NH Project First Step 1 of 9 11% Before We StartThis form is to assist in the process of applying for the First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Grant, funded through the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency. This grant is awarded by the New Hampshire Department of Safety. The grant award process is facilitated by NH Project FIRST, a program of the New Hampshire Division of Fire Standards and Training and Emergency Medical Services.Are you starting your application for funding, or have you already finished your application and would like to submit it now?Start application processSubmit already-completed applicationIs this your initial application for funding or are you reapplying for funding to continue your program?Initial applicationRenewalWe recommend that if you are applying for funding for the first time, that you contact NH Project FIRST team prior to filling out your application. Please give us a call at (603) 223-4200 or by email Grant GuidanceWould you prefer to apply through an online form or by filling out a PDF?Online FormPDF In order to complete your application, please download the PDF application here. To submit your PDF application, you may email NHProjectFirst@dos.nh.gov or return to this page and submit online.PDF ApplicationPlease upload your completed PDF application hereAccepted file types: pdf. Have you read the NH Project FIRST Grant Guidance?YesNoHave you read the NH Project FIRST Application ChecklistYesNo ChecklistApplications for funding can be complex. In order to help simplify the process, please go through this pre-application checklist. Here, we will haveRead the FR-CARA Grant Guidance found on the NH Project FIRST website for program information, policies, and compliance requirements Complete The online grant application must be completed by someone authorized on behalf of the applying community/agency (fiscal agent for the grant) Complete "Data Universal Numbering System" Number (D-U-N-S)To complete this application, you will need a screenshot of your community/agency's "Data Universal Numbering System" Numbers (D-U-N-S). D-U-N-S numbers may be looked up or obtained here (this link will open in a new tab and not interfere with this form).I do not know my agency's "Data Universal Numbering System" NumberMy agency does not have a "Data Universal Numbering System" NumberI have my agency's "Data Universal Numbering System" NumberData Universal Numbering System" Number (D-U-N-S)Please input your community/agency's "Data Universal Numbering System" Number (D-U-N-S)Submit most current Independent Audit Report or NH MS-60 at the time of application or contact the NH Project FIRST team if your current report has been provided to the NH Department of Safety.In order to complete your applicationI have it and i'll upload it nowI have already submitted it/the previously-submitted is still currentI need to upload/submit later (required to complete this application)Independent Audit Report or NH MS-60Please upload your Independent Audit Report or NH MS-60 Drop files here or Submit most current Independent Audit Report or NH MS-60 at the time of application or contact the NH Project FIRST team if your current report has been provided to the NH Department of Safety. Complete Contact information for Primary & Secondary Points of Contact and Fiscal/Financial Agent Complete Project Proposal & Milestones – Detailed with estimated timeframes for each milestone (post award forward). Use the templates on the NH Project FIRST web site to assist you in this process. Complete Program Costs & Expenses – If applicable, estimate costs to implement program with provided budget worksheets (training costs, supplies, program implementation, & other activities). Complete Mobile Integrated Healthcare (MIH) Plan – If required, submit a copy of your MIH Plan to NH Project FIRST program staff for approval. Use the MIH templates on the NH Project FIRST web site to assist you in this process. Complete Complete the Assurances document (SF-42b Assurances Non Construction.pdf) and return with your application paperwork. Complete Applicant InformationRequesting Community/AgencyCommunity/Agency DUNS Number Program Summary InformationWould you want to conduct follow-up visits with individuals?*YesNoProposal NarrativeMobile Integrated Healthcare (MIH) Plan Program ComponentsAre you requesting monetary funding for program costs & expenses?YesNoMonetary funding opportunities include: Program Activities Program activities consist of funding for implementing your program. Costs can include salary and wages for personnel’s time to implement the program. (See Salary and Wages in the Grant Guidance.) Program activities may include promotional and educational event costs to promote and educate the public and at-risk individuals/support networks Training Activities OUD in the 603 Course: Costs/expenses for personnel to attend 2 hour Division-delivered training and any additional training for specific program staff. This course is recommended for initial applicants and can be re-taken as continuing education Data Collection and Information Systems Program activities consist of funding for implementing your program. Costs can include salary and wages for personnel’s time to implement the program. (See Salary and Wages in the Grant Guidance.) Program activities may include promotional and educational event costs to promote and educate the public and at-risk individuals/support networks Supplies, Equipment, & Other Activities Program activities consist of funding for implementing your program. Costs can include salary and wages for personnel’s time to implement the program. (See Salary and Wages in the Grant Guidance.) Program activities may include promotional and educational event costs to promote and educate the public and at-risk individuals/support networks Program Budget Program activities consist of funding for implementing your program. Costs can include salary and wages for personnel’s time to implement the program. (See Salary and Wages in the Grant Guidance.) Program activities may include promotional and educational event costs to promote and educate the public and at-risk individuals/support networks How many Naloxone kits are requested for the performance periodAre you aware all first responders must be licensed to administer naloxone in the State of New Hampshire?YesNoDo all first responders participating in your proposed program have the appropriate licensure to administer naloxone in the State of New Hampshire?YesNo Compliance ConditionsBy checking the box below, I certify a Mobile Integrated HealthCARE (MIH) plan will be submitted to the Division for approval and the project will not start until the plan is approved and the grant is awarded I understand and agree an MIH Plan must be submitted to the Division for approval and will not start until the plan is approved and the grant is awarded. Signature & Certification