[Federal Register Volume 67, Number 227 (Monday, November 25, 2002)]
[Notices]
[Pages 70602-70611]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-29837]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 03017]


Systems-Based Diabetes Prevention and Control Programs (DPCPs); 
Notice of Availability of Funds

A. Authority and Catalog of Federal Domestic Assistance Number (CFDA)

    This program is authorized under section 301(a) and 317(k)(2)of the 
Public Health Service Act, (42 U.S.C. section 241(a) and 247b(k)(2), as 
amended). The Catalog of Federal Domestic Assistance number is 93.988.

B. Purpose

    The Centers for Disease Control and Prevention (CDC), announces the 
availability of fiscal year (FY) 2003 funds for a cooperative agreement 
program for Systems-Based Diabetes Prevention and Control Programs 
(DPCPs). This program addresses the ``Healthy People 2010'' focus areas 
of Diabetes, Immunization, Access to Quality Health Services, Chronic 
Kidney Disease, Heart Disease and Stroke, Vision and Hearing, Nutrition 
and Overweight, Physical Activity and Fitness, and Public Health 
Infrastructure.
    Measurable outcomes of the program will be in alignment with the 
following performance goal for the National Center for Chronic Disease 
Prevention and Health Promotion (NCCDPHP): Increase the capacity of 
state diabetes control programs to address the prevention of diabetes 
and its complications at the community level.
    The Program will continue to emphasize prevention of complications 
and premature mortality among people with diabetes (i.e. secondary and 
tertiary prevention). Further, the Program will continue to incorporate 
a model of influence by linking new programs and existing programs that 
support social and environmental policies for the promotion of wellness 
in both people with diabetes, and those at risk for diabetes. In the 
future, CDC plans (pending available resources) to turn increasing 
attention to the identification and dissemination of lifestyle 
interventions proven to be effective in preventing or delaying Type 2 
diabetes among people with impaired fasting glucose or impaired glucose 
tolerance.
    For additional background information please see attachment II of 
this announcement as posted on the CDC web site at: www.cdc.gov.

C. Eligible Applicants

    Assistance will be provided only to the health departments of 
states or their bona fide agents, and Territories, including the 
District of Columbia, the Commonwealth of Puerto Rico, the Virgin 
Islands, the Commonwealth of the Northern Mariana Islands, American 
Samoa, Guam, the Federated States of Micronesia, the Republic of the 
Marshall Islands, and the Republic of Palau. Competition is limited to 
health departments or their bona fide agents because they are uniquely 
positioned to perform, oversee and coordinate diabetes prevention and 
control activities in public health settings and as part of a larger 
public health system. All States and Territories are currently 
receiving funding for diabetes programs under prior CDC announcements 
97064, 98034, and/or 99078.

(Note: Throughout this document the use of the term ``State'' or 
``statewide'' also refers to the Territories described above.)

    For the first year, states currently receiving CDC funds for 
Comprehensive Programs (funded under program announcements 97064, 
98034, and 99078) are entitled to apply for Comprehensive Program 
funding only.
    States currently receiving CDC funds for Core Programs (funded 
under program announcement 99078) are eligible to apply for either Core 
or Comprehensive Program funding. Applicants will receive only a Core 
or Comprehensive award.

[[Page 70603]]

    Current Core programs applying for Core funding will undergo a 
technical review of their application and will be funded pending 
receipt and approval of a technically acceptable application.
    Current Comprehensive Programs and Core Programs applying for 
Comprehensive funding must submit an application which will undergo a 
competitive review process by an independent objective review panel. As 
a contingency, currently funded Core programs applying for 
Comprehensive awards should submit two separate work plans, with budget 
line items and budget justifications, one for a Core Program and one 
for a Comprehensive Program.
    All applications received from current grant recipients under 
Program Announcements 97064, 98034, and 99078 will be funded for either 
a Core or a Comprehensive Program.
    After the first year, Tier 2 DPCPs (see explanation of Tier 2 in 
section ``E. Program Requirements'') will be eligible to compete for 
Special Projects of National Significance based on availability of 
funds in years two through four. Eligibility will be limited to high 
performing Tier 2 DPCPs that demonstrate multi-system integration of 
public health services and partnerships into a comprehensive, highly 
functioning, and accountable program. A number of key innovative 
strategies, implemented by these DPCPs, have been sustained or 
institutionalized, documented in public health reports or scientific 
literature and disseminated to other programs as appropriate.

    Note: Public Law 104-65 states that an organization described in 
section 501(c) (4) of the Internal Revenue Code of 1986 which 
engages in lobbying activities shall not be eligible for the receipt 
of Federal funds constituting an award, grant, loan or any form.

D. Funding

Availability of Funds

    Approximately $23 million is available in FY 2003 to fund 59 
awards. It is estimated that approximately $10 million will be 
available to fund approximately 41 Core awards. It is expected that the 
average federal contribution to the Core award will be $244,000, 
ranging from $50,000 to $400,000. Approximately $13 million will be 
available to fund approximately 18 Comprehensive awards. It is expected 
that the average federal contribution to the Comprehensive award will 
be $725,000 ranging from $400,000 to $900,000.
    It is expected that the awards will begin on or about March 30, 
2003, and will be made for a 12-month budget period within a project 
period of up to five years. Funding estimates may vary depending on 
availability of funds.
    Continuation awards within an approved project period will be made 
on the basis of satisfactory demonstration of accomplishment of 
proposed activities, performance improvement plans and results, and the 
availability of funds.

Direct Assistance

    You may request Federal personnel as direct assistance, in lieu of 
a portion of financial assistance.

Use of Funds

    Resources available under this program announcement may not be used 
to: (1) Support direct patient care services, screening services, 
individual health services, or the treatment of diabetes; (2) duplicate 
existing efforts the federal system has established for outpatient 
diabetes education reimbursement for the Medicare population through 
the Diabetes Education Program Recognition administered by the Centers 
for Medicaid and Medicare Services (CMS); or (3) supplant existing 
State or Federal funding including the Preventive Health and Health 
Service block grant or other sources.
    Programs that have adequately addressed the program key components 
(see attachment IV of this announcement as posted on the CDC web site) 
and are high performing comprehensive (or Tier 2 in years 2-5) programs 
may dedicate a portion of the resources available under this program 
announcement to conduct research projects. Funded research projects 
involving human subjects will be governed by 45 Code of Federal 
Regulations, part 46.
    Applicants are encouraged to identify and leverage opportunities 
which will enhance their work with other State health department 
programs that address related chronic diseases or risk factors. This 
may include cost sharing to support shared staff positions, such as a 
chronic disease epidemiologist, program evaluator, health communication 
specialist, etc. Other cost sharing activities that cut across chronic 
disease programs and are directly related to recipient program 
activities may also be appropriate.

Recipient Financial Participation

    Matching funds are required for this program. Matching funds are 
required from non-Federal sources in an amount not less than $1 for 
each $5 of Federal funds awarded to Core programs and; $1 for each $4 
for Comprehensive programs. The matching funds may be cash or its 
equivalent in-kind or donated services, fairly evaluated. The 
contribution may be made directly or through donations from public or 
private entities. Match requirements may change for Tier levels in 
years two through five. Matching funds must be consistent with the work 
plan activities that are submitted and approved.
    Matching funds may not be met through: (1) The payment of treatment 
services or the donation of treatment, or direct patient diabetes 
education services; (2) services assisted or subsidized by the Federal 
Government; or (3) the indirect or overhead of an organization.

Funding Preference

    Due to resource limitations, preference in funding Comprehensive 
Programs will be given to states with:
    1. A larger burden of diabetes and related complications.
    2. A larger proportion of residents experiencing racial and ethnic 
disparities in diabetes prevalence and diabetes related complications.
    3. Varied geographic representation across the United States.
    4. Varied distribution of population density among funded programs.

E. Program Requirements

    In conducting activities to achieve the purpose of this program, 
both Core and Comprehensive DPCPs will be responsible for the 
activities under 1. Recipient Activities (except where otherwise 
noted), and CDC will be responsible for the activities under 2. CDC 
Activities. It is expected that Comprehensive Programs will demonstrate 
a more intensive level of effort in each category of recipient 
activities.

1. Recipient Activities

    a. Define the burden of diabetes in a manner that informs and 
influences public health decision making: Maintain a state specific 
diabetes surveillance system. This should be accomplished through 
previously established surveillance systems and ensuring that the 
Behavioral Risk Factor Surveillance System (BRFSS), Diabetes Module (or 
other appropriate surveillance system for the Territories), is 
conducted yearly. Yearly administration of the Diabetes Module is a 
requirement. The surveillance system should support and inform public 
health decision making. At a minimum, this data should be used to 
generate performance-based outcome measures specific to recommended 
foot and eye exams, immunizations, and

[[Page 70604]]

annual Hemoglobin A1C (A1C) tests. It should also be used to guide 
program activities. Systems should monitor trends, disseminate data and 
information, and support evaluation efforts. Comprehensive Programs are 
expected to implement special surveillance strategies (e.g., over-
sampling, special surveys, sentinel surveillance systems) that address 
unmet surveillance needs.
    b. Establish and maintain a presence for diabetes prevention and 
control within the State Health Department. Implement the following 
critical functions of fiscal management, performance management, 
program assessment, and strategic planning to carry out the program by 
working through the respective State and Territorial Health Department 
infrastructure.
    (1). Fiscal Management: Develop a Fiscal Management system that 
supports the program. This system should have the following capacity: 
accurate and timely tracking of expenditures and sources of match 
support; accurate projection of categorical balances; and the 
prevention of excessive unobligated balances by having the flexibility 
to reallocate funds into appropriate budget categories if priorities 
change or if staffing patterns change. DPCPs need to establish linkages 
with appropriate state fiscal management staff, and develop a process 
for regularly assessing program needs and monitoring expenditures.
    (2). Performance Management: The DPCP should engage health 
department leadership to develop a performance management system that 
incorporates capacity improvement processes and strategic 
accountability measures. For Comprehensive Programs, a written plan of 
this performance management system should be in place. This should 
assist health department officials to create accountability processes 
within state programs. This will enable them to introduce rewards for 
good performance and consequences for poor performance. The performance 
management system should also be linked to the evaluation system and 
the budget process.
    (3). Program Assessment: DPCPs are expected to conduct reflective, 
partner-included assessments to identify strengths and needs in the 
DPCP's public health infrastructure. Efforts to strengthen identified 
essential public health services, deemed particularly important in 
achieving the program's goals, should follow the assessments by 
developing a performance improvement plan based on identified services 
that need strengthening. DPCPs will assess and continuously improve 
public health services so that policies and legislation related to 
issues such as access to quality care and environmental conditions 
encourage positive health outcomes. Further, DPCPs will support 
participatory community efforts promoting systems and community-based 
approaches aimed at increasing years of healthy life and eliminating 
the disproportionate burden of diabetes borne by particular racial and 
ethnic populations. The Ten Essential Public Health Services (see 
attachment III of this announcement as posted on the CDC web site) will 
provide the basis for assessment. More extensive involvement of 
partners state-wide is expected of Comprehensive Programs. State public 
health agencies may or may not be the lead agency for several specific 
essential public health services. In these cases, identifying the role 
of the state public health agency with a support role by the DPCP, will 
help in prioritizing the essential public health services most relevant 
to achieving the goals of the diabetes program. Performance improvement 
plans will be implemented in year two and beyond. DPCPs will be 
expected to demonstrate measurable results linked to performance 
improvement plans annually.
    (4). Strategic Planning: Develop or update a State Diabetes 
Strategic Plan for diabetes prevention and control with the goal of 
advancing the prevention and control of diabetes and its complications, 
improving access to and the quality of diabetes services and care, and 
eliminating disparities between population groups. The DPCP and its 
partners should be involved in the development and implementation of 
the State Diabetes Strategic Plan. The State Diabetes Strategic Plan 
should also inform and guide the activities of the DPCP and its 
partners. As they become available, the results of the Assessment 
should guide the periodic update and improvement of the State Diabetes 
Strategic Plan. For Comprehensive Programs, the plan should be 
comprehensive in nature and reflective of the strategies and activities 
of the diabetes health system in the state.
    c. Program Design Enhancement: Expand the current DPCP program 
model of influence. DPCPs should serve as a catalyst for change 
positively impacting people with diabetes, their families, and their 
communities. The DPCP should engage the State Diabetes Health System 
(SDHS) which includes the DPCP, the state health agencies and other 
health partners that contribute to diabetes services and programs at 
the state level, in this effort. Activities include the current 
population-based approaches for secondary and tertiary prevention for 
people with diabetes. All activities described must be relevant, 
complementary to, and consistent with ongoing national efforts such as 
the National Diabetes Education Program (NDEP), and with national 
priorities for eliminating racial and ethnic health disparities for 
diabetes. Core Program activities aligned with the ten essential public 
health services can include small scale pilots in selected geographic 
areas or statewide interventions. Comprehensive Programs are expected 
to have a wider scope of activities in all areas of influence. 
Comprehensive Programs must also develop public health activities that 
reach the entire State or implement an existing multifaceted intensive 
program in a limited geographical area within a defined target 
population. Allowable program activities that emerge from evolving 
science will be addressed in future guidance documents which will 
accompany each request for continuing application.
    d. Establish and Maintain Effective Partnerships: Create a culture 
of shared responsibility with the SDHS and other nontraditional 
partners. The DPCP and partners should collectively plan, implement, 
and evaluate goals and objectives and align resources to priorities. 
The DPCP should engage the SDHS to measure the quality and 
effectiveness of collective efforts and the DPCP's ability to establish 
and maintain effective partnerships. The goal should be inclusiveness 
rather than exclusiveness to achieve synergistic results. Within the 
State Health Department, the DPCP should collaborate and coordinate 
with partners such as nutrition, physical activity, tobacco, 
cardiovascular health, maternal and child health, health promotion, 
PHHS block grant, State Minority Health Program, Office of Women's 
Health, Office On Aging, public information officer, as well as data 
partners such as vital statistics and the State's BRFSS. Comprehensive 
Programs must demonstrate a more extensive partnership base and more 
significant level of engagement with those partners.
    e. Evaluation: Conduct ongoing monitoring and evaluation of 
diabetes prevention and control activities and strategies, including 
process and impact evaluation. State evaluation efforts should 
complement and be consistent with national program evaluation goals. 
Comprehensive Programs are expected to submit an evaluation methodology 
designed to demonstrate more in-depth, purposeful evaluation of program 
activities.
    f. Management Information System (MIS): The MIS will be used for 
post

[[Page 70605]]

award administration, program monitoring, technical assistance, and 
programmatic decision making. Programs are expected to ensure that 
information is entered into the MIS in a timely manner. Office of 
Management and Budget (OMB) clearance for the data collection initiated 
under this cooperative agreement has been approved. (OMB No. 0920-0479. 
Expiration date 7/31/2003.)
    g. Protection of Human Subjects: Ensure that program activities 
follow all applicable federal regulations concerning the protection of 
human subjects and the confidentiality of personally identifiable data.
Year One
    DPCPs will be awarded as either Core or Comprehensive Programs for 
the first year.
    1. Core programs are expected to establish and maintain a presence 
in the health department for diabetes prevention and control; define 
the burden of diabetes in the state and communicate it in a manner that 
informs and influences public health decision making; establish and 
maintain effective partnerships; develop a State Diabetes Strategic 
Plan; and engage in small scale pilots in accordance with program 
guidance.
    2. Comprehensive programs are expected to meet all of the 
requirements of a Core program and implement statewide interventions or 
implement multifaceted intensive strategies in geographically defined 
targeted populations to reduce or eliminate the burden of diabetes.
Years Two Through Five
    In subsequent years (years two through five), DPCPs will be placed 
in one of two Tier levels based on their performance as documented in 
the interim progress reports, and on the availability of funds. The 
award strategy is designed to support documented performance results 
from quality intervention and performance improvement plans. Awards 
will also be based on budget justification, alignment with CDC 
strategies, and the ability of a state to continuously execute 
performance improvement and intervention plans.
Tier 1
    This Tier level is intended to support capacity-building programs 
by establishing a performance management system; a state team with 
multiple skill sets; an epidemiology-based State Diabetes Strategic 
Plan to achieve program goals; highly functioning, accountable 
partnerships; and program strategies and activities to reduce 
documented burden of diabetes. In this Tier, culturally relevant small-
scale interventions at community and/or systems levels, with specific 
priority audiences in particular communities or geographic areas, are 
expected.
    The performance expectations of this Tier include
    1. Meeting minimum requirements outlined in the DPCP Key Components 
document (see attachment IV of this announcement as posted on the CDC 
web site).
    2. Developing a performance improvement plan reflecting priority 
areas identified in the diabetes public health assessment which is 
based on the ten essential public health services.
    3. Developing a work plan that meets program criteria (logic-
modeled) with budget justification.
    4. Providing evidence of results based on proximal performance 
measures which are anticipated to lead to the achievement of the CDC, 
Division of Diabetes Translation's (DDT's) National Objectives.
Tier 2
    DPCPs in this Tier level have a broader-based program capacity 
supported by the elements of Tier 1, but with increasingly integrated 
and highly functional partnerships and measurable effects. Programs in 
this Tier systematically implement priority strategies and 
interventions in priority communities throughout the state, consistent 
with their State Diabetes Strategic Plan. They must have evidence of 
improvement in the diabetes public health infrastructure. Program 
impacts and results must be evident and measurable through the DPCP 
performance management system. They have also demonstrated national 
leadership, sharing lessons learned among local, state, and national 
partners.
    The performance expectations of this Tier include:
    1. Demonstrating quality activities linked to the Ten Essential 
Public Health Services with activities in each of the four indicators.
    2. Demonstrating results in the implementation of improvement 
plans.
    3. Meeting the expectations of Tier 1.
    4. Developing a work plan that meets Tier 2 criteria (logic-
modeled) with budget justification based on Tier 2 funding levels.
    5. Demonstrating readiness in terms of capacity to take on a larger 
scope of program activities (staffing, management support, 
technological resources, partnerships, etc.).
    6. Providing evidence of results based on proximal performance 
measures which are anticipated to lead to the achievement of the CDC, 
DDT's National Objectives.
Special Projects of National Significance
    High performing Tier 2 programs will be eligible to request 
additional funding to support projects of national significance. Tier 2 
DPCPs who are awarded funds to carry out these Special Projects have 
demonstrated multi-system integration of public health services and 
partnerships into a comprehensive, highly functioning, and accountable 
program. A number of key innovative strategies, implemented by these 
DPCPs, have been sustained or institutionalized, documented in public 
health reports or scientific literature and disseminated to other 
programs as appropriate. It is anticipated that Special Projects will 
be funded for a specified period of time and may include one or more of 
the following: (1) Spreading successful population-based interventions 
accomplished in earlier phases of the program to reach populations 
still unserved; (2) Conducting projects which provide national 
leadership in sharing and promoting processes and results. Helping CDC 
to influence national policies based on emerging needs and discovery of 
effective practices and policies; and (3) Developing and conducting 
research projects of national significance, which appropriately 
contribute to the emerging diabetes public health science base.
    The performance expectations of the Special Projects will be 
specific to the nature of the Project, with the expectation that the 
Tier 2 programs that are conducting the Special Projects will:
    1. Demonstrate quality activities linked to the Ten Essential 
Public Health Services with activities in each of the four indicators.
    2. Demonstrate results in the implementation of improvement plans.
    3. Meet the expectations of Tier 2.
    4. Develop a work plan that meets criteria for Tier 2 programs and 
Special Projects with appropriate budget justification based on the 
nature of the Project.
    5. Demonstrate readiness in terms of capacity to take on a larger 
scope of program activities required to implement Special Projects 
(staffing, management support, technological resources, partnerships, 
etc.).
    6. Provide evidence of results based on proximal performance 
measures which are anticipated to lead to the

[[Page 70606]]

accomplishment of the CDC, DDT's National Objectives.
    2. CDC Activities.
    a. Provide ongoing guidance, training, consultation, and technical 
assistance in all aspects of diabetes prevention and control, as 
described under Recipient Activities.
    b. Provide up-to-date information that describes proven 
interventions and current research in appropriate areas of diabetes 
prevention and control.
    c. Provide resources, tools, and technical assistance to improve 
and enhance program evaluation efforts.
    d. Provide resources and technical assistance to improve monitoring 
and surveillance systems. Provide technical assistance in the 
coordination of surveillance and other data systems to measure and 
characterize the burden of diabetes.
    e. Collaborate with the DPCPs and other appropriate partners to 
develop and disseminate programmatic guidance and other resources for 
specific interventions, health communication campaigns, and other 
national initiatives.
    f. Facilitate the adoption and adaptation of effective practices 
through workshops, trainings, conferences, and electronic and verbal 
communication among recipients of cooperative agreement awards under 
this program announcement, and other diabetes prevention and control 
partners.
    g. Support the development and maintenance of a system for DPCP 
input into planning and sharing of information.
    h. Assist in and support the development and maintenance of 
partnerships and networks with Federal and non-Federal, public and 
private sector organizations to help implement diabetes prevention and 
control programs, thereby maintaining a national infrastructure to 
complement the infrastructure in the states and territories and their 
local jurisdictions.
    i. Facilitate effective communication and integration between NDEP 
and state DPCPs. This includes, but is not limited to, NDEP training, 
media, and other program products and tools.
    j. Provide up-to-date information on the responsible conduct of 
research and technical assistance for program activities involving 
human subjects.

F. Content

    The Program Announcement title and number must appear in the 
application. Use the information in the Program Requirements, Recipient 
Activities, Evaluation Criteria, and Other Requirements sections to 
develop the application content. Your application will be evaluated on 
the criteria listed, so it is important to follow them in laying out 
your program plan. The applications (excluding forms and attachments) 
should be no more than 50 pages, double-spaced, printed on one side, 
with one-inch margins, and unreduced 12 point font. Necessary 
supporting information (tables, organizational charts, position 
descriptions, etc.) may be provided as attachments. A signed original 
and two copies of the application must be mailed to the CDC Grants 
Office.
    Applicants are strongly encouraged to utilize the MIS. The format 
of DDT's MIS complements the application content specified in this 
announcement. Therefore, to avoid duplication of effort, the 
application content may be entered into the DDT MIS. Hard copies will 
be generated from the MIS for formal submission to the CDC Procurement 
and Grants Office with the required signed forms. OMB clearance for the 
data collection initiated under this cooperative agreement has been 
approved. (OMB No. 0920-0479. Expiration date 7/31/2003.)
    Applicants for comprehensive level funding must demonstrate optimal 
core capacity as evidenced by the following: Established surveillance 
systems; sound infrastructure and management (including fiscal 
management, performance management, program assessment, and strategic 
planning); proven experience with results in the implementation of well 
designed small-scale pilot projects; effective partnerships; and sound 
monitoring and evaluation of diabetes prevention and control activities 
including process and impact evaluation. In addition, Comprehensive 
Program applications must include a plan to develop public health 
activities that reach the entire State, or to implement an existing 
multifaceted intensive program in a limited geographical area within a 
defined target population.
    Both Core and Comprehensive Program applicants should respond to 
items one through seven below. However, applicants should note that in 
some areas different information is requested of applicants. Current 
Core grantees applying for a Comprehensive award should provide two 
separate applications, one Core application and one Comprehensive 
application, and address the comprehensive component by describing 
their planned or proposed comprehensive activities.
    1. Background and Need:
    a. Provide an estimate of the burden of diabetes and its 
complications, and its geographic and demographic distribution within 
the State. Reference the data sources that support these estimates. 
Describe the challenges to diminishing the morbidity and mortality from 
diabetes in your State.
    b. Include a description of the populations that are at high risk 
for diabetes in your State. If possible, describe the social, 
ecological, or economic conditions that contribute to the 
disproportionate burden of diabetes in the population, as well as 
knowledge, attitudes, and beliefs that impact the health practices of 
the population. If available, attach references for any studies or 
sources from which this information was obtained.
    c. Provide an analysis of the barriers to addressing the burden of 
diabetes in the State.
    2. Program Accomplishments and Proven Capacity:
    a. Describe efforts to develop and incorporate diabetes 
surveillance systems, including BRFSS, in monitoring and tracking 
diabetes-related health status in the State. Include information on how 
data is used in diabetes program planning and decision making.
    b. Describe unique or significant advances toward achieving program 
objectives and the CDC, DDT's National Objectives.
    c. Provide findings, conclusions, or status of pilot projects and/
or statewide activities. Where appropriate, provide success stories of 
program activities or other methods of determining success.
    d. Provide examples of successful efforts to influence the 
widespread application of accepted standards, policies, and protocols. 
Describe the methodology for determining the success of these efforts.
    e. Describe specific program activities and accomplishments in 
addressing the needs of underserved populations, or populations at high 
risk for diabetes in the State.
    f. Describe how the DPCP engages partners, including their diabetes 
advisory groups or coalitions, other Chronic Disease Programs, and non-
traditional partners, in program planning, implementation, coordinating 
efforts and evaluation in support of the DPCP work plan objectives.
    g. Describe how the DPCP has managed its fiscal and human resources 
in the past five years (including history of unobligated balances, how 
match requirements have been met, turnover in key staff positions, 
professional development of DPCP staff, supportive leadership, etc.).
    h. Provide letters of support that reflect the involvement of 
diverse (traditional and non-traditional) organizations in planning the 
response

[[Page 70607]]

to this program announcement. Include specific roles and 
responsibilities of the partner providing the letter in the State 
Diabetes Strategic Plan or activity/intervention that is pertinent.
    i. If available, provide a state diabetes strategic plan, diabetes 
advisory group or coalition by-laws, action plans, and any other 
substantive work products from these partnerships that demonstrate 
quality and effectiveness.
    3. Program Work Plan:
    Provide a clear work plan that addresses the items listed below. 
Some objectives may reflect the process by which the program or 
activity is developed, while others will reflect the actual public 
health impact, output or outcome that results.
    Each DPCP should state their measurable and time-phased objectives 
for the project period that will help achieve the goal(s) of the 
program. A ``logic model'' or causal relationship should be evident 
among the long term objectives, process objectives, and activities.
    a. Provide measurable and time-phased long term objectives for the 
five-year project period that should mirror the following CDC, DDT's 
National Objectives:
    (1). By 2008, DPCPs should have demonstrated success in achieving 
an increase in persons with diabetes who receive recommended foot 
exams, eye exams, flu and pneumococcal immunizations, and A1C tests.
    (2). By 2008, DPCPs should have demonstrated progress in 
establishing linkages for the promotion of wellness and physical 
activity for persons with diabetes.
    (3). By 2008, all DPCPs should have demonstrated progress in 
eliminating health disparities for high risk populations with respect 
to diabetes prevention and control.
    (4). Each DPCP should establish measurement procedures and 
surveillance systems, including baseline and target measurements of the 
percent of persons with diabetes receiving recommended foot exams, eye 
exams, flu and pneumococcal immunizations and recommended A1C tests, as 
a means of assessing program success. b. Provide measurable, specific 
and time-phased one year budget period objectives that will help 
achieve the stated time-phased long term objectives. c. Describe in 
detail a plan for systems-based activities, and methods for achieving 
each of the proposed one year budget period objectives.
    4. Evaluation Plan:
    Describe how progress, the achievement of program objectives and 
the effectiveness of program activities will be monitored and 
evaluated. Describe how data will be collected, analyzed, and used to 
improve the program. Specify the person(s) responsible for designing 
and implementing evaluation activities, collecting and analyzing data, 
and reporting findings. DPCPs should incorporate the six steps of the 
``CDC Framework for Program Evaluation'' when creating the DPCP 
evaluation plan. The six connected steps assist in the planning and 
evaluation of a variety of interventions. The CDC Evaluation Framework 
steps are:
    Step 1: Engage stakeholders: Include individuals and organizations 
that are involved in program operations, served or affected by the 
program, and the primary users of evaluation.
    Step 2: Describe the program: Descriptions should be sufficiently 
detailed to ensure understanding of program objectives and strategies. 
Include a logic model that links program objectives and activities to 
eventual outcomes/effects.
    Step 3: Focus the evaluation design: Specify the questions to be 
answered through the evaluation activities proposed. These questions 
should guide the evaluation process and be directly linked to the 
objectives stated above. Specify the methods for quantitative and 
qualitative data collection, such as the use of questionnaires, 
surveys, other data collection instruments, interviews, and focus 
groups, etc. (Assure that appropriate Human Subjects Research 
procedures and OMB requirements have been followed and documented.)
    Step 4: Gather credible evidence: Specify the information (data) 
that will be collected to answer the evaluation questions stated above. 
Specify the sources of information (data) to be collected. Since this 
evaluation is designed to measure change as a result of the 
intervention, specify the baseline against which the change is being 
measured.
    Step 5: Justify conclusions: Specify the process to be used to 
analyze, synthesize, and report the data.
    Step 6: Ensure use and share lessons learned: Explain how the data 
resulting from the evaluation will be used to improve or expand the 
program. Discuss how the results of the evaluation will be reported and 
who will receive the results.
    More information about the six steps can be found at: http://www.cdc.gov/eval/framework.htm.

    Note: Include samples of data collection tools in the 
attachments, if available.

    In addition, the evaluation plan should document and describe 
program successes, unmet needs, barriers, and problems encountered in 
planning, implementing, or in coordinating activities.
    5. Program Infrastructure and Management Plan: Describe how the 
program will be effectively managed including:
    a. Staffing: Minimal key staffing for the program should include a 
full-time DPCP coordinator, a designated evaluation lead, and a 
designated epidemiology/surveillance lead.
    b. Staffing Responsibilities: Responsibilities of key staff should 
include: a DPCP coordinator responsible for the overall program 
operation and coordination; a designated evaluation lead responsible 
for ensuring that the program and its projects are evaluated regularly 
for process and impact measures and that results are appropriately 
disseminated; and a designated epidemiology/surveillance lead who will 
ensure the integrity of surveillance systems and other DPCP 
epidemiological activities and facilitate intra and inter health 
department exchange of epidemiological information. In addition, the 
DPCP should designate a staff member to facilitate and oversee a 
process for integrating other program components such as NDEP messages 
and tools into program planning and implementation activities.
    c. Management Plan and Organization Operations: Provide a copy of 
the organizational chart that indicates the placement of the proposed 
program. A description of clear and direct lines of authority within 
the program staff and to the next two higher levels of supervisory 
authority should be provided. Fiscal controls and their relationship to 
program staff and management should be included. Discuss strategies for 
ensuring timely and appropriate communication among staff on the status 
of program implementation and related issues. The DPCP should receive 
guidance and support from the State Chronic Disease Director or the 
equivalent. The priority DPCP goals and objectives should be part of, 
or incorporated in, the overall State Health Department strategic plan.
    d. Qualifications: Describe the qualifications of the designated or 
proposed staff. Provide abbreviated (one-to-two page) resumes and brief 
job descriptions for designated staff, and brief job descriptions for 
the proposed staff.
    e. Responsibility: Identify key staff positions responsible for the 
implementation of each program activity, especially the required full

[[Page 70608]]

time coordinator, the evaluation lead and the epidemiology/surveillance 
lead.
    f. Contingency plans: Describe plans for ongoing management and 
operation of the project if there are unexpected vacancies, hiring 
restrictions, or difficulty recruiting in key positions.
    6. Financial Participation: Matching funds are required from non-
Federal sources in the amount of not less than $1 for each $5 of 
Federal funds awarded to Core Programs under this program announcement. 
Comprehensive Programs are required to match $1 for each $4 of Federal 
funds awarded under this announcement. Match requirements may change in 
years two through five. The applicant should identify and describe:
    a. Sources of allowable matching funds for the program and the 
estimated amounts from each.
    b. Procedures for documenting and tracking the receipt and value of 
noncash matching funds.
    7. Budget and Narrative Justification:
a. Financial Assistance
    Provide a detailed line-item budget and narrative justification for 
all operating expenses consistent with and clearly related to the 
proposed objectives and planned activities. Be precise about the 
program purpose of each budget item and itemize calculations when 
appropriate.
    Applicants are required to attend the DDT Annual Conference and the 
DPCP Project Directors' Meeting and should budget appropriately. DPCPs 
are also encouraged to attend and participate in non-conference 
training such as Diabetes Today and the Diabetes Collaborative, as 
appropriate. Other travel which may be of relevance to the DPCP goals 
and activities include the annual meetings of the following 
organizations: National Diabetes Education Program Partnership Network, 
ASTCDD (Chronic Disease Conference), American Diabetes Association 
(ADA), American Association for Diabetes Educators (AADE), National 
Association of Community Health Centers (NACHC), American Association 
of Health Plans (AAHP) and American Public Health Association (APHA). 
Travel budget should support other recipient activities as considered 
necessary.
b. Direct Assistance
    To request a Federal assignee, applicants must provide the 
following information:
    1). Number of assignees requested
    2). Description of the position and proposed duties
    3). Ability or inability to hire locally with financial assistance
    4). Justification for request
    5). Organizational chart and name of intended point of contact to 
assignee
    6). Opportunities for training, education, and work experiences for 
assignees
    7). Description of assignees' access to computer equipment for 
communication with CDC (e.g., personal computer at home, personal 
computer at workstation, shared computer at workstation on site, shared 
computer at a central office).

G. Application Submission and Deadline

Application Forms

    Submit the signed original and two copies of CDC Form 0.1246(E). 
Forms are available at the following Internet address: http://www.cdc.gov/od/pgo/forminfo.htm If you do not have access to the 
internet, or if you have difficulty accessing the forms on-line, you 
may contact the CDC Procurement and Grants Office Technical Information 
Management Section (PGO-TIM) at: 770-488-2700. Application forms can be 
mailed to you.

Submission Date, Time, and Address

    Applications must be received by 4 p.m. Eastern Time January 9, 
2003. Submit the application to: Technical Information Management--
PA03017, CDC Procurement and Grants Office, 2920 Brandywine 
Road, Room 3000, Atlanta, Georgia 30341-4146.

CDC Acknowledgment of Application Receipt

    A postcard will be mailed by PGO-TIM, notifying you that CDC has 
received your application.

Deadline

    Applications shall be considered as meeting the deadline if they 
are received before 4 p.m. Eastern Time on the deadline date. 
Applicants sending applications by the United States Postal Service or 
commercial delivery services must ensure that the carrier will be able 
to guarantee delivery of the application by the closing date and time. 
If an application is received after closing due to: (1) carrier error, 
when the carrier accepted the package with a guarantee for delivery by 
the closing date and time, or (2) significant weather delays or natural 
disasters, CDC will, upon receipt of proper documentation, consider the 
application as having been received by the deadline.
    Applications which do not meet the above criteria will not be 
eligible for competition and will be discarded. Applicants will be 
notified of their failure to meet the submission requirements.

H. Evaluation Criteria

    Applicants are required to provide measures of effectiveness that 
will demonstrate the accomplishment of the various identified 
objectives of the cooperative agreement. Measures of effectiveness must 
relate to the performance goal stated in section ``B. Purpose'' of this 
announcement. Measures must be objective and quantitative and must 
measure the intended outcome. These measures of effectiveness shall be 
submitted with the application and shall be an element of evaluation.
    An Objective Review Panel appointed by CDC will evaluate the 
scientific and technical merit of Comprehensive Program applications 
and their responsiveness to the information requested in the 
``Application Content'' sections above. Core Program applications will 
receive a technical review for acceptability. Each application will be 
reviewed and evaluated against the following criteria:
Core Program Evaluation Criteria (100 Points Total)
1. Program Work Plan (75 points Total)
    The extent to which the work plan addresses the following 
information:
a. Long Term and Process Objectives (10 points)
    Measurable, specific, time-phased five-year project period long 
term objectives, and measurable, time-phased one-year budget period 
process objectives that will help achieve the goals and objectives of 
the program. The applicant used the State's latest data as baseline.
b. Program Work Plan Methodology (25 points)
    The Program Work plan provides a detailed description of system-
based activities and methods for achieving each of the proposed one 
year budget period objectives that appears reasonable and likely to be 
successful.
c. Evaluation Plan (20 points)
    The plan for evaluating progress, the effectiveness of activities 
and attainment of each of the proposed objectives, to include a clear 
description of the evaluation methodology and frequency of reporting, 
appears adequate. The six steps of the CDC Framework for Program 
Evaluations are used as a framework for the plan. (See section E. 4. 
Evaluation Plan under Application Content section). Logic

[[Page 70609]]

models that link program objectives and activities to eventual 
outcomes/effects should be included.
d. Program Infrastructure and Management Plan (20 points)
    DPCP staffing pattern adequately supports the work plan proposed to 
include the number and type of staff and their qualifications and 
experience. The Management Plan describes a methodology for effective 
management, to include a sound management structure, i.e. a full time 
DPCP coordinator and designated evaluation and epidemiology/
surveillance leads; clear and direct lines of authority, supervisory 
and fiscal controls; contingency plans for ongoing management in case 
of unexpected staff disruption shall be included. Include a copy of the 
organizational chart that indicates the placement of the DPCP, resumes 
for designated staff, and job descriptions for the proposed staff. 
Strategies for ensuring timely and appropriate communication among 
staff on the status of program implementation and related issues are 
included in the plan. Describe how the DPCP and its partners will 
collaborate to collectively complete a diabetes specific assessment 
based on the ten essential public health services. The results of the 
assessment will assist in identifying specific areas of strength and 
areas for improvement in developing an optimal public health diabetes 
program in subsequent years.
2. Accomplishments and Proven Capacity of the Core Program (15 points)
    Core program accomplishments and activities that make it appear 
likely that the applicant will successfully carry out proposed 
activities, to include:
    a. Existing state-based diabetes surveillance system, including 
annual administration of the Diabetes Module of the BRFSS.
    b. Advances toward achieving the CDC, DDT's National Objectives 
(provide data as evidence of progress).
    c. Findings, conclusions, or status of pilot projects in health 
systems, health communications, and community interventions.
    d. Examples of successful efforts to influence the widespread 
application of accepted standards, policies, and protocols, which 
support diabetes prevention and control.
    e. Accomplishments of any diabetes advisory groups or coalitions in 
providing guidance to the DPCP in program planning, implementation, 
coordinating efforts and evaluation (may include a copy of the by-
laws).
    f. Activities and accomplishments in addressing the needs of 
underserved populations and/or populations with a disparate burden of 
diabetes and its related complications are included.
    g. DPCP's management of its fiscal and human resources in the past 
five years (including history of unobligated balances, how match 
requirements have been met, turnover in key staff positions, 
professional development of DPCP staff, supportive leadership, etc.) 
are addressed.
3. Background and Need (10 points)
    The extent to which the DPCP demonstrates the need for support. 
Narrative should include:
    a. Estimated prevalence of diabetes and its complications, and its 
geographic and demographic distribution within the State.
    b. Description of the high risk populations, including racial/
ethnic minorities, the elderly, and the indigent/disenfranchised 
population. Description of the characteristics of the targeted 
population relative to the social, ecological, or economic conditions 
that contribute to the disproportionate burden of diabetes in the 
population, as well as their knowledge, attitudes, beliefs, and health 
practices relative to diabetes.
    c. Analysis of the findings of (b) above in relation to known or 
anticipated barriers to diabetes education, self management, preventive 
community services and health care.
4. Budget and Justification (Reviewed but Not Scored)
    The extent to which the line item budget justification is 
reasonable and consistent with the purpose and program goal(s) and 
objectives of the cooperative agreement. This includes both requests 
for financial assistance and how the DPCP proposes to meet the match 
requirement.
    5. If any resources available under this program announcement will 
be used to conduct research projects involving human subjects, the 
application must adequately address Title 45 CFR Part 46. (Reviewed but 
Not Scored, however an application can be disapproved if the research 
risks are sufficiently serious and protection against risks is so 
inadequate as to make the entire application unacceptable.)
    6. The degree to which the applicant has met the CDC Policy 
requirements regarding the inclusion of women, ethnic, and racial 
groups in the proposed research. This includes: (1) The proposed plan 
for the inclusion of both sexes and racial and ethnic minority 
populations for appropriate representation; (2) The proposed 
justification when representation is limited or absent; (3) A statement 
as to whether the design of the study is adequate to measure 
differences when warranted; and (4) A statement as to whether the plans 
for recruitment and outreach for study participants include the process 
of establishing partnerships with community(ies) and recognition of 
mutual benefits. (Reviewed but Not Scored)
Comprehensive Program Evaluation Criteria (100 points total)
1. Program Work Plan (60 points total)
    The Program Work plan provides a detailed description of system-
based activities and methods for achieving each of the proposed 
objectives that appears reasonable and likely to be successful.
    a. Long Term and Process Objectives (10 points) Measurable, 
specific, time-phased five-year project period long term objectives, 
and measurable, specific, time-phased one year budget period process 
objectives, that will help achieve the time-phased long term objectives 
of the program, are provided. The DPCP used the state's latest data as 
baseline.
    b. Program Work Plan Methodology (20 points) The Work Plan provides 
a detailed description of systems-based activities and methods for 
achieving each of the proposed one year budget period objectives that 
appears reasonable and likely to be successful. Existing comprehensive 
activities are described, including plans for maintaining or modifying 
them. New Comprehensive program activities are adequately described and 
justified.
    c. Evaluation Plan (15 points) The plan for evaluating progress, 
the effectiveness of activities and attainment of each of the proposed 
objectives, to include a clear description of the evaluation 
methodology and frequency of reporting, appears adequate. The plan 
should incorporate the six steps of the CDC Framework for Program 
Evaluation. (See section E. 4. Evaluation Plan under Application 
Content section). Logic models that link program objectives and 
activities to eventual outcomes/effects should be included.
d. Program Infrastructure and Management Plan (15 points)
    DPCP staffing pattern adequately supports the work plan proposed to 
include the number and type of staff and their qualifications and 
experience. The Management Plan describes a methodology for effective 
management,

[[Page 70610]]

to include a sound management structure, i.e. a full time DPCP 
coordinator and designated evaluation and epidemiology/surveillance 
leads; clear and direct lines of authority, supervisory and fiscal 
controls; contingency plans for ongoing management in case of 
unexpected staff disruption shall be included. A copy of the 
organizational chart that indicates the placement of the DPCP, resumes 
for designated staff and job descriptions for the proposed staff. 
Strategies for ensuring timely and appropriate communication among 
staff on the status of program implementation and related issues are 
included in the plan. The management plan should demonstrate how the 
DPCP will address increased program responsibility and fiscal and human 
resources. Describe how the DPCP and its partners will collaborate to 
collectively complete a diabetes specific assessment based on the ten 
essential public health services. The results of the assessment will 
assist in identifying specific areas of strength and areas for 
improvement in developing an optimal public health diabetes program in 
subsequent years.
2. Program Accomplishments and Proven Capacity To Serve as a 
Comprehensive Program (35 points)
    Program accomplishments and activities that make it appear likely 
that the applicant will successfully carry out proposed comprehensive 
activities to include:
    a. Advanced and enhanced state-based diabetes surveillance system, 
minimally including annual administration of the diabetes module of the 
BRFSS.
    b. Status and impact of statewide and other comprehensive program 
activities in health systems, health communications, and community 
interventions that have advanced the program toward achieving 
improvements in the CDC, DDT's National Objectives. Data should be 
provided to support program impact and as evidence of progress.
    c. Description of evaluation activities and examples of efforts to 
disseminate program activities and lessons learned to the broader 
diabetes community.
    d. Evidence of internal and external policy changes resulting from 
comprehensive program efforts, including accomplishments of any 
diabetes advisory groups or coalitions (may include a copy of the by-
laws).
    e. Examples of successful efforts to influence the widespread 
application of accepted standards, policies, and protocols which 
support diabetes prevention and control.
    f. Accomplishments in addressing the needs of underserved 
populations and/or reducing health disparities in populations with a 
disparate burden of diabetes and its related complications.
    g. DPCP's management of its fiscal and human resources in the past 
five years (including history of unobligated balances, how match 
requirements have been met, turnover in key staff positions, 
professional development of DPCP staff, supportive leadership, etc.) 
are addressed.
3. Background and Need (5 points)
    The extent to which the DPCP demonstrates the need for support. 
Narrative should include:
    a. Estimated prevalence of diabetes and its complications, and its 
geographic and demographic distribution within the State.
    b. Description of the high risk populations, including racial/
ethnic minorities, the elderly, and the indigent/disenfranchised 
population. Description of the characteristics of the targeted 
population relative to the social, ecological, or economic conditions 
that contribute to the disproportionate burden of diabetes in the 
population, as well as their knowledge, attitudes, beliefs, and health 
practices relative to diabetes.
    c. Analysis of the findings of b. above in relation to known, or 
anticipated, barriers to diabetes education, self management, 
preventive community services and health care.
4. Budget and Justification (reviewed but not scored)
    The extent to which the line-item budget justification is 
reasonable and consistent with the purpose and program goals and 
objectives of the cooperative agreement. This includes both requests 
for financial assistance and how the DPCP proposes to meet the match 
requirement.
    5. If any resources available under this program announcement will 
be used to conduct research projects involving human subjects, the 
application must adequately address title 45 CFR part 46. (Reviewed but 
Not Scored, however, an application can be disapproved if the research 
risks are sufficiently serious and protection against risks is so 
inadequate as to make the entire application unacceptable.)
    6. The degree to which the applicant has met the CDC Policy 
requirements regarding the inclusion of women, ethnic, and racial 
groups in the proposed research. This includes: (1) The proposed plan 
for the inclusion of both sexes and racial and ethnic minority 
populations for appropriate representation; (2) The proposed 
justification when representation is limited or absent; (3) A statement 
as to whether the design of the study is adequate to measure 
differences when warranted; and (4) A statement as to whether the plans 
for recruitment and outreach for study participants include the process 
of establishing partnerships with community(ies) and recognition of 
mutual benefits. (Reviewed but Not Scored)

I. Other Requirements

Technical Reporting Requirements

    Provide CDC with a signed original and two copies of:
    1. Interim progress reports, no less than 90 days before the end of 
the budget periods. The format of the Division of Diabetes 
Translation's (DDT) Management Information System (MIS) is aligned with 
the interim progress report content. Therefore, to avoid duplication of 
effort, the interim progress report content may be entered into the DDT 
MIS and hard copies generated from MIS for formal submission to the CDC 
Procurement and Grants Office. The content of the interim progress 
report must be entered into the DDT MIS, by the grantee, within one 
month of the due date of the interim progress report. The interim 
progress report will serve as your non-competing continuation 
application, and must contain the following broad elements (subject to 
change as the program evolves): progress and performance for the first 
eight months of the current budget period objectives/activities, the 
proposed objectives/activities for the new year's budget period related 
to Surveillance, Work Plan, Program Coordination, Program 
Infrastructure, and Financial information (including a detailed line-
item budget and justification). Progress in implementing improvement 
plans starting in year two, must be reported as part of the required 
interim progress reports.
    2. Financial status report, no more than 90 days after the end of 
each budget period.
    3. Final financial and performance reports no more than 90 days 
after the end of the five year project period.
    Send all reports to the Grants Management Specialist identified in 
the ``Where to Obtain Additional Information'' section of this 
announcement.
    The following additional requirements are applicable to this 
program. For a complete description of each, see Attachment I of this 
announcement as posted on the CDC web site.


[[Page 70611]]


AR-1 Human Subjects Requirements
AR-2 Requirement for Inclusion of Women and Racial and Ethnic 
Minorities in Research
AR-7 Executive Order 12372 Review
AR-9 Paperwork Reduction Act Requirements
AR-10 Smoke-Free Workplace Requirements
AR-11 Healthy People 2010
AR-12 Lobbying Restrictions

J. Where To Obtain Additional Information

    This and other CDC announcements, the necessary applications, and 
associated forms can be found on the CDC web site, Internet address: 
http://www.cdc.gov. Click on ``Funding'' then ``Grants and Cooperative 
Agreements.''
    For general questions about this announcement, contact: Technical 
Information Management, CDC Procurement and Grants Office, 2920 
Brandywine Road, Room 3000, Atlanta, GA 30341-4146. Telephone (770) 
488-2700.
    For business management and budget assistance in the States, 
contact: Angela Webb, Grants Management Specialist, Acquisition and 
Assistance Branch B, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC), 2920 Brandywine Road, Room 3000, Atlanta, 
GA 30341-4146. Telephone (770) 488-2784. Email address: [email protected].
    For business management and budget assistance in the Territories, 
contact: Terri Brown, Grants Management Specialist, International & 
Territories Acquisition and Assistance Branch, Procurement and Grants 
Office, Centers for Disease Control and Prevention (CDC), 2920 
Brandywine Road, Room 3000, Atlanta, Georgia 30341-4146. Telephone 
(770) 488-2638. Email address: [email protected].
    For program technical assistance, contact: Patricia L. Mitchell, 
MPH, Health Comm. Section Chief, Program Development Branch, DDT, 
NCCDPHP, Centers for Disease Control and Prevention (CDC), 4770 Buford 
Highway, MS K10, Atlanta, GA 30341-3717. Telephone (770) 488-5634. 
Email address: [email protected].

    Dated: November 12, 2002.
Edward Schultz,
Acting Director, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC).
[FR Doc. 02-29837 Filed 11-22-02; 8:45 am]
BILLING CODE 4163-18-P