Healthcare Resiliency Program: Health Technology and Innovation (Short Range) RFA #34320-20327

Requirements Checklist

• Applications must include: (1) Application Form (Attachment 1, max 5 pages); (2) Competitive Requirements form; (3) Tearless Logic Model (Exhibit 1); (4) Biosketches or resumes for key project staff; (5) Job descriptions for newly hired positions (if applicable); (6) Letters of commitment/support from partners; (7) Grant Budget (Attachment 3 with line-item details per 2 CFR 200 Subpart E); (8) State of Tennessee Supplier Maintenance SDDA Access Form; (9) IRS Form W-9. All costs must comply with federal (2 CFR 200) and state procurement/cost regulations. Indirect/administrative costs not to exceed 10%.

Required attachments

• Application Form (Attachment 1, max 5 pages)
• Competitive Requirements Form
• Tearless Logic Model (Exhibit 1)
• Biosketch(es) or resumes for key personnel
• Job descriptions for positions to be hired (if applicable)
• Letters of Commitment and/or Support from partners
• Grant Budget (Attachment 3 & Line-Item Details)
• Supplier Maintenance SDDA Access Form
• IRS Form W-9

Submission Instructions

TDH Partner Portal: https://tndeptofhealth.caspio.app/tdh-partner-portal/home

Source Documents