Expired PA-14-030: Chronic Illness Self-Management in Children and Adolescents (R21)

Part 1. Overview Information

Participating Organization(s)	National Institutes of Health (NIH)
Components of Participating Organizations	National Institute of Nursing Research (NINR Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD)
Funding Opportunity Title	Chronic Condition Self-Management in Children and Adolescents (R21)
Activity Code	R21 Exploratory/Developmental Research Grant Award
Announcement Type	Reissue of PA-11-072
Related Notices	January 09, 2017 - This PA has been reissued as PA-17-116. NOT-OD-16-004 - NIH & AHRQ Announce Upcoming Changes to Policies, Instructions and Forms for 2016 Grant Applications (November 18, 2015) NOT-OD-16-006 - Simplification of the Vertebrate Animals Section of NIH Grant Applications and Contract Proposals (November 18, 2015) NOT-OD-16-011 - Implementing Rigor and Transparency in NIH & AHRQ Research Grant Applications (November 18, 2015) June 4, 2014 - Notice NOT-14-074 supersedes instructions in Section III.3 regarding applications that are essentially the same. February 21, 2014 - See Notice NOT-HD-14-003. Notice of NICHD’s Participation. February 5, 2014 - See Notice NOT-NR-14-007. This Notice is provided as a correction to Section I. Funding Opportunity Description.
Funding Opportunity Announcement (FOA) Number	PA-14-030
Companion Funding Opportunity	PA-14-029, R01 Research Project Grant
Number of Applications	See Section III. 3. Additional Information on Eligibility.
Catalog of Federal Domestic Assistance (CFDA) Number(s)	93.361, 93.865
Funding Opportunity Purpose	The purpose of this Funding Opportunity Announcement (FOA) is to encourage research to improve self-management and quality of life in children and adolescents with chronic conditions. Managing a chronic condition is an unremitting responsibility for children and their families. Children with a chronic condition and their families have a long-term responsibility for self-management. This FOA encourages research that takes into consideration various factors that influence self-management such as individual differences, biological and psychological factors, family and sociocultural context, family-community dynamics, healthcare system factors, technological advances, and the role of the environment.

Key Dates

Posted Date	December 11, 2013
Open Date (Earliest Submission Date)	January 16, 2014
Letter of Intent Due Date(s)	Not Applicable
Application Due Date(s)	Standard dates apply, by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
AIDS Application Due Date(s)	Standard AIDS dates apply, by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
Scientific Merit Review	Standard dates apply
Advisory Council Review	Standard dates apply
Earliest Start Date	Standard dates apply
Expiration Date	January 8, 2017
Due Dates for E.O. 12372	Not Applicable

Required Application Instructions

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Table of Contents

Part 1. Overview Information
Part 2. Full Text of the Announcement
Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

Purpose

The purpose of this Funding Opportunity Announcement (FOA) is to encourage research to improve self-management and quality of life in children and adolescents with chronic conditions Managing a chronic condition is an unremitting responsibility for children and their families. Children with a chronic condition and their families have a long-term responsibility for self-management. This FOA encourages research that takes into consideration various factors that influence self-management such as individual differences, biological and psychological factors, family and sociocultural context, family-community dynamics, healthcare system factors, technological advances, and the role of the environment.

This FOA is restricted to studies of children and adolescents ages 8 to 21 with chronic conditions as children younger are less likely to manage their health conditions. Researchers can focus on any age group within this range but investigators must demonstrate that the approach is appropriate to developmental stage. Studies of chronic mental illness or serious cognitive disability are beyond the scope of this FOA.

Background

Although chronic conditions are more common among older adults, the rate of chronic conditions among children has increased; more than half of children ages 8 to 14 have had a long-term health problem at some point. Chronic conditions are recognized as a leading health concern of the nation (Center for Disease Control and Prevention [CDC], 2009); their management now and in the future is a considerable challenge facing our health care system. The percentage of U.S. children and adolescents with a chronic health condition increased from 1.8% in the 1960s to more than 25% in 2007. Most chronic conditions require consistent and dedicated self-management to achieve optimal treatment goal. Due to changing needs as a child develops, promoting self-management in young people with chronic conditions poses unique challenges for the child, their parent(s), families, healthcare providers, and communities. Self-management research has primarily focused on older populations in which the burden and costs of chronic illness and disability are increasingly evident. However, the economic and the quality of life costs of chronic illness and disability in youth are equally burdensome and costly. Further, establishing self-management in youth may prevent or mitigate complications and costs as the children move into adulthood.

Children with chronic conditions must live with their condition even when the condition is in good control or in remission. Examples of chronic conditions include but are not limited to: asthma, obesity, diabetes, chronic/end-stage renal disease, cystic fibrosis, heart disease, HIV and some forms of cancer. The discussion below is meant to assist the applicant and is not exhaustive.

Asthma continues to be the leading chronic disorder among children and youth. In 2011, approximately 5 percent of all children had one or more asthma attacks in the previous 12 months. These children have ongoing asthma symptoms that could put them at risk for poorer health outcomes, including hospitalizations and death. Asthma morbidity continues to pose a significant personal and societal burden despite the availability of effective medications to manage the disease. Many children in the United States who should receive preventive medications do not receive them. Minority children and children living in poverty have a greater burden from asthma compared with white, more socioeconomically advantaged children and the same children are less likely to receive adequate treatment and are less likely to have family or community support for their asthma management. In addition, the incidence of allergy in children is on the rise. The biggest increases are seen in heavily populated areas. The rise is due to a composite of factors that are associated with the way children and adolescents live in homes and their exposure to inhalant allergens. Lower prevalence rates of allergic conditions in rural as compared with urban populations have been interpreted as indicating an effect of environmental exposures, such as air pollution. However, less is known about other factors of the rural environment which may determine the development of atopic sensitization and related illnesses.

Childhood obesity is an epidemic in the United States, one that is negatively impacting the physical and emotional health of our children, their families and society as a whole. Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. The percentage of children aged 6 11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12 19 years who were obese increased from 5% to 18% over the same period. In 2010, over one third of children and adolescents were overweight or obese. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat Overweight and obesity are the result of caloric imbalance too few calories expended for the amount of calories consumed and are affected by various genetic, behavioral, and environmental factors (2012). The multiple, complex causes of childhood obesity and its resulting long term health consequences present a compelling case to focus attention on the self-management issues for children and their families.

Diabetes, a leading cause of nephropathy, retinopathy, neuropathy, and coronary and peripheral vascular disease in adults, is the third most prevalent severe chronic disease of childhood in the U.S. (National Diabetes Data Group). About one in every 440 children and adolescents has diabetes (American Diabetes Association, 2009). Until a decade ago, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1, most often due to the autoimmune destruction of the -cells of the pancreas leading to an absolute deficiency of insulin. More recently, coincident with the rise in obesity in the population, there has been an increase in the incidence of type 2 diabetes, especially in adolescents from racial/ethnic minority groups. The SEARCH study reported that the rate of new cases of diabetes among youth was 19.0 per 100,000 each year for type 1 and 5.3 per 100,000 for type 2 diabetes (rates vary by race/ethnicity). For all types of diabetes, effective therapies are available; however, diabetes management requires complex balancing of medication dosing, diet and exercise in order to achieve good glucose control, while avoiding hypoglycemia. Achievement of good control is also dependent on frequent self-monitoring of blood glucose values. Complex and demanding treatment regimens may be overwhelming to families and especially difficult for adolescents. New technologies are available (e.g., insulin pumps, continuous glucose monitoring) that have been shown to improve outcomes but have lowered acceptability among adolescents with type 1 diabetes than among adults. Research to help youth with diabetes and their families manage this chronic disease and its health consequences (e.g., chronic kidney disease and end-stage renal disease) is essential, as self-management is crucial to improving health outcomes and quality of life, as well as to preventing numerous diabetic-related complications.

The main clinical manifestation of atherosclerosis, i.e., coronary heart disease (CHD), is usually not evident before middle age. However, the atherosclerotic process that eventually leads to clinical disease begins in childhood. Studying the cardiovascular risk factors in the young promises to increase our understanding of their influence in the development of cardiovascular changes and disease. Questions about the independent and combined effects of body composition, obesity, hypertension, and insulin resistance are of particular relevance. For example, hypertension (now classified as pre-hypertension) in children and adolescents continues to be defined as systolic BP (SBP) and/or diastolic BP (DBP), that is, on repeated measurement, >95th percentile. BP between the 90th and 95th percentile in childhood had been designated high normal. Both require lifestyle modification according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Both hypertension and pre-hypertension have become a significant health issue in the young because of the strong association of high BP with overweight and the marked increase in the prevalence of overweight children. One health concern associated with hypertensive changes in the young is the change in cardiac ventricular mass. Left ventricular mass in normo-tensive children has been related to lean body mass and measures of visceral fat. However, little is known about the progression of left ventricular mass changes from childhood to adulthood. More research is needed to address this issue, as well as, biobehavioral, environmental, and genetic associations resulting in cardiovascular disease development in children and adolescents.

According to the Cystic Fibrosis Foundation (2000), about 30,000 Americans, 20,000 Europeans, and 3000 Canadians have CF. In the United States, about 12 million people are carriers, and every year 2500 babies are born with CF. Cystic fibrosis (CF), an autosomal recessive genetic disorder, is the second most common life-shortening and fatal inherited disease. CF frequently has its first health impact in infancy often progressing through childhood into young adulthood. Respiratory symptoms and infections and pancreatic insufficiency increase with age; mortality is most often associated with chronic obstructive pulmonary disease and respiratory failure. CF is one of the most common fatal inherited diseases. It is most prevalent among Caucasians and Ashkenazi Jews: one in 25 people of European descent carries one gene for cystic fibrosis, making it the most common genetic disease among them. Individuals with cystic fibrosis can be diagnosed prior to birth by genetic testing or in early childhood by a sweat chloride test. There is no cure for cystic fibrosis, and the current median age of survival for people living in the U.S. is 36.6 years. Ultimately, lung transplantation is often necessary as cystic fibrosis worsens.

Migraine and tension-type headaches can be a chronic problem in children. Estimates indicate that 3.5-5% of all children will experience recurrent headaches consistent with migraine. Management consists of identifying triggering factors, providing pain relief, and considering prophylaxis (Medscape, 2013). The exact cause of migraine headaches remains unknown. Frequencies of migraine headaches increase as children go through puberty. Although prepubescent boys and girls suffer from migraine at approximately the same rate, more girls are affected post-menarche. Like the onset of migraine episodes in adults, migraines experienced by children are often incapacitating due to their sudden onset and accompanying symptoms (e.g., nausea, abdominal pain, vomiting. photophobia). Very young children may exhibit pain by irritability, crying, rocking, or seeking sleep in a dark room. Frequent migraines result in significant disability, lost time in school, reduced socialization, increased depression, and impaired quality of life. Key to prevention and treatment and a mainstay of self-management approaches to headache in children has been the identification of putative headache triggers. Headache triggers refer those aspects of a child’s environment or behavior that occur in close proximity to the onset of the headache episode. Self-monitoring and self-management are essential to migraine management as there are currently no biologic measures to predict headache onset or to assure accurate diagnosis.

Epilepsy is a chronic condition characterized by recurrent, unprovoked seizures. Delayed recognition of these seizures and inadequate treatment increases the risk for additional seizures, disability, and decreased health-related quality of life and, in rare instances, death. Although epilepsy can occur at any age, it is more likely to begin among children less than 2 years of age and among adults older than 65 years (CDC, 2013). Over 10 million children worldwide are estimated to have active epilepsy. Annual incidence rates range from 41-50 per 100,000 in developed countries; with the highest incidence in the first year of life. Epilepsy manifested by generalized onset seizures accounts for most of the newly diagnosed cases in the first 5 years of life. Temporal lobe epilepsy, the most common form of epilepsy that affects approximately one percent of the adult population, begins in late childhood and adolescence. However there is an association between temporal lobe epilepsy and febrile seizures in childhood, Over the past 15 years, syndrome-oriented clinical and EEG diagnosis, and better aetiological diagnosis, especially supported by neuroimaging, has helped to clarify the diversity of epilepsy in children, and has improved management. However, children and adolescents with epilepsy must adhere to daily prescriptions, manage drug side effects (e.g., lethargy, increased clumsiness and confusion), and cope with the social stigma of their condition and the potential of reduced autonomy (such as the inability to drive) in their teens.

The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS, report that 34 million people around the world had HIV in 2010. About one-half were women and one-tenth were children under age 15. In the US, the most recent data from the CDC show that over one million Americans aged 13 and older were living with HIV in 2009. The vast majority of these children acquired HIV from their mothers during pregnancy, labor, delivery or breastfeeding. As these children mature, they need to manage a regimen of medication that requires strict (95%) adherence. They also need to manage associated side-effects, psychosocial issues related to stigma, and avoid risk behaviors that can lead to transmission of the virus. Some of these issues may be even more complex among those young people who first become infected as adolescents since it can be assumed that these teenagers engage in high risk behaviors. In all situations, the relationship between the young person responsible for self-management and the caretakers must be considered.

Each year in the U.S. there are approximately 13,400 children between the ages of birth and 19 years of age who are diagnosed with cancer. About one in 300 boys and one in 333 girls will develop cancer before their 20th birthday. In 1998, about 2500 children died of cancer; resulting in cancer being the most common cause of death by disease for children and adolescents in America (CDC, 2010). Because of major treatment advances, 80% of these children will survive 5 years or more. Despite its rarity and major advances in treatment and supportive therapy, cancer is still the leading cause of death from disease in children younger than 15 years of age. The types of cancer that occur in children vary greatly from those seen in adults. Treatment is often a lengthy process resulting in long-term side effects and lifelong attention. For example, acute lymphocytic leukemia, the most common form of cancer in young children requires a maintenance phase of treatment following the more intensive induction treatment. Although children return to the community during maintenance treatment, they must deal with a wide range of concerns. These range from avoiding infection to dealing with cognitive issues, such as difficulties in learning mathematical skills. Other common forms of childhood cancer may result in the need to cope with loss of a limb, other permanent changes in body image, later concerns about fertility, or the need to avoid behaviors that will increase risk for heart disease or a second cancer as adults. In addition to childhood cancers, hematological disorders, such as sickle cell disease or hemophilia also require biobehavioral research on self-management.

While childhood chronic conditions vary relative to etiology, symptoms, treatment regimens, etc, children and families affected and dealing with any chronic condition share a number of challenges and commonalities. As a result, learning to live with a childhood chronic condition can be difficult for a child, their parents, siblings and other family members, and the community in which they live. The development of self-management practices for children and adolescents with chronic conditions requires active engagement of both young people and their parents/families, with attention to the psychosocial and environmental world of the young person. Research is needed to improve understanding of what contributes to optimal self-management in children living with a chronic condition, with consideration of developmental trajectories from childhood into adolescence and young adulthood.

As self-management includes sensitivity to cultural norms, values and practices, it informs the emerging science of research on health disparities. Also technology is becoming an increasing part of day-to-day self-management, presenting new challenges and driving new areas of research.

Research Objectives

Specific research areas focused on children and adolescents of interest include, but are not limited to, the following areas:

Develop and test biotechnological methods for monitoring the chronic condition and treatment adherence.

Develop and test new measurements of biological parameters to help children and adolescents monitor and determine the progression of their chronic condition so that they are able to seek assistance from parents and/or other appropriate persons.

Understand behaviors that support adherence and promote self-management to treatment and treatment regimens for complex chronic conditions.

Identify and test strategies for self-management and promotion of routine health promotion and monitoring and attention to co-morbid conditions.

Develop and test state of the art technologies to facilitate improve disease management through early self-identification and reporting of symptoms that suggest a worsening of the condition.

Design and test decision making strategies that promote healthy lifestyle choices.

Expand the understanding of biobehavioral factors that influence co-morbid condition/illness prevention and self-management, health outcomes, and/or quality of life.

Test interventions that promote the transfer of responsibility from caretakers to the young person, promoting greater self-management, including strategies specific to age or stage of development.

Test interventions that improve child and family functioning, quality of life, and health outcomes in light of the management requirements that are age appropriate.

Test self-management interventions tailored for the needs of youth and their families in rural areas, medically underserved settings, and in racial/ethnic groups; including research to understand factors that create barriers to self-management in these groups.

Examine the impact of a child having a stigmatized chronic condition on peer relationships, siblings, parents, and on family member roles, including ways to intervene to positively affect self-management.

Examine and explore ways to improve the relationship between families and schools in promoting self-management in children with chronic conditions.

Tailor and test interventions for children living in diverse family constellations such as single parent, extended families, with custodial grandparents or non-biological caretakers.

Test interventions designed to promote positive family relationships and coping in children with chronic conditions that have remissions and exacerbations.

Use child self-reported measures of health status, such as the Patient-Reported Outcomes Measurement Information System (PROMIS -www.nihpromis.org) in the assessment of chronic conditions (e.g., asthma, obesity, diabetes, cystic fibrosis, heart disease, HIV and some forms of cancer).

The R21 exploratory/developmental grant supports investigation of novel scientific ideas or new model systems, tools, or technologies that have the potential for significant impact on biomedical or biobehavioral research. An R21 grant application need not have extensive background material or preliminary information. Appropriate justification for the proposed work can be provided through literature citations, data from other sources, or, when available, from investigator-generated data. Preliminary data are not required for R21 applications; however, they may be included if available.

Section II. Award Information

Funding Instrument	Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.
Application Types Allowed	New Resubmission
Funds Available and Anticipated Number of Awards	The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.
Award Budget	Direct costs are limited to $275,000 over an R21 two-year period, with no more than $200,000 in direct costs allowed in any single year.
Award Project Period	The total project period may not exceed two years.

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made in response to this FOA.

Section III. Eligibility Information

1. Eligible Applicants

Eligible Organizations

Higher Education Institutions

Public/State Controlled Institutions of Higher Education
Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

Hispanic-serving Institutions
Historically Black Colleges and Universities (HBCUs)
Tribally Controlled Colleges and Universities (TCCUs)
Alaska Native and Native Hawaiian Serving Institutions
Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

Small Businesses
For-Profit Organizations (Other than Small Businesses)

Governments

State Governments
County Governments
City or Township Governments
Special District Governments
Indian/Native American Tribal Governments (Federally Recognized)
Indian/Native American Tribal Governments (Other than Federally Recognized)
Eligible Agencies of the Federal Government
U.S. Territory or Possession

Other

Independent School Districts
Public Housing Authorities/Indian Housing Authorities
Native American Tribal Organizations (other than Federally recognized tribal governments)
Faith-based or Community-based Organizations
Regional Organizations

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement, are not allowed.

Required Registrations

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
System for Award Management (SAM) (formerly CCR) Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
NATO Commercial and Government Entity (NCAGE) Code Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
Grants.gov Applicants must have an active DUNS number and SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account and should work with their organizational officials to either create a new account or to affiliate an existing account with the applicant organization’s eRA Commons account. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

2. Cost Sharing

This FOA does not require cost sharing as defined in the NIH Grants Policy Statement.

3. Additional Information on Eligibility

Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

NIH will not accept any application that is essentially the same as one already reviewed within the past thirty-seven months (as described in the NIH Grants Policy Statement), except for submission:

To an RFA of an application that was submitted previously as an investigator-initiated application but not paid;
Of an investigator-initiated application that was originally submitted to an RFA but not paid; or
Of an application with a changed grant activity code.

Section IV. Application and Submission Information

1. Requesting an Application Package

Applicants must download the SF424 (R&R) application package associated with this funding opportunity using the Apply for Grant Electronically button in this FOA or following the directions provided at Grants.gov.

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

For information on Application Submission and Receipt, visit Frequently Asked Questions Application Guide, Electronic Submission of Grant Applications.

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

Required and Optional Components

The forms package associated with this FOA includes all applicable components, required and optional. Please note that some components marked optional in the application package are required for submission of applications for this FOA. Follow all instructions in the SF424 (R&R) Application Guide to ensure you complete all appropriate optional components.

Instructions for Application Submission

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.

SF424(R&R) Cover