[Federal Register Volume 63, Number 116 (Wednesday, June 17, 1998)]
[Notices]
[Pages 33064-33073]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-16046]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention
[Announcement Number 98084]


Notice of Availability of Funds for 1998; State Cardiovascular 
Health Programs

Introduction

    The Centers for Disease Control and Prevention (CDC), announces the 
availability of fiscal year (FY) 1998 funds for a cooperative agreement 
program for State-based cardiovascular health programs. This 
announcement is the first of its kind and contains cardiovascular 
health program design components considered essential to increasing the 
leadership of State health departments in cardiovascular disease 
prevention and control. The essential components are characterized by 
definition of the cardiovascular disease problem within the State; 
development of partnerships and coordination among concerned 
nongovernmental and governmental partners; development of effective 
strategies to reduce the burden of cardiovascular diseases and related 
risk factors with an overarching emphasis on heart healthy policies and 
physical and social environmental changes at all levels as 
interventions; and monitoring of all the critical aspects of 
cardiovascular diseases.
    To improve the cardiovascular health of all Americans, every State 
health department should have the capacity, commitment, and resources 
to carry out comprehensive cardiovascular disease prevention and 
control programs. Applicants may apply for one, but not both, of the 
following levels of support:
    1. A Core Capacity Program to develop basic cardiovascular disease 
program functions and activities at the State level such as 
partnerships and program coordination, scientific capacity, inventory 
of policy and environmental strategies, State plan for cardiovascular 
diseases, training and technical assistance, strategies for addressing 
Priority Populations, and intervention strategies.
    2. A Comprehensive Program to implement and disseminate 
intervention activities throughout the State using health care 
settings, work sites, schools, media, the government, and community-
based organizations as primary modes of intervention for cardiovascular 
diseases.
    One optional enhanced school health program. Additional funding may 
be available for either a Core Capacity

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Program or a Comprehensive Program to collaborate with the State 
education agency and other relevant governmental and nongovernmental 
agencies to implement cardiovascular disease prevention strategies that 
address students, their families, school staff, and communities.
    While defining the problem of cardiovascular diseases and related 
risk factors within the State, the applicant may determine the Priority 
Populations to be addressed. Factors that may be considered when 
identifying Priority Populations include rates of cardiovascular 
diseases and related risk factors, lack of access to services, 
socioeconomic levels, and populations with documentation of high risk 
of cardiovascular diseases. The applicant may direct specific program 
interventions to reduce risk factors in key Priority Populations to 
levels at or below the general population.
    The 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 Heart Disease and 
Stroke. (For ordering a copy of Healthy People 2000, see the section 
``Where to Obtain Additional Information.'')

Authority

    This program is authorized under section 317(a) of the Public 
Health Service (PHS) Act [42 U.S.C.247b(a)], as amended. Applicable 
program regulations are found in 42 CFR Part 51b-Project Grants for 
Preventive Health Services.

Smoke-Free Workplace

    CDC strongly encourages all grant recipients to provide a smoke-
free workplace and to promote the nonuse 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, day care, health care, and early childhood development 
services are provided to children.

Eligible Applicants

    Assistance will be provided only to the health departments of 
certain States or their bona fide agents. Eligible States are limited 
to those in which mortality rates from ischemic heart disease or stroke 
exceed the national rates by ten percent or more. The eligible States 
(based on National Vital Records) are Alabama, Arkansas, Georgia, 
Indiana, Kentucky, Louisiana, Mississippi, Missouri, New York, North 
Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Virginia, West 
Virginia; and the District of Columbia.
    Other States or territories including 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 may apply; but, they must 
provide evidence that their mortality rate from ischemic heart disease 
exceeds 189.7/100,000 or the mortality rate from stroke exceeds 44.4/
100,000. Mortality statistics provided by the applicant must use ICD-9 
codes of 410-414 (Ischemic heart disease) and 430-438 (Stroke), age-
adjusted to the 1970 U.S. population, resident population only, for the 
35-74 year-old population of the State, for 1991-1995 based on National 
Vital Records available on CDC WONDER. This documentation must be 
provided in the Executive Summary of the Application Content section.
    State health departments are uniquely qualified to define the 
cardiovascular health problem throughout the State, to plan and develop 
statewide strategies to reduce the burden of cardiovascular diseases, 
to provide overall State coordination of cardiovascular health 
activities among partners, to lead and direct communities, to direct 
and oversee interventions within overarching State policies, and to 
monitor critical aspects of cardiovascular diseases. Therefore, because 
of these unique qualifications, competition is limited to State health 
departments.
    Eligible applicants may choose to address either the Core Capacity 
Program or the Comprehensive Program. However, applicants choosing to 
address the Comprehensive Program must meet the matching requirement 
for State funds (see Recipient Financial Participation).

Availability of Funds

    Approximately $4,750,000 is available in FY 1998 to fund 
approximately 8 States.
    A. Approximately $1,800,000 is available for approximately 6 Core 
Capacity Program awards. It is expected that the average award will be 
$300,000, ranging from $250,000 to $500,000.
    B. Approximately $2,500,000 is available for approximately 2 
comprehensive awards. It is expected that the average award will be 
$1,250,000 ranging from $1,000,000 to $1,500,000.
    C. Approximately $450,000 is available for one optional enhanced 
school health program that may be additional funding to either a Core 
Capacity Program or a Comprehensive Program.
    It is expected that the awards will begin on or about September 28, 
1998, and will be made for a 12-month budget period within a project 
period of up to 5 years. Funding estimates may vary and are subject to 
change.
    Continuation awards within the project period will be made on the 
basis of satisfactory progress and the availability of funds.
    If requested, federal personnel, equipment, or supplies may be 
provided in lieu of a portion of the financial assistance.
    States which compete for funds but do not receive an award and 
whose application is not disapproved, will maintain an ``approved but 
unfunded'' status for one year. If additional funds become available 
during the year, additional States may be considered for funding.
    CDC anticipates that additional funds may become available for 
addressing Priority Populations for recipients under this program 
announcement. If funds become available, recipients may be solicited to 
submit competitive supplemental applications for these funds.

Recipient Financial Participation

    Matching funds are required from State sources in an amount not 
less than $1 for each $4 of Federal funds awarded under the 
Comprehensive Program of this announcement. Applicants for the 
Comprehensive Program must provide evidence of State appropriated 
resources targeting cardiovascular health of at least 20 percent of the 
total approved budget. The Preventive Health and Health Services (PHHS) 
Block Grant may not be included as State resources.
    Applicants may not use these funds to supplant funds from State 
sources or the Preventive Health and Health Services Block Grant 
dedicated to cardiovascular health. Applicants must maintain current 
levels of support dedicated to cardiovascular health from State sources 
or the Preventive Health and Health Services Block Grant.

Use of Funds

    Funds provided under this program announcement are not intended to 
be used to conduct community-based pilot or demonstration projects.

Restrictions on Lobbying

    Applicants should be aware of restrictions on the use of Health and 
Human Services (HHS) funds for lobbying of Federal or State legislative 
bodies. Under the provisions of 31

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U.S.C. Section 1352 (which has been in effect since December 23, 1989), 
recipients (and their subtier contractors) are prohibited from using 
appropriated Federal funds (other than profits from Federal contract) 
for lobbying Congress or any Federal agency in connection with the 
award of a particular contract, grant, cooperative agreement, or loan. 
This includes grants/cooperative agreements that, in whole or in part, 
involve conferences for which Federal funds cannot be used directly or 
indirectly to encourage participants to lobby or to instruct 
participants on how to lobby.
    In addition, the FY 1998 Department of Labor, Health and Human 
Services, and Education, and Related Agencies Appropriations Act 
(Public Law 105-78) states in Sec. 503(a)and (b) no part of any 
appropriation contained in this Act shall be used, other than for 
normal and recognized executive-legislative relations, for publicity or 
propaganda purposes, for the preparation, distribution, or use of any 
kit, pamphlet, booklet, publication, radio, television, or video 
presentation designed to support or defeat legislation pending before 
the Congress or any State legislature, except in presentation to the 
Congress or any State legislative body itself. No part of any 
appropriation contained in this Act shall be used to pay the salary or 
expenses of any grant or contract recipient, or agent acting for such 
recipient, related to any activity designed to influence legislation or 
appropriations pending before the Congress or any State legislature.

Background

    Among men and women, and across all racial and ethnic groups, 
cardiovascular disease is our nation's leading killer and a leading 
cause of disability. More than 950,000 Americans die of cardiovascular 
disease each year, accounting for more than 40 percent of all deaths. 
Over half of these deaths occur among women.
    In 1998, cardiovascular diseases are estimated to cost our nation 
$274 billion. This amount includes health expenditures and lost 
productivity resulting from illness and death. The use of expensive 
treatment, although effective in delaying death from cardiovascular 
diseases, is likely to continue to increase the financial impact.
    Cardiovascular diseases are common and their risk factors are 
widespread in American society. Although most of the major risk factors 
for heart disease and stroke are modifiable or entirely preventable, 
over 80 percent of Americans report having at least one major risk 
factor. These include tobacco use, physical inactivity, poor diet, high 
blood pressure, high blood cholesterol, obesity, and diabetes.
    Major disparities exist among population groups, with a 
disproportionate burden of death and disability from cardiovascular 
diseases in minority and low-income populations. For example, the rate 
of premature deaths caused by cardiovascular diseases is greater among 
African-Americans than among white Americans. Disparities also exist in 
the prevalence of risk factors for cardiovascular diseases. For 
example, physical inactivity is higher for Mexican-American women (46 
percent) and African-American, non-Hispanic women (40 percent) than for 
white, non-Hispanic women (23 percent).

Purpose

    The purpose of this program is not only to provide financial and 
programmatic assistance that will aid States in developing, 
implementing, and evaluating cardiovascular disease prevention and 
control programs; but also, to assist States in developing their Core 
Capacity Programs into a Comprehensive Program.
    State Core Capacity Programs: The purpose of these programs is to 
develop and fill gaps in capacity and leadership in State health 
departments in areas critical to the implementation and management of a 
successful statewide comprehensive cardiovascular disease prevention 
program. Core Capacity Programs are the foundation upon which 
comprehensive cardiovascular health programs are built.
    State Comprehensive Programs: The purpose of these programs is to 
build upon core capacities of the State. They implement widespread 
interventions throughout the State, adopting population-based 
approaches for cardiovascular disease prevention and control that 
extends to all population groups, and a focused approach for priority 
populations. In addition to the components of the Core Capacity 
Programs, the Comprehensive Programs extend resources to local health 
agencies, communities, and organizations for implementation of the 
cardiovascular health strategies.

Program Requirements

    In conducting activities to achieve the purpose of this program, 
the recipient will be responsible for conducting the activities under 
A. (State Core Capacity Programs), below, or under B. (Comprehensive 
Programs), below, and CDC will be responsible for the conducting 
activities listed under C., below.

A. Recipient Activities for State Core Capacity Programs

1. Develop and Coordinate Partnerships
    Identify, consult with, and appropriately involve the State 
cardiovascular health partners to identify areas critical to the 
development of a statewide cardiovascular disease prevention and 
control program, coordinate activities, avoid duplication of effort, 
and enhance the overall leadership of the State with its partners. 
Within a State health department, coordinate and collaborate with 
partners in nutrition and physical activity and other areas such as 
tobacco, diabetes, cancer, health education, Preventive Health and 
Health Services Block Grant, laboratory, as well as with data systems 
such as vital statistics and behavioral risk factor surveillance. 
Within State government, collaboration and partnership with other 
departments such as education, transportation, parks and recreation, 
and with youth risk behavioral surveillance, should be developed. These 
partnerships and collaborative efforts should develop into memorandums 
of agreement (MOA) or similar formalized arrangements. The State health 
department should develop a statewide coalition with representation 
from other agencies, professional and voluntary groups, academia, 
community organizations, the media, and the public.
2. Develop Scientific Capacity to Define the Cardiovascular Disease 
Problem
    Enhance epidemiology, statistics, and data analysis from existing 
data systems such as vital statistics, hospital discharges, and 
behavioral risk factor surveillance to determine:
    a. Trends in cardiovascular diseases.
    b. Geographic distribution of the diseases.
    c. The racial and ethnic identities of populations at highest risk 
for cardiovascular diseases.
    d. Ways to integrate systems to provide comprehensive data needed 
for assessing and monitoring the cardiovascular health of populations 
and program outcomes.
    Monitoring and program evaluation are considered essential 
components of building scientific capacity. Scientific capacity may 
also extend to developing access to outside databases such as medical 
care, and to laboratory development consistent with the overall 
direction of the program. State public health laboratories, or 
laboratories contracted by States to perform lipid

[[Page 33067]]

and lipoprotein testing, should be standardized by the CDC Lipid 
Standardization Program.
3. Develop an inventory of Policy and Environmental Strategies
    Develop an inventory of policy and environmental issues in systems 
and settings, (State, communities, health care sites, work sites, 
schools) affecting the cardiovascular health of the general population 
and Priority Populations, to include such issues as food service 
policies; availability of opportunities such as sidewalks, recreation 
centers, parks, walking trails; restrictions on tobacco; and standards 
of care. Health care-related policy and environmental issues should be 
assessed in collaboration with purchasers of medical care, managed care 
organizations, and consumers. Attention should be paid to the needs of 
Priority Populations and the policy and environmental issues most vital 
to their cardiovascular health.
4. Develop or Update State Plan
    Develop or update a State plan for cardiovascular diseases to 
include specific objectives for future reductions in cardiovascular 
diseases and related risk factors. Develop a complete description of 
the cardiovascular disease problem geographically and demographically 
and include population-specific strategies for achieving the 
objectives. The strategies should emphasize population-based policy and 
environmental approaches as well as the needs of Priority Populations. 
The strategies may also include planning for program development at the 
community level, particularly for Priority Populations.
5. Provide Training and Technical Assistance
    Increase the skills of State health department and external 
personnel in areas such as data systems; use of data in program 
planning; assessing community assets and needs; cardiovascular diseases 
and related risk factors with emphasis on nutrition and physical 
activity; approaches to interventions with emphasis on policy and 
environmental issues; social marketing and communications; 
epidemiology; health promotion; partnering; cultural competency; 
community engagement; and program evaluation. Training may address 
State health department personnel as well as those at the local level, 
designated partners, and may include development of technical 
assistance to communities, work sites, health sites, schools, 
organizations of faith, and community-based organizations. This 
component may also extend to laboratory improvement for lipid 
measurement.
6. Develop Population-Based Strategies
    Develop population-based intervention strategies to reduce the 
burden of cardiovascular diseases in the State, with a strong emphasis 
on policy and environmental approaches for the general population. 
Primary strategies must address the cardiovascular risk factors of 
nutrition and physical activity. The strategies should be included in 
the updated State plan and may use health sites, work sites, schools, 
media, organizations of faith, community-based organizations, and 
governments, as effective means to reach people. Although Core Capacity 
awards do not include funds for implementation of strategies, the 
projected cost of implementing the strategies should be developed and 
included in progress reports.
7. Develop Culturally-Competent Strategies for Priority Populations
    Develop, and include in the State plan, strategies for enhanced 
program efforts to address Priority Populations with more intensive 
intervention than population-based approaches and specify how 
interventions would be designed appropriately for the priority 
populations to be addressed. Strategies should include policy and 
environmental approaches specific for the population to be addressed 
but may also include strategies for direct interventions such as 
community events, screenings, special classes, and campaigns designed 
to improve awareness of cardiovascular risk factors in the populations 
and to reduce risk factors in the populations to levels at or below the 
general population. Initiatives may be used to demonstrate the 
effectiveness of selected strategies or as a means to generate 
community support. Although Core Capacity awards do not include funds 
for implementation of strategies, the projected cost of implementing 
the strategies for Priority Populations should be developed and 
included in progress reports.
8. (Optional) Enhanced School Health Program
    Develop enhanced program efforts designed to reach youth during 
their formative years. Collaborate with the State education agency to 
sustain efforts with local education agencies and other relevant 
governmental and nongovernmental agencies to implement cardiovascular 
disease prevention strategies that address students, their families, 
school staff, and communities. Implement policy mandates, environmental 
change, school food service, classroom instruction, and involve 
families and community agencies in such efforts. Establish, strengthen, 
or expand education intended to prevent or reduce sedentary lifestyle, 
dietary patterns, and tobacco use, that result in disease; and 
integrate education into comprehensive school health education. 
Coordinate fully with State education and health programs and 
strengthen school health programs. Establish qualified staffing in the 
State departments of education as well as in the State health 
department.

B. Recipient Activities for Comprehensive Programs

1. Implement Population-Based Intervention Strategies Consistent with 
the State Plan.
    Strategies should include policy and environmental approaches, and 
other approaches disseminated through various settings including health 
care settings, work sites, schools, organizations of faith, 
governments, and the media. Interventions should be population-based, 
with objectives established that specify the population-wide changes 
sought. Approaches should extend to a relatively large proportion of 
the population to be addressed, rather than a few selected communities. 
Interventions should be coordinated such that health messages, 
policies, and environmental measures are consistent, the most cost-
effective methods are used for reaching the populations, and 
duplication of effort is avoided. Primary interventions must address 
physical activity and nutrition. Lipid and hypertension management are 
consistent with physical activity and good nutrition and may also be 
included. Efforts to address tobacco use should be coordinated with the 
State tobacco program; tobacco-related activities should not be 
duplicated. Implementation may extend to grants and contracts with 
local health agencies, communities, and nonprofit organizations.
2. Implement Strategies Addressing Priority Populations
    These strategies may include services directed to specific 
communities and segments of the population, and may include all 
appropriate modes of intervention needed to reach the populations to be 
addressed. These strategies may include more intensive, directed 
services by organizations including community-based organizations, 
organizations of faith, and State and national organizations

[[Page 33068]]

concerned with improving the health and quality of life of Priority 
Populations.
3. Specify and Evaluate Intervention Components
    Design and implement a program evaluation system. Evaluation should 
be limited in scope to address strategy implementation, changes in 
personal behavioral risk factors, and changes in policies and the 
physical and social environment affecting cardiovascular health. 
Evaluation should not include comparison communities or quasi-
experimental designs. Evaluation should cover both population-based 
strategies as well as targeted strategies. Evaluation should rely 
primarily upon existing data systems such as vital statistics, hospital 
discharges, behavioral risk factor surveillance, and youth risk 
behavioral surveys. The program should address measures considered 
critical to determine the success of the program.
4. Implement Professional Education Activities
    Provide professional education to health providers to assure 
appropriate prevention and counseling are offered routinely and that 
appropriate standards of care are provided to all.
5. Monitor Secondary Prevention Strategies
    Secondary prevention strategies may include such issues as aspirin 
and drug therapy, physical activity regimens, hormone replacement 
therapy, dietary changes, and hypertension and lipid management. 
Activities in secondary prevention should be limited primarily to 
monitoring the delivery of secondary prevention practices. Development 
of monitoring systems for secondary prevention practices should be 
coordinated with managed care providers, Medicaid, major employers, 
insurers, other organized health care providers, and purchasers of 
health care. Secondary prevention strategies may be integrated with 
professional education initiatives. Secondary prevention should not 
provide for drugs, patient rehabilitation, or other costs associated 
with the treatment of cardiovascular diseases.
6. (Optional) Enhanced School Health
    Develop enhanced program efforts designed to reach youth during 
their formative years. Collaborate with the State education agency to 
sustain efforts with local education agencies and other relevant 
governmental and nongovernmental agencies to implement cardiovascular 
disease prevention strategies which address students, their families, 
school staff, and communities. Implement policy mandates, environmental 
change, school lunch programs, classroom instruction, and involve 
families and community agencies in the efforts. Establish, strengthen, 
or expand education intended to prevent or reduce sedentary lifestyle, 
dietary patterns, and tobacco use that result in disease; and integrate 
education into comprehensive school health education. Coordinate fully 
with State education and health programs and strengthen school health 
programs. Establish qualified staffing in State department of education 
as well as the State health department.

C. CDC Activities

    1. Provide technical assistance in the coordination of surveillance 
and other data systems to measure and characterize the burden of 
cardiovascular diseases. Provide technical assistance in the design of 
surveillance instruments and sampling strategies, and provide 
assistance in the processing of data for States. Provide data on 
populations at highest risk. Provide data for national-level 
comparisons.
    2. Develop and disseminate programmatic guidance and other 
resources for specific interventions, media campaigns, and coordination 
of activities.
    3. Collaborate with the States and other appropriate partners to 
develop and disseminate recommendations for policy and environmental 
interventions including the measurement of progress in the 
implementation of such interventions.
    4. Collaborate with appropriate private, nonprofit organizations to 
coordinate a cohesive national program.
    5. Provide technical assistance to State public health laboratory 
or contract laboratory to standardize cholesterol, high density 
lipoproteins, and triglyceride measurements.
    6. Provide training and technical assistance regarding the 
coordination of nutrition and physical interventions.
    7. If requested, provide Federal personnel, equipment, or supplies 
in lieu of a portion of the financial assistance.

Technical Reporting Requirements

    An original and two copies of semiannual progress reports are 
required 30 days after each semiannual reporting period. A financial 
status report is required no later than 90 days after the end of each 
budget period. Final financial and performance reports are required no 
later than 90 days after the end of the project period. All reports are 
to be submitted to the Grants Management Branch, CDC. Progress reports 
should include the following:
    1. A comparison of actual accomplishments with the objectives 
established in the work plan for the period.
    2. Core Capacity programs should report the projected cost of 
implementing the strategies developed.
    3. Other pertinent information that includes, but is not limited 
to, the reasons for slippage if established goals were not met, 
analysis and explanation of unexpected delays or high costs of 
performance, and a listing of presentations and publications produced 
by, supported by, or related to, program activities.

Application Content

    Applicants must develop their applications in accordance with PHS 
Form 5161-1 (Revised 5/96), or new CDC Form 0.1246(E), information 
contained in this Program Announcement, and the format and page 
limitations outlined below. Applicants may apply for funding of either 
Core Capacity activities or Comprehensive activities, but not both, and 
must designate in the Executive Summary of their application the 
component (Core Capacity Program or Comprehensive Program) for which 
they are applying.
    Applications for the Core Capacity Program should not exceed 60 
double-spaced pages, single sided, in 12 point type, excluding the 
optional enhanced school health program, budget and justification, and 
appendixes. Applications for the Comprehensive Program should not 
exceed 120 double-spaced pages, single sided, in 12 point type, 
excluding the optional enhanced school health program, budget and 
justification, and appendixes. Applications for the Optional Enhanced 
School Health Program should not exceed 25 double-spaced pages, single 
sided, in 12 point type, excluding the optional enhanced school health 
program, budget and justification, and appendixes. Applicants should 
also submit appendixes including resumes, job descriptions, 
organizational chart, facilities, and any other supporting 
documentation as appropriate. All materials must be suitable for 
photocopying (i.e., no audiovisual materials, posters, tapes, etc.).

I. Executive Summary

    All applicants must provide a summary of the program applied for 
and whether the optional program is included (two pages maximum). 
States

[[Page 33069]]

and territories, other than the 17 eligible applicants, must include 
documentation of the required mortality statistics data.

II. Core Capacity Program

    (Narrative portions of the application may not exceed 60 double-
spaced pages.)

A. Staffing (Not Included in 60 Page Limitation)

    Describe program staffing and qualifications including contacts for 
physical activity, nutrition, and epidemiology. Provide organizational 
chart, resumes, job descriptions, and experience for all budgeted 
positions. Describe lines of communication between various related 
chronic disease programs.

B. Facilities (Not Included in 60 Page Limitation)

    Describe facilities and resources available to the program, 
including equipment available, communications systems, computer 
capabilities and access, and laboratory facilities if appropriate.

C. Background and Need

    Thoroughly describe the need for funding and the current resources 
available for Core Capacity activities, to include:
    1. The overall State cardiovascular disease problem.
    2. The geographic patterns, trends, age, gender, racial and ethnic 
patterns, and other measures or assessments.
    3. The barriers the State currently faces in developing and 
implementing a statewide program for the prevention of cardiovascular 
diseases.
    4. The advisory groups, partnerships, or coalitions currently 
involved with the State health department for cardiovascular disease 
prevention and control.
    5. The current chronic disease programs within the State health 
department.
    6. The gaps in resources, staffing, capabilities, and programs 
that, if addressed, might further the progress of cardiovascular 
disease prevention; and how the funds will be used to fill the gaps in 
the core capabilities of the State cardiovascular disease prevention 
and control efforts.

D. Core Capacity Work Plan

    Provide a work plan that addresses each of the required Core 
Capacity elements cited in the Recipient Activities section above, to 
include the following information:
    1. Program objectives for each of the elements. Objectives should 
describe what is to happen, by when, and to what degree.
    2. The proposed methods for achieving each of the objectives.
    3. The proposed plan for evaluating progress toward attainment of 
the objectives.
    4. A milestone and completion chart for all objectives for the 
project period.
    5. If human subjects research will be conducted, describe how human 
subjects will be protected.

E. (Optional) Enhanced School Health Program (Not Included in 60 Page 
Limit; Has Its Own 25 Page Limit)

    Enhanced program efforts designed to reach youth during their 
formative years may be included as a program component of a Core 
Capacity Program. Describe planned activities for collaboration with 
the State education agency to develop a sustained effort with local 
education agencies and other relevant governmental and nongovernmental 
agencies to implement cardiovascular disease prevention strategies that 
address students, their families, school staff, and communities. 
Effective strategies might include activities such as policy mandates, 
environmental change, classroom instruction, school lunch programs, and 
involvement of families and community agencies. Strategies should 
establish, strengthen, or expand education intended to increase regular 
physical activity and healthy dietary patterns and to prevent or reduce 
tobacco use; and should integrate such education into a coordinated 
school health program. Planned activities and strategies are expected 
to be fully coordinated between State education and health programs and 
to strengthen school health programs. Applicants may establish 
qualified staffing in the State department of education as well as the 
State health departments.

    Note: There is no penalty for not undertaking optional 
activities.

F. Core Capacity Program Budget

    Provide a line-item budget with justifications consistent with the 
purpose and proposed objectives, using the format in Form 5161-1 or CDC 
Form 0.1246(CDC). Applicants are encouraged to include budget items for 
travel for three trips to Atlanta, GA for three individuals to attend 
3-day training and technical assistance workshops.
    The budget for the optional enhanced school health program should 
be distinguished from the general budget.
    Supporting material such as organizational charts, tables, position 
descriptions, relevant publications, letters of support, memorandums of 
agreement, etc., should be included in the appendixes and be 
reproducible.

III. Comprehensive Program

    (Narrative portions of the Comprehensive Program application may 
not exceed 120 double spaced, 12 point typed pages.)

A. Background and Need

    Provide a thorough description of the need for support, to include 
a detailed analysis of the cardiovascular disease problem in the State, 
the geographic and demographic distribution, age, sex, racial and 
ethnic groups, educational, and economic patterns of the diseases as 
well as the trends over time. Describe the barriers to successful 
implementation of a statewide program for prevention of cardiovascular 
diseases within the State; partnerships and collaboration with related 
agencies, and the status of policies and environmental approaches in 
place that influence risk factors and public awareness. Describe how 
the funding will be used to fill the gaps in cardiovascular disease 
prevention activities. Provide a description of the populations to be 
addressed, including Priority Populations, and their constituencies and 
leadership potential to develop and conduct program activities.

B. Staffing (Not Included in 120 Page Limitation)

    Describe project staffing and qualifications including contacts for 
physical activity, nutrition, and epidemiology. Provide organizational 
chart, curriculum vitae, job descriptions, and experience needed for 
all budgeted positions. Describe lines of communication between various 
related chronic disease programs.

C. State Plan

    Provide the current State plan (dated January 1997 or later) that 
includes population-based policy and environmental strategies as well 
as strategies for implementing community programs which utilize health 
care settings, work sites, the media, schools, community-based 
organizations, the community at-large; and which includes strategies 
addressing specific Priority Populations and communities.

D. Evaluation

    Provide description of surveillance and monitoring activities that 
include mortality, changes in environmental and policy indicators, and 
behavioral risk factors including statistically valid estimates for 
populations to be addressed. Describe the capability for

[[Page 33070]]

special one-time surveys. Describe how each of the program elements 
will be evaluated and which measures are considered critical to monitor 
for evaluating the success of the program. Describe the various 
existing data systems to be employed, how the systems might be adapted, 
and the specific program elements to be evaluated by those systems. 
Describe the schedules for data collection and when analyses of the 
data will become available. Describe how human subjects will be 
protected, if human subjects research is conducted.

E. Comprehensive Program Work Plan

    The work plan should address each of the required Core Capacity 
elements cited in the Recipient Activities section above in sufficient 
detail to describe the results expected and how the State will achieve 
the results. Objectives and strategies should specify priority 
populations to be addressed, communities, or geographic areas of 
concern; complete listings of the policy and environmental changes 
sought to create a heart-healthy environment for the population; other 
intervention strategies; coordination among State partners; risk factor 
changes, and strategies for closing the gap in cardiovascular disease 
disparity. Interventions should be expressed in terms of changes sought 
for the general population as well as changes in Priority Populations 
to be addressed. Population-based approaches should extend to a 
relatively large proportion of the State population rather than a few 
selected communities. Targeted strategies should clearly define the 
Priority Populations to be addressed. Objectives should describe what 
is to happen, by when, and to what degree. A milestone and activities 
completion chart should be provided for all objectives for the project 
period.

F. Collaboration

    Provide letters of support describing the nature and extent of 
involvement by outside partners and coordination among State health 
department programs, other State agencies, and nongovernmental health 
and nonhealth organizations. Describe how the overall delivery of 
interventions for priority populations will be enhanced by these 
collaborative activities. Describe current data systems and how 
coordination will be ensured with managed care providers, Medicaid, 
major employers, insurers, and other organized health care providers, 
as well as purchasers of health care.

G. Training Capability

    Provide a description of training sessions for health professionals 
provided within the past three years. Include agendas, dates, 
professional status or occupation, and number of attendees. Provide 
other evidence of training capabilities deemed appropriate to the 
program.

H. Budget Justification

    Provide a line-item budget consistent with Form 5161-1 or CDC Form 
1246(E) along with appropriate justifications. Applicants are 
encouraged to include budget items for travel for three trips to 
Atlanta, GA for three individuals to attend 3-day training and 
technical assistance workshops.
    The budget for Priority Populations and the optional comprehensive 
school health program should be distinguished from the general budget. 
Please use the separate columns provided in the Budget Information Form 
424A Section B.

I. (Optional) Enhanced Comprehensive School Health Program Should Not 
Exceed 25 Double-Spaced Pages

    Enhanced program efforts designed to reach youth during their 
formative years may be included as a program component of a 
comprehensive capacity program. Describe planned activities for 
collaboration with the State education agency to develop a sustained 
effort with local education agencies and other relevant governmental 
and nongovernmental agencies to implement cardiovascular disease 
prevention strategies that address students, their families, school 
staff, and their communities. Effective strategies include policy and 
environmental changes, school food service, classroom instruction, and 
involvement of families and community agencies. Strategies should 
establish, strengthen, or expand education intended to increase regular 
physical activity and healthy dietary patterns and to prevent or reduce 
tobacco use; and should integrate such education into a coordinated 
school health program. Planned activities and strategies are expected 
to be fully coordinated between State education and health programs and 
to enhance school health programs. Applicants may establish qualified 
staffing in the State department of education as well as the State 
health department.
    Supporting material such as organizational charts, tables, resumes, 
position descriptions, relevant publications, letters of support, 
memorandums of agreement, etc., may be appended to the narrative 
portion of the application and are not included in the page limitation.

Special Guidelines for Technical Assistance Workshop

    Technical assistance will be available for potential applicants in 
Atlanta, Georgia, beginning at 1:00 EDT on June 29 and ending at noon 
EDT on June 30. The purpose of the workshop is to help potential 
applicants to:
    1. Understand the scope and intent of the Program Announcement for 
the State Cardiovascular Health Programs;
    2. Plan coordinated approaches to assist the nation's health 
agencies in efforts to prevent cardiovascular diseases and related risk 
factors;
    3. Understand the role of policy and environmental changes in 
improving cardiovascular health;
    4. Be familiar with the Public Health Services funding policies and 
application and review procedures.
    Attendance at this workshop is not mandatory. Attendees must pay 
their travel, per diem, and all other expenses related to attending the 
workshop. The workshop will be held only if 10 or more persons sign-up 
to attend.
    Each potential applicant may send not more than two representatives 
to this workshop. Please provide the names of the attendees to Nancy B. 
Watkins, Division of Adult and Community Health, National Center for 
Chronic Disease Prevention and Health Promotion, Centers for Disease 
Control and Prevention, telephone (770) 488-5425; fax (770) 488-5964 
within ten days after the publication date of the program announcement.

Evaluation Criteria

    Applications will be reviewed and evaluated according to the 
following criteria:

I. Core Capacity Program (Total 100 Points)

A. Staffing (10 Points)

    The degree to which the proposed staff have the relevant 
background, qualifications, and experience; and the degree to which the 
organizational structure supports staffs' ability to conduct proposed 
activities. The degree of coordination between relevant programs within 
the State health department.

B. Facilities (5 Points)

    The adequacy of the applicant's facilities and resources.

C. Background and Need (15 Points)

    The extent to which the applicant identifies specific needs and 
resources available for Core Capacity activities.

[[Page 33071]]

The extent to which the funds will successfully fill the gaps in State 
capabilities. The extent to which the applicant demonstrates a review 
of journals and other publications particularly for policy and 
environmental strategies.

D. Core Capacity Work Plan (60 Points)

    1. (20 Points) The extent to which the plan for achieving the 
proposed activities appears realistic and feasible and relates to the 
stated program requirements and purposes of this cooperative agreement.
    2. (20 Points) The extent to which the proposed methods for 
achieving the activities appear realistic and feasible and relate to 
the stated program requirements and purposes of the cooperative 
agreement.
    3. (10 Points) The extent to which the proposed plan for evaluating 
progress toward meeting objectives and assessing impact appears 
reasonable and feasible.
    4. (10 Points) The degree to which partnerships are demonstrated 
through collaborative activities or letters of support.

E. Objectives (10 Points)

    The degree to which objectives are specific, time-phased, 
measurable, realistic, and related to identified needs, program 
requirements, and purpose of the program.

F. Budget (Not Scored)

    The extent to which the budget appears reasonable and consistent 
with the proposed activities and intent of the program.

G. Human Subjects Research (Not Scored):

    If the proposed project involves human subjects, whether or not 
exempt from the DHHS regulations, the extent to which adequate 
procedures are described for the protection of human subjects.

H. (Optional) Enhanced School Health Program (100 Points--Scored 
Separately)

1. Work Plan (60 Points)
    The extent to which the plan for achieving the proposed activities 
appears realistic and feasible and relates to the stated purposes of 
the optional Enhanced School Health Program. The extent to which 
objectives and plans increase the State's overall capability to address 
cardiovascular disease prevention and control; will reach youth during 
their formative years; promote collaboration and coordination between 
the State health department and the education agency; and propose to 
integrate appropriate cardiovascular-related health education into a 
coordinated school health program.
2. Objectives (10 Points)
    The degree to which objectives are specific, time-phased, 
measurable, realistic, and related to identified needs and purpose of 
the program.
3. Evaluation (15 Points)
    The extent to which the proposed plan for evaluating progress 
toward meeting objectives and assessing impact appears reasonable and 
feasible.
4. Partnerships (15 Points)
    The degree to which partnerships are demonstrated through 
collaborative activities or letters of support.
    Content of Noncompeting Continuation Applications submitted within 
the project period need only include:
    A. A brief progress report that describes the accomplishments of 
the previous budget period.
    B. Any new or significantly revised items or information 
(objectives, scope of activities, operational methods, evaluation, key 
personnel, work plans, etc.) not included in year 01 or subsequent 
continuation applications.
    C. An annual budget and justification. Existing budget items that 
are unchanged from the previous budget period do not need 
rejustification. Simply list the items in the budget and indicate that 
they are continuation items.
    However, States receiving Core Capacity Program funding may submit 
a competitive application for Comprehensive Program funding at the end 
of any budget period within the 5-year project period, provided new 
funds are available to fund additional Comprehensive Programs. These 
applications must successfully address the application Evaluation 
Criteria for the Comprehensive Program; and, if successful, they will 
move from Core Capacity funding to Comprehensive funding. If 
unsuccessful, they will continue with Core Capacity funding.

II. Comprehensive Program (Total 100 points):

A. Background and Need (10 Points)

    The extent to which the funds will fill the gaps in the State's 
cardiovascular disease prevention activities. The extent to which the 
applicant identifies specific needs in relation to geographic and 
demographic distribution of cardiovascular diseases with particular 
emphasis on Priority Populations; identifies trends in mortality and 
risk factors; identifies barriers to successful program implementation; 
and describes existing policy and environmental influences in terms of 
their affect on public awareness and the risk factors for 
cardiovascular diseases.

B. Staffing (10 points)

    The degree to which the proposed staff have the relevant 
background, qualifications, and experience; the degree to which the 
organizational structure supports staffs' ability to conduct proposed 
activities; the degree of staff coordination between relevant program 
within the State health department.

C. Comprehensive Work Plan (50 Points)

    1. (20 Points) The extent to which the plan for achieving the 
proposed activities appears realistic and feasible and relates to the 
stated program requirements and purposes of this cooperative agreement. 
The extent to which the plan addresses the needs of the State, the 
feasibility of the plan and the appropriateness of the planned 
interventions to the cardiovascular disease problem, and the adequacy 
of the plan to identify and address the needs of Priority Populations. 
If applicable, the degree to which the applicant has met the CDC policy 
requirements regarding the inclusion of women, ethnic, and racial 
groups in proposed research. This includes: (a) the proposed plan for 
the inclusion of both sexes and racial and ethnic minority populations 
for appropriate representation; (b) the proposed justification when 
representation is limited or absent; (c) a statement as to whether the 
design of the study is adequate to measure differences when warranted; 
and (d) documentation of plans for recruitment and outreach for study 
participants that includes the process of establishing partnerships 
with community(ies) and recognition of mutual benefits.
    2. (20 points) The extent to which the State Cardiovascular 
Diseases Plan addresses the problem through policy and environmental 
strategies and other appropriate population-based approaches and the 
extent of program activities that use work sites, the media, schools, 
community-based organizations, organizations of faith, the community at 
large.
    3. (10 Points) The extent to which collaboration of State 
nutrition, physical activity, health promotion, and other chronic 
disease programs with external partners is used to deliver the program; 
the extent to which coordination with other State chronic disease 
programs and other State agencies enhances the cardiovascular disease 
program; and the

[[Page 33072]]

extent of involvement of community-based organizations in the 
implementation of the program.

D. Evaluation (15 Points)

    The extent to which the evaluation plan appears capable of 
monitoring progress toward meeting specific project objectives, 
assessing the impact of the program on the general population, 
assessing changes in the Priority Populations, monitoring utilization 
of secondary prevention strategies, and assessing the implementation of 
policy and environmental strategies.

E. Professional Education (5 Points)

    The extent of experience and history of the applicant in conducting 
professional education, to include the involvement of or delivery of 
education by health professions organizations, medical societies, 
organized health care providers, medical universities, and purchasers 
of health care. The adequacy of the staff and plan to coordinate, 
affect, or deliver professional education related to the overall State 
Cardiovascular Disease Plan.

F. Objectives (10 Points)

    The degree to which the objectives are specific, time-phased, 
measurable, realistic, and relate to identified needs and purposes of 
the program, for both the general population as well as the targeted 
populations.

G. Budget (Not Scored)

    The extent to which the budget appears reasonable and consistent 
with the proposed activities and intent of the program.

H. Human Subjects Research (Not Scored)

    If the proposed project involves human subjects, whether or not 
exempt from the DHHS regulations, the extent to which adequate 
procedures are described for the protection of human subjects.

I. (Optional) Enhanced School Health Program: (Total 100 Points--Scored 
Separately)

1. Work Plan (60 Points)
    The extent to which the plan for achieving the proposed activities 
appears realistic and feasible and relates to the stated purposes of 
the optional Enhanced School Health Program. The extent to which 
objectives and plans increase the State's overall capability to address 
cardiovascular disease prevention and control; will reach youth during 
their formative years; promote collaboration and coordination between 
the State health department and the education agency; and propose to 
integrate appropriate cardiovascular-related health education into a 
coordinated school health program.
2. Objectives (10 Points)
    The degree to which objectives are specific, time-phased, 
measurable, realistic, and related to identified needs and purpose of 
the program.
3. Evaluation (15 Points)
    The extent to which the proposed plan for evaluating progress 
toward meeting objectives and assessing impact appears reasonable and 
feasible.
4. Partnerships (15 Points)
    The degree to which partnerships are demonstrated through 
collaborative activities or letters of support.
    Content of Noncompeting Continuation Applications submitted within 
the project period need only include:
    A. A brief progress report that describes the accomplishments of 
the previous budget period.
    B. Any new or significantly revised items or information 
(objectives, scope of activities, operational methods, evaluation, key 
personnel, work plans, etc.) not included in year 01 or subsequent 
continuation applications.
    C. An annual budget and justification. Existing budget items that 
are unchanged from the previous budget period do not need 
rejustification. Simply list the items in the budget and indicate that 
they are continuation items.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372, which sets up a 
system for State and local government review of proposed federal 
assistance applications. Applicants (other than federally recognized 
Indian tribal governments) 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 send them to Sharron P. Orum, Grants Management Officer, 
Grants Management Branch, Procurement and Grants Office, Centers for 
Disease Control and Prevention, 255 East Paces Ferry Road, NE., Room 
300, Mailstop E-18, Atlanta, GA 30305, no later than 30 days after the 
application deadline date. The Program Announcement Number and Program 
Title should be referenced on the document. The granting agency does 
not guarantee to ``accommodate or explain'' State process 
recommendations it receives after that date.

Public Health System Reporting Requirements

    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 93.988.

Other Requirements

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by the cooperative agreement for cardiovascular 
health program will be subject to review by the Office of Management 
and Budget (OMB) under the Paperwork Reduction Act.

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 
form provided in the application kit. Should human subjects review be 
required, the proposed work plan should incorporate time lines for such 
development and review activities.

Women, Racial and Ethnic Minorities

    It is the policy of the Centers for Disease Control and Prevention 
(CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) 
to ensure that individuals of both sexes and the various racial and 
ethnic groups will be included in CDC/ATSDR-supported research projects 
involving human subjects, whenever feasible and appropriate. Racial and 
ethnic groups are those defined in OMB Directive No. 15 and include 
American Indian or Alaskan Native, Asian, Black or African American, 
Hispanic or Latino, Native Hawaiian or other Pacific Islander.

[[Page 33073]]

Applicants shall ensure that women, racial and ethnic minority 
populations are appropriately represented in applications for research 
involving human subjects. Where clear and compelling rationale exist 
that inclusion is inappropriate or not feasible, this situation must be 
explained as part of the application. This policy does not apply to 
research studies when the investigator cannot control the race, 
ethnicity and/or sex of subjects. Further guidance to this policy is 
contained in the Federal Register, Vol. 60, No. 179, pages 47947-47951, 
dated Friday, September 15, 1995.

Application Submission and Deadline

    The original and two copies of the application PHS Form 5161-1 
(Revised 5/96) or CDC Form 0.1246(E) must be submitted to Sharron P. 
Orum, Grants Management Officer, Grants Management Branch, Procurement 
and Grants Office, Centers for Disease Control and Prevention, 255 East 
Paces Ferry Road, NE., Room 300, Mailstop E-18, Atlanta, GA 30305, on 
or before August 5, 1998.
    1. Deadline. Applications shall be considered as meeting the 
deadline if they are either: a. Received on or before the deadline 
date. b. Sent on or before the deadline date and received in time for 
submission to the objective 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 that 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 G. Locke Thompson, 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-18, Atlanta, GA 30305; telephone 404-
842-6595, fax (404) 842-6513, or the Internet or CDC WONDER electronic 
mail at <[email protected]>. Programmatic technical assistance may be 
obtained from Nancy B. Watkins, Division of Adult and Community Health, 
National Center for Chronic Disease Prevention and Health Promotion, 
Centers for Disease Control and Prevention, telephone (770) 488-5425; 
fax (770) 488-5964, or the Internet or CDC WONDER electronic mail at 
<[email protected]>.
    You may obtain this and other CDC announcements from one of two 
Internet sites on the actual publication date: CDC's homepage at http:/
/www.cdc.gov or at the Government Printing Office homepage (including 
free on-line access to the Federal Register at http://
www.access.gpo.gov).
    Please refer to Program Announcement Number 98084 when requesting 
information and submitting an application on the Request for 
Assistance.
    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) 512-1800.

    Dated: June 11, 1998.
John L. Williams,
Director, Procurement and Grants Office, Centers for Disease Control 
and Prevention (CDC).
[FR Doc. 98-16046 Filed 6-16-98; 8:45 am]
BILLING CODE 4163-18-P