[Federal Register Volume 61, Number 90 (Wednesday, May 8, 1996)]
[Notices]
[Pages 20825-20831]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-11443]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement Number 612]
RIN: 0905-ZA97
Academic Medical Center/Community Health Network Childhood
Immunization Demonstration Projects; Notice of Availability of Funds
for Fiscal Year 1996
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1996 funds for cooperative agreement
demonstration projects to improve the delivery of immunizations to
preschool children in urban and rural areas. The purposes of this
program are to (1) increase immunization coverage among children
receiving care in academic medical centers networks of primary care
providers and/or in community health networks, (2) improve immunization
delivery by other providers working in specified Target Communities,
and (3) develop innovative methods that increase immunization coverage
among difficult-to-reach children without separating immunizations from
primary care.
CDC is committed to achieving the health promotion and disease
prevention objectives of Healthy People 2000, a national activity to
reduce morbidity and mortality and improve the quality of life. This
announcement is related to the priority area of Immunization. (For
ordering a copy of Healthy People 2000, see the section Where to Obtain
Additional Information.)
Authority
This program is authorized under sections 317 (42 U.S.C. 247b) and
311 (42 U.S.C. 243) of the Public Health Service Act as amended, and
the National Childhood Vaccine Injury Act (42 U.S.C. 300aa-1, et seq.).
Smoke-Free Workplace
CDC strongly encourages all grant recipients to provide a smoke-
free workplace and to promote the non-use of all tobacco products, and
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities that receive Federal funds in which education,
library, child care, health care, and early childhood development
services are provided to children.
Definitions
Academic Medical Center (AMC)--A medical school, hospital, or
center that is a participating institution in an accredited residency
program in pediatrics or family medicine, and that may be part of a
managed care organization serving Medicaid- eligible children.
Community Health Network (CHN)--A network of health care providers
which provides primary health care services to needy children with low
immunization coverage levels, but which does not necessarily include an
AMC, as defined above.
Health Professional Shortage Area (HPSA)--HPSAs are urban and rural
geographic areas, population groups, and facilities experiencing a
shortage of health professionals. The current designated HPSAs of
concern to this project are those relating to primary medical care and
are identified by the Health Resources and Services Administration,
Department of Health and Human Services in the Federal Register of
October 2, 1995 (60 FR 51518).
Immunization Action Plan (IAP)--An initiative first funded in 1992
for communities to develop and implement a broad-based plan to achieve
national immunization coverage goals by involving all interested groups
concerned with children's health.
Urban Area--For the purposes of this program, one of the 29 cities
originally funded, either directly or indirectly, by CDC as an IAP
area. Their IAP designation was based on a combination of factors
(i.e., magnitude of population, proportion of racial/ethnic minorities,
and internal areas or ``pockets'' of chronic low immunization coverage)
which most clearly corresponds to the intent of this demonstration
program. In alphabetical order, these cities are Atlanta, Georgia;
Baltimore, Maryland; Birmingham, Alabama; Boston, Massachusetts;
Chicago, Illinois; Cleveland, Ohio; Columbus, Ohio; Dallas, Texas;
Detroit, Michigan; El Paso, Texas; Houston, Texas; Indianapolis,
Indiana; Jacksonville, Florida; Los Angeles, California; Memphis,
Tennessee; Miami, Florida; Nashville, Tennessee; Milwaukee, Wisconsin;
Newark, New Jersey; New Orleans, Louisiana; New York, New York;
Philadelphia, Pennsylvania; Phoenix, Arizona; San Antonio, Texas; San
Diego, California; San Jose, California; San Juan, Puerto Rico;
Seattle, Washington; and Washington D.C.
Rural Area--For the purposes of this program, a HPSA
nonmetropolitan area, as specified by HRSA in the Federal Register of
October 2, 1995. HRSA notes that all HPSA nonmetropolitan areas are
beyond the boundary of a Metropolitan Statistical Area as established
by the Office of Management and Budget (OMB Bulletin 95-04 dated June
30, 1995).
Target Community--A geographic area (for urban areas having at
least 100,000 population) which the applicant defines by census tracts,
and which includes a designated HPSA and any contiguous census tract
areas to that HPSA in which, as the applicant must establish, a
majority of residing children <2 years old are from Medicaid-eligible
families.
Project Collaborator--A primary health care provider with clinic
facilities serving Target Community children which joins with the
applying AMC/CHN at the outset to carry out each task of this
demonstration project.
AMC/CHN Primary Care Clinic--A facility managed by, or affiliated
with, an AMC/CHN, or which is a Project Collaborator's clinic facility,
and which provides comprehensive primary care (immunizations, other
preventive care, and acute care) to children in a Target Community.
AMC Network of Children's Primary Care Providers--A collection of
geographically disbursed AMC Primary Care Clinics in which all serving
health care providers work under the facility's standards of care (and
which does not include private physicians with admitting privileges).
Clinic Assessment Software Application (CASA)--A software tool from
the National Immunization Program, CDC, for conducting immunization
clinic audits. It encompasses a standardized sampling methodology for
obtaining medical charts for abstractions. Immunization and utilization
``events'' are recorded in CASA, and CASA calculates various measures
of immunization status and practice.
Racial and Ethnic Minority Populations--Groups recognized as racial
and ethnic minority populations are: African-Americans, Alaska Natives,
American Indians, Asian Americans, Pacific Islanders, and Latinos/
Hispanics.
Eligible Applicants
Eligible applicants are Academic Medical Centers/Community Health
Networks which:
A. Provide immunization services for children in the context of
comprehensive primary care.
B. Have significant experience in delivering health care services
to underserved children in urban populations, or rural populations.
C. Are able to effect primary care policy in each of their own AMC/
CHN Primary Care Clinics, plus those of their project collaborators,
within each designated Target Community.
[[Page 20827]]
To be considered eligible applicants, AMCs must have an AMC network
of children's primary care providers, as defined in this program
announcement. To be considered eligible applicants, Community Health
Networks also must provide evidence of linkage to an AMC, as defined in
this program announcement, at least to the extent that an AMC agrees to
accept responsibility for the clinic-based process and outcome
evaluation of the CHN's proposed demonstration program.
Urban area applicants must designate one or more Target Communities
wherein collectively lives a minimum current annual birth cohort (all
children born in the same calendar year) of 8,000; and from which the
applicant currently serves a minimum of 4,000 from that birth cohort in
its network of AMC/CHN Primary Care Clinics. (NOTE: The headquarters of
the AMC/CHN, its Project Collaborators, or the project's designated
AMC/CHN Primary Care Clinics, need not be physically located within the
Target Community(ies), but the AMC/CHN Primary Care Clinics,
collectively, must be serving the specified minimum birth cohort from
the Target Community.)
Separate applications from an eligible applicant may be accepted
for review if aspects of one application do not depend on CDC
supporting any other application. Dependent applications will be
returned to the applicant without further consideration because CDC
intends to make only one award to any eligible applicant.
Availability of Funds
Approximately $5,400,000 is available in FY 1996 to fund
approximately four cooperative agreements, three in urban areas and one
in a rural area. Only one urban area award will be made in a State, but
this will not affect the award of the single rural area cooperative
agreement. It is expected that the average award will be $1,350,000 per
year (including direct and indirect costs), ranging from $1,000,000 to
$1,500,000, with awards being made on or before September 30, 1996. The
awards will be made for 12-month budget periods within a project period
of up to 5 years. Funding estimates may vary and are subject to change
based on the availability of funds.
Cooperative agreement applications which exceed the $1,500,000
(including direct and indirect costs) per year will be returned to the
applicant as non- responsive.
Continuation awards within the project period will be made on the
basis of satisfactory progress and the availability of funds.
At the request of the applicant, Federal personnel with skills in
immunization program operations may be assigned to a project in lieu of
a portion of the financial assistance provided for the initial budget
period(s) of this project.
Use of Funds
Allowable Uses
Funds should be targeted for implementation, management, and
evaluation of the project. Funds can support personnel and the purchase
of modest amounts of hardware and software to (1) create and operate
systems that track and improve the immunization status of children, (2)
link with the USDA Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC), and (3) conduct clinic assessments of
immunization coverage levels with feedback to the providers. Funds may
be used to support direct medical care, e.g., new or expanded primary
care services designed to increase immunization coverage levels, but it
is expected that this will be limited to the final task of the project.
Applicants may enter into contractual arrangements for goods or
services, or to support collaborative activities, but must retain
direct control of all tasks of the project.
Prohibited Uses
Cooperative agreement funds through this project cannot be used for
(1) construction, (2) renovation, (3) the purchase or lease of
passenger vehicles or vans, or (4) hiring or contracting personnel to
conduct interventions such as special remote vaccination clinics or
other vaccination-only activities that promote vaccination outside the
context of delivering primary medical care, or (5) supplanting any
current applicant expenditures.
Purpose
The purpose of these projects is for AMCs/CHNs to demonstrate
increases in immunization coverage levels (above the baseline percent)
of at least 25 percentage points in the AMC's/CHN's network of Primary
Care Clinics, at least 20 percentage points among other Target
Community health care providers, and at least 15 percentage points in
the overall population of each Target Community (attainment of the
latter to be determined by an independent evaluator under contract to
CDC), over a 5-year period through the use of conventional and
innovative practices. (A paper summarizing methods for improving
immunization practices in primary care settings is provided with each
application kit.) The projects have three specific tasks:
Task I--the AMC/CHN is to increase immunization coverage among
children already receiving care in the AMC's/CHN's network of Primary
Care Clinics. Concurrently, the AMC/CHN is asked to perform a community
needs assessment to adjust approaches to achieving Task I and to
prepare for carrying out Tasks II and III.
Task II--The AMC/CHN is to translate its experience with the
successful methods used to carry out Task I to other providers of
children's primary care within the Target Community(ies), resulting in
measurable changes in immunization practices and measurable
improvements in the immunization coverage among the children served by
the other providers.
Task III--The AMC/CHN is to use innovative or experimental
methodologies to improve immunization coverage levels in the Target
Community(ies). Task I focuses on children who receive care in the AMC/
CHN Primary Care Clinics. Task II focuses on children who receive care
from other Target Community health care providers. Task III requires
that the successful parts of Tasks I and II, along with any other
population-based strategies used, have an overall impact on
immunization coverage for the Target Community(ies).
Most AMCs/CHNs will initiate these three tasks in sequence, but
some AMCs/CHNs may be sufficiently advanced to initiate Tasks I and II
simultaneously. By midway into the project period, most AMCs/CHNs
probably will be conducting these three tasks concurrently.
Program Requirements
The following are application requirements:
A. Is your organization an Academic Medical Center or a Community
Health Network, as each is defined in this program announcement (if so,
please specify which)?
B. Does your AMC/CHN provide comprehensive primary care and
immunization services?
C. Does your AMC/CHN have experience in delivering services to
underserved child populations in the setting (urban area or rural area)
for which you intend to apply?
D. Have your AMC/CHN and each of your Project Collaborators been
providing primary medical care to infants and children for at least the
past 12 months?
E. Does your AMC/CHN have the ability to effect primary care policy
in each of the AMC/CHN Primary care
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clinics in the Target Communities you would propose for this project?
F. If you are an AMC, does your institution have a network of
primary care providers for children, as defined in this program
announcement?
G. If you are a CHN, do you have linkages with an AMC, as defined
in this program announcement, at least to the extent that an AMC has
agreed to accept responsibility for the clinic-based process and
outcome evaluation of the CHN's proposed demonstration program?
H.1. If you are applying for an urban area award, do you have at
least one AMC/CHN Primary Care Clinic serving at least one urban Target
Community with 100,000 population, as those terms are
defined in this program announcement?
H.2. If you are applying for an urban area award, do you have a
collective current annual birth cohort of at least 8,000 residing in
your proposed Target Community(ies)?
H.3. If you are applying for an urban area award, do your AMC/CHN
Primary Care Clinics serving the population from your proposed Target
Community(ies) collectively serve a current annual birth cohort of at
least 4,000?
H.4. If you are applying for a rural area award, do you have at
least one AMC/CHN Primary Care Clinic in at least one rural Target
Community, as those terms are defined in this program announcement?
I. Do each of the Target Communities you would select for this
project have at least one additional primary care provider, other than
an AMC/CHN Primary Care Clinic participating in this project, serving
children from the Target Community population?
J. Is there a commitment at the highest levels of your AMC/CHN that
the project manager, within reasonable limits, will be given sufficient
direct authority and institutional backing to make those decisions
necessary to ensure success of the project, even if those decisions may
affect other domains, such as clinic/provider policies and practices?
K. Do each of your AMC/CHN Primary Care Clinics in the Target
Community(ies) have an existing and proven patient information system
(automated or manual) capable of recording demographic information
about your enrolled population, and utilization information about
patient encounters and immunizations administered?
L. Are you able to identify a populations, preferably within your
MSA (if applying for an urban area award) or your State (if applying
for a rural area award), to serve as a control for CDC's population-
based evaluation of your project? (i.e., a population from an area
which includes a HPSA and which has a racial/ethnic composition and
Medicaid proportion which approximates (15 percent for each
population group and for the Medicaid proportion) their distribution
when the selected Target Communities are taken as a collective).
Provide a succinct but informative response to each application
requirement. Respond with ``N/A'' whenever a requirement does not
relate to your type of eligible applicant organization (AMC or CHN) or
the type of award (urban area or rural area) for which you are
applying. Your response must not exceed 4 pages or have independent
attachments, although you are encouraged to reference appropriate text
in, or attachments to, the application. Your response must appear as
the first 1-4 pages of the text of your application and be titled,
``Program Requirements.'' An affirmative response to each applicable
question (A-L) is required to qualify for further review. All responses
should provide adequate explanation and clarification of any
exceptions.
Cooperative Activities
In conducting activities 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
1. Task I activities include:
a. A Target Community needs assessment--To ensure effective program
planning, a recipient is expected to conduct a community needs
assessment in collaboration with the organizations/agencies serving the
Target Community populations. The intent is for recipients to obtain
information about these populations and to involve their
representatives actively in the development of the program plan.
Recipients are expected to: (1) use a participatory process that
includes relevant community organizations, State and local health
departments, and other local agencies; (2) identify and assess the
unmet immunization and primary care needs of the targeted
population(s); and, (3) document the available resources for supporting
an effort to raise immunization coverage levels in the Target
Community. Based on the results of the needs assessment, and in
coordination with CDC, a recipient is expected to develop a program and
community-specific plan for Task II and Task III. The needs assessment
should determine, describe, and document:
(1) Access to, and availability of, immunization and primary care
services for the population(s) of the Target Community(ies), barriers
to obtaining services, and specific unmet primary care needs; and;
(2) Technical assistance needs of providers and organizations
serving, or proposing to serve, Target Community populations.
The needs assessment should include the procedures used to identify
and assess immunization and primary care needs, the actual unmet
immunization and primary care needs, and any recent, current, or
proposed actions to be taken within the Target Community(ies) to
address them. This documentation also should include lessons learned
through the needs assessment process and the technical assistance
services planned (for Task II and Task III), so this information can be
shared with other organizations, agencies, and recipients.
b. Application of interventions in the AMC's/CHN's network of
primary care providers in the Target Community(ies)--In each AMC/CHN
Primary Care Clinic that operates in each Target Community selected for
this demonstration project, a recipient is expected to apply practices
that have been shown to improve and sustain immunization coverage. A
recipient is expected to document the efforts made, including successes
and failures and outcomes resulting from these activities. At a
minimum, these practices must be consistent with the Standards for
Pediatric Immunization Practices, with particular emphasis on the
following interventions:
(1) Reminder/recall systems--Each AMC/CHN Primary Care Clinic or
network of Primary Care Clinics should establish a reminder/recall
system conditioned on the immunization status of the enrolled patients.
(2) Provider immunization record assessment and feedback--The
recipient must ensure that a semiannual immunization record assessment
is conducted using software approved by CDC (such as CASA) for each
provider within each AMC/CHN Primary Care Clinic. The recipient may
perform CASA-type assessments of Task I, either through its own
resources or by engaging other expertise, such as the State or local
health department. (A paper on the supportive potential of public
health departments for this project is provided with each application
kit.) Depending on the expertise residing at the AMC chosen to take
responsibility for the clinic-based process and outcome evaluation of
its
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program, a CHN may want to insist that the AMC engage the State or
local health department, or another expert entity, to assist in
conducting its CASA-type clinic assessment. The data obtained through
these assessments should be used by the recipient in conjunction with
CDC to identify problems in immunization service delivery and to
formulate and implement solutions.
(3) Administration of vaccines--Target Community AMC/CHN Primary
Care Clinics should ensure that all providers administer all
appropriate vaccines at the appropriate time.
(4) Observance of the most current Recommended Immunization
Schedule, approved by the Advisory Committee on Immunization Practices
(ACIP), the American Academy of Pediatrics (AAP), and the American
Academy of Family Physicians (AAFP), or accelerated schedule, as
appropriate to an individual child.
(5) Observance of true immunization contraindications--AMC/CHN
Primary Care Clinics should practice only true contraindications to
vaccination, as stated in the most current ACIP recommendations.
c. Task I clinic-based process evaluation--A recipient is expected
to ensure the ongoing process evaluation of various Task I activities
to identify delivery problems. At a minimum, the quarterly process
indicators for each Target Community AMC/CHN Primary Care Clinic should
include:
(1) CASA-type utilization indicators.
(2) Enrollment status for each Target Community AMC/CHN Primary
Care Clinic.
(3) Appointment and reminder/recall process data.
d. Task I clinic-based outcome evaluation--On a semiannual basis, a
recipient is expected to ensure the gathering, analysis, and reporting
of immunization outcome indicators for each Target Community AMC/CHN
Primary Care Clinic relating to two age groups of children: 12-15 and
24-27 months of age. A recipient is expected to ensure that a baseline
CASA-type assessment is performed for each Target Community AMC/CHN
Primary Care Clinic and is repeated at 6-month intervals. Sampling
should be consistent with the CASA methodology.
2. Task II activities--The purpose of Task II is to improve the
immunization practices of other Target Community primary medical care
providers. This includes:
a. Continuing Task I activities in each AMC/CHN Primary Care
Clinic;
b. Exporting successful Task I activities to other AMC/CHN Primary
Care Clinic(s) serving the Target Community(ies); and,
c. Exporting successful Task I activities to other primary health
care providers serving the Target Community(ies).
d. Clinic-based process and outcome evaluations--As with Task I,
the recipient is responsible in performing Task II for ensuring that a
CASA-type assessment is periodically performed for each participating
primary health care provider in the Target Community(ies). Also, as
with Task I, the recipient may discharge this responsibility by using
its own resources or by engaging other expertise, such as the State or
local health department.
3. Task III activities--The purpose of Task III is to design and
test creative approaches to raising the immunization coverage level of
remaining Target Community children. Task III includes:
a. Continuing all Task I and Task II activities in the Target
Community(ies);
b. Developing creative, practical strategies for bringing all
infants into the primary health care delivery system for the earliest
recommended well-child-care visit, and retaining them in the system;
and developing protocols based on conventional scientific methods for
rigorously evaluating the feasibility of these strategies;
c. Developing creative, practical strategies for returning and
retaining children who have dropped out of the health delivery system,
and develop protocols based on conventional scientific methods for
rigorously evaluating the feasibility of these strategies;
d. Collaborating with CDC on the design of all Task III
investigations;
e. Implementing investigations to test Task III strategies.
f. Task III Evaluation--Procedures and parameters for the
evaluation of Task III activities will be described as part of the
individual protocols approved and implemented and on the schedule
specified in those protocols.
Although the projects resulting from this announcement are
demonstrations rather than research studies, valuable new knowledge
will be gained that can help other areas improve the immunization
status of children. It is expected that the recipients will publish
their methods and results. Data from individual projects belong to the
recipients but must be shared with the CDC, and CDC reserves the right
to publish scientific papers from data that are aggregated across
projects. Publication of individual project data in the same manuscript
with these aggregate data will be a shared responsibility with the
standard rules of authorship applying. Thus, all authors must have
participated in the creation, conduct, analysis, and interpretation of
results.
B. CDC Activities
1. Provide medical, epidemiologic, programmatic, and educational
consultation and technical assistance in planning, operating,
improving, and evaluating the demonstration project.
2. Provide technical assistance in community coalition development
to increase the potential for achieving Task II and Task III.
3. Provide oversight for the rigorous scientific approach to be
taken in Task III to increase the use of primary care by underserved
families of underimmunized children.
4. Ensure that recipients are provided population-based
immunization coverage data for their respective urban area or rural
area Target Community(ies) as such data become available from the
independent evaluation contractor.
5. Coordinate the dissemination of findings from the demonstration
project and collaborate with recipients on specific publications
involving data collected.
Evaluation Criteria
Upon receipt, applications will be screened by CDC staff for
completeness and responsiveness as outlined under the previous heading,
``Program Requirements'' (A-L). Incomplete applications and
applications which are not responsive will be returned to the applicant
without further consideration. Applications which are complete and
responsive may be subjected to a preliminary evaluation by a peer
review group to determine if the application is of sufficient technical
and scientific merit to warrant further review (triage); the CDC will
withdraw from further consideration applications judged to be
noncompetitive and promptly notify the principal investigator/program
director and the official signing for the applicant organization.
Applications accepted for full review will be reviewed and
evaluated according to the following criteria:
A.1. For Urban Area Applicants--The extent to which need for the
program is justified by the applicant's documentation of: (1) the
magnitude of unmet primary care needs and underimmunization (if
available) of urban inner city and other underserved populations in the
proposed Target Community(ies); and (2) the existence of the current
annual birth cohort residing in the proposed Target Community(ies)--10
Points.
[[Page 20830]]
A.2. For Rural Area Applicants--The extent to which need for the
program is justified by the applicant's documentation of the magnitude
of unmet primary care needs and underimmunization (if available) of the
underserved populations living in the proposed Target Community(ies)--
10 Points.
B. The extent to which the applicant's documentation establishes:
(1) experience in delivering children's primary care and immunization
services to underserved child populations in the Target Community(ies);
(2) knowledge of the population in the Target Community(ies), as
reflected by the cultural appropriateness of services that the
applicant is providing; and (3) existence of the current annual birth
cohort collectively served by AMC/CHN Primary Care Clinics
participating as part of the proposed Target Community(ies)--10 Points.
C. The extent to which the proposed program framework is
comprehensive, specific, reasonable, and realistic--20 Points.
D. The quality and feasibility of a narrative program proposal that
includes: (1) detailed plans for: (a) implementing all Task I and Task
II activities and general preparations for Task III; (b) program
management; (c) documenting the process, including successes and
failures, of implementing the activities of the three tasks; (d)
resolving problems that might be encountered in designing and
implementing program activities, (e.g., problems in recruiting, hiring,
or retaining staff; training of staff; monitoring and ensuring staff
performance; and monitoring and ensuring provider performance in Task
II and Task III); and (e) completing and submitting progress reports;
and (2) the extent to which: (a) the applicant's proposed Target
Community(ies) are visually represented on a census tract map; (b) data
regarding the applicant's proposed Target Community(ies) and AMC/CHN
Primary Care Clinics appear to document the infrastructure needed to
successfully conduct and evaluate this demonstration project; (c) the
plan to ensure the sustainability of the results of carrying out the
project's tasks is realistic; and (d) the plan is feasible in relation
to the size of the current annual birth cohort, both residing in the
Target Community(ies) and being served by AMC/CHN Primary Care Clinics
in the selected Target Community(ies)--20 Points.
E. The extent to which: (1) the evaluation plan, either of an
applying AMC or of a CHN through the AMC which will be responsible for
the clinic-based process and outcome evaluation for the CHN's project,
will measure the achievement of the applicant's stated goals and
objectives, quality assure services, and support the ongoing management
of the project; (2) the evaluation capability of an applying AMC, or of
a CHN through the AMC which will be responsible for clinic-based
process and outcome evaluation of the CHN's proposed demonstration
program; and (3) the proposed control population is visually
represented on a census tract map and meets the specifications for HPSA
inclusion, racial/ethnic group composition, and Medicaid proportion set
forth in subsection E. Evaluation Plan of the Application Contents
section--20 Points.
F. The extent to which the applicant's description of a patient
information system indicates a conclusion that the system is adequate
to support an effective program--10 Points.
G. The extent to which the applicant proposes and properly
documents potentially effective coordination, collaboration, and
working relationships with State/local health departments--5 Points.
H. The extent to which the applicant documents effective prior
working relationships with project collaborators, and the extent to
which the applicant will coordinate and collaborate with providers
(private and public), relevant community organizations, coalitions, and
other agencies serving the populations in the Target Community(ies).
For applying CHNs, the extent to which there is documentation showing
the details of an formal agreement whereby a collaborating AMC agrees
to assume responsibility for the clinic-based process and outcome
evaluation of the CHN's project activities--5 Points.
Funding Priorities
During the selection process of urban area demonstration projects,
CDC will make every effort to ensure that funded applications reflect a
geographic distribution, as well as racial/ethnic diversity of the
target populations; however, consistent with consideration of technical
merit, at least one urban area award will be made to an applicant
serving a predominantly African-American population, and at least one
award will be made to an applicant serving a predominantly Hispanic
population. No more than one urban area project will be funded in a
State. The award of a rural area project will not be affected by the
geographic distribution or ethnic/racial diversity of urban area
projects. Therefore, it is possible that an urban area project and the
single rural area project could be awarded in the same State, but not
to the same recipient.
Interested persons are invited to comment on the proposed funding
priority. All comments received on or before June 7, 1996 will be
considered before the final funding priority is established. If the
funding priority should change as a result of any comments received, a
revised announcement will be published in the Federal Register prior to
the final selection of awards. Written comments should be addressed to:
Ron Van Duyne, Grants Management Officer, Grants Management Branch,
Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, Room 321, Atlanta, Georgia
30305.
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 the SPOCs
have any State process recommendations on applications submitted to
CDC, they should send them to Lisa G. Tamaroff, Grants Management
Specialist, 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 due date. Please include the Program Announcement Number
and Program Title on the letter.
Public Health System Reporting Requirement
This program is subject to the Public Health System Reporting
Requirements. Under these requirements, all community-based non-
governmental applicants must prepare and submit the items identified
below to the head of the appropriate State and/or local health
agency(s) in the program area(s) that may be impacted by the proposed
project no later than the receipt date of the Federal application. The
appropriate State and/or local health agency is determined by the
applicant. The
[[Page 20831]]
following information must be provided:
A. A copy of the face page of the application (SF 424).
B. A summary of the project that should be titled ``Public Health
System Impact Statement'' (PHSIS), not to exceed one page, and include
the following:
1. A description of the population to be served;
2. A summary of the services to be provided; and
3. A description of the coordination plans with the appropriate
State and/or local health agencies.
If the State and/or local health official should desire a copy of
the entire application, it may be obtained from the State Single Point
of Contact (SPOC) or directly from the applicant.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance number is 93.268.
Other Requirements
Human Subjects
If the proposed project involves research on human subjects, the
applicant must comply with the Department of Health and Human Services
Regulations, 45 CFR Part 46, regarding the protection of human
subjects. Assurance must be provided to demonstrate that the project
will be subject to initial and continuing review by an appropriate
institutional review committee. The applicant will be responsible for
providing assurance in accordance with the appropriate guidelines and
forms provided in the application kit.
Application Submission and Deadline
A. Preapplication Letter of Intent
Although not a prerequisite of application, a non-binding letter of
intent-to-apply is requested from potential applicants. The letter
should be submitted to the Grants Management Specialist (whose address
is reflected in section B, ``Applications''). It should be postmarked
no later than one month prior to the planned submission deadline,
(e.g., June 12 for a July 12 submission). The letter should identify
the announcement number, the name of the applicant AMC or CHN and its
Project Collaborators, as defined in this announcement, and the
geographic type (urban or rural) of program which the intended
application will address. The letter of intent does not influence
review or funding decisions, but it will enable CDC to plan the review
more efficiently and thereby potentially benefit all applicants.
B. Application
The application should be carefully completed, following the
directions provided in this program announcement. The original and two
copies of the application PHS Form 5161-1 must be submitted to Lisa G.
Tamaroff, Grants Management Specialist, Grants Management Branch,
Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, Room 300, Mailstop E-13,
Atlanta, Georgia 30305, on or before July 12, 1996.
1. Deadline
Applications will 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 triage process, if it is employed, or the objective
review process if it is not. (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 that do not meet the criteria in 1.a. or 1.b. above
are considered late applications. Late applications will not be
considered and will be returned to the applicant.
Where To Obtain Additional Information
To receive additional written information call (404) 332-4561. You
will be asked to leave your name, address, and phone number and will
need to refer to Announcement #612. You will receive a complete program
description. The program announcement is also available on through the
CDC homepage on the Internet. The address for the CDC homepage is
http://www.cdc.gov. CDC will not send program announcements by
facsimile or express mail. If you have any questions after reviewing
the contents of all the documents, business management technical
assistance may be obtained from Lisa Tamaroff, Grants Management
Specialist, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 300, Mailstop E-13, Atlanta, Georgia 30305, telephone
(404) 842-6796, Internet address: [email protected].
Programmatic technical assistance may be obtained from Russ Havlak,
Immunization Services Division, National Immunization Program, Centers
for Disease Control and Prevention (CDC), Building 12, Corporate Square
Boulevard, Mailstop E-52, Atlanta, Georgia 30329, telephone (404) 639-
8569, Internet address: [email protected].
Please refer to Announcement Number 612 when requesting information
and submitting an application.
There may be delays in mail delivery as well as difficulty in
reaching the CDC Atlanta offices during the 1996 Summer Olympics (July
19-August 4). Therefore, CDC suggests the following to get more timely
responses to any questions: using internet/email, following all
instructions in this announcement, and leaving messages on the contact
person's voice mail.
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, D.C. 20402-9325, telephone: 202-512-1800.
Dated: May 2, 1996.
Joseph R. Carter,
Acting Associate Director for Management and Operations Centers for
Disease Control and Prevention (CDC).
[FR Doc. 96-11443 Filed 5-7-96; 8:45 am]
BILLING CODE 4163-18-P