[Federal Register Volume 69, Number 89 (Friday, May 7, 2004)]
[Notices]
[Pages 25802-25816]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-10416]



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Part VI





Department of Health and Human Services





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Centers for Disease Control and Prevention



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Steps to a Healthier US: A Community-Focused Initiative to Reduce the 
Burden of Asthma, Diabetes, and Obesity; Notice

  Federal Register / Vol. 69, No. 89 / Friday, May 7, 2004 / Notices  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 04234]


Steps to a Healthier US: A Community-Focused Initiative To Reduce 
the Burden of Asthma, Diabetes, and Obesity

I. Funding Opportunity Description
Authority
Purpose
Background
Activities
II. Award Information
III. Eligibility Information
Eligible Applicants
Cost Sharing or Matching
Other Eligibility Requirements
IV. Application and Submission Information
How To Obtain Application Forms and Form Instructions
Content and Form of Submission
Letter of Intent
Application
Submission Dates and Times
Explanation of Deadlines
Intergovernmental Review of Applications
Funding Restrictions
Other Submission Requirements/Addresses
V. Application Review Information
Review Criteria
Review and Selection Process
Anticipated Announcement and Award Date
VI. Award Administration Information
Award Notices
Administrative and National Policy Requirements
Reporting Requirements
VII. Agency Contacts
VIII. Other Information
    Announcement Type: New.
    Funding Opportunity Number: 04234.
    Catalog of Federal Domestic Assistance Number: 93.283.
    Key Dates:

Letter of Intent Deadline: May 27, 2004.
Application Deadline: June 21, 2004.

I. Funding Opportunity Description

    Authority: This program is authorized under section 301(a) and 
317(k)(2) of the Public Health Service Act, (42 U.S.C. 241(a) and 
247b(k)(2)), as amended.

    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) 2004 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 for Children and 
Families, Administration on Aging, 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''.
    The centerpiece of STEPS 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:
     Prevent 75,000 to 100,000 Americans from developing 
diabetes.
     Prevent 100,000 to 150,000 Americans from developing 
obesity.
     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 pre-diabetes; 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

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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 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.
    Communities funded under this cooperative agreement will join the 
23 currently funded communities in establishing 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.
    Activities: 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. 
In addition, applications that do not address all of the activities 
listed in the respective category under which they are applying will be 
considered non-responsive and will not be entered into the review 
process. You will be notified that your application did not meet 
submission requirements. (See section III 1., 2., 3. for eligibility 
criteria and definitions of these applicant categories.)

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, its equivalent, or a bona fide agent 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.
    iv. 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 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, 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: 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, 
contractors, 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:

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    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 Program Consultant informed and seek Program Consultant 
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.
    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-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

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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.
(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. Formulate an activity-based budget for 
years 2 through 5 of the program that directly corresponds to the logic 
model, revised community action plan, and completed evaluation plan.
(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/)
    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

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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 Program Consultant, 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 above 
under sections 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 equivalent, or a bona fide agent 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 above under 
Large City and Urban Community Recipient Activities section 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 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.
    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

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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

    In a cooperative agreement, HHS staff is substantially involved in 
the program activities, above and beyond routine grant monitoring. HHS 
Activities for this program are as follows:
(a) Leadership and Coordination
    i. HHS Steps to a HealthierUS Steering Committee. An HHS Steps to a 
HealthierUS 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 provides ongoing policy oversight and direction to STEPS and 
will continue to 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 has been established and is 
coordinated by the HHS Steps to a HealthierUS Steering Committee. The 
STEPS National Workgroup is comprised of representatives from funded 
communities, cities, tribes and States, and a wide variety of national 
partner 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 tribes 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.

II. Award Information

    Type of Award: Cooperative agreement. HHS involvement in this 
program is listed in the Activities section above.
    Fiscal Year Funds: 2004.
    Approximate Total Funding: $10,500,000 total; $5,000,000 for Large 
City and Urban Community applicants; $1,000,000 for Tribal applicants; 
$4,500,000 for State-Coordinated Small City and Urban Community 
applicants. Total funding in each category is subject to change based 
on the number of applications received and funding amounts requested.
    Approximate Number of Awards: 8 to 12 total; up to 5 Large City and 
Urban Community applicants; up to 2 Tribal applicants; up to 3 State-
Coordinated Small City and Urban Community applicants. The total number 
of awards in each category is subject to change based on the number of 
applications received and funding amounts requested.
    Approximate Average Award: $1,000,000 for Large City and Urban 
Community applicants; $500,000 for Tribal applicants; $1,500,000 for 
State-Coordinated Small City and Rural Community applicants. (This 
amount is for the first 12-month budget period, and includes both 
direct and indirect costs.)
    Floor of Award Range: $750,000 for large city and Urban Community 
applicants; $300,000 for Tribal applicants; $1,000,000 for State-
Coordinated Small City and Rural Community applicants.
    Ceiling of Award Range: $1,250,000 for Large City and Urban 
Community applicants; $600,000 for Tribal applicants; $2,000,000 for 
State-Coordinated Small City and Rural Applicants.
    If you request a funding amount greater than the ceiling of the 
award range, your application will be considered non-responsive, and 
will not be entered into the review process. You will be notified that 
your application did not meet the submission requirements.
    Anticipated Award Date: September 22, 2004.
    Budget Period Length: 12 months.
    Project Period Length: 5 years.
    Throughout the project period, CDC's commitment to continuation of 
awards will be conditioned on the availability of funds, evidence of 
satisfactory progress by the recipient (as documented in required 
reports), and the determination that continued funding is in the best 
interest of the Federal government.
    The lead/fiduciary agent for State-Coordinated Small City and Rural 
Community awardees 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. The remaining 25 percent of funds should be 
used to support the funded communities through technical assistance and 
other means. The 25 percent of the award described above is subject to 
a match requirement as described in section III.2. of this 
announcement.
    Awarded communities must show progress toward objectives during the 
first two years of funding to be eligible for continued funding in 
years three through five of the program. Continuation awards and level 
of funding within an approved project period (FY 2005 through FY 2008) 
will be based on the availability of funds and satisfactory progress in 
achieving performance measures as evidenced by required progress 
reports.

[[Page 25808]]

    Funding for FY 2005 and beyond is expected to range from $1,000,000 
to $2,000,000 for each Large City and Urban Community recipient; 
$300,000 to $1,000,000 for each Tribal recipient; and from $2,000,000 
to $2,500,000 for each State-Coordinated Small City and Rural Community 
recipient.
    It is also anticipated that additional FY 2005 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 2005 will be required to submit a revised work plan 
and budget in order to receive funds at FY 2005 funding levels during 
their first year of funding.
    Pending availability of funds, beginning in FY 2005 and each of the 
remaining years of this program announcement (September 22, 2005, 
through September 21, 2009), 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.

III. Eligibility Information

III.1. Eligible Applicants

    If your application is incomplete or non-responsive to the 
requirements listed in this section, it will not be entered into the 
review process. You will be notified that your application did not meet 
submission requirements.
    Cities and urban communities, and tribes or tribal consortia are 
eligible to apply directly under this announcement. In addition, States 
may coordinate the applications of up to four small cities and rural 
communities that do not meet the eligibility criteria for large cities/
urban communities or independent tribal applicants (see numbers 1 and 2 
below). In determining eligibility, Large City 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 City and Rural Community applicants must meet the 
criteria under number 3 below.
1. Large City and Urban Community Applicants
    The term ``large cities and urban communities'' is defined as any 
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. The District of Columbia is eligible to 
apply for funding under this section of the program announcement. 
Eligible applicants in this category must specify the intervention area 
that will be the focus of the STEPS program. The intervention area can 
be smaller than the entire city or community, but must be 
geographically contiguous and must include a population of at least 
150,000 residents but not more than 500,000 residents.
    The large city/urban community applicant must select a lead/
fiduciary agent designated by the mayor, county executive, or other 
equivalent governmental official. In many cases, the official local 
health department or its equivalent will serve as the lead/fiduciary 
agent. However, the mayor, county executive or other equivalent 
governmental official may name a different entity as the bona fide 
agent to serve as the lead/fiduciary agency.
    A bona fide agent is the official fiscal agent the mayor (or other 
equivalent official) determines will function on behalf of the 
community for this award. In most instances, the bona fide agent is a 
foundation or non-profit organization that serves as the legal agent 
for applying for Federal grants for the local health agency. Other 
entities (such as departments of education, community-based 
organizations or universities) may be proposed as a bona fide agent but 
the mayor must determine those agents and the agents must have an 
established capability to serve as fiduciary agents. If you are 
applying as a bona fide agent of a local government, you must provide a 
letter from the local government as documentation of your status. Place 
this documentation behind the first page of your application form.
    Only one application will be accepted from each eligible large city 
and urban community.
2. Tribal Applicants
    The term ``tribal applicants'' is defined as federally recognized 
tribal governments, Regional Area Indian Health Boards, Urban Indian 
organizations, tribal consortia and inter-tribal Councils which serve 
10,000 or more American Indians/Alaskan Natives in their catchment 
area(s). The tribal applicant must select a lead/fiduciary agent as 
designated by the Principal tribal elected official or chief executive 
officer. Only one application will be accepted from each eligible 
tribal entity.
3. State-Coordinated Small City and Rural Community Applicants
    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. To be eligible, 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.
    The State applicant must select a lead/fiduciary agent designated 
by the Governor. In many cases, the official state health department or 
its equivalent will serve as the lead/fiduciary agent. However, the 
Governor may name a different entity as the bona fide agent to serve as 
the lead/fiduciary agency.
    A bona fide agent is the official fiscal agent the Governor 
determines will function on behalf of the community for this award. In 
most instances, the bona fide agent is a foundation or non-profit 
organization that serves as the legal agent for applying for Federal 
grants for the State health agency. Other entities (such as departments 
of education, community-based organizations, universities) may be 
proposed as a bona fide agent but the Governor must determine those 
agents and the agents must have an established capability to serve as 
fiduciary agents. If you are applying as a bona fide agent of a state 
government, you must provide a letter from the state government as 
documentation of your status. Place this documentation behind the first 
page of your application form.
    Only one application will be accepted from each State.

III.2. Cost Sharing or Matching

    Matching funds are required for this project. Matching funds are 
required from non-Federal sources in an amount not less than 25 percent 
of Federal funds awarded to Large City and Urban Community Grantees. 
State grantees funded under the State-Coordinated Small City and Rural 
Community Program are required to provide a match not less than 50 
percent of the funds retained by the States to support the funded 
communities through technical assistance and other means. In no case 
shall the amount to be matched be less than 25 percent of the award to 
the State.
    In an effort to move grantees toward a self-sustaining program, the 
HHS

[[Page 25809]]

Secretary may require an increase in the match requirements in years 2 
through 5 of the program. For the purpose of the initial application's 
5 year plan and budget, applicants should calculate budgets based on 
the first year match requirements listed above.
    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. Matching funds must 
be consistent with the community action plans that are submitted and 
approved. The total amount of Federal funds requested (including direct 
and indirect costs), combined with the amount for matching shall 
constitute the grantee's proposed costs for the budget period.
    Matching funds may not be met through: (1) The payment of treatment 
services or the donation of treatment, or direct patient education 
services; (2) services assisted or subsidized by the Federal 
government; or (3) the indirect or overhead of an organization.
    Matching funds are not required of Tribal Applicants. However, 
Tribal Applicants are encouraged to identify financial and in-kind 
contributions from their own organization and their partners to support 
and sustain the activities of this program announcement. Applications 
from tribal entities that include private partners who contribute in-
kind or funding support and incentives to these efforts are strongly 
encouraged.

III.3. Other Eligibility Requirements

    If you request a funding amount greater than the ceiling of the 
award range, your application will be considered non-responsive, and 
will not be entered into the review process. You will be notified that 
your application did not meet the submission requirements.
    You must respond to all of the activities stipulated in section I 
``Activities'' to be eligible for this program. Applications that do 
not address all activities will be considered non-responsive, and will 
not be entered into the review process.
    You must submit a timely Letter of Intent (LOI) to be eligible to 
apply for this program. See sections IV.2, IV.3, and IV.6 of this 
announcement for more information on LOI submission.

    Note: Title 2 of the United States Code section 1611 states that 
an organization described in section 501(c)(4) of the Internal 
Revenue Code that engages in lobbying activities is not eligible to 
receive Federal funds constituting an award, grant, or loan.

    Applications that do not meet the matching requirements stipulated 
in section III.2 above will be considered non-responsive and will not 
be entered into the review process.

IV. Application and Submission Information

IV.1. How To Obtain Application Forms and Form Instructions

    To apply for this funding opportunity use application form CDC 
1246. Application forms and instructions are available on the CDC Web 
site, 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) staff at: 770-488-2700. Application forms can be mailed to 
you.

IV.2. Content and Form of Submission

    Letter of Intent (LOI): A Letter of Intent (LOI) from the Chief 
Executive Officer (Mayor, county executive, tribal chief, Governor or 
other equivalent governmental official) is required from all potential 
applicant communities for the purposes of determining eligibility and 
planning the competitive review process. As only one application per 
community will be accepted, LOIs will be used to identify communities 
that might inadvertently submit more than one application. If multiple 
LOIs from a single community are received, those organizations will be 
contacted to facilitate communication among the various parties so that 
a single application can be developed for that community, and the lead/
fiduciary agent identified for the community. Failure to submit a LOI 
will preclude you from submitting an application. In addition, 
organizations submitting LOIs from communities that do not meet the 
eligibility criteria will be contacted.
    Format: The LOI should be no more than two pages (8.5 x 11), 
double-spaced, printed on one side, with one-inch margins, written in 
English (avoiding jargon), and unreduced 12-point font.
    Content: 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 lead/fiduciary agency or organization, the 
official contact person and that person's telephone 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 Activities section, 
Review Criteria section, 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. You must submit a project narrative with your application forms. 
The narrative must be submitted in the following format:
     Maximum number of pages: 50 pages for Large City and Urban 
Community applicants; 50 pages for Tribal applicants; 100 pages for 
State-Coordinated Small City and Rural Community Applicants. If your 
narrative exceeds the page limit, only the first pages which are within 
the page limit will be reviewed.
     Font size: 12 point unreduced.
     Double-spaced.
     Paper size: 8.5 by 11 inches.
     Page margin size: One inch.
     Printed only on one side of page.
     Held together only by rubber bands or metal clips; not 
bound in any other way.
     Other format requirements:
1. Large City and Urban Community Applicants
    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.

[[Page 25810]]

(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. The 
executive summary is limited to 2 pages.
(d) Application Narrative
    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. If your narrative exceeds the page limit, only 
the first 50 pages will be reviewed. The narrative consists of sections 
(e)-(m), described as follows:
(e) 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.
(f) 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.
(g) 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.
(h) 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.
(i) 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 or 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.
(j) Financial Contributions
    Description of financial and in-kind resources, if any, that will 
be contributed toward activities initiated as part of STEPS.
(k) 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.
(l) 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.
(m) Letters of Support
    The narrative must include a summary of the organizations that have 
submitted 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. Actual letters and memoranda should be 
placed in an appendix.
(n) 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 or 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 2004, applicants should budget for a 5-day trip 
to Atlanta for 5 to 6 key leadership team and project staff for a 
workshop early in the first budget year, and a 2-to-4-day trip to 
Washington, DC for 5 to 6 key leadership team and project staff for a 
conference later in the first budget year. Use Standard Form 424A 
(Budget Information--Non-Construction Programs).
    b. Provide estimated budgets for FY 2005 through FY 2008 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

[[Page 25811]]

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).
(o) Appendices
    The following additional information may be included in appendices. 
The appendices will not be counted toward the narrative page limit. 
Appendices are limited to the following items:
     Curriculum vitae.
     Resumes.
     Organizational charts.
     Letters of support or memoranda of understanding.
    Any material submitted in the appendices that is not listed here 
will not be reviewed. All information included in appendices should be 
clearly referenced within the 50-page narrative to aid reviewers in 
connecting information in the appendices to that provided in the 
narrative.
2. Tribal Applicants
    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) Table of Contents
    A table of contents should be provided as described in 1.(b) above 
for Large Cities and Urban Communities.
(c) Executive Summary
    An executive summary should be provided as described in 1.(c) above 
for Large Cities and Urban Community applications. The executive 
summary is limited to 2 pages.
(d) Narrative Content
    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. If your narrative exceeds the page limit, only 
the first 50 pages will be reviewed. The narrative should address the 
content described under 1.(e) through (m) above for Large Cities and 
Urban Community applications.
(e) Budget and Budget Justification/Narrative
    The budget should be included as described under 1.(n) above for 
Large Cities and Urban Communities. Travel estimates should be made as 
for Large Cities and Urban Communities, for 3 to 5 staff.
(f) Appendices
    Appendices should be included as described under 1.(o) above for 
Large Cities and Urban Community applications.
3. State-Coordinated Small City and Rural Community Applicants
    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. The 
executive summary is limited to 3 pages.
(d) Application Narrative
    The narrative (excluding appendices) must be no more than 100 
pages, double-spaced, printed on one side, with one-inch margins, and 
unreduced 12-point font. If your narrative exceeds the page limit, only 
the first 100 pages will be reviewed. The narrative consists of 
sections e-n, described as follows:
(e) 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.
(f) 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.
(g) 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.
(h) 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.
(i) 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.
(j) 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

[[Page 25812]]

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.
(k) Financial Contributions
    Description of financial and in-kind resources that will be 
contributed toward new activities initiated as part of STEPS.
(l) 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.
(m) 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.
(n) Letters of Support
    The narrative must include a summary of the organizations that have 
submitted 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. Actual letters and memoranda should be 
placed in an appendix.
(o) Budget and Budget Justification/Narrative
    The budget tables and justification are not included in the 100 
page application narrative. The following must be included in the 
budget:
    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:
     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 2004, applicants should budget 
for a 5-day trip to Atlanta for 7 to 10 key leadership team and project 
staff for a workshop early in the first budget year, and a 2-to-4-day 
trip to Washington, DC for 7 to 10 key leadership team and project 
staff for a conference later in the first budget year.
     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 2004, 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. Use 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).
(p) Appendices
    The following additional information may be included in appendices. 
The appendices will not be counted toward the narrative page limit. 
Appendices are limited to the following items:
     Curriculum vitae.
     Resumes.
     Organizational charts.
     Letters of support or memoranda of understanding.
    Any material submitted in the appendices that is not listed here 
will not be reviewed. All information included in appendices should be 
clearly referenced within the 50-page narrative to aid reviewers in 
connecting information in the appendices to that provided in the 
narrative.
    You are required to have a Dun and Bradstreet Data Universal 
Numbering System (DUNS) number to apply for a grant or cooperative 
agreement from the Federal government. The DUNS number is a nine-digit 
identification number, which uniquely identifies business entities. 
Obtaining a DUNS number is easy and there is no charge. To obtain a 
DUNS number, access http://www.dunandbradstreet.com or call 1-866-705-
5711. For more information, see the CDC Web site at: http://www.cdc.gov/od/pgo/funding/pubcommt.htm. If your application form does 
not have a DUNS number field, please write your DUNS number at the top 
of the first page of your application, and/or include your DUNS number 
in your application cover letter.
    Additional requirements that may require you to submit additional 
documentation with your application are listed in section ``VI.2. 
Administrative and National Policy Requirements.''

[[Page 25813]]

IV.3. Submission Dates and Times

    LOI Deadline Date: May 27, 2004. CDC requires that you send a LOI 
if you intend to apply for this program.
    Application Deadline Date: June 21, 2004.
    Explanation of Deadlines: LOIs and Applications must be received in 
the CDC Procurement and Grants Office by 4 p.m. eastern time on the 
deadline date. If you send your LOI or application by the United States 
Postal Service or commercial delivery service, you must ensure that the 
carrier will be able to guarantee delivery of the application by the 
closing date and time. If CDC receives your LOI or application 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, you will be given 
the opportunity to submit documentation of the carriers guarantee. If 
the documentation verifies a carrier problem, CDC will consider the LOI 
or application as having been received by the deadline.
    This announcement is the definitive guide on LOI and application 
submission address and deadline. It supersedes information provided in 
the application instructions. If your LOI or application does not meet 
the deadline above, it will not be eligible for review, and will be 
discarded. You will be notified that your LOI or application did not 
meet the submission requirements.
    CDC will not notify you upon receipt of your LOI or application. If 
you have a question about the receipt of your LOI or application, first 
contact your courier. If you still have a question, contact the PGO-TIM 
staff at: 770-488-2700. Before calling, please wait two to three days 
after the LOI or application deadline. This will allow time for 
applications to be processed and logged.

IV.4. Intergovernmental Review of Applications

    Executive Order 12372 does not apply to this program.

IV.5. Funding restrictions

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 those described under the ``Activities'' section of 
this announcement.
    Funds received under this announcement may not be used to supplant 
or 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.
    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 2004 STEPS awards. Direct assistance in lieu of 
cash may be available in subsequent years.
    Funded agencies are eligible to receive indirect costs in this 
program. However the indirect costs allowed in this program are limited 
to the negotiated indirect cost rate or 5 per cent of the total award 
amount, whichever is less. If you are requesting indirect costs in your 
budget, you must include a copy of your current indirect cost rate 
agreement. If your indirect cost rate is a provisional rate, the 
agreement should be less than 12 months of age.
    Awards will not allow reimbursement of pre-award costs.
    Guidance for completing your budget can be found on the CDC Web 
site, at the following Internet address: http://www.cdc.gov/od/pgo/funding/budgetguide.htm.

IV.6. Other Submission Requirements

    LOI Submission Address: Submit your LOI by express mail, delivery 
service, fax, or e-mail to: Technical Information Management--
PA04234, CDC Procurement and Grants Office, 2920 Brandywine 
Road, Atlanta, GA 30341.
    Application Submission Address: Submit the original and two hard 
copies of your application by mail or express delivery service to: 
Technical Information Management--PA04234, CDC Procurement and 
Grants Office, 2920 Brandywine Road, Atlanta, GA 30341.
    LOIs and applications may not be submitted electronically at this 
time.

V. Application Review Information

V.1. Review Criteria

    You 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 goals stated in the ``Purpose'' section of this 
announcement. Measures must be objective and quantitative, and must 
measure the intended outcome. These measures of effectiveness must be 
submitted with the application and will be an element of evaluation.
    An Independent Objective Review Group appointed by HHS will 
evaluate the quality of 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. Does the five-year community action plan include 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. Is the community action plan and its evaluation based on sound 
scientific evidence of community intervention effectiveness?
    c. Are the individual intervention strategies and the action plan 
as a whole likely to be effective? This includes the estimated efficacy 
of each intervention based on existing science, the likely reach of 
each intervention (percentage of the community likely to be engaged or 
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. Does the proposed plan include interventions/strategies to 
address all of the disease, condition and risk factor areas covered by 
STEPS (nutrition, physical activity, tobacco, asthma, diabetes, and 
obesity)?
    e. How well does the plan reflect and build 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. Does the applicant include a plan to sustain the project long 
term?
ii. School Interventions (10 of 40 Points)
    a. Does the applicant describe plans to implement school-based 
interventions

[[Page 25814]]

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. Does the applicant provide a feasible 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. Are the school-based interventions and the evaluation of them 
based on sound scientific evidence of their effectiveness?
    d. Are the proposed objectives and activities for school-based 
interventions 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. Is the lead/fiduciary agency clearly identified?
    ii. Does the lead/fiduciary agency have the capacity to ensure 
accountability for expenditures in relationship to performance of all 
key partners?
    iii. Does the applicant clearly and fully describe the proposed 
structure of the project including decision-making processes?
    iv. Does the applicant provide letters of support and memoranda of 
understanding (as appropriate) with partner agencies and organizations?
    v. Do letters of support and memoranda of understanding describe 
specific collaborative actions to be undertaken and the role of the 
partners?
    vi. Do the key partner organizations within the applicant community 
provide financial or in-kind contributions toward the success of the 
STEPS initiative?
    vii. Does the applicant describe realistic plans to coordinate 
proposed activities with state- and community-level programs to prevent 
and control chronic disease?
    viii. How well qualified are proposed staff regarding relevant 
background, expertise, qualifications, and experience to successfully 
accomplish the goals of the STEPS Program?
    ix. Does the proposed staffing plan appear appropriate to the level 
of work proposed and demonstrate the intent to minimize staff levels in 
order to maximize funding for interventions?
    x. Does the applicant describe 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. Does the applicant describe 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. Are appropriate data sources currently available or will they 
be made available?
    iii. Does the evaluation plan include the use of BRFSS and YRBS?
    iv. Are appropriate data sources 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?
    v. Does the applicant describe plans to collaborate fully in 
external, independently coordinated evaluation activities to evaluate 
the overall impact of STEPS?
    vi. Does the applicant demonstrate the capability to conduct 
surveillance and program evaluation, access and analyze official data 
sources, and use evaluation to strengthen the program?
    vii. Does the applicant describe how the project is anticipated to 
improve specific performance measures and outcomes compared to baseline 
performance?
(d) Background and Need (10 Points)
    i. Is the proposed intervention area clearly and thoroughly 
described, including the populations to be served?
    ii. Are data provided that substantiate the 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. Are data provided that substantiate existing health risk 
behaviors and risk factors related to chronic diseases in the proposed 
intervention area and populations to be served?
    iv. Are assets and barriers to successful program implementation 
identified?
    v. How well are existing resources being leveraged and used to 
complement or contribute to the effort planned in the proposal?
(e) Community Consortium (10 Points)
    i. Does the applicant demonstrate the ability to establish a 
consortium that is inclusive of key partners, and related coalitions?
    ii. Are all of the required partner organizations (see E.1.b.) 
included in the community consortium?
    iii. Does the applicant describe the capacity of the proposed 
consortium in terms of leadership, expertise, community representation, 
collaborative experience/abilities, and agency representation?
    iv. Do the key partners demonstrate a high-level commitment to 
planning, implementing, and evaluating the proposed project, including 
a commitment of staff and other resources?
    v. Have members of the proposed consortia successfully worked 
together or with others in the past to achieve improved health 
outcomes?
(f) Communication and Information Sharing (5 Points)
    i. Does the applicant describe plans to share experiences, 
strategies, and results with other interested States, communities, and 
partners?
    ii. Does the applicant describe 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)
    Is the budget 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 ``Evaluation Criteria'' V.1.a) through 
g) above.
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, 10 points per community if four communities). This section 
will be evaluated according to the same criteria for Large City and 
Urban Community proposals under ``Evaluation Criteria'' V.1.a) (i-ii) 
above.
b. Project Leadership, Collaboration, and Proposed Structure (15 
Points)
    i. Is the lead/fiduciary agency clearly identified?
    ii. Does the lead/fiduciary agency have the capacity to ensure 
accountability for expenditures in

[[Page 25815]]

relationship to performance of all key partners?
    iii. Does the applicant clearly and fully describe the proposed 
structure of the project including decision-making processes, 
monitoring, problem solving, and providing support to community-based 
programs?
    iv. Does the applicant provide letters of support and memoranda of 
understanding (as appropriate) with partner agencies and organizations?
    v. Do letters of support and memoranda of understanding describe 
specific collaborative actions to be undertaken and the role, 
responsibilities, and commitment of resources of the partners?
    vi. Do the key partner organizations within the State and proposed 
communities provide financial or in-kind contributions toward the 
success of the STEPS initiative?
    vii. Does the applicant describe realistic plans to coordinate 
proposed activities with State- and community-level programs to prevent 
and control chronic disease?
    viii. Do the proposed staff have the relevant background, 
qualifications, and experience to successfully accomplish the goals of 
the STEPS Program?
    ix. Does the proposed staffing plan appear appropriate to the level 
of work proposed and demonstrate the intent to minimize staff levels in 
order to maximize funding for interventions?
    x. Does the applicant describe clearly defined roles of project 
staff and an appropriate percent time each is committing to STEPS?
    xi. Does the proposed local consortia have the capacity for 
leadership, technical expertise, community representation, 
collaborative experience/abilities, and agency representation to 
successfully accomplish the goals of the STEPS Program?
    x. Does the applicant describe the 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. Does the applicant describe the past history and evidence of 
effectiveness of community partnerships within the 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. Does the applicant describe 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. Are appropriate data sources currently available or will they 
be made available?
    iii. Does the evaluation plan include the use of BRFSS and YRBS?
    iv. Are appropriate data sources 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?
    v. Does the applicant describe 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?
    vi. Does the applicant demonstrate the capability to conduct 
surveillance and program evaluation, access and analyze official data 
sources, and use evaluation to strengthen the program?
    vii. Does the applicant describe 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. Does the applicant propose a State-Community Management Team 
fully capable of guiding and directing the overall project?
    ii. Does the state have sufficient experience, expertise, and 
capacity to assist local communities in the activities of this project?
    iii. Does the applicant include evidence of having provided 
guidance and support to local communities that resulted in successful 
implementation and outcomes?
    iv. Are specific methods to assist local communities in the 
activities of this project described?
e. Background and Need (10 Points)
    i. Is the proposed intervention area clearly and thoroughly 
described, including the populations to be served?
    ii. Are data provided that substantiate the 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. Are data provided that substantiate existing health risk 
behaviors and risk factors related to chronic diseases in the proposed 
intervention area and populations to be served?
    iv. Are assets and barriers to successful program implementation 
identified?
    v. How well are existing resources being leveraged and used to 
complement or contribute to the effort planned in the proposal?
f. Communication and Information Sharing (5 Points)
    i. Does the applicant describe plans to share experiences, 
strategies, and results with other interested states, communities, and 
partners?
    ii. Does the applicant describe 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)
    Is the budget reasonable and consistent with the proposed 
activities and intent of the program?

V.2. Review and Selection Process

    Eligibility: LOIs and applications will be reviewed for 
eligibility. Applications that are non-responsive to the eligibility 
criteria will not advance through the review process. Applicants will 
be notified that their application did not meet submission 
requirements.
    Completeness: Applications will be reviewed for timeliness and 
completeness. Late applications, applications for which an LOI was not 
submitted, and incomplete applications (i.e., those that do not include 
all required forms and all elements described in section IV.2 of this 
program announcement) will not be entered into the review process. 
Applicants will be notified that their application did not meet 
submission requirements.
    Responsiveness: Applications will be reviewed for responsiveness. 
Applications that do not address all of the activities described in 
sections I.1, I.2, or I.3 of this program announcement will be 
considered non-responsive and will not be entered into the review 
process. Applicants will be notified that their application did not 
meet submission requirements.
    Review Process: An objective review panel will evaluate complete 
and responsive applications according to the criteria listed in the 
``V.1. Review Criteria.'' The following factors affect the award 
selection.

[[Page 25816]]

    1. The scores provided by the objective review. A minimum score of 
80 points must be received for further consideration.
    2. Geographic distribution across the country, considering the 
location of existing Steps grantee communities.
    3. Standardized scores. Multiple objective review panels will be 
used to evaluate the volume of applications generated by this 
announcement. HHS reserves the right to consider the applicant's rank 
on the objective review panel and/or a calculated standardized score. 
Standardized scores are used to normalize variations in scoring among 
the panels identified by the panels' average scores, standard 
deviations, median scores, minimum scores, maximum scores. Standardized 
scores take into account the average and standard deviation of the 
panel scores, thereby setting each panel's average score equal to zero, 
and allowing direct comparisons across panels.
    In addition, the following factors may affect the funding decision. 
Preference in funding, based on well-documented data, may be given to 
ensure:
     Inclusion of populations disproportionately affected by 
chronic disease and associated risk factors.
     Inclusion of geographic areas with high, age-adjusted 
rates of chronic disease and associated risk factors.
     Geographic distribution of STEPS programs nationwide.
     Inclusion of communities of varying sizes, including 
rural, suburban, and urban communities.

V.3. Anticipated Announcement and Award Dates

    September 22, 2004.

VI. Award Administration Information

VI.1. Award Notices

    Successful applicants will receive a Notice of Grant Award (NGA) 
from the CDC Procurement and Grants Office. The NGA shall be the only 
binding, authorizing document between the recipient and CDC. The NGA 
will be signed by an authorized Grants Management Officer, and mailed 
to the recipient fiscal officer identified in the application.
    Unsuccessful applicants will receive notification of the results of 
the application review by mail.

VI.2. Administrative and National Policy Requirements

    45 CFR parts 74 and 92.
    For more information on the Code of Federal Regulations, see the 
National Archives and Records Administration at the following Internet 
address: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html.
    The following additional requirements apply to this project:
     AR-8 Public Health System Reporting Requirements;
     AR-9 Paperwork Reduction Act Requirements;
     AR-10 Smoke-Free Workplace Requirements;
     AR-11 Healthy People 2010;
     AR-12 Lobbying Restrictions.
    Additional information on these requirements can be found on the 
CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/ARs.htm.

VI.3. Reporting Requirements

    You must provide CDC with an original, plus two hard copies of the 
following reports:
    1. Interim progress report will be due May 30, 2005, and subsequent 
interim progress reports will be due on the 30th of May each year 
through May 30, 2009. The progress report will serve as the 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. 
Detailed changes in the activity-based budget, the line-item budget, 
existing contracts, summary budget, and budget justification. 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 or 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, 2005 and subsequent annual 
progress reports will be due on the 20th of November each year through 
November 20, 2009.
    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 ``Agency Contacts'' section of this announcement.

VII. Agency Contacts

    For general questions about this announcement, contact: Technical 
Information Management Section, CDC Procurement and Grants Office,2920 
Brandywine Road, Atlanta, GA 30341, telephone: 770-488-2700.
    For program technical assistance, contact: Dr. Mary Vernon-Smiley, 
Centers for Disease Control and Prevention, 4770 Buford Highway, NE., 
Mailstop K-40, Atlanta, GA 30341, telephone: 770-488-6164, e-mail 
address: [email protected].
    For financial, grants management, or budget assistance, contact: 
Sylvia Dawson, Grants Management Specialist, CDC Procurement and Grants 
Office, 2920 Brandywine Road, Atlanta, GA 30341, telephone: 770-488-
2771, e-mail: [email protected].
    For business management and budget assistance, in the territories 
contact: Vincent Falzone, Procurement and Grants Office, Centers for 
Disease Control and Prevention, 2920 Brandywine Rd., Room 3000, 
Atlanta, GA 30341-4146, telephone: 770-488-2763, e-mail address: 
[email protected].

VIII. Other Information

    A live, interactive webcast about this announcement and the STEPS 
Program will be held on May 19, 2004, starting at 1 p.m. eastern 
standard time. Information about the webcast, including directions on 
how to participate, as well as common questions and answers about this 
program announcement can be found at http://www.HealthierUS.gov.
    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''.

    Dated: April 30, 2004.
William P. Nichols,
Acting Director, Procurement and Grants Office, Centers for Disease 
Control and Prevention.
[FR Doc. 04-10416 Filed 5-4-04; 2:52 pm]
BILLING CODE 4163-18-P