OMB Number: 0980-0204Expiration Date: 12/31/2009Project Abstract SummaryProgram Announcement (CFDA) Program Announcement (Funding Opportunity Number)CDC-RFA-DD09-901 Closing Date07/06/2009' Applicant NameThe American Society Of Human Genetics' Length of Proposed Project 48Application Control No.Federal Share Requested (for each year)* Federal Share 1st Year * Federal Share 2nd Year$ 116,140 $ 118,390* Federal Share 4th Year * Federal Share 5th Year$ 123,030 $Non-Federal Share Requested (for each year)* Non-Federal Share 1st Year * Non-Federal Share 2nd Year 5,405 5,567* Non-Federal Share 4th Year * Non-Federal Share 5th Year $1 ; 5,906* Project TitleAmerican Society of Human Genetics Pioblic Health Genetics Fellowship* Federal Share 3rd Year120,686* Non-Federal Share 3rd Year 5,734 OMB Number: 0980-0204Expiration Date: 12/31/2009Project Abstract Summary* Project SummaryThe Public Health Genetics Fellowship Program is a collaboration between the American Society of Human Genetics (ASHG) and the Centers for Disease Control and Prevention (CDC)to train highly qualified genetics professional inthe arena of public health genetics and genomics. ASHG and CDC will provide senior staff members to serve asco-directors and mentors for the program. Candidates will be actively recruited from the largest pool ofgenetics professionals available, and selected jointly by the two collaborating organizations. The Program willtrain fellows in methods to do research and translate those findings into public health situations and practice.The fellows will be provided opportunities to present their work, with or without supervision (As appropriate) atnational and international meetings, to submit articles for peer-reviewed journals, and to participate ingenetics and public health policy and research forums and meetings, including committee appointments wheneverfeasible.This application is a continuation of CDC Program established under PA 04059, which has trained four fellows whohave achieved successful placements in organizations and universities to utilized their expanded skills. Twocurrent fellows are in the program and will also find competitive placements based on their successful coirpletionof the program.* Estimated number of people to t>e served as a result of the av/ard of this grant100000DISCLOSURE OF LOBBYING ACTIVITIESComplete this form to disclose lobbying activities pursuant to2. * Status of Federal Action: I I a. bid/offer/application [X] b. initial award I I c. post-awardEntity:1. * Type of Federal Action: a. contract X b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting [X] Prime | [SubAwardeeAmerican Society of Human Genetics-* S(ree/19650 Rockville Pike CityNOT A LOBBY ORGANIZATIONState MD: MarylandCongressional District, if laiown; MD Bth5. If Reporting Entity in No.4 is Subawardee, Enter6. * Federal Department/Agency:8. Federal Action Number, if known:10. a. Name and Address of Lobbying Registrant:Prefix* Last NameBoughman Street 1 City StateName and Address of Prime: Approved by OMB31 U.S.C.1352 0348-0046* Report Type: |X| a- initial filing j [ b. material changeZip7. * Federal Program Name/Description: CFDA Number, if applicable:9. Award Amount, if known:$Middle NameSufHxZipb. Individual Performing Services (including address if different from No.lOa)Prefix First Name Middle Name' Lasr Name SuffixBoughman Street 1 Street 2 City State Zip'I < Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered Into. This disclosure Is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Inspection. Any person who falls to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature; completed on submission to Grants.gov*Name: Prefix First Name Middle Name' l-ast Name SuffixBoughmanTItie: Executive Vice President Telephone No.: 301 634 7307 Date: completed on submission to Grants.gov *- r,,'1--I ^O'-. ' -' ,. ->^, . ^-.j-'i',-,' Authorized for L.ocal Reproduction.Federa'IUse.0n!yw'.'i-~i-'' i'**-,',' . <'': ' t''. -. 4^-: i ,',,' )', ' , .' Stendopd Form LLL (Rev. 7-97)Grant Program Catalog of Federal Function or Domestic Assistance Activity Number(a) (b) Public Health1. Genetics Fellowship Program2. Ptjblic Health Genetics Fellowship Program Public Health3. Genetics Fellowship Program Public Health4. Genetics Fellowship Program5. Totals OMB Approval No. 4040-0006BUDGET INFORMATION - Non-Construction Programs Expiration Date 07/30/2010SECTION A - BUDGET SUMMARYEstimated Unobligated Funds New or Revised BudgetFederal Non-Federal Federal Non-Federal Total (c) (d) (e) (f) (g)$ 116,140.00 $ 2,800.Ool $ $ $ 118,940.00-118,390.00 2,900.00 121,290.00120,686.00 3,100.00 123,786.00123,030.00 3,300.00 126,330.00$ 478,246.00 $ 12,100.00 $ $ $ 490,346.00 Standard Form 424A (Rev. 7- 97)Prescribed by OMB (Circular A-102) Page 16. Object Class Categoriesa. Personnelb. Fringe Benefitsc. Traveld. Equipmente. Suppliesf. Contractualg. Constructionh. Otheri. Total Direct Charges (sum of 6a-6h)j. Indirect Chargesk. TOTALS (sum of 61 and 6j)7. Program Income SECTION B - BUDGET CATEGORIES Gi^NT PROGRAM, FUNCTION OR ACTIVlPi' Total(1) (2) (3) (4) (5) Public Health Public Health Public Health Public Health Genetics Fellowship Genetics Fellowship Genetics Fellowship Genetics Fellowship Program Program Program Program$ 5,500.00 $ 5,665.00 $ 5,835.00 $ 6,010.00 $ 23,010.001,540.00 1,587.00 1,634.00 1,683.00 6,444.005,000.00 5,000.00 5,000.00 5,000.00 20,000.000.00 0.00 0.00 0.00500.00 500.00 500.00 500.00 2,000.00101,900.00 103,938.00 106,017.00 108,137.00 419,992.000.00 0.00 0.00 0.00. 1,700.00 1,700.00 1,700.00 1,700.00 6,800.00 116,140.00 118,390.00 120,686.00 123,030.00 $ 478,246.00 0.00 0.00 $$ 116,140.00 $ 118,390.00 $ 120,686.00 $ 123,030.00 $ 478,246.00$ $ $ $ $ Authorized Reproduction Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1Afor LocalSECTION(a) Grant Program public Health Genetics Fellowship Program8. Public Health Genetics Fellowship Program9. public Health Genetics Fellowship Program ,10. Public Health Genetics Fellowship Program11.C - NON-FEDERAL RESOURCES (b) Applicant (c)State (d) Other Sources (e)TOTALS $ 5,405.00 $ $ $ 5,405.005,568.00 5,568.005,735.00 5,735.005,405.00 5,405.0012. TOTAL (sum of lines 8-11) $ 22,113.00 $ $ $ 22,113.00 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter13. Federal $ 116,140.00 $ 29,035.00 $ 29,035.ool $ 29,035.00 $ 29,035.0014. Non-Federal $ 5,405.00 1,352.00 1,352.00 1,350.00 1,351.0015. TOTAL (sum of lines 13 and 14) $ 121,545.00 $ 30,387.00 $ 30,387.00 $ 30,385.00 $ 30,386.00 SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b)First (c) Second (d) Third (e) Fourth public Health Genetics Fellowship Program16. $ 29,035.00 $ 29,597.00 $ 30,171.00 $ 30,757.ool17. public Health Genetics Fellowship Program18. public Health Genetics Fellowship Program public Health Genetics Fellowship Program19.20. TOTAL (sum of lines 16 - 19)21. Direct Charges: 478,24623. Remarks: The contractual relationship is29,035.00 29,598.00 30,172.00 30,758.0029,035.00 29,597.00 30,171.00 30,757.0029,035.00 $ 116,140.00 $SECTION F - OTHER BUDGET INFORMATION 22. Indirect Charges: 0established directly with the fellow, as the fellow is servingAuthorized for Local Reproduction29,598.00 30,172.00 30,758.00118,390.00 $ 120,686.00 $ 123,030.00off-site from the applicants offices. standard Form 424A (Rev. 7- 97)Prescribed by OMB (Circular A -102) Page 2 PHS-5161-1 (7/00) CHECKLIST OMB Approval No. 0920-0428Public Burden Statement: Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428). Do not send the completed form to this address.Public reporting burden of this collection of information is estinnated to average 4hours per response, including the time for reviewing instructions, searching NOTE TO APPLICANT:existing data sources, gathering and nnaintaining the data needed, andcompleting and reviewing the collection of infonnation. An agency may not This form must be completed and submitted with the original of yourconduct or sponsor, and a person is not required to respond to a collection of application. Be sure to complete both sides of this form. Checl^ theinformation unless it displays a cun-ently valid OiWB control number. Send appropriate boxes and provide the information requested. This form should becomments regarding this burden estimate or any other aspect of this attached as the last age of the signed original of the application. This page iscollection of information, including suggestions for reducing this burden to CDC, reserved for PHS staff use only.Type of Application: I NEW [^ Noncompeting Continuation [] Competing Continuation [^ SupplementalPART A: The following checklist is provided to assure that proper signatures, assurances, and certifications have been submitted. Included NOT Applicable1. Proper Signature and Date2. Proper Signature and Date on PHS-5161-1 'Certifications' page 3. Proper Signature and Date on appropriate 'Assurances' page, i.e., SF-424B (Non-Constmction Programs)or SF-424D (Constmction Programs)4. If your organization currently has on file with DHHS the following assurances, please identify which havebeen filed by indicating the date of such filing on the line provided. (All four have been consolidated into asingle fonm, HHS Fonm 690) Civil Rights Assurance (45 CFR 80) Assurance Conceming the Handicapped (45 CFR 84) Q Assurance Conceming Sex Discrimination (45 CFR 86) Assurance Conceming Age Discrimination (45 CFR 90 & 45 CFR 91).5. Human Subjects Certification, when applicable (45 CFR 46) DPART B: This part is provided to assure that pertinent information has been addressed and included in the application. YES NOT Applicable1. Has a Public Health System Impact Statement for the proposed program/project been completed anddistributed as required? D 1x12. Has the appropriate box been checked on the SF-424 (FACE PAGE) regarding intergovernmental reviewunder E.O. 12372 ? (45 CFR Part 100)3. Has the entire proposed project period been identified on the SF-424?4. Have biographical sketch(es) with job description(s) been attached, when required? D5. Has the 'Budget Infonnation' page, SF-424A (Non-Construction Programs) or SF-424C (ConstructionPrograms), been completed and included?6. Has the 12 month detailed budget been provided? n7. Has the budget for the entire proposed project period with sufficient detail been provided? 0 n8. For a Supplemental application, does the detailed budget address only the additional funds requested? D9. For Competing Continuation and Supplemental applications, has a progress report been included? D DPART C; in the spaces provided below, please provide the requested information. nBusiness Official to be notified If an award Is to be madeName: Prefix: Dr. First Name: joann Middle Name: U LastName: iBouqhinan I Suffix: IphDTitle: [Executive Vice PresidentOrganization: Iftmerican Society of Htmian GeneticsAddress: Streetl 9650 Rockville Pike Street 2: I * City: Isethesda * State: MD: Maryland Province: Country: |usA: UNITED STATES ' Zip / Postal Code: 20814 Teleptione Number. UQ-J^ g34 7309E-mail Address: Hboughmanigashq.orqFax Number: 301 634 7079APPLICANT ORGANIZATION'S 12-DIGIT DHHS EIN (if already assigned)Q 52-1419397PHS-5161-1 (7/00)PART C (Continued): In the spaces provided below, please provide the requested information.Program DirectorProject Director/Principal Investigator designated to direct the proposed projectName: Prefix: ' ' First Name: ' Joann ' Middle Name: h Dr. * Last Name: JBoughman I Suffix: I PhDTitle: [Executive Vice PresidentOrganization:Address: 'Streetl:Street2: City: State:' Country:* Telephone Number:E-mail Address:Fax Number:|american Society of HUman Genetics9650 Rockville PikeBethesdaMD: MarylandUSA: UNITED STATES * Zip / Postal Code: 20814301 634 7307jboughmangashq. org301 634 7079SOCIAL SECURITY NUMBER HIGHEST DEGREE EARNED308-50-1523 PhDPART D: A private, nonprofit organization must include evidence of its nonprofit status with the application. Any of the following is acceptableevidence. Checl^ the appropriate box or complete the 'Previously Filed' section, whichever is applicable.I-I (a) A reference to the organization's listing in the Internal Revenue Service's (IRS) most recent list of tax-exempt organizations described in section'-' 501 (c)(3) of the IRS Code.[X] (b) A copy of a currently valid Internal Revenue Service Tax exemption certificate.]-I (c) A statement from a State taxing body, State Attorney General, or other appropriate State official certifying that the applicant organization has a'-' nonprofit status and that none of the net earnings accrue to any private shareholders or individuals.I I (d) A certified copy of the organization's certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization,I-I (e) Any of the above proof fcor a State or national parent organization, and a statement signed by the parent organization that the applicant organization is a local nonprofit affiliate.If an applicant has evidence of current nonprofit status on file witti an agency of PI-IS, it wiii not be necessary to file similar papers again, but the placeand date of fiiinq nnusl be indicated.Previously Filed with: ' (Agency) on ' (Date)INVENTIONSIf this is an application for continued support, include: (1) the report of inventions conceived or reduced to practice required by the terms and conditions ofthe grant; or (2) a list of inventions already reported, or (3) a negative certification.EXECUTIVE ORDER 12372Effective September 30,1983, Executive Order 12372(Intergovernmental Review of Federal Programs) directed OMB toabolish OMB Circular A-95 and establish a new process for consultingwith State and local elected officials on proposed Federal financialassistance. The Department of Health and Human Servicesimplemented the Executive Order through regulations at 45 CFR Part100 (Inter-governmental Review of Department of Health and HumanServices Programs and Activities). The objectives of the ExecutiveOrder are to (1) increase State flexibility to design a consultationprocess and select the programs it wishes to review, (2) increase theability of State and local elected officials to influence Federal decisionsand (3) compel Federal officials to be responsive to State concems, orexplain the reasons.The regulations at 45 CFR Part 100 were published in FederalRegister on June 24, 1983, along with a notice identifying theDepartment's programs that are subject to the provisions of Executive Order12372. Infonnation regarding PHS programs subject to Executive Order 12372is also available from the appropriate awarding office.States participating in this program establish State Single Points of Contact(SPOCs) to coordinate and manage the review and comment on proposed Federalfinancial assistance. Applicants should contact the Govemor's office forinfonnation regarding the SPOC, programs selected for review, and theconsultation (review) process designed by their State.Applicants are to certify on the face page of the SF-424 (attached) whether therequest is for a program covered under Executive Order. 12372 and, whereappropriate, whether the State has been given an opportunity to comment.Project Narrative File(s)* IWandatory Project Narrative File Filename: Project Narrative Foriti.pdfAdd.Ma^ridatory.PrpieciNarTative:File| peletejMandaltog_^Project:Narrat2ve^^ y'^yy_!^JPJ?J !y.LP!?J?p!:-^ ,r'!^*Ly^.^'^g,}To add more Project Nan^ative File attachments, please use the attachment buttons below. Add QptionalvRrbject Narrative File Delete Optional Project Narrative,File View Qptional:Prdject Narrative-File
