[Federal Register Volume 59, Number 65 (Tuesday, April 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-8057]
[[Page Unknown]]
[Federal Register: April 5, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement 425]
1994 Capacity Building for Core Components of Breast and Cervical
Cancer Prevention and Control Programs
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1994 funds for new competing
cooperative agreements to initiate capacity building for the core
components of comprehensive breast and cervical cancer control
programs.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of ``Healthy People
2000,'' a PHS-led national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is related to the
priority area of Cancer. (To order a copy of ``Healthy People 2000,''
see the section Where to Obtain Additional Information.)
Authority
This program is authorized under section 301(a) (42 U.S.C. 241(a)),
section 317(k)(3) (42 U.S.C. 247b(k)(3)), and section 1501 (42 U.S.C.
300k) of the Public Health Service Act, as amended.
Smoke-Free Workplace
The Public Health Service strongly encourages all cooperative
agreement recipients to provide a smoke-free workplace and promote the
non-use of all tobacco products. This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.
Eligible Applicants
Eligible applicants are the official public health agencies of the
five States of Idaho, Kentucky, Nevada, South Carolina and Tennessee or
their bona fide agents or instrumentalities and the District of
Columbia, American Samoa, the Commonwealth of Puerto Rico, the Virgin
Islands, the Federated States of Micronesia, Guam, the Northern Mariana
Islands, the Republic of the Marshall Islands, and the Republic of
Palau. All other States were previously funded under Program
Announcement Numbers 121, 122, 221, and 321 entitled ``Early Detection
and Control of Breast and Cervical Cancer,'' in FY 1991, 1992, and
1993, and are not eligible to compete for funding under this program
announcement.
Availability of Funds
Approximately $1,200,000 is available in FY 1994 to fund
approximately 7 awards. It is expected that the average award will be
$170,000, ranging from $150,000 to $200,000. It is expected that the
awards will begin on or about June 30, 1994, and will be made for a 12-
month budget period within a project period of up to 3 years. Funding
estimates may vary and are subject to change.
Continuation awards within the project period are made on the basis
of satisfactory progress and availability of funds.
Funding preference will be given to applications from State health
departments who are in the initial planning phase for statewide breast
and cervical cancer screening.
At the request of the applicant, Federal personnel may be assigned
to a project in lieu of a portion of the financial assistance.
Purpose
The purpose of these cooperative agreements is to support State
health departments in their efforts to develop their capacity to carry
out a program for early detection and control of breast and cervical
cancer. The intent is to initially enable States to build the necessary
infrastructure towards providing a comprehensive breast and cervical
cancer early detection program. Resources available under this program
announcement may not be used to support screening and follow up
services for breast and cervical cancer.
Program Requirements
In conducting activities to achieve the purpose of this program,
the recipient shall be responsible for the activities under A., below,
and CDC shall be responsible for conducting activities under B., below:
A. Recipient Activities
The following six elements are essential and integral components in
the development of a State-based comprehensive breast and cervical
cancer control program. Planning for conducting the core components
must occur during the first and second year, with implementation begun
by completion of the project period.
1. Breast and Cervical Cancer Control Plan and Coalition
In developing a comprehensive breast and cervical cancer control
program, the applicant should include the following:
a. A State level breast and cervical cancer control coalition
including representation from key private, professional, voluntary and
public (e.g., American Cancer Society) cancer organizations,
legislators, and consumers.
b. A proposed breast and cervical cancer control plan that
describes:
(1) Goals and objectives to address breast and cervical cancer
control.
(2) Proposed strategies to meet those objectives.
(3) An assessment of existing and needed resources to develop the
comprehensive breast and cervical cancer control program.
2. Public Education
A plan for a comprehensive public education program based on an
assessment of the target populations educational needs. Successful
public education programs are those that influence knowledge,
attitudes, and practices related to breast and cervical cancer
screening adherence in target populations by utilizing all available
resources which may include, but are not limited to, the American
Cancer Society, State medical societies, and universities.
3. Professional Education
A plan for conducting an assessment of the health care providers to
determine important practice information useful in developing an
education program. This could include: (1) Screening behaviors in their
practices; (2) Knowledge of screening guidelines; (3) Use of screening
reminder systems; (4) Laboratories used for reading Pap smears; and (5)
Sites of mammography referrals.
After the health care provider assessment has been conducted,
States should collaborate with appropriate professional groups and
organizations to develop a provider education program. The development
of a health provider education program would transmit information on
the efficacy and appropriate use of screening procedures and reminder
systems for providers.
Participate in the CDC sponsored training workshops and meetings by
ensuring that appropriate representatives attend using travel funds
provided through this cooperative agreement.
4. Quality Assurance
In preparation for developing a statewide quality assurance
component: (1) Conduct a statewide assessment to determine the current
status and identify areas of need in mammography and cervical cytology
quality assurance; and (2) Develop the components of a comprehensive
quality assurance program based on guidelines developed by CDC.
a. Mammography
The achievement of mammography's full potential contribution to the
process of early breast cancer detection requires that quality
assurance procedures be systematically applied in routine practice.
Mammography quality assurance encompasses the importance of the design,
function, and operation of equipment, patient and provider
communication, image quality, interpretation of the mammogram,
communication of the radiologist's interpretation, and record keeping.
The minimal quality level for mammography shall include the
following criteria:
(1) Properly trained and experienced personnel.
(2) Proper use of appropriate, well-maintained, dedicated
equipment.
(3) Periodic performance evaluation tests of the imaging system
following guidelines recommended by the American College of Radiology.
b. Cervical Cytology
The minimal quality level for cervical cytology shall include the
following criteria:
(l) Properly trained, accredited, and certified personnel.
(2) Licensed laboratories that maintain an ongoing quality
assurance program, to include provisions for alternative cervical
cancer screening techniques if such systems are used by the
participating laboratories.
(3) Appropriate reporting and communication of results.
5. Surveillance
States should assess current capabilities and develop a plan to
ensure that changes in disease burden and screening behavior can be
adequately monitored. To do this, a surveillance system should:
a. Collect population-based information on race, incidence, staging
at diagnosis, and mortality from breast and cervical cancers.
b. Identify population segments at higher risk for disease and for
failure to be screened.
c. Identify factors that contribute to disease burden and limited
or inequitable access to early detection and treatment services.
d. Monitor the number and characteristics of women screened and
outcomes of screening.
e. Monitor screening resources, including the number of mammography
facilities, cytology laboratories, and providers of cytology screening.
f. Design and conduct case studies and other epidemiologic
investigations to determine factors associated with avoidable morbidity
and mortality.
g. Publish a yearly report summarizing the population status with
respect to these conditions.
6. Evaluation
Attention should be given to the development, establishment, and
design of individual components to ensure that there can be meaningful
evaluation. The evaluation plan should assess the performance and
effectiveness of intervention components, including:
a. Coalition development.
b. Cancer plan development.
c. Public education.
d. Professional education.
e. Quality assurance.
f. Surveillance.
At a minimum, the evaluation plan should assess the existing State
breast and cervical cancer control program and should include the
following:
a. A description of the evaluation plan and how evaluation results
will be used.
b. A description of methods used to assess the development of
program activities in all program components.
B. CDC Activities
1. Convene meetings for representatives of States receiving awards
for workshops and sharing information.
2. Convene meetings for representatives of States receiving awards
for training purposes.
3. Disseminate to State health departments relevant state-of-the-
art research findings and public health recommendations that relate to
early detection, diagnosis, and treatment for breast and cervical
cancer.
4. Collaborate with recipients in planning, operating, and
evaluating program activities and coordinating projects' participation
in all components of the cancer program.
5. Collaborate with recipients in developing surveillance and data
systems and in the States' analysis and evaluation of data.
6. Provide technical assistance in the development of public and
professional education components.
7. Collaborate with recipients in disseminating outcome indicators
and their integration into program operation.
8. Provide guidance in the development and establishment of
specific morbidity reduction objectives.
9. Provide technical information and guidelines in the development
of quality assurance procedures for mammography and cervical cytology.
10. Provide technical assistance and direction in the development
of evaluation efforts.
Evaluation Criteria
Applications will be reviewed and evaluated according to the
following criteria:
1. The capability of the State health department's commitment to
carry out the planning, intervention, and evaluation process and the
overall plan to accomplish this process. (10 points)
2. The extent to which the applicant assesses the breast and
cervical cancer program needs of the target population and justifies
the program's focus on the target population. (10 points)
3. The consistency of the specific and time-related, measurable
objectives with the stated purpose of the cooperative agreement and the
ability to achieve the objectives, activities, and milestones of the
program within the specified period. (15 points)
4. The extent of the applicant's ability to assure community and
professional support and involvement, to use available resources, and
to ensure that the coalition assumes a major role in the program. (10
points)
5. The ability of the applicant to identify appropriate staff for
the program who are available and trained to carry out the required
task. (5 points)
6. The extent to which the applicant's plan reflects integration of
breast and cervical cancer program elements into the health care
delivery system through the formation of program linkages and the
development of a cancer program advisory group or task force. (10
points)
7. Evidence of the applicant's commitment to develop and maintain a
surveillance system, a breast and cervical cancer registry, and a
method to track the knowledge, attitudes, and practices of the targeted
population. (10 points)
8. The quality of the public education plan, including the ability
to develop, carry out, and evaluate interventions for target
populations. (5 points)
9. The quality of the professional education plan, including the
ability to develop, carry out, and evaluate interventions for target
populations. (5 points)
10. The quality of the mammography and cervical cytology quality
assurance plan. (10 points)
11. The quality of the applicant's evaluation plan. (10 points)
12. The extent to which the budget is reasonable and consistent
with the intended use of cooperative agreement funds. (Not Weighted)
Recipient Financial Participation
This program has no statutory formula. No specific matching funds
are required; however, the application should include specifics on the
applicant's contribution to the overall program cost and reflect a
commitment to long-term progressive support on the part of non-Federal
funding sources.
Executive Order 12372 Review
Applications are subject to Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. Applicants should contact their State Single
Point of Contact (SPOC) as early as possible to alert them to the
prospective applications and receive any necessary instructions on the
State process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC for each affected State. A
current list of SPOCs is included in the application kit. If SPOCs have
any State process recommendations on applications submitted to CDC,
they should forward them to Edwin L. Dixon, Grants Management Officer,
Grants Management Branch, Procurement and Grants Office, Centers for
Disease Control and Prevention (CDC), 255 East Paces Ferry Road, NE.,
Atlanta, Georgia 30305, no later than 60 days after the application
deadline date. The granting agency does not guarantee to ``accommodate
or explain'' for State process recommendations it receives after that
date.
Public Health System Reporting Requirement
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance number is 93.283.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by cooperative agreement will be subject to
review by the Office of Management and Budget (OMB) under the Paperwork
Reduction Act.
Application Workshop
CDC will conduct an application workshop for potential applicants
via conference calls. The workshop will address specifics of the
program announcement and provide attendees with guidance on the
assessment, planning, and development of infrastructure and each of the
essential core components of a comprehensive breast and cervical cancer
control program. Those wishing to participate in the conference calls
must register by contacting Tanya Hicks at (404) 488-4880. For
additional information please refer to the ``Where To Obtain Additional
Information'' section of this announcement.
Application Submission and Deadline
The original and two copies of the application PHS Form-5161-1 must
be submitted to Edwin L. Dixon, Grants Management Officer, Grants
Management Branch, Procurement and Grants Office, Centers for Disease
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 314,
Mailstop E-18, Atlanta, Georgia 30305, on or before May 25, 1994.
1. Deadline
Applications shall be considered as meeting the deadline if they
are either:
(a) Received on or before the deadline date; or
(b) Sent on or before the deadline date and received in time for
submission to the independent review group. (Applicants must request a
legibly dated U.S. Postal Service postmark or obtain a legibly dated
receipt from a commercial carrier or U.S. Postal Service. Private
metered postmarks shall not be acceptable as proof of timely mailing.)
2. Late Applications
Applications which do not meet the criteria in 1.(a) or 1.(b) above
are considered late applications. Late applications will not be
considered in the current competition and will be returned to the
applicant.
Where To Obtain Additional Information
A complete program description, information on application
procedures, an application package, and business management technical
assistance may be obtained from Nealean K. Austin, Grants Management
Specialist, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 314, Mailstop E-18, Atlanta, Georgia 30305, telephone
(404) 842-6508.
Programmatic technical assistance may be obtained from Kevin Brady,
Program Services Branch, Division of Cancer Prevention and Control,
National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention (CDC), 4770 Buford Highway,
NE., Mailstop K-57, Atlanta, Georgia 30341, telephone (404) 488-4880
and FAX (404) 488-4727.
Please refer to Announcement Number 425 when requesting information
and submitting an application.
Potential applicants may obtain a copy of ``Healthy People 2000''
(Full Report; Stock No. 017-001-00474-0) or ``Healthy People 2000''
(Summary Report; Stock No. 017-001-00473-1) referenced in the
Introduction through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325, telephone (202) 783-3238.
Dated: March 30, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 94-8057 Filed 4-4-94; 8:45 am]
BILLING CODE 4163-18-P