05-096, Department of Health and Human Services
1. DATE ISSUED (Mo./DaylYr.) 12. CFDA NO. DEPARTMENT OF HEALTH AND HUMAN SERVICES
09/22/2005 93.008 PUBLIC HEALTH SERVICE
3. SUPERCEDES AWARD NOTICE dated OPHS Office of Grants Management
except that any additions or restrictions previously imposed remain
in effect unless specilically rescinded 1101 Wootton Parkway
4. GRANT NO. 5. ADMINISTRATIVE CODES Suite 550
5 MRC8G030083-03-00 08G-82 Rockville, MD 20852
Formerly: U828G03041 NOTICE OF GRANT AWARD
6. PROJECT PERIOD Mo./DaylYr. Mo./DaylYr.
From 09/30/2003 Through 09/29/2006 AUTHORIZATION (Legislation/Regulations)
7. BUDGET PERIOD Mo.lDaylYr. Mo.lDaylYr. Title XVII, Section 1701(e) (1), Public Health Service Act As Amended
From 09/30/2005 Through 09/29/2006
8. TITLE OF PROJECT (OR PROGRAM) (Limft to 56 spaces)
Medical Reserve Corps Demonstration Grant Program
9. GRANTEE NAME AND ADDRESS 10. DIRECTOR OF PROJECT (PROGRAM DIRECTOR/PRINCIPLE INVESTIGATOR)
(LAST NAME FIRST AND ADDRESS)
a. City of Cupertino Hovey, Marsha
b. 10300 Torre Avenue 10300 Torre Avenue
c. Cupertino, Santa Clara, CA 95014
d. Cupertino, Santa Clara e.CA f. 95014 Phone: 408-777-3335
11. APPROVED BUDGET (Excludes PHS Direct Assistance) 12. AWARD COMPUTATION FOR GRANT
I PHS Grant Funds Only a. Amount of PHS Financial Assistance (/rom iltem II.u) 50,000
II Total project costs including grant lunds and all other financial participation []] b. Less Unobligated Balance From Prior Budget Periods 0
(Select one and place NUMERAL in box) c. Less Cumulative Prior Award(s) This Budget Period 0
a. Salaries and Wages 23,500 d. AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION 1$ 50,000
b. Fringe Benefits 0 13. RECOMMENDED FUTURE SUPPORT
c. Total Personnel Costs ................ .............. 23,500 (Subject to the availability of funds and satisfactory progress of the project):
d. Consultants .............................................. 0 YEAR TOTAL DIRECT COSTS YEAR TOTAL DIRECT COSTS
e. Equipment .............................................. 5,900 a. 4 d. 7
f Supplies ............................. ................ 10,100 b. 5 e. 8
g. Travel .... ................. ....................... 5,100 c. 6 f 9
h. Patient Care - Inpatient ............................... 0 14. APPROVED DIRECT ASSISTANCE BUDGET (IN LIEU OF CASH):
i. Patient Care - Outpatient ............................... 0 a. AMOUNT OF PHS Direct Assistance 0
j. Alterations and Renovations ............ ........ ......... 0 b. Less Unobligated Balance From Prior Budget Periods 0
k. Other .......... ... .... ............ ................ 5,400 c. Less Cumulative Prior Award(s) This Budget Period 0
I. Consortium/Contractual .. ...... .... ....... ........ 0 d. AMOUNT OF DIRECT ASSISTANCE THIS ACTION 1$ 0
m Trainee Related Expenses ......... ................ .... 0 15. PROGRAM INCOME SUBJECT TO 45 CFR PART 74, SUBPART F, OR 45 CFR 92.25, SHALL BE
USED IN ACCORD WITH ONE OFTHE FOLLOWING ALTERNATIVES: 0
n. Trainee Stipends ............................... 0 (Select one and place LETTER in box.)
a DEDUCTION
o. Trainee Tuition and Fees ... .. ...................... 0 b. ADDITIONAL COSTS
c. MATCHING
Trainee Travel 0 d OTHER RESEARCH (Add I Deduct Option)
p. ................ ........" ..... .......... .... <. OTHER (SfHI REMARKS)
q. TOTAL DIRECT COSTS . 50,000 16. THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY, THE PHS ON THE ABOVE mLED PROJECT
r. INDIRECT COSTS o (rateO%oITADC) 0 AND IS SUBJECT TO THE TERMS AND CONomONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING:
a The grant program legislations cited above
TOTAL APPROVED BUDGET $ 50,000 b The grant program regulation cited above.
s. c. This award notice including tefTT'ls and conditions, if any. noted below under REMARKS
SBIR Fee 0 d. PHS Grants Polley Statement including addenda In effect aa 01 the beginning date of the budget period
l. e. 45 CFR Part 74 or 45 CFR Part 92 as awllcable.
u. Federal Share $ 50,000 In the event there are conflicting or otherwise inconsistent policies applicable to the grant, the above order of precedence shall prevail
Acceptance of the grant terms and conditions is acknowledged by the grantee when funds are drawn or otherwise obtained from the
v. Non-Federal Share $ 0 grant payment system.
REMARKS: (Other Terms and Conditions 00 Yes
See Attached Terms and Conditions.
o
No)
~NTS MANAGEMENT (Signature (Name - TypedIPrint) (Title)
"A C4"" A~ /"1. /b Karen Campbell Grants Management Officer, OPHS
17.0BJ 41. 45 I 18. CRS - EIN 1946027368A1 19. LIST NO. CONGo DIST.:
FY-CAN DOCUMENT NO. ADMINISTRATIVE CODE AMT ACTION FIN ASST AMT ACTION OR ASST
20. 5-1990790 b. U28G03041A c. 08G-82 d. 50.000 e. 0
21. b. c. d. e.
22. b. c. d. e.
PHS-5152-' (rev. 7/92)
(NOTE: See reverse for payment Information)
NOTICE OF GRANT AWARD (Continuation Sheet)
PAGE 20f4 DATE ISSUED
09/22/2005
GRANT NO. 5 MRCSG030083-03-00
SPECIAL TERMS AND REQUIREMENTS
1. Grantees must obtain prior approval from the Grants Management Officer (GMO) for any
change in the Project Director or Project Coordinator including replacement, absence or
reduction in the level of participation. The GMO must be notified no later than 30 days before
the expected date of departure or change in participation level. A resume must be submitted for
approval for any replacement.
2. A progress and evaluation report is due to the Office of Grants Management 90 days after the
end of the budget period. An original and one copy of each report must be submitted.
3. Recommended future support as indicated on the award notice in item #13 includes both direct
and indirect costs and is subject to availability of Federal funds and is based on satisfactory
progress and justifiable programmatic needs of the project.
4. The grantee shall comply with the restrictions on lobbying set out in 45 CFR Part 93. In addition,
the grantee shall comply with the restrictions on grantee lobbying in section 503 of the FY 2005
Appropriations Act, as follows:
a) No part of any appropriation contained in this Act shall be used, other than for normal and
recognized executive-legislative relationships, for publicity or propaganda purposes, for the
preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or
video presentation designed to support or defeat legislation pending before the Congress or any
State legislature, except in presentation to the Congress or any State legislature itself.
b) No part of any appropriation contained in this Act shall be used to pay the salary or expenses
of any grant or contract recipient, or agent acting for such recipient, related to any activity
designed to influence legislation or appropriations pending before the Congress or any State
legislature.
5. Grant funds shall supplement and not supplant funds received from any other Federal, State or
local program or any private sources of funds.
PHS-5152-2
NOTICE OF GRANT AWARD (Continuation Sheet)
PAGE 30f4 DATE ISSUED
09/22/2005
GRANT NO. 5 MRCSG030083-03-00
STANDARD TERMS
1. Requests that require prior approval from the awarding office (See Chapter 8, PHS Grants Policy
Statement) must be submitted in writing to the GMO. Only responses signed by the GMO are to
be 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 any OPHS
Program Office.
2. Responses to reporting requirements, conditions, and requests for postaward amendments must
be mailed to the attention and address of the Grants Management Specialist indicated in the
"Contacts" section. All correspondence should include the Federal grant number (item 4 on page
1 of this document) and requires the signature of an authorized business official and/or the
project director. Failure to follow this guidance will result in a delay in responding to your
correspondence.
REPORTING REQUIREMENTS
1. The Single Audit Act Amendments of 1996 (31 U.S.C. 7501-7507) combined the audit
requirements for all entities under one Act. An audit is required for all entities which expend
$500,000 or more of Federal funds in each fiscal year. The audits are due within 30 days of
receipt from the auditor or within 9 months of the end of the fiscal year, whichever occurs first.
The audit report when completed should be sent to the Federal Audit Clearinghouse, Bureau of
the Census, 1201 E. 10th Street, Jeffersonville, IN 47132.
2. A Financial Status Report SF-269 (long form) is due to the Office of Grants Management
within 90 days after expiration of the budget period.
CONTACTS
1. PAYMENT PROCEDURES:
Payments for grants awarded by OPHS Program Offices are made through the Division of
Payment Management (http://www.psc.gov/). Applicant organizations are assigned a 12-digit
Entity Identification Number for payment and accounting purposes. That number is an expansion
PHS-5152-3
NOTICE OF GRANT A WARD (Continuation Sheet)
PAGE 40f4 DATE ISSUED
09/22/2005
GRANT NO. 5 MRCSG030083-03-00
of the 9-digit Employer Identification Number assigned to an organization by the Internal
Revenue Service. PMS is administered by the Program Support Center (PSC), DHHS.
Inquiries regarding payments should be directed to (http://www.dpm.psc.f!;ov. Division of
Payment Management, P.O. Box 6021, Rockville, MD 20852, 1-877-614-5533.
2. Fraud, Abuse and Waste:
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.
Office of Inspector General, Department of Health and Human Services, Attn: HOTLINE 330
Independence Ave., SW, Room 5140 Cohen Building, Washington, DC 20201 e-mail
htips@os.dhhs.gov 1-800-447-8477 (l-800-HHS-TIPS)
3. For assistance on grants administration issues please contact: DeWayne Wynn, Grants
Management Specialist, at (240) 453-8453, FAX (240) 453-8823, e-mail
dwynn@osophs.dhhs.gov or OPHS, Grants Management Office, 1101 Wootton Parkway, Suite
550, Rockville, MD 20852.
4. For assistance on programmatic issues please contact: LCDR April Kidd, at (301) 443-4951,
FAX (301) 480-1163, e-mail AKidd@osophs.dhhs.gov or Office of the Surgeon General,
Parklawn Building, 5600 Fishers Lane, Rm 18C-14, Rockville, MD 20857.
PHS-5152-4