell,Grants Management Officer on:03/03/2020 17.OBJ,CLASS:41.51 18,CRS-EIN: 1946000512A3 19.FUTURE RECOMMENDED FUNDING:$0.00 SUB SUBPROGRAM FY-CAN CFDA �19H:49MCOOI CUMENT NO. AMT.FIN.ASST. AMT.DIR.ASST. CODE ACCOUNT CODE 20-3B96020 93.926 50 $980,000.00 $0.00 19-HIS-ERED I Apnnrar verrmn document oNy Tno darernanr may COnlan lmnu accuasiur'.ly n.Mlenge fur Nu::­a.roa0ar urns.to uccP.'r:mame�nlamraban,arulySal compl�anl ar.ernffn Milli vunron ar awuuslo on rno MRSA OWN-NarearaM:.eyOu need Nora mramaAon,poa.a comocr MASS ronlnrl eonler:r 177-J6J-J777.l.rm le!un,ET,-.1da11 NOl'ICF-OF AWARD(Continuation Shoat) Dam Issued:313/2020 5:08:13 I'M Ao•ard Number:5 I149MCOO130-20.00 HRSA Electronic Handbooks (EHBs) Registration Requirements The Project Director of the grant(listed on this NoA)and the Authorizing Official of the grantee organization are required to register(if not already registered)within HRSA's Electronic Handbooks(EHBs).Registration within HRSA EHBs is required only once for each user for each organization they represent.To complete the registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this NoA.After you have completed the initial registration steps(i.e.,crealed an individual account and associated it with the correct grantee organization record),be sure to add this grant to your portfolio.This registration in HRSA EHBs is required for submission of noncompeling continuation applications.In addition,you can also use HRSA EHBs to perform other activities such as updating addresses, updating email addresses and submitting certain deliverables electronically.Visit hllps://grants3.hrsa.gov/2010/WebEPSExternal/Interface/common/accesscontrol/login.aspx to use the system.Additional help is available online and/or from the HRSA Call Center at 877-Go4-HRSA/877-464-4772. Terms and Conditions Failure to comply with the remarks,terms,conditions,or reporting requirements may result in a draw down restriction being placed on your Payment Management System account or denial of future funding. Grant Specific Term(s) 1. Healthy Start funds may not be used for entertainment costs.Trips and/or activities for Healthy Start clients must relate to both the goal of reducing infant mortality and the approved project objectives 2. Fund raising costs are unallowable.Healthy Start funds,e.g.,staff salary,contract personnel,consultants or costs for items to be sold or raffled,may not be used for fund raising activities. 3. The replacement of,or significant change in the responsibilities of senior project staff,including the project director,project manager,and chief financial officer,must have prior approval from the Grants Management Officer.The grantee must obtain prior approval from the awarding office for changes in scope,direction,type of service delivery or training,and rebudgeling of Healthy Start funds. 4. All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement:http://www.hrsa.gov/grants/hhsg ranlspolicy.pdf 5. Effective December 26,2014,all references to OMB Circulars for the administrative and audit requirements and the cost principles that govern Federal monies associated with this award are superseded by the Uniform Guidance 2 CFR 200 as codified by HHS at 45 CFR 75, 6. The funds for this award are sub-accounted in the Payment Management System(PMS)and will be in a P type(sub accounted)account. This type of account allows recipients to specifically identify the individual grant for which they are drawing funds and will assist HRSA in monitoring the award.If your organization previously received a grant under this program,it was in a G type(cash pooled)account designated by a PMS Account Number ending in G or G1.Now that this grant is sub accounted the PMS Account Number will be changed to reflect either P or P1.For example,if the prior year grant was in payee account number 2AAG it will now be in 2AAP.Similarly,if the prior year grant was in payee account 2AAG1,the grant will be in payee account 2AAP1.The P sub account number and the sub account code (provided on page 1 of this Notice of Award)are both needed when requesting grant funds. You may use your existing PMS username and password to check your organizations P account access.If you do not have access, complete a PMS Access Form(PMS/FFR Form)found at:httl)s://pms.psc.gov/grant-recipients/access-neWLIser.lilinl and send it to the fax number indicated on the bottom of the form.If you have any questions about accessing PMS,contact the PMS Liaison Accountant as identified at:https://pms.psc.gov/Find-pros-liaison-account@nt.hlml. 7. This Notice of Award is issued based on HRSA's approval of the Non-Competing Continuation(NCC)Progress Report.All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement: htlp://www.hrsi.gov/grants/hhsgranlspolicy.pdf Program Specific Term(s) 1. The management Team,including key personnel,must reflect the cultural diversity of the Community to be served. 2. This award is governed by the post-award requirements cited in Subpart D-Post Federal Award Requirements,standards for program and fiscal management of 45 CFR Part 75 except when the Notice of Award indicates in the"Remarks"section that the grant is included under "Expanded Authority".These recipients may lake the following actions without prior approval of the Grant Management Office: Section 75.308 c(2)(d)(1)Incur pre-award costs up to 90 calendar days before the award.See also 75.458. Section 75.308 c(2)(d)(2)Initiate a one-time extension of the period of performance by up to 12 months unless one or more of the conditions Page 2 NOTICE OF AWARD(Continuation Sheel) Date Issued:313/3020 5:08:13 PM Award Number:5 1149M000150.20-00 outlined in paragraphs(d)(2)(i)through(iii)of this section apply.For one-lime extensions,the recipient must notify the HHS awarding agency in writing with the supporting reasons and revised period of performance at least 10 calendar days before the end of the period of performance specified in the Federal award.This notification must be submitted through the Electronic Handbooks(EHB).This one-time extension may not be exercised merely for the purpose of using unobligated balances. Section 75.308 c(2)(d)(3)Carry forward unobligated balances to subsequent periods of performance. Except for funds restricted on a Notice of Award,grantee organizations are authorized to carry over unobligated grant funds up to the lesser of 25%or$250.000 of the amount awarded for that budget period remaining al the end of that budget period,If the unobligated balance is in excess of 25%of the total amount awarded,or$250,000,whichever is less,and the grantee wishes to carry the funds forward,the grantee must obtain prior approval from the Grants Management Office. The grantee must notify the Grants Management Office when it has elected to carry over unobligated balances under Expanded Authority and the amount to be carried over.The notification must be provided under item 12,'Remarks",on the initial submission of the Federal Financial Report(FFR). For all other Post Award request refer Standard Term 5 below. 3, Each project is expected to establish a plan to recover,to the maximum extent feasible,third party revenues to which it is entitled for services provided;garner all other available Federal,slate,local,and private funds;and charge beneficiaries according to their ability to pay for services without creating a barrier to those services.Where third-party payors,including Government agencies,are authorized or are under legal obligation to pay all or a portion of charges for health care services,"all such sources must be billed for covered services, and every effort must be made to obtain payment.Each service provider receiving Federal funds,either directly or indirectly,must have a procedure to identify all persons served who are eligible for third-party reimbursement." 4. All MCHB discretionary grant projects are expected to incorporate a carefully designed and well-planned evaluation protocol capable of demonstrating and documenting measurable progress toward achieving the stated goals.The measurement of progress toward goals should focus on systems,health and performance indicators,rather than solely on the intermediate process measures. 5. In accordance with the requirements of the"Government Performance and Results Act(GPRA)of 1993"(Public Law 103-62),MCHB has established measurable goals for Federal programs that can be reported as part of the budgetary process,thus linking funding decisions with performance.Performance measures and data elements for all MCHB-funded grant programs including Healthy Start have been finalized.As previously communicated all Healthy Start projects are expected to participate in the MCHB reporting requirements system. 6. Grantees are requiredto participate in any National Evaluation of Healthy Start Programs and respondto data request for information from the Division and the supporting HSperformance project.Grantees must use the DHSPS screening tools,must report aggregatelevel data on a monthly basis to DHSPS,and report progress on benchmarks inlhe MCHB Discretionary Grants Information System 7. HRSA reserves the right to reduce base awards for grantees that consistently maintain unobligated balance greater than$100,000. 8. A grantee can propose to include an evidence-based home visiting model as part of their Healthy Start(HS)program as long as each component of the program addresses the four HS approaches,and the evidence-based model allows for the HS program to collect the data included in the HS screening tools.That is,the requirements of any curriculum or model chosen do not supersede the requirements of HS. 9. HRSA reserves the right to reduce funding if,after receiving Technical Assistance,grantee cannot fulfil the requirements of the grant,i.e. progress on benchmarks,number of participants served. 10. Grantees are to budget for up to 3 persons to attend all mandatory regional meetings and the Healthy Start convention. Standard Term(s) 1. Recipients must comply with all terms and conditions outlined in their grant award,including grant policy terms and conditions outlined in applicable Department of Health and Human Services(HHS)Grants Policy Statements,and requirements imposed by program statutes and regulations and HHS grant administration regulations,as applicable;as well as any requirements or limitations in any applicable appropriations acts. 2. All discretionary awards issued by HRSA on or after October 1,2006,are subject to the HHS Grants Policy Statement(HHS GPS)unless otherwise noted in the Notice of Award(NOA).Parts I through III of the HHS GPS are currently available at http://www.hrsa.gov/grants/hhsgrantspolicy,pdf.Please note that the Terms and Conditions explicitly noted in the award and the HHS GPS are in effect. 3. 'This[projecUpublication/program/website)(is/was]supported by the Heallh Resources and Services Administration(HRSA)of the U.S. Department of Health and Human Services(HHS)as part of an award totaling$XX with xx percentage financed with non-governmental sources.The contents are those of the author(s)and do not necessarily represent the official views of,nor an endorsement,by HRSA,HHS or the U.S.Government." Recipients are required to use this language when issuing statements,press releases,requests for proposals,bid solicitations,and other HRSA-supported publications and forums describing projects or programs funded in whole or in part with HRSA funding.Examples of HRSA-supported publications include,but are not limited to,manuals,looikits,resource guides,case studies and issues briefs. Page 3 NOTICE OF AWARD(Continuntinn Sheet) Date Issued:3/3/3030 5:08:13 I'M Awwd Number:5 11,19MC00150.20.00 4. Recipients and sub-recipients of Federal funds are subject to the strictures of the Medicare and Medicaid anti-kickback statute(42 U.S.C. 1320a-7b(b)and should be cognizant of the risk of criminal and administrative liability under this statute,specifically under 42 U.S.C. 1320 7b(b)Illegal remunerations which slates,in part,that whoever knowingly and willfully:(A)Solicits or receives(or offers or pays)any remuneration(including kickback,bribe,or rebate)directly or indirectly,overtly or covertly,in cash or in kind,in return for referring(or to induce such person to refer)an individual to a person for the furnishing or arranging for the furnishing of any item or service,OR(B)In return for purchasing,leasing,ordering,or recommending purchasing,leasing,or ordering,or to purchase,lease,or order,any goods,facility, services,or item....For which payment may be made in whole or in part under subchapter XIII of this chapter or a State health care program, shall be guilty of a felony and upon conviction thereof,shall be fined not more than$25,000 or imprisoned for not more than five years,or both. 5. Items that require prior approval from the awarding office as indicated in 45 CFR Part 75[Note:75(d)HRSA has not waived cost-related or administrative prior approvals for recipients unless specifically stated on this Notice of Award]or 45 CFR Part 75 must be submitted as a Prior Approval action via Electronic Handbooks(EHBs).Only responses to prior approval requests signed by the GMO are considered valid.Grantees who take action on the basis of responses from other officials do so at their own risk.Such responses will not be considered binding by or upon the HRSA. In addition to the prior approval requirements identified in Part 75,HRSA requires grantees to seek prior approval for significant rebudgeting of project costs.Significant rebudgeting occurs when,under a grant where the Federal share exceeds$100,000.cumulative transfers among direct cost budget categories for the current budget period exceed 25 percent of the total approved budget(inclusive of direct and indirect costs and Federal funds and required matching or cost sharing)for that budget period or$250,000,whichever is less. For example,under a grant in which the Federal share for a budget period is S200,000,if the total approved budget is$300,000,cumulative changes within that budget period exceeding$75,000 would require prior approval).For recipients subject to 45 CFR Part 75,this requirement is in lieu of that in 45 CFR 75 which permits an agency to require prior approval for specified cumulative transfers within a grantee's approved budget.(Note,even if a grantee's proposed rebudgeling of costs falls below the significant rebudgeling threshold identified above,grantees are still required to request prior approval,if some or all of the rebudgeling reflects either a change in scope,a proposed purchase of a unit of equipment exceeding$25,000(if not included in the approved application)or other prior approval action identified in Part 75 unless HRSA has specifically exempted the grantee from the requirement(s).] 6. Payments under this award will be made available through the DHHS Payment Management System(PMS).PMS is administered by the Division of Payment Management,Financial Management Services,Program Support Center,which will forward instructions for obtaining payments.Inquiries regarding payments should be directed to:ONE-DHHS Help Desk for PMS Support at 1-877-614-5533 or PMSSupport@psc.hhs.gov.For additional information please visit the Division of Payment Management Website at https://pms.psc.gov/. 7. The DHHS Inspector General maintains a toll-free hotline for receiving information concerning fraud,waste,or abuse under grants and cooperative agreements.Such reports are kept confidential and callers may decline to give their names if they choose to remain anonymous.Contact:Office of Inspector General,Department of Health and Human Services,Attention:HOTLINE,330 Independence Avenue Southwest,Cohen Building,Room 5140,Washington.D.C.20201,Email:Htips@os.dhhs.gov or Telephone:1-800-447-8477(1- 800-HHS-TIPS). 8. Submit audits,if required,in accordance with 45 CFR Part 75,to:Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jefferson,IN 47132 PHONE:(310)457-1551,(800)253-0696 loll free ht(ps://harvester.census.gov/facweb/default.aspxt. 9. EO 13166,August 11,2000,requires recipients receiving Federal financial assistance to lake steps to ensure that people with limited English proficiency can meaningfully access health and social services.A program of language assistance should provide for effective communication between the service provider and the person with limited English proficiency to facilitate participation in,and meaningful access to,services.The obligations of recipients are explained on the OCR websile at HHS Limited English Proficiency(LEP). 10. This award is subject to the requirements of Section 106(g)of the Trafficking Victims Protection Act of 2000,as amended(22 U.S.C. 7104).For the full text of the award term,go to: Mips://www.lirsa.gov/sites/defau[Ufiiles/hrsa/grants/manage/trafficicing-in-persons.I)df.If you are unable to access this link,please contact the Grants Management Specialist identified in this Notice of Award to obtain a copy of the Term. 11. The Further Consolidated Appropriations Act,2020,§202,(P.L 116-94),enacted December 20,2019,restricts the amount of direct salary that may be paid to an individual under a HRSA grant or cooperative agreement to a rate no greater than Executive Level II of the Federal Executive Pay Scale,Effective January 2020,the Executive Level II salary level is$197,300.This amount reflects an individual's base salary exclusive of fringe benefits.An individual's institutional base salary is the annual compensation that the recipient organization pays an individual and excludes any income an individual may be permitted to earn outside the applicant organization duties.HRSA funds may not be used to pay a salary in excess of this rate.This salary limitation also applies to sub-recipients under a HRSA grant or cooperative agreement.The salary limitation does not apply to payments made to consultants under this award although,as with all costs, those payments must meet the test of reasonableness and be consistent with recipient's institutional policy.None of the awarded funds may be used to pay an individual's salary at a rate in excess of the salary limitation.Note:an individual's base salary,per se,is NOT constrained by the legislative provision for a limitation of salary.The rate limitation simply limits the amount that may be awarded and Page 4 NOIIC1101:AWARD(Conlinuarion Shed) Daic Issued:3/312020 5:0l;:13 PM Award Number:5 1149MC00150-20.0o charged to HRSA grants and cooperative agreements.For individuals whose salary rates are in excess of Executive Level II,the non- federal entity may pay the excess from non-federal funds. 12. To serve persons most in need and to comply with Federal law,services must be widely accessible.Services must not discriminate on the basis of age,disability,sex,race,color,national origin or religion.The HHS Office for Civil Rights provides guidance to grant and cooperative agreement recipients on complying with civil rights laws that prohibit discrimination on these bases.Please see Ililp://vp/vw.lilis.gov/civil-rights/for-individuals/index.litml,HHS also provides specific guidance for recipients on meeting their legal obligation under Title VI of the Civil Rights Act of 1964,which prohibits discrimination on the basis of race,color or national origin in programs and activities that receive Federal financial assistance(P.L.88-352,as amended and 45 CFR Part 75).In some instances a recipient's failure to provide language assistance services may have the effect of discriminating against persons on the basis of their national origin.Please see hllp://wv�Nv.hhs.gov/civil-rights/for-individuals/special-topics/limited-englisti-prorciencylindex.hlml to learn more about the Title VI requirement for grant and cooperative agreement recipients to lake reasonable steps to provide meaningful access to their programs and activities by persons with limited English proficiency. 13. Important Notice:The Central Contractor registry(CCR)has been replaced.The General Services Administration has moved the CCR(o the System for Award Management(SAM)on July 30,2012.To learn more about SAM please visit litti)s:Hwmv.sam.gov/SANI/. It is incumbent that you,as the recipient,maintain the accuracy/currency of your information in the SAM at all limes during which your entity has an active award or an application or plan under consideration by HRSA,unless your entity is exempt from this requirement under 2 CFR 25,110.Additionally,this term requires your entity to review and update the information at least annually after the initial registration, and more frequently if required by changes in your information.This requirement flows down to subrecipients.Note:SAM information must be updated at least every 12 months to remain active(for both grantees and sub-recipients).Granls,gov will reject submissions from applicants with expired registrations.It is advisable that you do not wait until the last minute to register in SAM or update your information. According to the SAM Quick Guide for Grantees(hlips://www.sam.gov/SAM/transclipUQuicl<_Guide_for_Granls-Regislralions.pdf),an entity's registration will become active after 3-5 days.Therefore,check for active registration well before the application deadline. 14. In any grant-related activity in which family,marital,or household considerations are,by statute or regulation,relevant for purposes of determining beneficiary eligibility or participation,grantees must treat same-sex spouses,marriages,and households on the same terms as opposite-sex spouses,marriages,and households,respectively.By"same-sex spouses,"HHS means individuals of the same sex who have entered into marriages that are valid in the jurisdiction where performed,including any of the 50 states,the District of Columbia,or a U.S.territory or in a foreign country,regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage.By "same-sex marriages,"HHS means marriages between two individuals validly entered into in the jurisdiction where performed,including any of the 50 stales,the District of Columbia,or a U.S.territory or in a foreign country,regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage.By"marriage,"HHS does not mean registered domestic partnerships,civil unions or similar formal relationships recognized under the law of the jurisdiction of celebration as something other than a marriage.This term applies to all grant programs except block grants governed by 45 CFR part 96 or 45 CFR Part 98,or grant awards made under titles IV-A, XIX,and XXI of the Social Security Act;and grant programs with approved deviations. 15. §75.113 Mandatory disclosures. Consistent with 45 CFR 75.113,applicants and non-federal entities must disclose,in a timely manner,in writing to the HHS awarding agency,with a copy to the HHS Office of Inspector General(OIG),all information related to violations of federal criminal law involving fraud, bribery,or gratuity violations potentially affecting the federal award.Sub recipients must disclose,in a timely manner,in writing to the prime recipient(pass through entity)and the HHS OIG,all information related to violations of federal criminal law involving fraud,bribery,or gratuity violations potentially affecting the federal award.Disclosures must be sent in writing to the awarding agency and to the HHS OIG at the following address: Department of Health and Human Services Health Resources and Services Administration Office of Federal Assistance Management Division of Grants Management Operations 5600 Fishers Lane,Mailstop 10SWH-03 Rockville,MD 20879 AND U.S.Department of Health and Human Services Office of Inspector General Attn:Mandatory Grant Disclosures,Intake Coordinator 330 Independence Avenue,SW,Cohen Building Room 5527 Washington,DC 20201 Fax:(202)205-0604(Include:"mandatory Gran(Disclosures"in subject line)or Email:MandatoryGranteeDisclosures@oig.lihs.gov Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371.Remedies for noncompliance, Pacc 5 NOTICE OF AWARD(Caminuaiian Shea) Date Issucd;3/3/2020 5:03:13 PM Award Number:5 11,19MC00150-20-00 including suspension or debarment(See 2 CFR parts 180&376 and 31 U.S.C.3321).The recipient must include this mandatory disclosure requirement in all sub-awards and contracts under this award- Non-Federal entities that have received a Federal award including the term and condition outlined in Appendix XII are required to report certain civil,criminal,or administrative proceedings to www.sam.gov.Failure to make required disclosures can result in any of the remedies described in§75.371,including suspension or debarment.(See also 2 CFR parts 180 and 376,and 31 U_S.C.3321). Recipient integrity and performance matters.If the total Federal share of the Federal award is more than$500,000 over the period of performance,Appendix XII to CFR Part 200 is applicable to this award. Reporting Requirement(s) 1. Due Date:Within 90 Days of Award Issue Date The grantee must submit a Performance Report within 90 days after receipt of the NoA.This report should include completing the financial forms,project abstract,grant summary and performance measures.The performance report must be submitted using the Electronic Handbook(EHB). 2, Due Date:Annually(Budget Period)Beginning:Budget Start Date Ending:Budget End Date,due Quarter End Date after 90 days of reporting period. The grantee must submit an annual Federal Financial Report(FFR).The report should reflect cumulative reporting within the project period and must be submitted using the Electronic Handbooks(EHBs).The FFR due dales have been aligned with the Payment Management System quarterly report due dates,and will be due 90, 120,or 150 days after the budget period end date.Please refer to the chart below for the specific due dale for your FFR: • Budget Period ends August—October:FFR due January 30 • Budget Period ends November—January:FFR due April 30 • Budget Period ends February—April:FFR due July 30 • Budget Period ends May—July:FFR due October 30 Failure to comply with these reporting requirements will result in deferral or additional restrictions of future funding decisions. Contacts NoA Email Address(es): Name Role Email David Pomaville Authorizing Official dpomaville@fresnocounlyca.gov Michael Chu Business Official mchu@fresnocountyca.gov Ah Vang Point of Contact,Program Director ahvang@fresnocountyca.gov Note:NoA emailed to these address(es) Program Contact: For assistance on programmatic issues,please contact Michael Muni at: 5600 Fishers Ln Rockville,MD,20852-1750 Email:mmuni@hrsa.gov Phone:(301)443-2052 Division of Grants Management Operations: For assistance on grant administration issues,please contact Ernsley Charles at: 5600 Fishers Ln Rm 10N146A Rockville,MD,20852-1750 Email:ECharles@hrsa.gov Phone:(301)443-8329 Fax:(301)443-6343 Page 6 Notice of Award Department of Health and Human Services FAINII H4900150 Health Resources and Services Administration Federal Award Date:02/26/2021 Recipient Federal Award I11FO1'I11atiO11 Recil --lnfot motion - - ...._. �'- _ - --- ---- , 1.Recipient Name 11.Award Number COUNTY OF FRESNO 5 H491V.000150-21-00 PO BOX 118G7 Fresno,CA 93775.1867 12.Unique Federal Award identification Number(FAIN) H4900150 1 2.Congressional District of Recipient - 16 13.Statutory Authority 3.Payment System Identifier(ID) Public Health Service Act,Section 751 Public Health Service Act:Title III,Part 0,Section 330H;42 U.SC.254c-8 1946000512A3 Public Health Service Act,Title III,Part D,4 330H(42 U.S.C.254c-8),as amended by the 4.Em to er Identification Number(EIN) Healthy Start Reauthorization Act of 2007(P.L.110.339) 94-6000512 i 14.Federal Award Project Title j 5.Data Universal Numbering System(DUNS) ELINIMINATING DISPARITIES IN PERINATAL HEALTH 556197655 ' 15.Assistance Listing Number G.Recipient's Unique Entity Identifier 93.926 7,Project Director or Principal Investigator 16.Assistance listing Program Title Ah Vang healthy Start Initiative ahvang@fresnoceuntyca,gov (559)600-3330 17.Award Action Type 8.Authorized Official Noncompo[Ing Continuation David Pomaville 18.Is the Award R&D? dpomaville@fresnocountyca.gov No Fedet-al Agency Information Summary Federal Award Financial Information 9.Awarding Agency Contact Information 19.Budget Period Start Date 04/O1/2021-End Date 03/31/2022 Ernsley P Charles Grants Management Specialist 20.Total Amount of Federal Funds obligated by this Action $955,033.00 Health Resources and Services Administration 20o.Direct Cost Amount ECharles@hrsa.gov (301)443-8329 201).Indirect Cost Amount 10.Program Official Contact Information21,Authorized Canyuver $0.00 Michael Muni i 22,Offset $24,967.00 Health Resources and Services Administration mmuni@hrsa.gov 23.Tot:d Amount of Federal Funds Obligated this huddel periud $955,033.00 (301)443-2052 24.Total Approved Cost Sharing or Matching,where applicable $0.00 - 25.Total Federal and Non-Federal Approved this Budget Period $980,000.00 i 26.Project Period Start Date 04/01/2019-End Date 03/31/2024 27.Total Amount of the.Forivml Award inciuding Approvorl $2,910,576.00 Cast Shoring or 61awhing this Project P(Mud 28,Authorized Treatment of Program Income Addition 29.Grants Management Officer-Signature Tammy Ponion on 02/26/2021 30.Itelital'll3 Page I ,printer versrpn Jecumonl pnry rlio tlaNnonl n,ay I.Yn apnin acta�va.9ty nNIM9pa lw U,e rcreon,patlrruierc raaccwtsan,ain/prms4cn,nluly 609[cmp'nnl accos,tla lfTr.rt version if arvinalo on Ina NR5,L7oclrercc N�.J1cc4,.Ilypu n�W mo,a n,a�mahon aoare epnracr HAS,canrod a wal 077-464.4772,a am to 8 pn,ET,nue4dayr NOTICE OF AWARD(Continuation ShLet) Date Issued:2/26/2021 1:27:06 PM Award Number:5 1149MCOOI SO.21.00 f"f Notice of Award Li �� 1=�— -� Award Number:5 H49MC00150-21-00 HEatn Federal Award Date:02/26/1021 Health Resources and Services Administration — 131.APPROVED BUDGET:(Excludes Direct Assistance) '33,RECOMMENDED FUTURE SUPPORT: (Subject to the availability of funds and satisfactory progress of project) [XI Grant Funds Only ----------.__----...__-- I I Total project costs including grant funds and all other financial participation YEAR TOTAL COSTS 00000 $980, . � a. Salaries and Wages: —— ----—------ ------$362.691.00 22 I I b. Fringe Benefits: $264,787.00 23 $980,000.00 I - C. Total Personnel Costs: $627.478.00 34.APPROVED DIRECT ASSISTANCE BUDGET:(In lieu of cash)--_ d. Consultant Casts: $0.00 a.Amount of Direct Assistance — $0.00 e. Equipment: S926.00 i b.Less Unawarded Balance of Current Year's Funds $0.00 I. supplies: $10,182,00 1 c.Less Cumulative Prior Award(s)This Budget period $0.00 g. Travel: $19,230.00 i d.AMOUNT OF DIRECT ASSISTANCE THIS ACTION $OAO h. Conslructlon/Alteration and Renovation; $0.00 35.FORMER GRANT NUMBER I. Other: $7,211.0036.OBJECT CLASS i j. Consortium/Contractual Costs: $233,400.00 41.51 - i k. Trainee Related Expenses: $0.00 37.BHCMISII:__------- —.-----------------.----_-._.—._.�—_--� 1. Trainee Stipends: $0.00 m. Trainee Tuition and Fees: 50.00 n. Trainee Travel: $0,00 i o. TOTAL DIRECT COSTS: $898,427.00 p. INDIRECT COSTS(Rate:16 of SB.W/TADC): $81,573.00 q. TOTAL APPROVED BUDGET: $980,000.00 i.Less Non-Federal Share: $0.00 ii.Federal Share: $9BO,000,00 32.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: a. Authorized Financial Assistance This Period $980,000.00 b. Less Unobligaled Balance from Prior Budget Periods i.Additional Authority $0.00 li,Offset $24,967.00 C. Unawarded Balance of Current Year's Funds $0.00 d. Less Cumulative Prior Award(s)This Budget Period $0.00 e. AMOUNT OF FINANCIAL ASSISTANCE TI115 ACTION $955,033.00 38.THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO,AND AS APPROVED BY HRSA,IS ON THE ABOVE TITLED PROJECT AND IS SUBJECT TO THE TERMS ANO CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a.The grant program legislation cited above.b.The grant program regulation cited above,c.This award notice including terms and conditions,if any,noted below under REMARKS.d.45 CFR Part 75 as applicable.In the event there are conflicting or otherwise inconsistent policies applicable to the grant,the above order of precedence shall I prevail.Acceptance of the grant terms and conditions Is acknowledged by the grantee when funds are drawn or otherwise obtained from the grant payment system. 39.ACCOUNTING CLASSIFICATION CODES SUBPROGRAM SUB ACCOUNT FY-CAN CFDA DOCUMENT NO. AMT.FIN,ASST, AMT.DIR.ASST. CODE CODE 21•3898020 93.926 19H49MC00150 $955,033.00 $0.00 19 H15-EKED Page 2 NOTICE OF A WARD(Continuation Sheet) Date Issued:2126/2021 I:27:06 I'M Award Number.5 1-149MC00150-21-00 HRSA Electronic Handbooks (EHBs) Registration Requirements The Project Director of the grant(listed on this NoA)and the Authorizing Official of the grantee organization are required to register(if not already registered)within HRSA's Electronic Handbooks(EHBs).Registration within HRSA EHBs is required only once for each user for each organization they represent.To complete the registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this NoA.After you have completed the initial registration steps(i.e.,created an individual account and associated it with the correct grantee organization record),be sure to add this grant to your portfolio.This registration in HRSA EHBs is required for submission of noncompeting continuation applications.In addition,you can also use HRSA EHBs to perform other activities such as updating addresses,updating email addresses and submitting certain deliverables electronically.Visit https:Hgrants3.hrsa.gov/2010/WebEPSExternal/Interface/common/accesscontrol/login.aspx to use the system.Additional help is available online and/or from the HRSA Call Center at 877-Go4-HRSA/877-464-4772. Terms and Conditions Failure to comply with the remarks,terms,conditions,or reporting requirements may result in a draw down restriction being placed on your Payment Management System account or denial of future funding. Grant Specific Term(s) 1. Healthy Start funds may not be used for entertainment costs.Trips and/or activities for Healthy Start clients must relate to both the goal of reducing infant mortality and the approved project objectives 2. Fund raising costs are unallowable.Healthy Start funds,e.g.,staff salary,contract personnel,consultants or costs for items to be sold or raffled,may not be used for fund raising activities. 3. The replacement of,or significant change in the responsibilities of senior project staff,including the project director,project manager,and chief financial officer,must have prior approval from the Grants Management Officer.The grantee must obtain prior approval from the awarding office for changes in scope,direction,type of service delivery or training,and rebudgeling of Healthy Start funds. 4. This Notice of Award is issued based on HRSA's approval of the Non-Competing Continuation(NCC)Progress Report.All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement: lilip://%,Avw.I)rsa.gov/grants/IilisgrinIspolicy.1)df 5. Effective December 26,2014,all references to OMB Circulars for the administrative and audit requirements and the cost principles that govern Federal monies associated with(his award are superseded by the Uniform Guidance 2 CFR 200 as codified by HHS at 45 CFR 75. 6. The funds for this award are in a sub-account in the Payment Management System(PMS).This type of account allows recipients to specifically identify the individual grant for which they are drawing funds and will assist HRSA in monitoring the award.Access to the PMS account number is provided to individuals at the organization who have permissions established within PMS.The PMS sub-account code can be found on the HRSA specific section of the NoA(Accounting Classification Codes).Both the PMS account number and sub-account code are needed when requesting grant funds.Please note that for new and competing continuation awards issued after 101112020, the sub-account code will be the document number. You may use your existing PMS username and password to check your organizations'account access.If you do not have access,complete a PMS Access Form(PMS/FFR Form)found at:littps://ptns.psc.gov/grant-recipients/access-newuser.html.If you have any questions about accessing PMS,contact the PMS Liaison Accountant as identified at:liltps://I)ms.psc.govlfind-pms-liaison-accoun(ant.hlml. 7. All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in(he Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement:hHp://www.hrsa.gov/grants/hhsgrantspolicy,pdf 8. This Notice of Award provides the offset of an unobligated balance in the amount of$24,967 from the 12/1/2019—11/30/2020 budget period to the current budget period.Please be advised Vial if the final resolution of the audit determines that the unobligated balance of Federal Funds is incorrect,HRSA is not obligated to make additional Federal Funds available to cover the shortfall, Program Specific Term(s) 1. The management Team,including key personnel,must reflect the cultural diversity of the Community to be served. 2. This award is governed by the post-award requirements cited in Subpart D-Post Federal Award Requirements,standards for program and fiscal management of 45 CFR Part 75 except when the Notice of Award indicates in the"Remarks"section that the grant is included under "Expanded Authority".These recipients may take the following actions without prior approval of the Grant Management Office: Section 75.308 c(2)(d)(1)Incur pre-award costs up to 90 calendar days before the award.See also 75.458. Fobe 3 NOTICE 0I7 AWARD(Continuation Slice() Date Issued:2/26/2021 1:27:06 1'M Award Number:5 1149M CON 50.21-00 Section 75,308 c(2)(d)(2)Initiate a one-lime extension of the period of performance by up to 12 months unless one or more of the conditions outlined in paragraphs(d)(2)(i)through(iii)of this section apply.For one-lime extensions,the recipient must notify the HHS awarding agency in writing with the supporting reasons and revised period of performance at least 10 calendar days before the end of the period of performance specified in the Federal award.This notification must be submitted through the Electronic Handbooks(EHB).This one-time extension may not be exercised merely for the purpose of using unobligaled balances. Section 75.308 c(2)(d)(3)Carry forward unobligaled balances to subsequent periods of performance. Except for funds restricted on a Notice of Award,grantee organizations are authorized to carry over unobligaled grant funds up to the lesser of 25%or$250,000 of the amount awarded for that budget period remaining at the end of that budget period.If the unobligaled balance is in excess of 25%of the total amount awarded,or$250,000,whichever is less,and the grantee wishes to carry the funds forward,the grantee must obtain prior approval from the Grants Management Office. The grantee must notify the Grants Management Office when it has elected to carry over unobligated balances under Expanded Authority and the amount to be carried over.The notification must be provided under item 12,"Remarks",on the initial submission of the Federal Financial Report(FFR). For all other Post Award request refer Standard Term 5 below. 3. Each project is expected to establish a plan to recover,to the maximum extent feasible,third party revenues to which it is entitled for services provided;garner all other available Federal,slate,local,and private funds;and charge beneficiaries according to their ability to pay for services without creating a barrier to those services.Where third-party payors,including Government agencies,are authorized or are under legal obligation to pay all or a portion of charges for health care services,"all such sources must be billed for covered services,and every effort must be made to obtain payment.Each service provider receiving Federal funds,either directly or indirectly,must have a procedure to identify all persons served who are eligible for third-party reimbursement." 4. All MCHB discretionary grant projects are expected to incorporate a carefully designed and well-planned evaluation protocol capable of demonstrating and documenting measurable progress toward achieving the stated goals.The measurement of progress toward goals should focus on systems,health and performance indicators,rather than solely on the intermediate process measures. 5. In accordance with the requirements of the"Government Performance and Results Act(GPRA)of 1993"(Public Law 103-62),MCHB has established measurable goals for Federal programs that can be reported as part of the budgetary process,thus linking funding decisions with performance.Performance measures and data elements for all MCHB-funded grant programs including Healthy Start have been finalized.As previously communicated all Healthy Start projects are expected to participate in the MCHB reporting requirements system. 6. Grantees must use the DHSPS screening tools,must report aggregate level data on a monthly basis to DHSPS,and report progress on benchmarks in the MCHB Discretionary Grants Information System. 7. Grantees are required to participate in the National Evaluation of Healthy Start Programs and respond to data request for information from the Division and the supporting HS performance project. 8. HRSA reserves the right to reduce base awards for grantees that consistently maintain unobligated balance greater than$100,000. 9. A grantee can propose to include an evidence-based home visiting model as part of their Healthy Start(HS)program as long as each component of the program addresses the four HS approaches,and the evidence-based model allows for the HS program to collect the data included in the HS screening tools.That is,the requirements of any curriculum or model chosen do not supersede the requirements of HS. 10. HRSA reserves the right to reduce funding if,after receiving Technical Assistance,grantee cannot fulfil the requirements of the grant,i.e. progress on benchmarks,number of participants served. 11. Grantees are to budget for up to 3 persons each to attend mandatory regional meetings,and the Healthy Start convention. Standard Term(s) 1, Your organization must comply with all HRSA Standard Terms unless otherwise specified on your Notice of Award. Reporting Requirement(s) 1. Due Date:Within 90 Days of Award Issue Date The grantee must submit a Performance Report within 90 days after receipt of the NoA.This report should include completing Ilse financial forms,project abstract,grant summary and performance measures.The performance report must be submitted using the Electronic Handbook(EHB). 2, Due Date:Annually(Budget Period)Beginning:Budget Start Date Ending:Budget End Date,due Quarter End Date after 90 days of reporting period. The recipient must submit an annual Federal Financial Report(FFR).The report should reflect cumulative reporting within the project period of the document number.Effective October 1,2020,all FFRs will be submitted through the Payment Management System(PMS). Technical questions regarding the FFR,including system access,should be directed to the Help Desk at PMSFFRSupl)ort@psc.hlis.gov. psc.hlis.gov. Page 4 NOTICE OF AWARD(Coniinualion Shcet) Date Issued:2/26/2021 1:27:06 I'M Award Number:5 1-149MC00150.21-00 The FFR will be due 90,120,or 150 days after the budget period end date.Please refer to the chart below for the specific due date for your FFR. • Budget Period ends August—October:FFR due January 30 • Budget Period ends November—January:FFR due April 30 • Budget Period ends February—April:FFR due July 30 • Budget Period ends May—July:FFR due October 30 Failure to comply with these reporting requirements will result in deferral or additional restrictions of future funding decisions. Contacts NoA Email Address(es): Name Role Email Ah Vang Point of Contact,Program Director ahvang@rresnocountyca.gov David Pornaville Authorizing Official dpomaville@fresnocounlyca.gov Michael Chu Business Official mchu@fresnocounlyca.gov Note:NoA emailed to these address(es) All submissions in response to conditions and reporting requirements(with the exception of the FFR)must be submitted via EHBs.Submissions for Federal Financial Reports(FFR)must be completed in the Payment Management System(li((ps:llpins.psc.govl). I'agc 5 Notice of Award Department of Health and Human Services fAlNll H4900150 Health Resources and Services Administration Federal Award Date:05/14/2022 �C Recipient Information FeLleral Award Information 1.Recipient Name 11.Award Number COUNTY OF FRESNO 6 H49MCOD150-22.01 PO BOX 11867 Fresno,CA 93775-1867 12.Unique Federal Award Identification Number(FAIN) H4900150 2.Congressional District of Recipient •j 16 13.Statutory Authority 3.Payment System Identifier(ID) 42 U.S.C.4 254c•8 I 1946000512A3 14,Federal Award Project Title j 4.Employer Identification Number(EIN) '� ELINIMINATING DISPARITIES IN PERINATAL HEALTH 9 4—6 0 0 0 512 15•Assistance Listing Number S.Data Universal Numbering System(DUNS) 93.926 556197655 16.Assistance Listing Program Title j G.Recipient's Unique Entity Identifier i Healthy Start Initiative GLPSPZLWSZE1 17.Award Action Type 7.project Director or Principal Investigator Administrative Ah Vang 18.Is the Award R&D? ' ahvang@fresnocounlyca.gov No (559)600.3330 S.Authorized Official Summary Federal Award Financial Information Federal Agency Information 19.Budget Period Start Date 04/O1/2022•End Date 03/31/2023 9.Awarding Agency Contact Information 20.Total Amount of Federal Funds Obligated by this Action $352,767.00 Ernsley P Charles 20a.Direct Cast Amount Grants Management Specialist Office of Federal Assistance Management(OFAM) 2(Ih.Indirect Cost Amount ' Division of Grants Management Office(DGMO) 21,Authorized Carryover $0.00 ECharles@hrsa.gov $248,659.00 22,Offset (301)443-8329 10.Program Official Contact Information - 23.Total Amounl of Federal Funds Obligated this budget period $352,768.00 Sandra Malhoslah 24.Total Approved Cost Sharing or Matching,where applicable $0.00 Maternal and Child Health Bureau(MCHB) 25.Taal Federal and Non-Federal Approved this Budget Period $980,000.00 smathoslah@hrsa.gov (301)443.0625 26.Project Period Start Date 04/01/2019-End Date 03/31/2024 - - 27.Total Amount of the Federal Award including Approved $3,263,344.00 Cast Sharing or Matching Ibis Prolecl Period 28.Authorized Treatment of Program Income Addition Z9.Grants Management Officer-Signature Tammy Ponton on 06/14/2022 30.RemarksThis grant is under Expanded Authority. Page I A prinlavulian dacumsnl a+ly Tne da vnronr uayc•da.•n lame acwfvO,Vly nLian7 la lAo aueon ivaJavul�If T.eccorr rauo inromauan,aruay SGticanrManlaaaisi[Ie HTAIL vorfionff avaAuolo on trio llRS.I FJocbaMc NardaecA:ll ypu noadmefa nlenrn 1acl HRSAeaalPcfeenlar a 1977-164.1777.8 '1,BPm ET'%a Adal's NO'fICG OF AWARD(Continuation Shcet) Date Issued:6114/2022 3:54:13 PM Awnrd Number:6 1449MCODISO.22-01 Notice of Award Hea;h Res::cos 3 Ssc:e3_?�:r;5a:c^ Award Number:6 H49MC00150.22-01 Federal Award Dale:06/14/2022 Maternal and Child Health Bureau(MCHB) 31.APPROVED BUDGET:(Excludes Direct Assistance) 33,RECOMMENDED FUTURE SUPPORT: i [XI Grant Funds Only i (Subject to the,availability of funds and satisfactory progress of project) . - ..._.. --.. . ._. - ._- '-----___. ..-..- ---- O Total project costs including grant funds and all other financial participation YEAR TOTAL COSTS f a. Salaries and Wages: $362,691.00 23 $980,000.00 b. Fringe Benefits: $264,787.00 34.APPROVED DIRECT ASSISTANCE BUDGET:(in lieu of cash) - - c. Total Personnel Costs: $627,478.00 a.Amount of Direct Assistance $0.00 it. Consultant Costs: $0.00 i b,Less Unawarded Balance of Current Year's Funds $0.00 j o. Equipment: $926.00 C.Less Cumulative Prior Award(s)This Budget Period $0,00 I I. Supplies: SW,182.00 d.AMOUNT OF DIRECT ASSISTANCE THIS ACTION $0.00 g. Travel: $19,230,00 135.FORMER GRANT NUMBER h. Construction/Alteratinn and Renovation: $0,00 j 36.OBJECT CLASS i. Other: $7.211.00 41.51 j, Consortium/Contractual Costs: $233,400.00 i'37.GHCMISII k. Trainee Related Expenses: $0.00 I. Trainee Stipends: $0.00 1 in, Trainee Tuition and Fees: $0.00 n. Trainee Travel: $0.00 I o. TOTAL DIRECT COSTS: $898,427.00 t j p. INDIRECT COSTS(Rate;%of S&W/TADC): $81,573.00 I q• TOTAL APPROVED BUDGET: $980,000.00 j 1.Less Non-Federal Share: $0.00 ii.Federal Share: $980,000.00 (32.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: a. Authorized Financial Assistance This Period $980,000.00 b. Less Unoblittaled Balance from Prior Budget Periods L Additional Authority $0.00 ii.Offset $627,232.00 c. Unawarded Balance of Current Year's Funds $0.00 d. Less Cumulative Prior Awards)This Budget Period $1.00 AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION $352,767.00 '.38.THIS AWARD IS BASED ON THE APPLICATION APPROVED BY HRSA FOR THE PROJECT NAMED IN ITEM 14.FEDERAL AWARD PROJECT TITLE AND IS SUBJECT To THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE AS: .The program authorizing statue and program regulation cited in this Notice of Award;b.Conditions on activities and expenditures of funds in certain other applicable astatutory requirements,such as those included in appropriations restrictions applicable to HRSA funds;c.45 CFR Part 75;d.National Policy Requirements and all other requirements described in the HHS Grants Policy Statement;e.Federal Award Performance Goals;and f.The Terms and Conditions cited In this Notice of Award.In the even[ there are conflicting or otherwise inconsistent policies applicable to the award,the above order of precedence shall prevail.Recipients indicate acceptance of the award,and j terms and conditions by obtaining funds from the payment system. 39.ACCOUNTING CLASSIFICATION CODES FY•rAN CFDA DOCUMENT AMT.FIN.ASST. AMT.DIR,ASST. SUB PnOGRAM CODE SUB ACCOUNT CODE NUMBER 22-3898020 93.926 191-149M000150 $352,767.00 $0.00 N/A 19-HIS-ERED Pagc 2 NOTICE Of AWARD(Contimiaiinu Shea) Dale Issued:6/1.112022 3:54:13 PM Award Number:6 1-I49MCODI50-22.01 HRSA Electronic Handbooks (EHBs) Registration Requirements The Project Director of the grant(listed on this NoA)and the Authorizing Official of the grantee organization are required to register(if not already registered)within HRSA's Electronic Handbooks(EHBs).Registration within HRSA EHBs is required only once for each user for each organization they represent.To complete the registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this NoA.After you have completed the initial registration steps(i.e„created an individual account and associated it with the correct grantee organization record),be sure to add this grant to your portfolio.This registration in HRSA EHBs is required for submission of noncompeling continuation applications.In addition,you can also use HRSA EHBs to perform other activities such as updating addresses,updating email addresses and submitting certain deliverables electronically.Visit https://grants3.hrsa.gov/20101WebEPSExternal/Interface/common/accesscontrol/login.aspx to use the system.Additional help is available online and/or from the HRSA Call Center at 877-Go4-HRSA/877-464-4772. Terms and Conditions Failure to comply with the remarks,terms,conditions,or reporting requirements may result in a draw down restriction being placed on your Payment Management System account or denial of future funding. Grant Specific Term(s) 1. This Notice of Award provides the offset of an unobligated balance in the amount of$248,658 from the 411/2020-3/31/2021 budget period to the current budget period.Please be advised that if the final resolution of the audit determines that the unobligated balance of Federal Funds is incorrect,HRSA is not obligated to make additional Federal Funds available to cover the shortfall. 2. This revised Notice of Award is Issued to provide the balance of funds which satisfies the requested funding for 411/22-3/31/23.Grant funds totaling 25%or more of the authorized total must receive prior approval before being reallocated. All prior terms and conditions remain In effect unless specifically removed. Contacts NoA Email Address(es): Name lRole Email Ah Vang I Program Director ahvang@fresnoccuntyca.gov Note:NoA emailed to these address(es) All submissions in response to conditions and reporting requirements(with the exception of the FFR)must be submitted via EHBs.Submissions for Federal Financial Reports(FFR)must be completed in the Payment Management System(hltps://pins.)sc.gov/). Page 3 y Notice Award 4 FAIN Department of Health and Human Services Fnlrul H4900150 (L Health Resources and Services Administration FedernI Award Date:03/10/2023 ! Recipient Information Federal Award Information 1.Recipient Name C I1.Award Number COUNTY OF FRESNO PO BOX 118137 5 H49MC00150-23-00 Fresno,CA 93775.1867 12.Unique Federal Award Identification Number(FAIN) 2.Congressional District of Recipient H4900150 � 16 13.Statutory Authority 3.Payment Systern Identifier(ID) 42 U.S.C.4 254c-8 1946000512A3 14,Federal Award Project Title i 4.Employer Identification Number(EIN) ELINIMINATING DISPARITIES IN PERINATAL HEALTH - 9 4-6 0 0 0 51.2 15.Assistance Listing Number S.Data Universal Numbering System(DUNS) 93.926 556197655 16.Assistance Listing Program Title 6.Recipient's Unique Entity Identifier Healthy Start Initiative GLP5PZLWSZE3 17.Award Action Type 7.Project Director or Principal Investigator Noncompeting Continuation Ali Vang ahvang@fresnocountyca.gov i 18.Is the Award R&D? (559)600.3330 Na S.Authorized official ; Summary Federal Award Financial Information 1 David Luchird j • Director ! 19.Budget Period Start Date 04/01/2023-End Date 03/31/2024 dluchini@fresnocounlyca.gov 1 20.Total Amount of Federal Funds Obligated by this Action $678,548.00 (559)600.3200 20a.Direct Cost Amount Federal Agency information 20b.Indirect Cost Amount I 9.Awarding Agency Contact Information 21.Authorized Carryover $0.00 Ernsley P Charles Grants Management Specialist 22.Olfsel $301,452.00 Office of Federal Assistance Management(OFAM) 23.Total Amount of Federal Funds Obligated this budge(period $678,548.00 Division of Grants Management Office(DGMO) ECharles@hrsa.gov ! 24.Total Approved Cost Sharing or Matching,where applicable $0.00 (301)443-8329 25.Total Federal and Non-Federal Approved this Budget Period $980,000,00 ! 10.Program Official Contact Information 26.Project Period Start Date 04/01/2019-End Date 03/31/2024 Mabatemije Otubu Maternal and Child Health Bureau(MCHB) 27.Total Amount of the Federal Award including Approved $3,941,892.00 1 MOtubu@hrsa.gov Cos(Sharing or Matching this Project Period (301)594-4462 28.Authorized Treatment of Program Income Addition 29.Grants Management Officer-Signature William Davis on 03/10/2023 1 30.Remarks This grant is under Expanded Authority. [,age I n pr,nlor vmieneorenranlan'y iea ticcumonlmay rNaln romo a[car:ietidycnn'Iongoa PoNee lcrern roaeo/uforr.ie eccara famoinlormulun,alvay 509 ranr;Lmd ammilb/a HDdL venlon i,-latla on lbe HRSA E/Or1-Handbook.,RyaunaeC ,,,o mfartna'�on,yeeao contort HRSA ronlac!conlo,a1 977•a0a-a772,B e�h e en,ET,neakeaya NOTICE OP AWARD(Continuation Sheet) Dale Issued:3110/2023 1:05:43 PM Award Number:5 IJ49MC00I50.23-00 L(# ' it Notice of Award 1 J-I—r]J — --' Award Number:5 H49MC00150.23-00 FeallResa::C dSUM-SMIr.O;Ila::- Federal Award Date:03/1012023 Maternal and Child Health Bureau(MCHB) -- - 31.APPROVED BUDGET:(Excludes Direct Assistance) 1 33.RECOMMENDED FUTURE SUPPORT: (Subject to the availability of funds and satisfa (XI Grant Funds Onlyctory progress of project} 1 O Total project costs including,grant funds and all other linandal participation I YEAR TOTAL COSTS a. Salaries and Wages: $362,691,00 Not applicable b. Fringe Benefits: $264,787.00 34,APPROVED DIRECT ASSISTANCE BUDGET:(In lieu of cash) c. Total Personnel Costs: $627,478.00 I a.Amount of Direct Assistance $0.00 i d, Consultant Costs: $0.00 b.Less Unawarded Balance of Current Year's Funds $0.00'i L. Equipment: $0.00 C.Less Cumulative Prior Award(s)This Budget Period $0.00 f. Supplies: $10,182.00 d,AMOUNT OF DIRECT ASSISTANCE THIS ACTION $0.00 g, Travel: $19,230.00 35.FORMER GRANT NUMBER h. Construction/Alteration and Renovation: $0'00 1 36.00)ECT CLASS i. Other: $8,137.00 41.51 J. Consortium/Contractual Casts. $233,400.00 37.BHCMISrI I k. Trainee Related Expenses: 50.00 i I, Traince Stipends: I m. Tralnce Tuition and Fees; $0.00 1 n. Trainee Travel: $0.00 o. TOTAL DIRECT COSTS: $898,427.00 i p. INDIRECT COSTS(Rate:%of S&W/TADC): $81,573.00 q. TOTAL APPROVED BUDGET: $980,000.00 { i.less Non-Federal Share: $0,00 ii.Federal Share: $980,000.00 32.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: a. Authorized Financial Assistance This Period $980,000.00 b. Less Unobligated Balance from Prior Budget Periods i i.Additional Authority $0.00 ii.Offset $301,452.00 i c. Unawarded Balance of Current Year's Funds $0.00 d. Less Cumulative Prior Award(s)This Budget Period $0.00 e. AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION $678,548.00 36,THIS AWARD IS BASED ON THE APPLICATION APPROVED BY HRSA FOR THE PROJECT NAMED IN ITEM 14.FEDERAL AWARD PROJECT TITLE AND IS SUBIECTTO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE AS: I and expenditures of Funds in certain other applicable a.The program authorizing statue and program regulation cited in this Notice of Award;b.Conditions on activities statutory requirements,such as those included in appropriations restrictions applicable to HRSA funds;c.45 CFR Part 75;d.National Policy Requirements and all other requirements described in the HHS Grants Policy Statement;e.Federal Award Performance Goals;and f.The Terms and Conditions cited in this Notice of Award.In the event there are conflicting or otherwise inconsistent policies applicable to the award,the above order of precedence shall prevail.Recipients indicate acceptance of the award,and terms and conditions by obtaining funds from the payment system. 39,ACCOUNTING CLASSIFICATION CODES -- - DOCUMENT AMT.FIN.ASST. AMT.DIR.A55T, SUB PROGRAM CODE SUD ACCOUNT CODE FY-CAN CFDA NUMBER 23•3898020 93.926 19H49MC00150 $678,548.00 $0,00 N/A 19-HIS-EKED - Page 2 NOTICE OF AWARD(Continuation Shect) Date Issue:3/10/2023 1:05:43 I'fvt Award Number.5 I N9MC00150-23.00 HRSA Electronic Handbooks (EHBs) Registration Requirements The Project Director of the grant(listed on this NoA)and the Authorizing Official of the grantee organization are required to register(if not already registered)within HRSA's Electronic Handbooks(EHBs).Registration within HRSA EHBs is required only once for each user for each organization they represent.To complete the registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this NoA.After you have completed the initial registration steps(i,e.,created an individual account and associated it with the correct grantee organization record),be sure to add this grant to your portfolio.This registration in HRSA EHBs is required for submission of noncompeting continuation applications.In addition,you can also use HRSA EHBs to perform other activities such as updating addresses,updating email addresses and submitting certain deliverables electronically.Visit htlps:Hgrants3.hrsa.gov/201O/WebEPSExternal/Interface/commonlaccesscontrolilogin.aspx to use the system.Additional help is available online and/or from the HRSA Call Center at 877-Go4-HRSA/877.464-4772. Terms and Conditions Failure to comply with the remarks,terms,conditions,or reporting requirements may result in a draw down restriction being placed on your Payment Management System account or denial of future funding. Grant Specific Term(s) 1. Healthy Start funds may not be used for entertainment costs.Trips and/or activities for Healthy Start clients must relate to both the goal of reducing infant mortality and the approved project objectives 2. Fund raising costs are unallowable,Healthy Start funds,e.g.,staff salary,contract personnel,consultants or costs for items to be sold or raffled,may not be used for fund raising activities. 3. The replacement of,or significant change in the responsibilities of senior project staff,including the project director,project manager,and chief financial officer,must have prior approval from the Grants Management Officer.The grantee must obtain prior approval from the awarding office for changes in scope,direction,type of service delivery or training,and rebudgeting of Healthy Start funds. 4. 45 CFR Part 75 applies to all federal funds associated with the award.Part 75 has been effective since December 26,2014.All references to prior OMB Circulars for the administrative and audit requirements and the cost principles that govern Federal monies associated with this award are superseded by the Uniform Guidance 2 CFR Part 200 as codified by HHS at 45 CFR Part 75. 5. The funds for this award are in a sub-account in the Payment Management System(PMS).This type of account allows recipients to specifically identify the individual grant for which they are drawing funds and will assist HRSA in monitoring the award.Access to the PMS account number is provided to individuals at the organization who have permissions established within PMS.The PMS sub-account code can be found on the HRSA specific section of the NoA(Accounting Classification Codes).Both the PMS account number and sub-account code are needed when requesting grant funds.Please note that for new and competing continuation awards issued after 10/11/2020, the sub-account code will be the document number. You may use your existing PMS username and password to check your organizations'account access.If you do not have access,complete a PMS Access Form(PMS/FFR Form)found at:htips://pmsapp.psc.gov/pms/app/tiserrequest.If you have any questions about accessing PMS,contact the PMS Liaison Accountant as identified at: http://pms.l)sc.gov/find-pms-liaison-accountan(.Iitml 6. All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement:hltp://www.hrsa.gov/grants/hhsgranlspolicy.pdf 7. 45 CFR Part 75 applies to all federal funds associated with the award.Part 75 has been effective since December 26,2014.All references to prior OMB Circulars for the administrative and audit requirements and the cost principles that govern Federal monies associated with this award are superseded by the Uniform Guidance 2 CFR Part 200 as codified by HHS at 45 CFR Part 75. 8. This Notice of Award is issued based on HRSA's approval of the Non-Competing Continuation(NCC)Progress Report.All post-award requests,such as significant budget revisions or a change in scope,must be submitted as a Prior Approval action via the Electronic Handbooks(EHBs)and approved by HRSA prior to implementation.Grantees under"Expanded Authority,"as noted in the Remarks section of the Notice of Award,have different prior approval requirements.See"Prior-Approval Requirements"in the DHHS Grants Policy Statement:littfxlhwaw.tirsa.gov/grants/hhsgraTitspolicy.pdf 9. The funds for this award are in a sub-account in the Payment Management System(PMS).This type of account allows recipients to specifically identify the individual grant for which they are drawing funds and will assist HRSA in monitoring the award.Access to the PMS account number is provided to individuals at the organization who have permissions established within PMS.The PMS sub-account code can be found on the HRSA specific section of the NoA(Accounting Classification Codes).Both the PMS account number and sub-account code are needed when requesting grant funds.Please note that for new and competing continuation awards issued after 1 0/112 0 2 0, the sub-account code will be the document number. Page 3 NOTICE OF AWARD(Continu,10011 Sheol) Date Issued:3/10/2023 1:05:43 PM Award Number:5 1-149MC00150-23-00 You may use your existing PMS username and password to check your organizations'account access.If you do not have access,Complete a PMS Access Form(PMS/FFR Form)found at:httl)s://prnsapp.psc.gov/pros/al)l)/userrequesl.If you have any questions about accessing PMS,contact the PMS Liaison Accountant as identified at: http://pms.psc.gov/find-pros-liaison-accountani.litml 10. This Notice of Award provides the offset of an unobligaled balance in the amount of S301,452 from 4/1/2021-3/31/2022 budget period to the current budget period.Please be advised that if the final resolution of the audit determines that the unobligaled balance of Federal Funds is incorrect,HRSA is not obligated to make additional Federal Funds available to cover the shortfall. Program Specific Term(s) 1. The management Team,including key personnel,must reflect the cultural diversity of the Community to be served. 2. This award is governed by the post-award requirements cited in Subpart D-Post Federal Award Requirements,standards for program and fiscal management of 45 CFR Part 75 except when the Notice of Award indicates in the"Remarks"section that the grant is included under "Expanded Authority".These recipients may take the following actions without prior approval of the Grant Management Office; Section 75.308 c(2)(d)(1)Incur pre-award costs up to 90 calendar days before the award.See also 75.458. Section 75.308 c(2)(d)(2)Initiate a one-lime extension of the period of performance by up to 12 months unless one or more of the conditions outlined in paragraphs(d)(2)(i)through(iii)of this section apply.For one-lime extensions,the recipient must notify the HHS awarding agency in writing with the supporting reasons and revised period of performance at least 10 calendar days before the end of the period of performance specified in the Federal award.This notification must be submitted through the Electronic Handbooks(EHB).This one-lime extension may not be exercised merely for the purpose of using unobligaled balances. Section 75.308 c(2)(d)(3)Carry forward unobligaled balances to subsequent periods of performance. Except for funds restricted on a Notice of Award,grantee organizations are authorized to carry over unobligaled grant funds up to the lesser of 25%or$250,000 of the amount awarded for that budget period remaining at the end of that budget period.If the unobligaled balance is in excess of 25%of the total amount awarded,or$250,000,whichever is less,and the grantee wishes to carry the funds forward,(lie grantee must obtain prior approval from the Grants Management Office. The grantee must notify the Grants Management Office when it has elected to carry over unobligated balances under Expanded Authority and the amount to be carried over.The notification must be provided under item 12,"Remarks",on the initial submission of the Federal Financial Report(FFR). For all other Post Award request refer Standard Term 5 below. 3. Each project is expected to establish a plan to recover,to the maximum extent feasible,third party revenues to which it is entitled for services provided;garner all other available Federal,slate,local,and private funds;and charge beneficiaries according to their ability to pay for services without creating a barrier to those services.Where third-party payors,including Government agencies,are authorized or are under legal obligation to pay all or a portion of charges for health care services,"all such sources must be billed for covered services,and every effort must be made to obtain payment.Each service provider receiving Federal funds,either directly or indirectly,must have a procedure to identify all persons served who are eligible for third-party reimbursement." 4. All MCHB discretionary grant projects are expected to incorporate a carefully designed and well-planned evaluation protocol capable of demonstrating and documenting measurable progress toward achieving the staled goals.The measurement of progress toward goals should focus on systems,health and performance indicators,rather than solely on the intermediate process measures. 5. In accordance with the requirements of the"Government Performance and Results Act(GPRA)of 1993"(Public Law 103-62),MCHB has established measurable goals for Federal programs that can be reported as part of the budgetary process,thus linking funding decisions with performance.Performance measures and data elements for all MCHB-funded grant programs including Healthy Start have been finalized.As previously communicated all Healthy Start projects are expected to participate in the MCHB reporting requirements system. 6. Grantees must use the DHSPS screening tools,must report aggregate and client level data on a monthly basis to DHSPS,and report progress on benchmarks in the MCHB Discretionary Grants Information System. 7. Grantees are required to participate in the National Evaluation of Healthy Start Programs and respond to data request for information from the Division and the supporting HIS performance project. 8. HRSA reserves the right to reduce base awards for grantees that consistently maintain unobligaled balance greater than$100,000. 9. A grantee can propose to include an evidence-based home visiting model as part of their Healthy Start(HS)program as long as each component of the program addresses the four HIS approaches,and the evidence-based model allows for the HS program to collect the data included in the HS screening tools.That is,the requirements of any curriculum or model chosen do not supersede the requirements of HS. 10. Grantees are to budget for up to 3 persons to attend all mandatory regional meetings and the Healthy Start convention. 11. HRSA reserves the right to reduce funding if,after receiving Technical Assistance,grantee cannot fulfil the requirements of the grant.i.e, progress on benchmarks,number of participants served. Pagc 4 NOTICGOF AWARD(Continuation Sheet) Date Issued:3/10/2023 1:05:43 I'M Award Number:5 1•119MC00150.33-00 Standard Term(s) 1. Your organization is 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,per HRSA Standard Terms(unless otherwise specified on your Notice of Award),and Legislalive Mandates.The effectiveness of these policies,procedures,and controls is subject to audit. Reporting Requirement(s) 1. Due Date:Within 90 Days of Project End Date The grantee must submit a Performance Report within 90 days after the end of the project period.This report should include completing the financial forms,project abstract,grant summary and performance measures.The performance report must be submitted using the Electronic Handbook(EHB). 2. Due Date:Annually(Budget Period)Beginning:Budget Start Date Ending: Budget End Date,due 90 days after end of reporting period. The recipient must submit,within 90 days after budget period end dale,an annual Federal Financial Report(FFR).The report should reflect cumulative reporting within the project period of the document number.All FFRs must be submitted through the Payment Management System(PMS).Technical questions regarding the FFR,including system access should be directed to the PMS Help Desk by submitting a ticket through the self-service web portal(PMS Self-service Web Portal),or calling 877-614-5533. Failure to comply with these reporting requirements will result in deferral or additional restrictions of future funding decisions. Contacts NoA Email Address(es): Name Role Email David Luchini Authorizing Official dluchini@fresnocounlyca.gov Ah Vang Program Director,Point of Contact ahvang@fresnocountyea.gov Michael Chu Business Official mchu@fresnocounlyca.gov Note:NoA emailed to these address(es) All submissions in response to conditions and reporting requirements(with the exception of the FFR)must be submitted via EHBs.Submissions for Federal Financial Reports(FFR)must be completed in the Payment Management System(hIJps://Pr11s-Psc.gov/)- Page 5 Department of Health and Human Services Notice of Award / FAINII H4900150 lr` Health Resources and Services Administration Federal Award Date:07/05/2023 Recipient Information P Federal Award Information j 1.Recipient Name COUNTY OF FRESNO 11.Award Number 6 H49MC00150-23-01 PO BOX 11867 Fresno,CA 93775-1867 12.Unique Federal Award Identification Number(FAIN) 2.Congressional District of Recipient H4900150 16 13•Statutory Authority 3.Payment System Identifier(ID) 42 U.S.C.§254c-8 1946000512A3 14.Federal Award Project Title 4.Employer Identification Number(EIN) EUNIMINATING DISPARITIES IN PERINATAL HEALTH - 9 4—6 0 0 0 512 15,Assistance Listing Number S.Data Universal Numbering System(DUNS) 93.926 556197655 16.Assistance Listing Program Title 6.Recipient's Unique Entity Identifier Healthy Start Initiative GLPSPZLWSZEI 17.Award Action Type 7.Project Director or Principal Investigator Administrative Ah Vang Project Director 18.Is the Award R&D? ahvang@fresnocountyca,gov No (559)600.3330 j----- --- ---- --...----_-_-- --- - Summary Federal Award Financial Information S.Authorized Official 19.Budget Period Start Date 04/O1/2023-End Date 03/31/2024 Federal Agency InfO1'mat1O11 20.Total Amount of Federal Funds Obligated by this Action $15,000,00 9.Awarding Agency Contact Information Carla Lloyd I 20a.Direct Cost Amount Grants Management Specialist lob.Indirect Cost Amount Office of Federal Assistance Management(OFAM) Division of Grants Management Office(DGMO) 27.Authorized Carryover $0.00 CLLOYD@HRSA.GOV 22,Offset $0.00 (301)443-0164 23.Total Amount of Federal Funds Obligated this budget period $693,548.00 1 10.Program Official Contact Information 24.Total Approved Cost Sharing or Matching,where applicable $0,00 Mabatemije Otubu Maternal and Child Health Bureau(MCHB) 25.Total Federal and Non-Federal Approved this Budget Period $995,000.00 MOtubu@hrsa.gov 26.Project Period Start Date 04/01/2019-End Date 03/31/2024 (301)594-4462 27,Total Amount of the Federal Award including Approved Cost Sharing or Matching this Project Period 3,956,892,00 28.Authorized Treatment of Program Income Addition 29.Grants Management Officer—Signature James Smith on 07/05/2023 30.Retnarlts Page I A pnnror ver:ien documaM only.The dacumenl maycanlan some accarvbihlychaRengas Po�Ihe ecraan loader u+ers To accuse lama/nlamlalion,a lulry5QU'.m0.m accesvble HTML v ionis avad.bla an lho HRSA E/ad-xHandbooks.Ilyou n dmm ,n maum.pfsase romatl HRSAmnlacl eenler t 677-464-4772,Sam to S pm ET,Ivaakdays NOTICE OF AWARD(Continuation Sheet) Date Issued:7/5/2023 11:08:57 AM Award Number:6 H49MCOO 150-23-01 HRSANotice of Award Award Number:6 H49MC00150-23.01 Federal Award Date:07/05/2023 Maternal and Child Health Bureau(MCHB) 31.APPROVED BUDGET:(Excludes Direct Assistance) 33.RECOMMENDED FUTURE SUPPORT: [X] Grant Funds Only (Subject to the availability of funds and satisfactory progress of project) () Total project costs including grant funds and all other financial participation YEAR TOTAL COSTS a. Salaries and Wages: $362,691.00 Not applicable b. Fringe Benefits: $264,787.00 34.APPROVED DIRECT ASSISTANCE BUDGET:(In lieu of cash) c. Total Personnel Costs: $62.7,478.00 a.Amount of Direct Assistance $0.00 d. Consultant Costs: $0-GO b,Less Unawarded Balance of Current Year's Funds $0.00 e. Equipment: $0•0o c.Less Cumulative Prior Award(s)This Budget Period $0,00 f. Supplies: $25,182.00 d.AMOUNT OF DIRECT ASSISTANCE THIS ACTION $0.00 g. Travel: $19,230.00 35.FORMER GRANT NUMBER h. Construction/Alteration and Renovation: $0,00 36.OBJECT CLASS I. Other: $8,137.00 41.51 _ — j. Consortium/Contractual Costs: $233,400.00 37.BHCMISM k. Trainee Related Expenses: $0.00 1. Trainee Stipends: $0.00 m. Trainee Tuition and Fees: $0.00 n. Trainee Travel: $0.00 o. TOTAL DIRECT COSTS: $913,427.00 p. INDIRECT COSTS(Rate:%of 5&W/TADC): $81,573.00 q. TOTAL APPROVED BUDGET: $995,000.00 i.Less Non-Federal Share: $0.00 ii.Federal Share: $995,000.00 32.AWARD COMPUTATION FOR FINANCIAL ASSISTANCE: a. Authorized Financial Assistance This Period $995,OD0.00 b. Less Unobligated Balance from Prior Budget Periods i.Additional Authority $0.00 it,Offset $301,4S2.00 c. Unawarded Balance of Current Year's Funds $0.00 d. Less Cumulative Prior Award(s)This Budget Period $679,548.00 e. AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION $15,000.00 38.THIS AWARD IS BASED ON THE APPLICATION APPROVED BY HRSA FOR THE PROJECT NAMED IN ITEM 14.FEDERAL AWARD PROJECT TITLE AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE AS: a.The program authorizing statue and program regulation cited in this Notice of Award;b.Conditions on activities and expenditures of funds in certain other applicable statutory requirements,such as those Included in appropriations restrictions applicable to HRSA funds;c.45 CFR Part 75;d.National Policy Requirements and all other requirements described in the HHS Grants Policy Statement;e.Federal Award Performance Goals;and f.The Terms and Conditions cited in this Notice of Award.In the event there are conflicting or otherwise inconsistent policies applicable to the award,the above order of precedence shall prevail.Recipients indicate acceptance of the award,and terms and conditions by obtaining funds from the payment system. 39.ACCOUNTING CLASSIFICATION CODES FY-CAN CFDA DOCUMENTNUMBER AMT.TIN.ASST. AMT.DIR.ASST. SUB PROGRAM CODE SUB ACCOUNT CODE 23-3898020 93.926 19IA49MC00150 $15,000.00 $0.00 N/A 19-HIS-ERED Page 2 9 WORKSPACE FORM 1-800 G " GRANTS.COv'- SUPPORT@GRANTS.GO.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package.This form can be completed in its entirety oHline using Adobe Reader.You can save your form by clicking the"Save"button and see any errors by clicking the"Check For Errors"button.In-progress and completed forms can be uploaded at any time to Grants.gov using the Workspace feature. When you open a form,required fields are highlighted in yellow with a red border.Optional fields and completed fields are displayed in white.If you enter invalid or incomplete information in a field,you will receive an error message.Additional instructions and FAOs about the Application Package can be found in the Granis.gov Applicants tab. OPPORTUNITY&PACKAGE DETAILS: Opportunity Number: HRSA-19-049 Opportunity Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opportunity Package ID: PK000245324 CFDA Number: 93.926 CFDA Description: Healthy Start Initiative Competition ID: HRSA-19-049 Competition Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health Opening Date: Closing Date: 11/27/2018 Agency: Health Resources and Services Administration Contact Information: contact Benita Baker, MS at (301)443-0543 or email FICHBHealthyStart@hrsa.gov WORKSPACE Workspace ID: WS00220665 Application Filing Name: Fresno DPH Healthy Start 2019-24 DUNS: _ 5561976550000 Organization: FRESNO, COUNTY OF Form Name: Application for Federal Assistance (SF-424) Form Version: 2.1 Requirement: Mandatory Download Date/Time: Nov 26, 2018 07:59:36 PM EST Form State: No Errors FORM ACTIONS: OMB Number:4040-0004 Expiration Dale:12/3112019 Application for Federal Assistance SF-424 '1.Type of Submission: 2.Type of Application: 'If Revision,select appropriate lelter(s): Preapplication ❑New ®Application ®Continuation Other(Specify): Changed/Corrected Application ❑Revision 4.Applicant Identifier: Comp a ed by ra"�nfs.gav upon submission. 5a.Federal Entity Identifier: 51b.Federal Award Identifier. H49MC00150 State Use Only: 6.Dale Received by Stale:E== 7.Stale Application Identifier. B.APPLICANT INFORMATION: `a.Legal Name: County of Fresno b.Emptoyerlraxpayer Identification Number(EIN/TIN): 'c.Organizational DUNS: 9 4-6 0 0 0 512 15561976550000 d.Address: `Streets: PO Box 11867 Slreet2: 'City: Fresno County/Parish: Stale: CA: California Province: 'Country: USA: UNITED STATES 'Zip/Postal Code: 193775-1867 e.Organizational Unit: Department Name: Division Name: f.Name and contact information of person to be contacted on matters involving this application: Prefix: First Name: lAh Middle Name: Last Name: Fang Suffix: Title: Health Educator Organizational Affiliation: Fresno County Department of Public Health *Telephone Number. 5596003330 Fax Number: 5594554705 Email: ahvang@fresnocountyca.gov Application for Federal Assistance SF-424 9.Type of Applicant 1:Select Applicant Type: B: County Government Type of Applicant 2:Select Applicant Type: Type of Applicant 3:Select Applicant Type: Other(specify): •10.Name of Federal Agency: Health Resources and Services Administration 11.Catalog of Federal Domestic Assistance Number: 93.926 CFDA Title: Healthy Start Initiative '12.Funding Opportunity Number: FIRSA-19-049 Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 13.Competition Identification Number: HRSA-19-049 Title: Healthy Start Initiative: Eliminating Disparities in Perinatal Health 14.Areas Affected by Project(Cities,Counties,States,etc.): xsmap2019-2024.pdf Acid Attachmcnt Delete Attachment View Attachment 15,Descriptive Title of Applicant's Project: Babies First: Eliminating Disparities in Perinatal Health Attach supporting documents as specified in agency instructions. Add Attachments I Delete Attachments I View Attachments Application for Federal Assistance SF-424 16,Congressional Districts Of: a.Applicant CA-016 •b.Program/Project cA-016 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Deleie Allachident V!ao:fi[(a:,hnbel 17,Proposed Project: a.Start Dale: 04/O1/2019 'b.End Date: 03/30/2029 1a.Estimated Funding($): a.Federal 950,000.00 b.Applicant 0.001 c.State 0.001 d.Local 479,252.00 e.Other 2,019,099,00 f. Program Income 0.001 •g.TOTAL 3,498,351.00 19.Is Application Subject to Review By State Under Executive Order 12372 Process? X1 a.This application was made available to the State under the Executive Order 12372 Process for review on li/26/zole b.Program is subject to E.O.12372 but has not been selected by the State for review. ❑ c.Program is not covered by E.O.12372. 20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) ❑Yes ©No If"Yes",provide explanation and attach Add Attachnie,t Delete Atlaclunenl I ViewAllachmenl 21.'By signing this application,I certify(1)to the statements contained in the list of certifications-and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ©"I AGREE •'The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: First Name: iDavid Middle Name: I Last Name: Pomaville Suffix: Title: Director Telephone Number. 5596003200 Fax Number: 5596001687 Email: dpomaville@fresnocountyca.gov Signature of Authorized Representative: lCompleted by Granls.gov upon submission. 'Dale Signed: Completed by Gran!s.gov upon submission.