[Federal Register Volume 68, Number 90 (Friday, May 9, 2003)]
[Notices]
[Pages 25035-25047]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-10986]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 03135]


Steps to a HealthierUS: A Community-Focused Initiative To Reduce 
the Burden of Asthma, Diabetes, and Obesity; Notice of Availability of 
Funds

    Application Deadline: July 15, 2003.

A. Authority and Catalog of Federal Domestic Assistance Number

    This program is authorized under section 301(a) and 317(k)(2) of 
the Public Health Service Act, (42 U.S.C., sections 241(a) and 
247b(k)(2), as amended. The Catalog of Federal Domestic Assistance 
Number is 93.283.

B. Purpose

    The Department of Health and Human Services (HHS), acting through 
the Centers for Disease Control and Prevention (CDC), and combining the 
strengths and resources of all relevant HHS agencies and programs, 
announces the availability of fiscal year (FY) 2003 funds for a 
cooperative agreement program to implement the Secretary of HHS 
Initiative for Americans entitled Steps to a HealthierUS (hereafter 
referred to as STEPS). The relevant HHS agencies and offices include, 
but are not limited to, the Administration on Aging, Administration for 
Children and Families, Agency for Healthcare Research and Quality, CDC, 
Centers for Medicare and Medicaid Services, Food and Drug 
Administration, Health Resources and Services Administration, Indian 
Health Service, National Institutes of Health, Office of Disease 
Prevention and Health Promotion, and the Substance Abuse and Mental 
Health Services Administration hereafter referred to as ``HHS 
agencies'').
    STEPS is a bold new initiative. The centerpiece of this initiative 
is a five-year cooperative agreement program to create healthier 
communities by improving the lives of Americans through innovative and 
effective community-based health promotion and chronic disease 
prevention and control programs.
    STEPS is based on the President's HealthierUS Initiative, which 
highlights the influence that healthy lifestyles and behaviors--such as 
making healthful nutritional choices, being physically active, and 
avoiding tobacco use and exposure--have in achieving and maintaining 
good health for persons of all ages. STEPS will work through public-
private partnerships at the community level to support community-driven 
programs that enable persons to adopt healthy lifestyles that 
contribute directly to the prevention, delay, and/or mitigation of the 
consequences of diabetes, asthma, and obesity.
    The initiative's goals are to:

[sbull] Prevent 75,000 to 100,000 Americans from developing diabetes
[sbull] Prevent 100,000 to 150,000 Americans from developing obesity
[sbull] Prevent 50,000 Americans from being hospitalized for asthma

    The purpose of STEPS is to enable communities to reduce the burden 
of chronic disease, including: Preventing diabetes among populations 
with prediabetes; increasing the likelihood that persons with 
undiagnosed diabetes are diagnosed; reducing complications of diabetes; 
preventing overweight and obesity; reducing overweight and obesity; and 
reducing the complications of asthma. STEPS will achieve these outcomes 
by improving nutrition; increasing physical activity; preventing 
tobacco use and exposure, targeting adults who are diabetic or who live 
with persons with asthma; increasing tobacco cessation, targeting 
adults who are diabetic or who live with persons with asthma; 
increasing use of appropriate health care services; improving the 
quality of care; and increasing effective self-management of chronic 
diseases and associated risk factors.
    The key to the success of STEPS will be community-focused programs 
that include the full engagement of schools, businesses, faith-
communities, health care purchasers, health plans, health care 
providers, academic institutions, senior centers, and many other 
community sectors working together to promote health and prevent 
chronic disease. STEPS programs need to build on, but not duplicate, 
current and prior HHS programs and coordinate fully with existing 
programs and resources in the community.

Background

    In the United States today, seven of ten deaths and the vast 
majority of serious illness, disability, and health care costs are 
caused by chronic diseases, such as diabetes, asthma, and obesity. 
Underlying these serious diseases are several important risk factors 
that can be modified years before they contribute to illness and death. 
Three risk factors--poor nutrition, lack of physical activity, and 
tobacco use and exposure--are major contributors to the nation's 
leading causes of death and must be addressed as part of this 
initiative. The first two of these risk factors contribute primarily to 
obesity and diabetes. Tobacco use contributes primarily to asthma, but 
it also contributes to the risk of poor circulation and heart disease 
among those who have diabetes. Research has demonstrated a clear link 
between exposure to tobacco smoke and exacerbation of asthma, and has 
provided evidence of a causal link between exposure to tobacco smoke 
and the development of asthma. Research has also shown that smoking 
heightens the risk for diabetes-related complications of neuropathy and 
nephropathy; cigarette use has been shown to be a significant risk 
factor for death by coronary heart disease in type 2 diabetes. By 
requiring recipients to address nutrition, physical activity, and 
tobacco use as core components of their community interventions, STEPS 
programs will reduce the burden of diabetes, asthma, and obesity.
    Efforts to address risk factors and disease management through 
improved health care access, health care utilization, health care 
quality, and self-management skills, including adherence to medication 
and other health regimens, also may be addressed as part of this 
initiative. While payment for health care services is not an allowable 
expense under this program announcement, increasing access to and use 
of diagnostic screening and improved treatment can be accomplished in 
four primary ways: (1) Identifying existing services and resources in 
the community and linking/referring persons to treatment; (2) educating 
health care providers on current standards of care and methods for 
implementing those standards; (3) developing consumer awareness and 
demand for quality health care (e.g., using media to promote increased

[[Page 25036]]

demand for vaccinations, appropriate screenings, and treatment); (4) 
helping health care providers implement effective office-based 
strategies, such as patient reminder systems, that help ensure timely 
and appropriate care.
    This cooperative agreement is designed to establish community-
based, coordinated, comprehensive health promotion, prevention, and 
control programs of sufficient intensity and durability to create 
sustainable change and thereby achieve the ``Healthy People 2010'' 
objectives shown in Attachment A. All referenced attachments are posted 
with this announcement on the CDC Web site (http://www.cdc.gov). Click 
on ``Funding'' then ``Grants and Cooperative Agreements''.
    Resources useful to the preparation of applications and in support 
of program implementation are available in Attachment B.
    Cooperative agreement recipients are expected to participate fully 
in coordinated monitoring and evaluation activities that include 
collecting and reporting common performance measures as well as 
participating in an independent, external evaluation to measure the 
impact of STEPS.

C. Eligible Applicants

    Cities, urban communities, states, and Tribes or Tribal consortia 
are eligible under this announcement. The District of Columbia, other 
large cities, and urban communities (defined as a contiguous geographic 
area (including counties) with a population exceeding 400,000 persons) 
with substantial expertise and infrastructure for the design, delivery 
and evaluation of chronic disease prevention and control interventions 
can apply directly under this announcement (hereafter referred to as 
``Large City and Urban Community'' applicants). Federally recognized 
Tribal Governments, Regional Area Indian Health Boards, Urban Indian 
organizations, and Inter-Tribal Councils which serve 10,000 or more 
American Indians/Alaskan Natives in their catchment area(s) can apply 
directly under this announcement (hereafter referred to as ``Tribal'' 
applicants). All other communities, not otherwise included in the 
applications above, may be eligible for awards under state applications 
(hereafter referred to as ``State-Coordinated Small City and Rural 
Community'' applicants).
    In determining eligibility, Large Community and Urban Community 
applicants must meet the criteria under number 1 below, Tribal 
applicants must meet the criteria under number 2 below, and State-
Coordinated Small Cities and Rural Community applicants must meet the 
criteria under number 3 below.

    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, contract, or any other 
form.

1. Large City and Urban Community Applicants

    The official local health department (or its bona fide agent), or 
its equivalent, as designated by the mayor, county executive, or other 
equivalent governmental official, will serve as the lead/fiduciary 
agent for a Large City and Urban Community application. For this 
announcement, the term ``large cities and urban communities'' is 
defined as any contiguous geographic area (including counties) with a 
population exceeding 400,000 persons. The District of Columbia is 
eligible to apply for funding under this section of the program 
announcement. Large City and Urban Community Applicants can specify an 
intervention area that is smaller than the entire city or community, 
but the intervention area must be geographically contiguous and must 
include a population of at least 150,000 residents, but not more than 
500,000 residents. Only one application will be accepted from each 
eligible large city and urban community.

2. Tribal Applicants

    Federally recognized Tribal Governments, Regional Area Indian 
Health Boards, Urban Indian organizations, and Inter-Tribal Councils as 
designated by the Principal Tribal elected official or chief executive 
officer will serve as the lead/fiduciary agency for tribal 
applications. Each tribal application must include a minimum population 
of 10,000 American Indians/Alaskan Natives within a defined geographic 
area or set of areas that may or may not be geographically contiguous.

3. State-Coordinated Small City and Rural Community Applicants

    The official state health department (or its bona fide agent), or 
its equivalent, as designated by the Governor, is to serve as the lead/
fiduciary agency for Small City and Rural Community applications. For 
this announcement, the term ``State'' includes the 50 states, the 
Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of 
the Northern Marianna Islands, American Samoa, Guam, the Federated 
States of Micronesia, the Republic of the Marshall Islands, and the 
Republic of Palau. States must identify two to four communities of 
total resident size not to exceed 800,000 persons combined. Each 
selected community must be geographically contiguous and include a 
minimum population of 10,000 persons. Neighboring small or rural 
counties may be grouped together to form a single, contiguous 
``community.'' States are strongly encouraged to include diverse 
communities that vary in size and location. HHS anticipates funding 
some programs that encompass rural communities as well as small cities. 
Only one application will be accepted from each state.

D. Funding

Availability of Funds

    Approximately $13,650,000 is available in FY 2003 to fund STEPS. Of 
this amount, approximately $9,000,000 is available to fund 9 to 12 
Large City and Urban Community applications. It is expected that the 
average award will be $1,000,000 and will range from $750,000 to 
$1,250,000. Approximately $250,000 is available to fund one Tribal 
application. Of the total amount available, approximately $4,400,000 is 
available to fund up to four State-Coordinated Small City and Rural 
Community application. It is expected that the average award will be 
$1,500,000 and will range from $1,000,000 to $2,000,000. State Health 
Departments must ensure that 75 percent of the total STEPS award is 
distributed on an annual basis to the identified communities in the 
state-coordinated application within four months of the award date, and 
that the remaining funds are used to support the funded communities 
through technical assistance and other means.
    It is expected that awards will begin on or about September 22, 
2003, and will be made for a 12-month budget period within a project 
period of up to five years. It is expected that projects will emphasize 
program assessment and evaluation during the first two years of 
funding. Continuation awards and level of funding within an approved 
project period (FY 2004 through FY 2007) will be based on the 
availability of funds and satisfactory progress in achieving 
performance measures as evidenced by required progress reports.
    Funding for FY 2004 and beyond is expected to range from $2,000,000 
to $3,000,000 for each Large City and Urban Community recipient; 
$300,000 to $1,000,000 for each Tribal recipient; and from $4,000,000 
to $10,000,000 for each State-Coordinated Small City and Rural 
Community recipient. It is also anticipated that additional FY 2004

[[Page 25037]]

resources may enable the Secretary to fund additional prevention 
initiatives based on this announcement or a separate announcement.
    Applicants funded for the first time in FY 2004 will be required to 
submit a revised work plan and budget in order to receive funds at FY 
2004 funding levels during their first year of funding.
    Pending availability of funds, beginning in FY 2004 and each of the 
remaining years of this program announcement (September 22, 2004 
through September 21, 2007), there may be an open season for new 
competitive applications. Specific guidance will be provided with exact 
application due dates and funding levels each year.

Recipient Financial Participation

    Matching funds, that is, a specific percentage of program costs 
that must be contributed by a recipient in order to be eligible for 
this announcement, are not required. Applicants are encouraged, 
however, to identify financial and in-kind contributions from their own 
organization and their partners to support and sustain the activities 
of this program announcement. Program applications that include private 
partners who contribute in-kind or funding support and incentives to 
these efforts are strongly encouraged.

Funding Preferences

    Preference in funding, based on well-documented data, may be given 
to ensure:
    [sbull] Inclusion of populations disproportionately affected by 
chronic disease and associated risk factors.
    [sbull] Inclusion of geographic areas with high, age-adjusted rates 
of chronic disease and associated risk factors.
    [sbull] Geographic distribution of STEPS programs nationwide.
    [sbull] Inclusion of communities of varying sizes, including rural, 
suburban, and urban communities.

Use of Funds

    Cooperative agreement funds may be used to expand, enhance, or 
complement existing activities to accomplish the objectives of this 
program announcement. Funds may be used to pay for, but are not limited 
to: staffing, consultants, contractors, materials, resources, travel, 
and associated expenses to implement and evaluate intervention 
activities such as: promoting healthy food choices in away-from-home 
settings; encouraging restaurants to label heart-healthy menu items; 
establishing community walking programs; helping schools, worksites, 
shopping malls, senior centers, and other community locations establish 
health-promoting programs and environments; establishing community-
based education, exercise, healthy nutrition, and smoking cessation 
programs in accessible locations; educating health plans and providers 
regarding standards for preventive health care practices and how to 
fully implement them; enhancing office-based systems to ensure that 
persons with chronic disease are called for routine exams and other 
follow-up; using information technology (such as the web and email) to 
communicate with people with chronic disease or associated risk 
factors; developing community support groups for persons with chronic 
disease or associated risk factors; conducting awareness and media 
campaigns to educate persons about their risk of chronic disease and 
what actions to take; using health risk appraisals such as the American 
Diabetes Association's self-assessment risk tool, ``Take the Test/Know 
Your Score''; conducting community-based outreach to high-risk 
individuals, encouraging them to seek appropriate care; establishing 
telephone hotlines for tobacco cessation and other health information 
needs; training lay health workers (``promotoras'') to conduct health 
promotion programs.
    Funds received under this announcement may not be used to supplant/
replace existing local, state, or federal funds or activities. 
Cooperative agreement funds may not be used for direct patient care, 
diagnostic medical testing, patient rehabilitation, pharmaceutical 
purchases, facilities construction, lobbying, basic research or 
controlled trials.
    Lead/fiduciary agencies will be eligible to receive up to five 
percent of their total award for indirect costs.

Direct Assistance

    Direct assistance, that is, assistance provided by the Federal 
government in the form of Federal employee staffing when detailed to 
the recipient (pay, allowances, and travel), supplies, or equipment in 
lieu of cooperative agreement/financial assistance funds, is not 
available as part of FY 2003 STEPS awards. Direct assistance in lieu of 
cash may be available in subsequent years.

E. Program Requirements

    All recipient activities funded under this program announcement 
need to coordinate with and reinforce, but not duplicate, related, 
existing federal, state, and local activities. In conducting activities 
to achieve the purpose of this program announcement, Large Cities and 
Urban Community applicants will be responsible for the activities 
listed under number 1 below, Tribal applicants for the activities 
listed under number 2 below, State-Coordinated Small City and Rural 
Community applicants for the activities listed under number 3 below, 
and HHS Agencies for the activities listed under number 4 below. All 
recipients must address both community and school-based components.

1. Large City and Urban Community Recipient Activities

(a) Fiduciary Responsibilities
    i. Lead Agency. Establish the lead/fiduciary agency to be the local 
health department (or its bona fide agent) or its equivalent as 
designated by the mayor, county executive, or other equivalent 
governmental official.
    ii. Allocate Funds. Allocate and disperse funds to the local 
education agency or agencies responsible for schools within the 
intervention area, and additional key partners and collaborators to 
implement recipient activities. Include adequate funds to participate 
fully in the substantial data collection and evaluation activities 
associated with this award.
    iii. Contract Services. Contract for services, as needed, to 
accomplish the objectives of this program announcement.
    vi. Link Budget to Performance. Provide integrated progress and 
financial reports that link the performance and expenditures of the 
local health department and all key partners.
    v. Sustainability. If funded for years three through five, engage 
in efforts that will sustain successful interventions on a long-term 
basis.
(b) Community Consortium
    Identify key partners and coalitions that focus on the prevention 
and control of chronic disease and associated risk factors. Build an 
alliance of partnerships and coalitions committed to participating 
actively in the planning, implementation, and evaluation of STEPS. 
Effective partnerships are central to the success and sustainability of 
STEPS. Key partners should demonstrate a high-level commitment to the 
initiative by their willingness to invest expertise, leadership, 
personnel, and other resources in the success of the project.
    Partners must include, but are not limited to, the mayor's office 
(or equivalent); local and state health departments; local and state 
education agencies; key community, health care, voluntary, and 
professional

[[Page 25038]]

organizations; business, community, and faith-based leaders; and at 
least one lay person representative of the population to be served. 
Other partners may include, but are not limited to, existing community 
coalitions (especially those already focusing on chronic diseases), 
Federally Qualified Health Centers including community health centers 
\1\, worksite wellness programs, health care purchasers, health plans, 
unions, health care providers for farm and migrant workers and their 
families, school-based and school-linked clinics, health care providers 
for the homeless, primary care associations, social service providers, 
health maintenance organizations, private providers, hospitals, 
universities, schools of public health, academic health centers, 
organizations that serve young children and youth, parks and recreation 
departments, departments of transportation, public housing authorities, 
state Medicaid officials, service organizations, food manufacturers and 
distributors, aging services organizations, senior centers, community 
action groups, consumer groups, and the media.

    Note: \1\ Consolidated Health Centers under Section 330, of the 
Public Health Service Act are commonly referred to as community 
health centers. They include centers that tailor resources for 
populations such as low-income persons, the uninsured, homeless 
people, migrant and seasonal farm workers, and public housing 
residents.

(c) Leadership, Coordination, and Management
    i. Leadership Team. Establish and coordinate a leadership team 
responsible for overseeing project activities, establishing and 
maintaining an organizational structure and governance for the 
community consortium (including decision-making procedures), 
determining the project budget and subcontracts, and participating in 
project-related local and national meetings. The leadership team must 
include, but is not limited to, the local health department, the local 
education agency or agencies, and other key leaders from the community.
    ii. Project Staff. Establish and maintain paid project staff to 
include a full-time project coordinator with management experience in 
risk factor interventions and community-based chronic disease 
prevention and control. Other part-time or full-time staff, contactors, 
and consultants must be sufficient in number and expertise to ensure 
project success and have demonstrated skills and experience in 
coalition and partnership development, community mobilization, health 
care systems, public health, program evaluation, epidemiology, data 
management, health promotion, policy and environmental interventions, 
health care quality improvement, communications, resource development, 
school health, and the risk factor and disease areas targeted by the 
program.
    iii. Project Management. The project coordinator with the other 
project staff and leadership team, should:
    a. Encourage active participation of consortium members in project 
activities and decisions, through regular meetings and other proactive 
methods of communication
    b. Actively oversee all project activities during their planning, 
development, implementation, and evaluation phases
    c. Track performance in relationship to the achievement of short-
term and intermediate outcomes and budgetary expenditures
    d. Seek technical assistance from the State, HHS agencies, other 
Federal agencies, other recipients, national voluntary organizations, 
universities, or other sources
    e. Keep the Project Officer informed and seek Project Officer input 
and assistance
    f. Take corrective action promptly when necessary to ensure project 
success
    g. Participate in STEPS-wide program evaluations.
    iv. Coordinate with State Plans and Activities. Ensure that 
community objectives, activities, and interventions are consistent with 
and supportive of state plans and activities for the prevention and 
control of diabetes, asthma, obesity, and associated risk factors. 
Ensure that community objectives, activities, and interventions do not 
duplicate existing efforts.
    (d) Community Action Plan, Community and School-Based Interventions
    Identify and implement high priority, eligible intervention 
strategies proven to prevent and control diabetes, asthma, and obesity. 
To establish such priorities, communities must examine their chronic 
disease burden, at-risk populations, current services and resources, 
and partnership capabilities to develop a comprehensive community 
action plan.
    Communities can select particular areas of programmatic focus 
within STEPS. However, all communities must address nutrition, physical 
activity, and tobacco use and exposure since these areas will 
positively impact primary and/or secondary prevention in diabetes, 
asthma, and obesity. Additionally, communities are expected to 
implement other specific interventions to reduce the burden of the 
diseases/conditions addressed by STEPS (asthma, diabetes, and obesity). 
Such interventions might include: (1) Conducting community-wide 
campaigns to implement a diabetes assessment questionnaire (e.g., 
American Diabetes Association's ``Are You at Risk?''); (2) promoting 
quality care by providing health care settings with effective systems 
for handling referrals, follow-ups, and patient reminder systems; and 
(3) providing training for health care providers on how to establish 
effective asthma care plans with patients and their families.
    i. Community Interventions. Programs are expected to employ 
multiple, evidence-based public health strategies based on the existing 
and emerging research base and careful scientific reviews such as the 
Guide to Community Preventive Services (http://www.thecommunityguide.org/), the Guide to Clinical Preventive Services 
(http://www.odphp.osophs.dhhs.gov/pubs/guidecps/) and http://www.ahrq.gov/clinic/prevnew.htm), and the National Registry for 
Effective Programs (http://modelprograms.samhsa.gov/template.cfm?page=nrepbutton). Effective public health strategies may 
include changes to the social and physical environments; health 
promotion, public education, and information; media and other 
communication strategies; technological advances; economic incentives 
and disincentives; system improvements; provider education and medical 
office-based improvement strategies. (See Attachment C for additional, 
example intervention strategies).
    While project activities should reach all persons in an identified 
intervention area, special efforts should be taken to ensure focus on 
populations with disproportionate burden of chronic diseases/conditions 
who also tend to experience disparities in access to and use of 
preventive and health care services. Populations of special focus might 
include racial and ethnic minorities, low-income persons, the medically 
underserved, persons with disabilities, and others with special needs. 
Programs must be culturally competent, and meet the health literacy and 
linguistic needs of target populations in the intervention area.
    Programs should optimize resources by coordinating and partnering 
with existing programs and resources in the community, surrounding 
areas, and the state (e.g., state incentive grant programs). Programs 
should expand the resources available through public-

[[Page 25039]]

private ventures, foundation grants, public funding, and in-kind 
contributions in order to achieve and sustain STEPS outcomes.
    Collaborative partnerships with, for example, professional 
organizations; health care providers, employers/purchasers, and plans; 
faith-based organizations; schools; child care, early childhood 
programs, and other organizations that serve children and youth; senior 
centers or service organizations; primary care associations; area 
health education centers; community health centers; local, regional, 
and state chapters of national chronic disease organizations (e.g., the 
American Diabetes Association, the American Heart Association, the 
American Lung Association, the Asthma and Allergy Foundation of 
America, the American Cancer Society); and many others will be key to 
reaching affected populations and delivering and sustaining effective 
programs. Strong, cooperative linkages between clinical preventive care 
and community public health should be established and maintained.
    With direction and coordination from the leadership team, the 
community consortium should develop and implement priority community 
health interventions to prevent and control diabetes, asthma, obesity, 
and associated risk factors in the identified intervention area. Such 
interventions may include:
    a. Actively engaging members of the intended audience in community 
assessments, program planning (including establishing program goals and 
specifying intervention content and design), delivery, evaluation, and 
program improvement.
    b. Supporting community-based initiatives to increase physical 
activity, improve nutrition, and eliminate tobacco use and exposure.
    c. Increasing healthy food choices in restaurants, grocery stores, 
vending machines, worksites, shopping malls, senior centers, and other 
community settings. http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm
    d. Increasing access to and use of attractive and safe locations 
for engaging in physical activity.
    e. Increasing access to and use of effective cessation programs for 
persons who use tobacco, targeting adults who are diabetic or who live 
with persons with asthma. (http://www.surgeongeneral.gov/tobacco/default.htm)
    f. Improving strategic communication through the use of media and 
information technologies to improve public awareness and motivation to 
establish healthy nutrition, physical activity, and avoidance of 
tobacco use.
    g. Developing supportive environments to complement and sustain 
individual change efforts.
    h. Providing social support, reinforcement, and inducements to make 
healthy choices.
    i. Enlisting the support of organizations and settings (e.g., after 
school programs, worksites, youth-serving organizations, families, 
faith-based organizations, senior centers, and health care partners) to 
encourage and support healthy behavior.
    j. Working with health care providers, health plans, and employer/
purchasers to increase the use of evidence-based preventive care 
practices.
    k. Improving access to and utilization of quality health care 
services for primary and secondary prevention of the Steps diseases/
conditions (asthma, diabetes, and obesity).
    l. Increasing self-management skills, including adherence to 
medication and other health regimens, among persons with established 
risk factors or chronic disease.
    m. Ensuring adequate provider education, including strategies to 
implement national guidelines on quality care, and improving provider 
communication and counseling skills.
    n. Educating persons with chronic disease on the proper management 
of their disease and the importance of seeking early, appropriate care 
to prevent and minimize complications.
    o. Raising levels of health literacy to enable persons to make 
informed health decisions.
    ii. School interventions. With guidance from the local education 
agency or agencies, implement school health interventions to prevent 
and control diabetes, asthma, and obesity in the same intervention area 
being served by the community interventions. Such interventions may 
include:
    a. Identifying or establishing a full-time school health program 
coordinator and School Health Council to direct project activities and 
assist in their implementation. See the American Cancer Society's Guide 
on the Role of the School Health Coordinator and Guide to School Health 
Councils. (http://www.schoolhealth.info)
    b. Reviewing and strengthening the schools' health-related policies 
and instructional programs using the CDC's School Health Index (http://www.cdc.gov/nccdphp/dash/SHI/), and the National Association of State 
Boards of Education's Fit, Healthy and Ready to Learn: A School Health 
Policy Guide. (http://www.nasbe.org/HealthySchools/fithealthy.mgi)
    c. Providing adequate physical education for all students 
throughout the school year and increasing opportunities for physical 
activity through recess, intramural activities, and other offerings. 
(http://www.cdc.gov/nccdphp/dash/healthtopics/physical_activity/guidelines/index.htm)
    d. Providing professional development for staff to enable them to 
deliver effective, skills-based health instruction for students (http://www.nasn.org/).
    e. Implementing staff wellness programs that include health 
assessment, health promotion, and health management components.
    f. Ensuring that school food service personnel are qualified and 
trained in the use of United States Department of Agriculture (USDA) 
guidelines for healthy eating.
    g. Wherever food is served in school, make appealing foods 
available that are low in fat, sodium, and added sugars. Limit the sale 
and distribution of foods of minimal nutritional value. (http://www.cdc.gov/nccdphp/dash/healthtopics/nutrition/guidelines/index.htm)
    h. Establishing a tobacco-free school environment that prohibits 
tobacco use on school property, in school vehicles, at school-sponsored 
events (on and off school property) for students, staff, and visitors, 
at all times in order to reduce potential exposure to those with 
asthma. Offer or refer students and staff to school- or community-based 
tobacco use cessation programs, targeting those who have diabetes or 
who live with persons with asthma. (http://www.cdc.gov/nccdphp/dash/healthtopics/tobacco/guidelines/index.htm)
    i. Alleviating indoor air quality problems caused by allergens and 
irritants such as smoke, dust, mites, molds, warm-blooded animals, and 
cockroaches.
    j. Establishing management and support systems for students with 
targeted health problems. Ensure communication and coordination among 
students, families, relevant school staff, and community health and 
mental health providers.
    k. Coordinating school, family, and community efforts. Assist 
families to support a healthy lifestyle for their children and 
families. Link school efforts to community programs and activities.
    l. Working with school-based and school-linked clinics, assist 
students and families in meeting their chronic disease-related health 
needs.

[[Page 25040]]

(e) Updated Community Action Plans
    Within the first eight months, finalize a five-year community 
action plan, based on the guidelines of this announcement, the 
preliminary plan submitted with this application, input from the 
application review process, newly available community information, HHS 
agencies and other sources of technical support, and continuing 
discussions with the community consortium. Base your revised action 
plan on a logic model that serves as the foundation for prioritizing, 
planning, and budgeting interventions, program management, and program 
sustainability (See Attachment B for references regarding logic model 
development and use). Review and update the community action plan 
annually to reflect community needs, opportunities, resources, and 
program evaluation findings.
(f) Project Monitoring and Evaluation
    i. Risk Factor Surveillance. Work with the state health department 
and CDC to expand existing surveillance mechanisms to collect 
representative Behavioral Risk Factor Surveillance System (BRFSS) 
baseline data for 1,500 to 2,000 adults within the intervention area, 
and repeat such assessments on an annual basis. (http://www.cdc.gov/brfss/ brfss/)
    Work with the state education agency and CDC to collect 
representative baseline data from the Youth Risk Behavior Surveillance 
System (YRBSS) (including, at a minimum, information on nutrition, 
physical activity, asthma, and tobacco) for 1,500 to 2,000 middle and/
or high school students within the intervention area, and repeat such 
assessments on at least a biennial basis. (http://www.cdc.gov/nccdphp/dash/yrbs/about_yrbss.htm)
    ii. Existing Data Sources. Identify existing data sources that can 
be used to design and monitor STEPS interventions, including hospital 
discharge data; medical care practice data; vital statistics data; 
Women, Infants, and Children (WIC) data; community health centers data; 
Medicaid and Medicare data; school data such absentee rates, academic, 
health, and risk information; and other sources of information about 
individual, group, or community health status, needs, and resources.
    iii. Common Performance Measures. STEPS recipients will participate 
in establishing a common set of core performance measures to track the 
number and types of persons served by various intervention strategies 
and the achievement of related short-term, intermediate, and long-term 
outcomes. Recipients must agree to collect and report on core 
performance measures using standardized methodology to document how 
intervention strategies are being implemented and are successfully 
addressing STEP priorities. Performance goals should show the link 
between program activities and the achievement of the initiative's 
overarching goals. See Attachment A for selected ``Healthy People 
2010'' objectives that are anticipated to form part of the core 
performance measures.
    iv. Comprehensive Evaluation Plan. Agree to participate fully in a 
STEPS-wide independent, external evaluation to examine and document the 
effectiveness of this cooperative agreement program. An important 
mechanism for changing behavior and implementing effective practices in 
a variety of settings is the ability to examine and act on successes, 
barriers to success, and failures. The recipients are expected to be 
full partners in the evaluation of this initiative by actively 
gathering and submitting data on selected outcome and performance 
measures. Grantees will also participate in other evaluation activities 
that may include regular debriefings, descriptive case studies, special 
analyses, and mid-course adjustments.
    v. Data-Based Decision Making. Projects are expected to use all the 
information above, in consultation with their Project Officer, to 
design and modify intervention strategies and the community action 
plan; revise budgets and subcontracts; request technical assistance 
from HHS agencies and/or contracted experts; recruit new members to the 
consortium; and/or change the structure of the consortium to improve 
project participation and outcomes.
(g) Information Sharing
    Actively promote the sharing of experiences, strategies, and 
results with both funded and unfunded cities, communities, and 
interested partners. Ensure effective, timely communication and 
exchange of information, experiences, and results through the use of 
the internet; management information systems; other electronic 
approaches and formats; workshops; site visits to and between 
communities and cities; and other activities.

2. Tribal Recipient Activities

    Recipient activities are the same as the activities outlined under 
sections E.1. (a) through (g) for Large Cities and Urban Communities.

3. State-Coordinated Small City and Rural Community Recipient 
Activities

(a) State Fiduciary Responsibilities
    i. Lead Agency. Establish the lead/fiduciary agency to be the state 
health department (its bona fide agent) or its equivalent as designated 
by the Governor.
    ii. Allocate Funds. Allocate and disperse funds to communities, the 
state education agency, other key partners to implement recipient 
activities at the community level. Include adequate funds to 
participate fully in the substantial data collection and evaluation 
activities associated with this award.
    iii. Contract Services. Contract for services, as needed, to 
accomplish the objectives of this program announcement.
    iv. Link Budget to Performance. Provide integrated progress and 
financial reports that link the performance and expenditures of the 
communities and all key partners.
    v. Sustainability. If funded for years three through five, engage 
in efforts that will sustain successful community programs on a long-
term basis.
(b) Small City and Rural Community Responsibilities
    Each of the two to four identified communities is expected, with 
state assistance, to assume the responsibilities identified under Large 
City and Urban Community Recipient Activities section E.1. (a) through 
(g).
(c) Leadership/Coordination/Management
    In support of the communities, the state health department should 
establish and coordinate a State-Community Management Team, including 
participation from the funded communities, the state health department, 
education agency, Office of Rural Health, any city or large community 
that is funded within the state borders under this program 
announcement, and other key public and private sector partners.
    i. Coordinate community objectives with state health plans. Ensure 
that, community, and city objectives, activities, and interventions are 
consistent with, and are supportive of state plans and activities for 
the prevention and control of diabetes, asthma, and obesity.
    ii. Collaboration. Ensure collaboration between the community and 
city programs funded under this program announcement and other state 
and local chronic disease prevention and control programs.

[[Page 25041]]

    iii. Project Staff. Establish and maintain project staff sufficient 
to provide oversight and technical assistance to the funded 
communities.
(d) Technical Assistance
    The state health department and state education agency should 
provide or facilitate the provision of technical assistance, 
consultation, and support to the funded communities in:
    i. Monitoring Disease Burden. Defining and monitoring the burden of 
chronic diseases and disparities through surveillance, epidemiology, 
and existing data sources (e.g., vital statistics, hospital discharge 
data, WIC data, community health centers data, Health Centers Uniform 
Data System, Medicaid and Medicare data).
    ii. Risk Factor Surveillance. Working with participating 
communities and other interested parties, ensure that surveillance 
mechanisms are in place to monitor changes in risk factors (e.g., BRFSS 
& YRBSS).
    iii. Program Evaluation. Work with funded communities on on-going 
evaluation, including assessing the effectiveness of, targeting of, 
number of persons reached by, and use of intervention strategies; 
tracking the accomplishment of activities and the achievement of short-
term and intermediate outcomes; monitoring changes in health outcomes; 
tracking performance in relationship to budget execution; and using 
program evaluation findings to adjust plans and strengthen the program.
    iv. Evidence-Based Practices. Accessing and sharing with funded 
communities current prevention effectiveness, intervention 
effectiveness, and other research and program evaluation findings. 
Identifying and sharing promising practices.
    v. Community Support. Helping to build community engagement, 
mobilization, ownership, and organization.
    vi. Intervention Selection and Development. Identifying, 
recommending, and adapting, evidence-based intervention strategies 
consistent with the needs, cultures, and resources of the communities.
    vii. Resource Development. Promoting public and private resource 
development in support of community-based intervention strategies and 
long-term sustainability.
(e) Project Monitoring and Evaluation
    The state health department should work with each of the selected 
communities to ensure that surveillance mechanisms collect 
representative data for program planning and monitoring. Obtain 
existing and new data sources to better understand the burden and 
trends of chronic diseases, and associated risk factors, and the 
effects of the STEPS program.
(f) Information Sharing
    The state health department should actively promote the sharing of 
experiences, strategies, and results among communities and cities 
within the state, between states funded under this program 
announcement, and with other interested communities. Support community 
efforts by ensuring effective, timely communication and exchange of 
information, experiences, and results through the use of the internet; 
management information systems; other electronic approaches and 
formats; workshops; site visits to and between communities and cities; 
and other activities.

4. HHS Activities

(a) Leadership and Coordination
    i. HHS Prevention Steering Committee. An HHS Prevention Steering 
Committee has been established to coordinate and organize the ``Steps 
to a HealthierUS'' initiative and is comprised of high-level 
representatives of relevant HHS agencies and offices. The Committee 
will provide ongoing policy oversight and direction to STEPS and will 
coordinate technical assistance from each agency in support of the 
successful achievement of the purposes and performance objectives of 
this program announcement.
    ii. STEPS workgroup. A STEPS workgroup comprised of representatives 
from funded communities, cities, tribes and states will be established 
and coordinated by the HHS Prevention Steering Committee in 
collaboration with the National Association of City and Community 
Health Officers, the Association of State and Territorial Health 
Officials, the National Association of Community Health Centers, the 
Association of Maternal and Child Health Programs, and other public 
health leadership organizations to:
    a. Ensure collaboration between the recipients and their key 
partners funded under this program announcement and other local and 
state chronic disease prevention and control programs.
    b. Anticipate the priority needs of recipients and prepare to meet 
these needs on a timely basis so that STEPS is implemented efficiently 
and successfully.
    c. Assist in organizing and facilitating approaches to sharing 
experiences, lessons learned, results, and resources among recipients 
and existing community and state local chronic disease programs.
    d. Make available the expertise, staff, and evidence-based 
resources of HHS agencies to assist and enhance the work of funded 
communities, states, and tribes.
    iii. In concert with all of the HHS activities planned in support 
of STEPS, the Indian Health Service will provide additional 
coordination and assistance to the tribe funded under this 
announcement.
(b) Technical Assistance
    Provide technical assistance, training, and support to funded 
projects in the areas of surveillance and epidemiology, community 
assessment and planning, evidence-based interventions, community 
mobilization and partnership development, monitoring of program 
performance outcomes, data management, program sustainability, and 
other areas as needed. Provide on-site assistance, workshops, 
webforums, training and intervention materials.
(c) Evaluation Oversight and Coordination
    HHS will separately fund and direct an independent, external 
evaluation of STEPS. However, recipients are expected to budget for 
their full participation in the data collection associated with this 
external review. Additionally, HHS will coordinate cross-site 
evaluation activities, including the establishment of core performance 
measures. HHS will provide, or ensure the provision of, expert 
resources to assist communities, states and tribes in the design, 
collection, analysis, and use of comparable evaluation data for 
evaluating and strengthening their programs.

F. Content

Letter of Intent (LOI)

    An LOI is requested from all potential applicants for the purpose 
of planning the competitive review process. The narrative should be no 
more than two pages, double-spaced, printed on one side, with one-inch 
margins, and unreduced 12-point font. LOIs should include the following 
information: (1) The program announcement title and number; (2) whether 
the application will be from a Large City and Urban Community 
applicant, a Tribal applicant, or a State-Coordinated Small City and 
Rural Community applicant; and (3) the name of the applicant agency or 
organization, the official contact person and that person's telephone

[[Page 25042]]

number, fax number, mailing and e-mail addresses. If the LOI is being 
sent from a Large City and Urban Community applicant, also provide the 
exact boundaries and total population size of the contiguous geographic 
area with population exceeding 400,000 persons that qualifies the 
applicant as eligible for this program announcement.

Application

    The program announcement title and number must appear in the 
application. Use the information in the Program Requirements, Other 
Requirements, Evaluation Criteria, and this section to develop the 
application content. Your application will be evaluated on the criteria 
listed, so it is important to follow this guidance carefully. Content 
requirements for Large City and Urban Community applicants are listed 
under number 1 below; for Tribal applicants under number 2 below; and 
for State-Coordinated Small City and Rural Community applicants under 
number 3 below:
1. Large City and Urban Community Applicants
    The narrative (excluding appendices) must be no more than 50 pages, 
double-spaced, printed on one side, with one-inch margins, and 
unreduced 12-point font. In addition to the application forms, the 
application must contain the following in this order:
    (a) Official Transmittal Letter. Letter of transmittal from the 
Chief Executive Officer (Mayor, county executive, or other equivalent 
governmental official) committing local government support, identifying 
the lead agency (local health department, bona fide agent, or 
equivalent) and citing the amount requested.
    (b) Table of Contents. Table of Contents with page numbers for each 
of the following sections.
    (c) Executive Summary. Executive summary briefly describing the 
overall project, intervention area and population size, partnerships, 
intervention strategies, and major short-term and intermediate 
outcomes.
    (d) Lead Agency. Description of the lead agency, including 
fiduciary and programmatic capabilities, as well as an inventory of 
current agency activities related to this announcement.
    (e) Intervention Area. Description of the intervention area, 
including its demographic, geographic and political boundaries, target 
populations to receive special focus under this award, as well as 
evidence of the burden of disease, disparities in diabetes, asthma, 
obesity, associated risk factors, and access to and use of proven 
prevention and control interventions. Description of current activities 
and projects underway to address chronic diseases in the intervention 
area. Overview of the assets and deficiencies of the intervention area, 
including state, local, and private sector efforts, and a description 
of findings from any community assessments or asset mapping done in the 
past three years.
    (f) Staff. Description of the proposed STEPS staff, including 
resumes or job descriptions for the full-time project coordinator and 
other key staff, the qualifications and responsibilities of each staff 
member and the percent of time each are committing to STEPS.
    (g) Community. Description of the community consortium, including a 
list of key partners, and documentation of their capabilities; their 
commitment to specific functions, responsibilities, and resources; and 
evidence of prior successful collaborations. The structure, decision-
making processes, and methods for accountability of the members should 
be described as well as how coordination and linkage with existing 
programs and interventions with similar focus will be maintained.
    (h) Community Action Plan. A preliminary five-year community action 
plan that includes the community and school interventions to be 
employed in the intervention area. The community action plan should 
include time-phased, specific, measurable, and realistic short-term and 
intermediate outcomes based on the needs of the community and gaps in 
current prevention and control activities. The community action plan 
should identify likely approaches, strategies, and interventions to be 
used over the entire five-year project period to address nutrition, 
physical activity, and tobacco use and exposure as well as additional 
interventions to address the targeted STEPS chronic diseases/
conditions. The organizations responsible for the interventions should 
be clearly identified as well as the target populations to be 
addressed. The community action plan should address first year 
activities in depth and their relationship to attaining specific short-
term and intermediate outcomes. The community action plan should 
include a plan to ensure long-term sustainability of project efforts 
and outcomes.
    (i) Financial Contributions. Description of financial and in-kind 
resources, if any, that will be contributed toward activities initiated 
as part of STEPS.
    (j) Evaluation and Monitoring. A plan for data identification, 
collection, and use for program planning and monitoring. Describe 
efforts to obtain existing and new data sources to better understand 
chronic disease burden and trends, related risk factors and the effects 
of STEPS. Provide specific assurances to track common performance 
measures and participate fully in an independent, external evaluation 
of STEPS processes and outcomes. Performance goals should directly link 
program activities to the achievement of the initiative's overarching 
goals. Describe how the project is anticipated to improve specific 
performance measures and outcomes compared to baseline performance.
    (k) Communications Plan. A plan to communicate and share 
information with the members of the consortium, the community, and 
other key partners. The plan should describe the proposed exchange of 
information, the means and proposed timing of communication, with an 
emphasis on communications innovations such as electronic formats, 
management information systems, webforums, etc.
    (l) Budget and Budget Justification/Narrative. i. Allocate Budget. 
Clearly indicate estimated budget amounts to be allocated and dispersed 
to the local education agency or agencies and other key consortium 
members. Provide a description of the funding mechanisms and timelines 
that will be used to disperse these funds.
    ii. One-Year and Five-Year Budgets. In support of the five-year 
community action plan, provide both a detailed budget and budget 
justification/narrative for the first budget year, and a budget 
estimate for budget years two through five.
    a. Provide a detailed budget for the first budget year in support 
of each activity that must be completed in the first year of program 
operations to accomplish the short-term and intermediate outcomes 
specified in the five-year community action plan. Develop a budget 
justification and narrative that describes all requested funds by 
object class category: personnel, fringe benefits, travel, equipment, 
supplies, contractual, and other direct costs. As part of the request 
for travel funds in FY 2003, applicants should budget for two trips to 
workshops and/or conferences for key staff members of the lead/
fiduciary organization and its key partners. For planning purposes, use 
Atlanta and Washington, DC as the travel destinations. Summarize all of 
the first-year requested funds in the form included in Attachment D, 
Activity-Based Plan and Budget. This information must be consistent 
with the first year budget information entered in Section B of Standard 
Form 424A

[[Page 25043]]

(Budget Information--Non-Construction Programs).
    b. Provide estimated budgets for FY 2004 through FY 2007 that are 
linked to the accomplishment of intermediate outcomes. For each budget 
year, include budget estimates for two trips to workshops and/or 
conferences for key staff members of the lead/ fiduciary organization 
and its key partners. For planning purposes, use Atlanta and 
Washington, DC as the travel destinations. Provide budget estimates for 
each year for each object class category in Section B of a separate 
Standard Form 424A (Budget Information--Non-Construction Programs).
    (m) Letters of Support. Provide letters of support and Memoranda of 
Understanding (as appropriate) from the local health agencies, local 
Education Agency or agencies, Health Center Networks or Primary Care 
Associations and other key members of the consortium that specify their 
roles, responsibilities, and resources.
2. Tribal Applicants
    The narrative (excluding appendices) should be no more than 50 
pages double-spaced, printed on one side, with one-inch margins, and 
unreduced 12-point font. In addition to the application forms, the 
application must contain the following in this order:
    (a) Official Transmittal Letter. Letter of transmittal from the 
Principal Tribal elected official or the chief executive officer of the 
Tribe, Inter-Tribal Council, Urban Indian Organization, or Regional 
Area Indian Health Board identifying the lead agency and citing the 
amount requested.
    (b) Narrative Content. The remainder of the narrative should 
address the content described under F.1. b) through m) above for Large 
Cities and Urban Communities.
3. State-Coordinated Small City and Rural Community Applicants
    The narrative (excluding appendices) should be no more than 100 
pages, double-spaced, printed on one side, with one-inch margins, and 
unreduced 12-point font. In addition to the application forms, the 
application must contain the following in this order:
    (a) Official Transmittal Letter. Letter of transmittal from the 
Governor committing state support, identifying the lead agency (state 
health department, bona fide agent, or equivalent) and citing the 
amount requested.
    (b) Table of Contents. Table of Contents with page numbers for each 
of the following sections.
    (c) Executive Summary. Executive Summary briefly describing the 
overall project; intervention area(s) and population sizes; 
partnerships, intervention strategies, and major short-term and 
intermediate outcomes.
    (d) State Lead Agency. Description of the lead agency including 
fiduciary and programmatic capabilities, as well as an inventory of 
current agency activities related to this announcement. Description of 
the state health department's ability to provide, and history of 
providing, expert assistance to local communities in the design and 
delivery of evidence-based approaches to chronic disease prevention and 
control.
    (e) Community Lead Agencies. Description of the lead agency (local 
health department or equivalent) for each of two to four separate 
community intervention areas, including fiduciary and programmatic 
capabilities, as well as an inventory of current agency activities 
related to this announcement.
    (f) Intervention Areas. Description of each of the community 
intervention areas, including their demographic, geographic and 
political boundaries, target populations to receive special focus under 
this award, as well as evidence of the burden of disease, and 
disparities in diabetes, asthma, obesity, associated risk factors, and 
access to and use of proven prevention and control interventions. 
Description of current state, local, and private-sector activities 
underway to address chronic diseases in the intervention areas. 
Overview of the assets and deficiencies of the intervention areas 
including a description of findings from any community assessments or 
asset mapping done in the past three years.
    (g) Staffing. Description of the proposed STEPS staff including 
resumes or job descriptions for full-time project coordinators in each 
community and other key staff at the state and community levels, the 
qualifications and responsibilities of each staff member and percent of 
time each is committing to STEPS.
    (h) Community Consortia. Description of the community consortia for 
each community including a list of key partners and documentation of 
their capabilities; their commitment to specific functions, 
responsibilities, and resources; and evidence of prior successful 
collaborations. The structure, decision-making processes, and methods 
for accountability of the members should be described as well as how 
coordination and linkage with existing programs and interventions with 
similar focus will be maintained.
    (i) Community Action Plans. A preliminary five-year community 
action plan for each community that includes the community and school 
interventions to be employed in the intervention areas. The community 
action plans should include time-phased, specific, measurable, and 
realistic short-term and intermediate outcomes that are based on the 
needs of the communities and gaps in current prevention and control 
activities. The community action plans should identify likely 
approaches, strategies, and interventions to be used over the entire 
five-year project period to address nutrition, physical activity, and 
tobacco use and exposure as well as additional interventions to address 
the STEPS chronic diseases/conditions (asthma, diabetes, and obesity). 
The organizations responsible for the interventions should be clearly 
identified as well as the target populations to be addressed. The 
community action plan should address first year activities in depth and 
their relationship to attaining specific short-term and intermediate 
outcomes. The community action plan should include a plan to ensure 
long-term sustainability of project efforts and outcomes.
    (j) Financial Contributions. Description of financial and in-kind 
resources that will be contributed toward new activities initiated as 
part of STEPS.
    (k) Evaluation and Monitoring. A plan for data identification, 
collection, and use for program planning and monitoring for each 
community. Describe efforts to obtain existing and new data sources to 
better understand the burden and trends of chronic diseases and their 
risk factors and the effects of the STEPS program. Provide specific 
assurance from each community, and from the state, to track common 
performance measures and to participate fully in an independent, 
external evaluation of STEPS outcomes. Describe for each community how 
the project is anticipated to improve specific performance measures and 
outcomes compared to baseline performance.
    (l) Communication Plans. A plan for each community to communicate 
and share information with the members of their consortia, other key 
partners, and their own communities broadly, as well as with other 
funded communities and the state. The plans should describe the 
proposed exchange of information, the proposed means and timing of 
communication, with an emphasis on communications innovations such as 
electronic formats, management information systems, webforums, etc.

[[Page 25044]]

    (m) Budget and Budget Justification/Narrative i. Community Funding. 
Provide a description of how the state will distribute a minimum of 75 
percent of total STEPS funds to the identified communities within four 
months of the receipt of their award.
    ii. Allocate Budget. Clearly indicate estimated budget amounts to 
be allocated and dispersed to the funded communities, the State 
Education Agency, and other state partners. Provide a description of 
the funding mechanisms and timelines that will be used to disperse 
these funds.
    iii. One-Year and Five-Year Budgets. In support of the five-year 
community action plans, provide a detailed budget and budget 
justification/narrative for the first budget year and a budget estimate 
for years two through five.
    a. Provide a detailed budget for the first budget year in support 
of each activity that must be completed in the first year of program 
operations to accomplish the short-term and intermediate outcomes 
specified in the five-year community action plans. This detailed budget 
must include:
    [sbull] State expenditures. A budget justification and narrative 
that describes all requested funds for the State Health and Education 
Agencies, and other key state partners by object class category: 
personnel, fringe benefits, travel, equipment, supplies, contractual, 
and other direct costs. State expenditures should clearly reflect 
activities that support the efforts of the funded communities. As part 
of the request for travel funds in FY 2003, applicants should budget 
for two trips to workshops and/or conferences for key staff members of 
the lead/fiduciary organization and its key partners. For planning 
purposes, use Atlanta and Washington, DC as the travel destinations. 
Summarize all of the first-year state-level expenditures in the form 
included in Attachment D, Activity-Based Plan and Budget.
    [sbull] Community expenditures. For each community, a budget 
justification and narrative that describe all requested funds for the 
local health department, the local education agency or agencies, and 
other key community partners by object class category in support of 
first-year activities in the five-year community action plan. As part 
of the request for travel funds in FY 2003, applicants should budget 
for two trips to workshops and/or conferences for key community 
members. For planning purposes, use Atlanta and Washington, DC as the 
travel destinations. Summarize all of the first-year requested funds, 
by community, in the form included in Attachment D, Activity-Based Plan 
and Budget Form.
    [sbull] The information above should be consistent with the first 
year budget information entered in Section B of Standard Form 424A 
(Budget Information---Non-Construction Programs).
    b. Provide estimated budgets for FY 2004 through FY 2007 that are 
linked to the accomplishment of intermediate outcomes for each funded 
community. For each budget year, include budget estimates for two trips 
to workshops and/or conferences for key staff members of the lead/
fiduciary organization and its key partners. For planning purposes, use 
Atlanta and Washington, DC as the travel destinations. Provide the 
estimated total budget for each year (i.e., state plus all funded 
communities) for each object class category in Section B of Standard 
Form 424A (Budget Information---Non-Construction Programs).
    (n) Letters of Support. Provide letters of support and Memoranda of 
Understanding (as appropriate) from the local health departments and 
education agencies, state education agency, and other key members of 
the consortia that specify their roles, responsibilities, and 
resources.

G. Submission and Deadline

Letter of Intent (LOI) Submission

    On or before June 1, 2003 submit the LOI to: Dr. Stephanie Zaza, 
National Center for Chronic Disease Prevention and Health Promotion, 
Centers for Disease Control and Prevention, 4770 Buford Highway E.E., 
Mailstop K-40, Atlanta, GA 30341.

Application Forms

    Submit the signed original and two copies of the CDC 0.1246 form. 
Forms are available at: 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, please 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

    The application must be received by 4 p.m. Eastern Time, July 15, 
2003. Submit the application to: Technical Information Management--PA 
03135, CDC Procurement and Grants Office, Centers for Disease Control 
and Prevention, 2920 Brandywine Rd., Atlanta, GA 30341-4146.
    Applications may not be submitted electronically.

Acknowledgement of Application Receipt

    A postcard will be mailed by PGO-TIM, notifying you that CDC has 
received your application.
Deadline
    LOIs and applications shall be considered as meeting the deadline 
if they are received before 4:00 p.m. Eastern Time on the deadline 
date. Any applicant who sends their application 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.
    Any application that does not meet the above criteria will not be 
eligible for competition, and will be returned to the applicant. The 
applicant will be notified of their failure to meet the submission 
requirements.

H. Evaluation Criteria

    An Independent Objective Review Group appointed by HHS will 
evaluate each application against the following criteria. Evaluation 
criteria for Large City and Urban Communities are listed under number 1 
below, for Tribes under number 2 below, and for State-Coordinated Small 
City and Rural Communities under number 3 below.

1. Large City and Urban Community Applicants

(a) Intervention Strategies (40 Points)
    i. Community Interventions (30 of 40 points). a. The degree to 
which the applicant describes a five-year community action plan with 
objectives and activities that are specific, time-phased, measurable, 
realistic, and related to identified needs and gaps in existing 
programs, program requirements, and purposes and goals of this 
cooperative agreement program.
    b. The degree to which the science-base for effective community 
interventions is being used to create the community action plan and its 
evaluation.
    c. The likely effectiveness of each intervention strategy as well 
as the plan as a whole. This includes the estimated efficacy of each 
intervention based on existing science, the likely reach of each 
intervention (percentage of the

[[Page 25045]]

community likely to be engaged/impacted by the intervention), the 
extent to which interventions build on and complement, but do not 
duplicate, existing programs, and the potential synergy created through 
multiple interventions.
    d. The degree to which the proposed plan addresses nutrition, 
physical activity, tobacco, and intervention strategies/activities to 
address the chronic diseases/conditions covered by STEPS (asthma, 
diabetes, and obesity).
    e. The degree to which the plan reflects and builds on a 
substantiated and comprehensive understanding of the assets, 
attributes, and deficiencies of the communities including non-STEPS-
related activities completed or on-going in these communities.
    f. The extent to which the applicant includes a plan to sustain the 
project long term.
    ii. School Interventions (10 of 40 points). a. The extent to which 
the applicant describes plans to implement school-based interventions 
that promote healthy lifestyles among students and their families, and 
address the prevention and control of chronic diseases within the same 
intervention area as the community interventions.
    b. The clarity and feasibility of a plan to establish a full-time 
school health program coordinator and a school health council that will 
direct school-based activities and assist in their implementation.
    c. The degree to which the science-base for effective school-based 
interventions is being used to create the community action plan and its 
evaluation.
    d. The extent to which the proposed objectives and activities are 
specific, time-phased, measurable, realistic, feasible, and related to 
identified needs and gaps in existing programs, program requirements, 
and purposes and goals of this cooperative agreement program.
    (b) Project Leadership and Management (20 Points)
    i. The identification of a lead/fiduciary agency that will ensure 
accountability for expenditures in relationship to performance of all 
key partners.
    ii. The extent to which the applicant describes the proposed 
structure of the project including decision-making processes.
    iii. The extent to which the applicant provides letters of support 
and Memoranda of Understanding (as appropriate) with partner agencies 
and organizations, and the extent to which these documents describe 
specific collaborative actions to be undertaken and the role of the 
partners.
    iv. The extent to which the applicant and its key partner 
organizations provide financial or in-kind contributions toward the 
success of the STEPS initiative.
    v. The extent to which the applicant describes realistic plans to 
coordinate proposed activities with state- and community-level programs 
to prevent and control chronic disease.
    vi. The degree to which proposed staff have the relevant 
background, expertise, qualifications, and experience.
    vii. The degree to which the proposed staffing plan appears 
appropriate to the level of work proposed and demonstrates the intent 
to minimize staff levels in order to maximize funding for 
interventions.
    viii. The extent to which the applicant describes clearly defined 
roles of project staff and an appropriate percent of time each is 
committing to STEPS.
    (c) Plan for Project Monitoring and Evaluation (15 Points)
    i. The extent to which the applicant describes plans to collaborate 
with other STEPS recipients in developing and implementing a set of 
common performance measures to monitor the success of funded projects.
    ii. The extent to which appropriate data sources are currently 
available or will be made available, and are used to monitor and track 
changes in community capacity; the extent to which interventions reach 
populations at high risk; changes in risk factors, chronic disease 
burden, and disparities; the relationship between interventions and 
outcomes; and changes in program efficiency.
    iii. The extent to which the applicant describes plans to 
collaborate fully in external, independently coordinated evaluation 
activities to evaluate the overall impact of STEPS.
    iv. The extent to which evidence is provided to demonstrate the 
applicant's capability to conduct surveillance and program evaluation, 
access and analyze official data sources, and use evaluation to 
strengthen the program.
    v. The extent to which the applicant describes how the project is 
anticipated to improve specific performance measures and outcomes 
compared to baseline performance.
    (d) Background and Need (10 Points)
    i. The extent to which the proposed intervention area is described, 
including the populations to be served.
    ii. The extent to which data are provided substantiating existing 
burden and/or disparities of chronic diseases and conditions, 
specifically diabetes, asthma, and obesity in the proposed intervention 
area and populations to be served.
    iii. The extent to which data are provided substantiating existing 
health risk behaviors and risk factors related to chronic diseases in 
the proposed intervention area and populations to be served.
    iv. The extent to which assets and barriers to successful program 
implementation are identified.
    v. The extent to which existing resources will be utilized to 
complement or contribute to the effort planned in the proposal.
    (e) Community Consortium (10 Points)
    i. The extent to which the applicant demonstrates the ability to 
establish a consortium that is inclusive of key partners, and related 
coalitions.
    ii. The extent to which the applicant describes the capacity of the 
proposed consortium in terms of leadership, expertise, community 
representation, collaborative experience/abilities, and agency 
representation.
    iii. The extent to which key partners demonstrate a high-level 
commitment to planning, implementing, and evaluating the proposed 
project, including a commitment of staff and other resources.
    iv. The extent to which members of the proposed consortia have 
successfully worked together or with others in the past to achieve 
improved health outcomes.
(f) Communication and Information Sharing (5 Points)
    i. The extent to which the applicant describes plans to share 
experiences, strategies, and results with other interested states, 
communities, and partners.
    ii. The extent to which the applicant describes plans to ensure 
effective and timely communication and exchange of information, 
experiences and results through mechanisms such as the internet, 
management information systems, other electronic formats, workshops, 
publications, and other innovations.
(g) Budget (not scored)
    The extent to which the budget appears reasonable and consistent 
with the proposed activities and intent of the program.

2. Tribal Applicants

    Will be evaluated according to the Large City and Urban Community 
evaluation criteria listed under H.1. (a) through (g) above.

[[Page 25046]]

3. State-Coordinated Small City and Rural Community Applicants

(a) Intervention Strategies (40 Points)

    The points for this section will be divided equally between the two 
to four pre-selected communities where project activities and 
interventions will occur (i.e., 20 points per community if the project 
proposes to work in two communities, 13 points per community if three 
communities, ten points per community if four communities). This 
section will be evaluated according to the same criteria for Large City 
and Urban Community proposals under H.1.a) (i-ii) above.
(b) Project Leadership, Collaboration, and Proposed Structure (15 
Points)
    i. The identification of a lead/fiduciary agency that will ensure 
accountability for expenditures in relationship to performance of all 
key partners.
    ii. The extent to which the applicant describes the proposed 
structure of the project including decision-making processes, 
monitoring, problem solving, and providing support to community-based 
programs.
    iii. The extent to which the applicant provides letters of support 
and Memoranda of Understanding (as appropriate) with partner agencies 
and organizations, and the extent to which these documents describe 
specific collaborative actions to be undertaken and the role, 
responsibilities, and commitment of resources of the partners.
    iv. The extent to which the applicant and its key partner 
organizations provide financial or in-kind contributions toward the 
success of the STEPS initiative.
    v. The extent to which the applicant describes realistic plans to 
coordinate proposed activities with state- and community-level programs 
to prevent and control chronic disease.
    vi. The degree to which proposed staff have the relevant 
background, qualifications, and experience to facilitate support to 
community-level efforts.
    vii. The degree to which the proposed staffing plan appears 
appropriate to the level of work proposed and demonstrates the intent 
to minimize staff levels in order to maximize funding for 
interventions.
    viii. The extent to which the applicant describes clearly defined 
roles of project staff and an appropriate percent time each is 
committing to STEPS.
    ix. The capacity of the proposed local consortia in terms of 
leadership, expertise, community representation, collaborative 
experience/abilities, and agency representation.
    x. Past history and evidence of effectiveness of community-state 
partnerships in relation to health issues and interventions (especially 
those related to chronic disease prevention and control, and those 
involving the specific communities selected for this program).
    xi. Past history and evidence of effectiveness of community 
partnerships in the two to four proposed communities in relation to 
health issues and interventions (especially those involving chronic 
disease prevention and control).
(c) Plan for Project Monitoring and Evaluation (15 Points)
    i. The extent to which the applicant describes plans for the state 
and proposed communities to collaborate with other STEPS recipients in 
developing and implementing a set of common performance measures to 
monitor the success of funded projects.
    ii. The extent to which appropriate data sources are currently 
available or will be made available to monitor and track changes in 
community capacity; the extent to which community-driven interventions 
reach populations at high risk; changes in risk factors, chronic 
disease burden, and disparities; the relationship between interventions 
and outcomes; and changes in program efficiency.
    iii. The extent to which the applicant describes plans for the 
state, proposed communities, and other key partners to collaborate 
fully in external, independently coordinated evaluation activities to 
evaluate the overall impact of STEPS.
    iv. The extent to which evidence is provided to demonstrate the 
applicant's capability to conduct surveillance and program evaluation, 
access and analyze official data sources, and use evaluation to 
strengthen the program and support community-based efforts.
    v. The extent to which the applicant describes how the project is 
anticipated to improve specific performance measures and outcomes 
compared to baseline performance.
(d) Capacity to Guide and Support Intervention Communities (15 Points)
    i. The extent to which the applicant proposes a State-Community 
Management Team fully capable of guiding and directing the overall 
project.
    ii. The extent of state experience, expertise, and capacity to 
assist local communities in the activities of this project are 
described. Evidence of having provided guidance and support to local 
communities that resulted in successful implementation and outcomes.
    iii. The extent to which specific methods are described to assist 
local communities in the activities of this project.
(e) Background and Need (10 Points)
    i. The extent to which the proposed intervention communities are 
described, including the populations to be served.
    ii. The extent to which data are provided substantiating the burden 
and disparities of chronic diseases and conditions, specifically 
diabetes, asthma, and obesity in the proposed intervention communities 
and populations to be served.
    iii. The extent to which data are provided substantiating health 
risk behaviors and risk factors related to chronic diseases in the 
proposed intervention communities and populations to be served.
    iv. The extent to which assets and barriers to successful program 
implementation are identified in each intervention community.
    v. The extent to which existing resources will be utilized to 
complement or contribute to the effort planned in the proposal.
(f) Communication and Information Sharing (5 Points)
    i. The extent to which the applicant describes plans to share 
experiences, strategies, and results between the proposed communities, 
with the state, and with other interested communities and partners.
    ii. The extent to which the applicant describes plans to ensure 
effective and timely communication and exchange of information, 
experiences, and results between the proposed communities, the state, 
and others through mechanisms such as the internet, managements 
information systems, other electronic formats, workshops, and other 
innovations.
(g) Budget (Not Scored)
    The extent to which the budget appears reasonable and consistent 
with the proposed activities and intent of the program.

I. Other Requirements

Technical Reporting Requirements

    Provide CDC with original and two copies of:
    1. Interim progress report will be due May 30, 2004, and subsequent 
interim progress reports will be due on the 30th of May each year 
through May 30, 2008. The progress report will serve as the

[[Page 25047]]

non-competing continuation application for the subsequent year, and 
must contain the following elements:
    (a) A succinct description of the program accomplishments/narrative 
and progress made in achieving short-term and intermediate outcomes and 
other performance measures within the planned budget during the first 
six months of the budget period.
    (b) The reason(s) for not achieving established short-term and 
intermediate outcomes and other performance measures within the planned 
budget and what will be done to achieve unmet objectives.
    (c) Current budget period financial progress.
    (d) New budget period proposed program activities and objectives.
    (e)Detailed changes in the activity-based budget, the line-item 
budget, existing contracts, summary budget, and budget justification.
    (f)For newly proposed contracts, provide the name of the 
contractor(s), method of selection, period of performance, scope of 
work, and itemized budget and budget justification/narrative.
    2. An annual progress report summarizing the budget period (12 
month) accomplishments for each budget period objective. The annual 
progress report will be due on November 20, 2004 and subsequent annual 
progress reports will be due on the 20th of November each year through 
November 20, 2007.
    3. Financial status report, no more than 90 days after the end of 
the budget period.
    4. Final financial, performance, and evaluation 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.

Additional Requirements

    The following additional requirements are applicable to this 
program. For a complete description of each, see Attachment I of the 
program announcement as posted on the CDC web site.

AR-7--Executive Order 12372 Review
AR-8--Public Health Systems Reporting Requirements
AR-9--Paperwork Reduction Act Requirements
AR-10--Smoke-Free Workplace Requirements
AR-11--Healthy People 2010
AR-12--Lobby Restrictions

J. Where To Obtain Additional Information

    A live, interactive satellite broadcast and webcast about this 
announcement and the STEPS Program will be held on May 22, 2003, from 1 
to 3 pm Eastern Standard Time. After May 1, 2003, updates about this 
broadcast and participation information may be found at http://www.phppo.cdc.gov/phtn.
    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 Rd., Room 3000, Atlanta, GA 30341-2700, Telephone: 770-488-
2700.
    For business management and budget assistance, contact: Ms. Sylvia 
Dawson, Procurement and Grants Office, Centers for Disease Control and 
Prevention, 2920 Brandywine Rd., Room 3000, Atlanta, GA 30341-4146, 
Telephone: 770-488-2771, E-mail address: [email protected].
    For business management and budget assistance, in the territories 
contact: Charlotte Flitcraft, Procurement and Grants Office, Centers 
for Disease Control and Prevention, 2920 Brandywine Rd., Room 3000, 
Atlanta, GA 30341-4146, Telephone: 770-488-2632, Email address: 
[email protected].
    For program technical assistance, contact: Dr. Stephanie Zaza, 
Centers for Disease Control and Prevention, 4770 Buford Highway NE., 
Mailstop K-40, Atlanta, GA 30341, Telephone: 770-488-6452, E-mail 
address: [email protected].

Edward Schultz,
Acting Director, Procurement and Grants Office, Centers for Disease 
Control and Prevention.
[FR Doc. 03-10986 Filed 5-6-03; 8:45 am]
BILLING CODE 4163-18-P