[Federal Register Volume 86, Number 211 (Thursday, November 4, 2021)]
[Notices]
[Pages 60883-60893]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24039]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Zero Suicide Initiative

    Announcement Type: New.
    Funding Announcement Number: HHS-2022-IHS-ZSI-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.654.

Key Dates

    Application Deadline Date: February 2, 2022.
    Earliest Anticipated Start Date: March 21, 2022.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for a 
cooperative agreement for the Zero Suicide Initiative (ZSI). This 
program is authorized under the Snyder Act, 25 U.S.C. 13; the Transfer 
Act, 42 U.S.C. 2001(a); and the Indian Health Care Improvement Act, 25 
U.S.C. 1665 et seq. This program is described in the Assistance 
Listings located at https://sam.gov/content/home (formerly known as 
Catalog of Federal Domestic Assistance) under 93.654.

Background

    Since 1999, suicide rates within the Unites States have been 
steadily increasing.\1\ On March 2, 2018, the Centers for Disease 
Control and Prevention's Morbidity and Mortality Weekly report released 
a data report, ``Suicides Among American Indian/Alaska Natives--
National Violent Death Reporting System, 18 States, 2003 to 2014,'' 
which highlights American Indian/Alaska Natives having the highest 
rates of suicide of any racial/ethnic group in the Unites States. The 
suicide rate for American Indian/Alaska Native (AI/AN) adolescents and 
young adult ages 15 to 34 (19.1/100,000) was 1.3 times that of the 
national average for that age group (14/100,000).\2\ In June 2019, the 
National Center for Health Statistics, Health E-Stat reported in 
``Suicide Rates for Females and Males by Race and Ethnicity: United 
States, 1999 and 2017,'' suicide rates increased for all race and 
ethnicity groups but the largest increase occurred for non-Hispanic AI/
AN females (139% from 4.6 to 11.0 per 100,000). Suicide is the 8th 
leading cause of death among all AI/AN people across all ages and may 
be underestimated.
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    \1\ Curtin SC, Hedegaard H. Suicide rates for females and males 
by race and ethnicity: United States, 1999 and 2017. NCHS Health E-
Stat. 2019.
    \2\ Leavitt RA, Ertle AE, Sheats K, Petrosky E, Ivey-Stephenson 
A, Fowler KA (2018) Suicides Among American Indian/Alaska Natives--
National Violent Death Reporting System, 18 States, 2003 to 2014. 
MMWR Morb Mortal Wkly Rep 2018;67: 37-240.
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    The `Zero Suicide' model is a key component of the National 
Strategy for Suicide Prevention (NSSP) and is a priority of the 
National Action Alliance for Suicide Prevention (https://theactionalliance.org/). The `Zero Suicide' model focuses on developing 
a system-wide approach to improving care for individuals at risk of 
suicide who are currently using health and behavioral health systems. 
This award will support implementation of the `Zero Suicide' model 
within Tribal and Urban Indian health care facilities and systems that 
provide direct care services to AI/AN individuals in order to raise 
awareness of suicide, establish integrated systems of care, and improve 
outcomes for such individuals. Applicants are encouraged to visit 
https://www.hhs.gov/surgeongeneral/reports-and-publications/suicide-prevention/index.html to access a copy of the 2012 National Strategy.

Purpose

    The purpose of this program is to improve the system of care for 
those at risk for suicide by implementing a comprehensive, culturally 
informed, multi-setting approach to suicide prevention in Indian health 
systems. This award represents a continuation of the IHS effort to 
implement the Zero Suicide approach in Indian Country. The intent of 
this announcement is to initiate a new, or build upon the previous, 
Zero Suicide Initiative efforts. Existing efforts have focused on 
foundational learning of the key concepts of the Zero Suicide 
framework, technical assistance, and consultation for several AI/AN 
Zero Suicide communities. As a result of these efforts, both the unique 
opportunities and challenges of implementing Zero Suicide in Indian 
Country have been identified. To best capitalize on opportunities and 
surmount such challenges, this program focuses on the core Seven 
Elements of the Zero Suicide model as developed by the Suicide 
Prevention Resource Center (SPRC) at https://zerosuicide.edc.org/toolkit/zero-suicide-toolkit:
    1. Lead--Create and sustain a leadership-driven, safety-oriented 
culture committed to dramatically reducing suicide among people under 
care. Include survivors of suicide attempts and suicide loss in 
leadership and planning roles;
    2. Train--Develop a competent, confident, and caring workforce;
    3. Identify--Systematically identify and assess suicide risk among 
people receiving care;
    4. Engage--Ensure every individual has a pathway to care that is 
both timely and adequate to meet his or her needs. Include 
collaborative safety planning and restriction of lethal means;
    5. Treat--Use effective, evidence-based treatments that directly 
target suicidal thoughts and behaviors;
    6. Transition--Provide continuous contact and support, especially 
after acute care; and,
    7. Improve--Apply a data-driven, quality improvement approach to 
inform system changes that will lead to improved patient outcomes and 
better care for those at risk.

Required, Optional, and Allowable Activities

    Each applicant must describe how they plan to implement the 
following core elements of this program in their project narrative and 
incorporate culture within the approach to each of the seven elements.
1. Lead
    a. Establish a leadership-driven strategic plan which includes 
session planning (see link https://

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zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-
template) to transform the delivery of suicide care within the health 
care system.
    b. Describe the organizational steps to broaden the responsibility 
for suicide care across the entire health care system.
    c. Detail the specific role of leadership to ensure system 
transformation is achieved. Examples of leadership commitment can 
include, but are not limited to: Tribal Resolutions, Tribal codes, 
formal suicide care policies, and formation of Zero Suicide Initiative 
advisory boards.
2. Train
    a. Evaluate training needs and develop a formal training plan for 
suicide prevention gatekeeper training (examples include, but are not 
limited to, Question Persuade Refer, Applied Suicide Intervention 
Skills Training, and Mental Health First Aid). In addition, the 
training plan should include training in treating suicide risk 
(examples include, but are not limited to, Dialectical Behavioral 
Therapy, Cognitive Processing Therapy for Suicide Prevention, and 
Cognitive Therapy for Suicidal Patients).
    b. The formal training plan for staff should focus across the 
health care system to strengthen and advance the skills of health care 
staff and providers at all levels.
    c. Training must target increasing competence in the delivery of 
culturally informed, evidence-based suicide care in all health care 
settings. Survey at https://zerosuicide.edc.org/sites/default/files/ZS%20Workforce%20Survey%20July%202020.pdf will be completed and 
reported on at the initiation of the period of performance.
    d. Train new or existing staff with an emphasis in these functions 
(see link https://zerosuicide.edc.org/resources/resource-database/suicide-care-training-options).
    e. Project/program oversight.
    f. Case management/coordination to ensure continuity of care across 
and between various departments, health care systems, and or levels of 
care (e.g., transfer from high risk to low risk, discharge from 
inpatient mental health care).
    g. Data collection support and access for Electronic Health Record 
(EHR), clinical application, project coordinator support, and other 
data related activities. Adopt and/or enhance computer systems, 
including management information system, EHRs, and other systems/
software, to better document and manage patient needs, the care 
process, integration with related support services, and track outcomes.
3. Identify
    a. Implement system-wide policies and procedures for comprehensive 
suicide care standards to include, at a minimum:
    i. Universal screening of all patients ages 10 and above for 
suicide risk using validated instruments (see link https://zerosuicide.edc.org/resources/resource-database/ask-suicide-screening-questions-asq-toolkit).
    ii. Full suicide risk assessment of all patients with positive 
suicide risk screen (including risk level formulation), using (see link 
https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/suicide-prevention/pages-from-suicide_prevention_compendium_5_11_20_updated-july2020_ep3_4.pdf).
    iii. Individual Safety Plan for all patients with positive suicide 
risk screen to include counseling patients on reduction to access of 
lethal means and means restriction (see link https://www.sprc.org/resources-programs/patient-safety-plan-template).
    iv. Procedure and protocol for tracking patients at increased risk 
for suicide by placing patients on a suicide care management plan/
pathway. This must also address how patients are monitored while on the 
plan/pathway, how often patients are re-evaluated to assess risk level, 
when it is appropriate to remove patient from plan/pathway, follow-up 
protocols after patients are removed from plan/pathway, etc. (see link 
https://www.jointcommission.org/sea_issue_56/).
    b. Develop protocols for every individual identified as at risk of 
suicide to continuously monitor the individual's progress through their 
EHR or other data management system to include the following:
    i. Rapid follow-up of adults who have attempted suicide or 
experienced a suicidal crisis after being discharged from a treatment 
facility, e.g., local emergency departments, inpatient psychiatric 
facilities, including direct linkage with appropriate health care 
agencies to ensure coordinated care services and protocols are in place 
to ensure patient safety, especially among high-risk adults with 
serious mental illness. This must include outreach telephone contact 
within 24 to 48 hours after discharge and securing an appointment 
within 1 week of discharge (see link https://www.jointcommission.org/resources/patient-safety-topics/suicide-prevention/).
    ii. Establish health system leadership including outside service 
providers (i.e., local suicide prevention crisis lines to help with 
follow-up contacts, etc.), and develop teams to guide the 
implementation of the Zero Suicide model within their agencies.
4. Engage
    a. Develop a Suicide Care Management Plan for every patient 
identified as high risk of suicide (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-template). Implement a process for continuous monitoring of those 
patients' progress through their EHR or other data management system, 
and adjust treatment as necessary.
5. Treat
    a. Develop a strategy and specific plan (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-data-elements-worksheet) to collect, analyze, and disseminate data related 
to suicide care across the health care system.
    b. Use a data-informed approach for quality improvement at the 
levels of policy, process, and practice. Wherever possible, this 
approach should include a unified EHR, or memorandum of understanding/
memorandum of agreement (MOU/MOA) to establish a process to share data 
between and across systems of care for all patients in a suicide risk 
clinical pathway. For example, a data report that indicates a high 
percentage of patients being discharged from inpatient stays failed to 
receive follow-up appointments may result in implementing a plan to 
reduce that number by changing staffing patterns and processes to focus 
on scheduling follow-up care.
    c. Apply the use of evidence-based practices to screen, assess, and 
treat individuals at risk for suicide in a way that incorporates 
culturally informed practices and activities. Clearly describe how 
cultural best practices and/or traditional approaches are offered, 
utilized, and/or incorporated within the health care system to 
complement/augment into the evidence-based protocols with those at risk 
for suicide.
    d. Evidence-based practices, where appropriate, may include:
    i. Suicide risk screening--Ask Suicide-Screening Questions (see 
link https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/index.shtml).
    ii. Columbia Suicide Severity Rating Scale (see link https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english).

[[Page 60885]]

    iii. Suicide Risk Assessment--Brief Suicide Safety Assessment (see 
link https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/youth-outpatient/youth-outpatient-brief-suicide-safety-assessment-worksheet.shtml).
    iv. Columbia Suicide Severity Rating Scale (see link https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english).
    v. Suicide treatment--Dialectical Behavioral Therapy (see link 
https://www.sprc.org/resources-programs/dialectical-behavior-therapy).
    vi. Cognitive Therapy for Suicidal Patients (see link https://www.sprc.org/resources-programs/cognitive-therapy-suicide-prevention).
    vii. Cultural best practices and/or traditional approaches--
Language immersion, traditional healers, and traditional ceremonies 
(see link https://zerosuicide.edc.org/toolkit/toolkit-adaptations/indian-country).
6. Transition
    a. The Suicide Care Management Plan must include the following (see 
link https://zerosuicide.edc.org/resources/resource-database/best-practices-care-transitions-individuals-suicide-risk-inpatient-care):
    i. Protocols for safety planning and reducing access to lethal 
means in a point-to-point transition of care within a system;
    ii. Rapid follow-up of adults who have attempted suicide or 
experienced a suicidal crisis after being discharged from a treatment 
facility (e.g., local emergency departments, inpatient psychiatric 
facilities), including direct linkage with appropriate health care 
agencies to ensure coordinated care services are in place;
    iii. Protocols to ensure patient safety, especially among high-risk 
adults in health care systems who have attempted suicide, experienced a 
suicidal crisis, and/or have a serious mental illness. This must 
include outreach telephone contact within 24 to 48 hours after 
discharge and securing an appointment within 1 week of discharge (see 
link https://zerosuicide.edc.org/toolkit/transition and/or https://theactionalliance.org/healthcare/caretransitions).
7. Improve
    a. Describe the quality improvement activities that will be used to 
track progress towards your process and outcome measure and how these 
data will be used to inform the ongoing implementation of the project 
and beyond (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-template).
    In addition to the seven elements listed above, the following 
activities are also required:
    1. Seek the IHS's approval for key positions to be filled. Key 
positions include, but are not limited to, the Project Director, 
Project Coordinator, and Evaluator.
    2. Consult and accept guidance from IHS staff on performance of 
programmatic and data collection activities to achieve the goals of the 
cooperative agreement.
    3. Maintain ongoing communication with the IHS including a minimum 
of one call per month, keeping Federal program staff informed of 
emerging issues, developments, and problems as appropriate.
    4. Invite the IHS Program Official to observe and provide feedback 
to policy, steering, advisory, or other task forces.
    5. Maintain ongoing collaboration with the IHS ZSI Technical 
Assistance Coordinating Center, the Suicide Prevention Resource Center, 
and the National Suicide Prevention Lifeline.
    6. Provide required documentation for monthly and annual reporting 
and data surveillance around suicidal behavior in selected health and 
behavioral health care systems.

Practice-Based Evidence, Promising Practices, and Local Efforts

    The IHS encourages the implementation of Tribal and/or culturally 
appropriate suicide prevention and intervention strategies but 
recognizes the limited range of formally evaluated evidence-based 
practices for suicide and substance abuse that have been developed 
specifically for the American Indians/Alaska Natives population. In 
addition to formally evaluated practices, which exist in the research 
and practice literature, evidence for other practices are allowed in 
this grant program. Evidence of other practices may include unpublished 
studies, preliminary evaluation results, clinical (or other 
professional association) guidelines, findings from focus groups with 
community members, local community surveys, etc.
     Document the evidence that the practice(s) you have chosen 
is appropriate for the outcomes you want to achieve.
     Explain how the practice you have chosen meets the goals 
for this program.
     Describe any modifications/adaptations you will need to 
make to your proposed practice(s) to meet the goals of your project and 
why you believe the changes will improve the outcomes.
     Discuss training needs or plans for training to 
successfully implement the proposed evidence-based practice(s).

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2022 is 
approximately $2,000,000. Individual award amounts for the first budget 
year are anticipated to be between $200,000 and $300,000. The funding 
available for competing and subsequent continuation awards issued under 
this announcement is subject to the availability of appropriations and 
budgetary priorities of the Agency. The IHS is under no obligation to 
make awards that are selected for funding under this announcement.
Anticipated Number of Awards
    Approximately 8-10 awards will be issued under this program 
announcement, with a set aside of up to two awards issued to eligible 
UIOs.
Period of Performance
    The period of performance is for 5 years.
Cooperative Agreement
    Cooperative agreements awarded by the Department of Health and 
Human Services (HHS) are administered under the same policies as 
grants. However, the funding agency, IHS, is anticipated to have 
substantial programmatic involvement in the project during the entire 
period of performance. Below is a detailed description of the level of 
involvement required of the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
    1. Approve all proposed key positions/personnel.
    2. Facilitate linkages to other IHS/Federal government resources 
and help grantees access appropriate technical assistance.
    3. Assure that the grantee's project activities are aligned with 
the mission, strategic goals and objectives of the IHS, and with the 
goals of the Zero Suicide Initiative.
    4. Coordinate cross-site evaluation participation in grantee and 
staff required monitoring conference calls.
    5. Promote collaboration with other IHS and Federal health and 
behavioral health initiatives, including the Substance Abuse Mental 
Health Services Administration (SAMHSA), the

[[Page 60886]]

National Action Alliance for Suicide Prevention, the National Suicide 
Prevention Lifeline, the SPRC, and the Zero Suicide Institute.
    6. Provide technical assistance on all aspects of the ZSI program 
implementation and sustainability.
    7. Share aggregate data related to suicide behavior and clinical 
care necessary to determine that the project has met expected and 
identified goals, objectives, and outcomes. Describe the process of 
continuous involvement based on results and analysis of the same.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity the applicant must be 
one of the following as defined by 25 U.S.C. 1603:
     A federally recognized Indian Tribe as defined by 25 
U.S.C. 1603(14). The term ``Indian Tribe'' means any Indian Tribe, 
band, nation, or other organized group or community, including any 
Alaska Native village or group or regional or village corporation, as 
defined in or established pursuant to the Alaska Native Claims 
Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is 
recognized as eligible for the special programs and services provided 
by the United States to Indians because of their status as Indians.
     A Tribal organization as defined by 25 U.S.C. 1603(26). 
The term ``Tribal organization'' has the meaning given the term in 
section 4 of the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 5304(1)): ``Tribal organization'' means the recognized 
governing body of any Indian Tribe; any legally established 
organization of Indians which is controlled, sanctioned, or chartered 
by such governing body or which is democratically elected by the adult 
members of the Indian community to be served by such organization and 
which includes the maximum participation of Indians in all phases of 
its activities: Provided that, in any case where a contract is let or 
grant made to an organization to perform services benefiting more than 
one Indian Tribe, the approval of each such Indian Tribe shall be a 
prerequisite to the letting or making of such contract or grant. 
Applicant shall submit letters of support and/or Tribal Resolutions 
from the Tribes to be served.
     An Urban Indian organization as defined by 25 U.S.C. 
1603(29). The term ``Urban Indian organization'' means a nonprofit 
corporate body situated in an urban center, governed by an urban Indian 
controlled board of directors, and providing for the maximum 
participation of all interested Indian groups and individuals, which 
body is capable of legally cooperating with other public and private 
entities for the purpose of performing the activities described in 25 
U.S.C. 1653(a). Applicants must provide proof of non-profit status with 
the application, e.g., 501(c)(3).
    The program office will notify any applicants deemed ineligible.
    Note: Please refer to Section IV.2 (Application and Submission 
Information/Subsection 2, Content and Form of Application Submission) 
for additional proof of applicant status documents required, such as 
Tribal Resolutions, proof of nonprofit status, etc.

2. Cost Sharing or Matching

    The IHS does not require matching funds or cost sharing for grants 
or cooperative agreements.

3. Other Requirements

    Applications with budget requests that exceed the highest dollar 
amount outlined under Section II Award Information, Estimated Funds 
Available, or exceed the period of performance outlined under Section 
II Award Information, Period of Performance, are considered not 
responsive and will not be reviewed. The Division of Grants Management 
(DGM) will notify the applicant.
Additional Required Documentation
Tribal Resolution
    The DGM must receive an official, signed Tribal Resolution prior to 
issuing a Notice of Award (NoA) to any applicant selected for funding. 
An Indian Tribe or Tribal organization that is proposing a project 
affecting another Indian Tribe must include resolutions from all 
affected Tribes to be served. However, if an official, signed Tribal 
Resolution cannot be submitted with the application prior to the 
application deadline date, a draft Tribal Resolution must be submitted 
with the application by the deadline date in order for the application 
to be considered complete and eligible for review. The draft Tribal 
Resolution is not in lieu of the required signed resolution but is 
acceptable until a signed resolution is received. If an application 
without a signed Tribal Resolution is selected for funding, the 
applicant will be contacted by the Grants Management Specialist (GMS) 
listed in this funding announcement and given 90 days to submit an 
official, signed Tribal Resolution to the GMS. If the signed Tribal 
Resolution is not received within 90 days, the award will be forfeited.
    Tribes organized with a governing structure other than a Tribal 
council may submit an equivalent document commensurate with their 
governing organization.
Proof of Nonprofit Status
    Organizations claiming nonprofit status must submit a current copy 
of the 501(c)(3) Certificate with the application.

IV. Application and Submission Information

1. Obtaining Application Materials

    The application package and detailed instructions for this 
announcement are available at https://www.Grants.gov.
    Please direct questions regarding the application process to Mr. 
Paul Gettys at (301) 443-2114 or (301) 443-5204.

2. Content and Form Application Submission

    Mandatory documents for all applicants include:
     Abstract (one page) summarizing the project.
     Application forms:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
     Project Narrative (not to exceed 30 pages). See IV.2.A, 
Project Narrative for instructions.
    1. Background information on the organization.
    2. Proposed scope of work, objectives, and activities that provide 
a description of what the applicant plans to accomplish.
     Budget Justification and Narrative (not to exceed four 
pages). See IV.2.B, Budget Narrative for instructions.
     One-page Timeline Chart.
     Tribal Resolution(s). A Tribal Resolution expressing a 
bona fide commitment to a Zero Suicide model within the health and 
behavioral health care system must be provided.
     Letters of Support from organization's Board of Directors 
(if applicable).
     501(c)(3) Certificate (if applicable).
     Biographical sketches for all Key Personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Certification Regarding Lobbying (GG--Lobbying Form).

[[Page 60887]]

     Copy of current Negotiated Indirect Cost rate (IDC) 
agreement (required in order to receive IDC).
     Organizational Chart (optional).
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    1. Email confirmation from Federal Audit Clearinghouse (FAC) that 
audits were submitted; or
    2. Face sheets from audit reports. Applicants can find these on the 
FAC website at https://harvester.census.gov/facdissem/Main.aspx.
Public Policy Requirements
    All Federal public policies apply to IHS grants and cooperative 
agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be 
deemed subjected to discrimination by reason of their exclusion from 
benefits limited by Federal law to individuals eligible for benefits 
and services from the IHS. See https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html.
Requirements for Project and Budget Narratives
    A. Project Narrative: This narrative should be a separate document 
that is no more than 30 pages and must: (1) Have consecutively numbered 
pages; (2) use black font 12 points or larger; (3) be single-spaced; 
and (4) be formatted to fit standard letter paper (8\1/2\ x 11 inches).
    Be sure to succinctly answer all questions listed under the 
evaluation criteria (refer to Section V.1, Evaluation Criteria) and 
place all responses and required information in the correct section 
noted below or they will not be considered or scored. If the narrative 
exceeds the page limit, the application will be considered not 
responsive and will not be reviewed. The 30-page limit for the 
narrative does not include the work plan, standard forms, Tribal 
Resolutions, budget, budget justifications, narratives, and/or other 
items.
    There are four parts to the project narrative:

Part 1--Statement of Need;
Part 2--Implementation Approach and Work Plan;
Part 3--Organizational Capacity;
Part 4--Data Collection and Reporting.

    Below are additional details about what must be included in the 
project narrative.
    The intent of this announcement is to initiate or build upon Zero 
Suicide Initiative efforts. Applicants previously funded by IHS for ZSI 
implementation must report on the status of their goals/milestones. If 
goals/milestone were not achieved by those applicants, they are 
expected to provide clear explanation of the barriers that prevented 
the achievement of previous goal/milestones in the application to this 
funding announcement.
Part 1: Statement of Need (Limit--6 Pages)
    The statement of need describes the scope and scale of suicide 
behavior within the community served and within the health and/or 
behavioral health system. This section must identify gaps in suicide 
care delivery and those gaps and any other barriers in providing 
comprehensive, culturally informed care to those at risk for suicide. 
The statement of need provides the facts and evidence that support the 
need for the project and establishes that the Tribe, Tribal 
organization, or UIO understands the problems and can reasonably 
address them. Applicant's data may include the following metrics 
outlined below.
Identify
     Describe the proposed catchment area and demographic 
information on the population(s) to receive services through the 
targeted systems or agencies, e.g., race, ethnicity, federally 
recognized Tribe, language, age, socioeconomic status, sex, and other 
relevant factors, such as literacy.
Improve
     Provide evidence of the prevalence of suicidal behavior 
within the population(s) of focus, including any current limitations of 
data collection in the health system. In addition, discuss how the 
proposed project will address disparities in access, service use, and 
outcomes for the population(s) of focus (see link https://zerosuicide.edc.org/toolkit/indian-country/improve-indian-country).
    1. Number of screenings performed.
    2. Number of those above screening cut off who receive a full 
suicide risk assessment.
    3. Numbers of those receiving a full risk assessment who have a 
collaboratively developed safety plan.
    4. Number of those with a collaboratively developed safety plan who 
have been counseled on reduction of access to lethal means.
    5. Percentage of all behavioral health clinicians who use evidence-
based practices to directly treat those at risk for suicide.
    6. Percentage of follow up on those who may be at risk for suicide 
to ensure safe transitions through care.
    7. Percentage of documentation on every loss by suicide.
     Documentation of the need for an enhanced infrastructure 
(system/process improvements) to increase the capacity to implement, 
sustain, and improve comprehensive, integrated, culturally informed, 
evidence-based suicide care within the identified health care system 
that is consistent with the purpose of the program as stated in this 
announcement (see link https://zerosuicide.edc.org/resources/zero-suicide-workforce-survey-resources). This may also include a clear 
description of any service gaps, staff/provider training deficits, 
service delivery fragmentations, and other barriers that could impact 
comprehensive suicide care for patients seen in the health system.
     Applicants are encouraged to review the Zero Suicide 
strategies and tools to help prepare for application to this 
announcement. Please see http://zerosuicide.sprc.org/sites/zerosuicide.actionallianceforsuicideprevention.org/files/Zero%20Suicide%20Workplan%20Template%2012.6.17.pdf.
Part 2: Implementation Approach & Work Plan (Limit--9 Pages)
    Applicant should develop a viable plan to address each of the 7 
Elements (see link http://zerosuicide.edc.org/toolkit) in a systematic, 
measureable, and interrelated manner. Evidence of plan to the 
identification, use, and measurement of the use of culturally informed 
practices and activities (see link https://zerosuicide.edc.org/resources/populations/native-american-and-alaska-native).
    Please include a Project Timeline in the application.
Lead
     A clear description of strategies to engage the highest 
levels of leadership and a broad cross section of the hospital system 
in order to develop organizational commitment, participation and 
sustainability (Letters of Commitment should be included as 
attachments). If the program is to be managed by a consortium or Tribal 
organization, identify how the project office relates to the member 
community/communities.
Transition
     A contingency plan that addresses short-term maintenance 
and long-term sustainability. How will continuity be maintained if/when 
there is a change in the operational environment (e.g., health care 
system leadership, staff turnover, change in project leadership, change 
in elected officials, etc.) to

[[Page 60888]]

ensure project stability over the period of performance. Additionally, 
describe long-term plan for sustainability of the ZSI model beyond the 
period of performance.
     Include how your project plans to involve survivors of 
suicide attempts and suicide loss in assessing, planning, and 
implementing your project.
Part 3: Organizational Capacity (Limit--8 Pages)
    This section focuses on how the organization may capitalize on 
existing resources, processes, human capital, quality initiatives, 
collaborative agreements, and surveillance capabilities as a means of 
overcoming barriers to a comprehensive, culturally informed system of 
suicide care.
Lead
     Describe any experience (successes and/or challenges) with 
the Zero Suicide model (e.g., attended a Zero Suicide Academy, etc.) or 
similar collaborative efforts (e.g., patient centered medical home, 
behavioral integration, trauma-informed systems, and improving patient 
care, etc.).
     Discuss the applicant Tribe, Tribal organization, or UIO 
experience with and capacity (or detailed plan) to provide culturally 
informed practices and activities for specific populations of focus.
     Explain how all departments/units/divisions are (or plan 
to be) involved in administering this project. You may also include how 
applicant organization currently (or plans to) collaborate with other 
organizations and agencies to provide care, including critical 
transition of care. Provide Letter(s) of Commitment, MOA, MOUs etc., 
from CEO, Tribal Health Director, Tribal Chair, etc.
     Describe the resources available for the proposed project 
(e.g., facilities, equipment, information technology systems, EHR 
capabilities, financial management systems, data sharing agreement, 
MOUs, etc.).
     List of all staff positions for the project, such as 
Project Director, project coordinator, case manager and other key 
personnel, and briefly describe their role and level of effort on the 
project.
Part 4: Data Collection and Reporting (Limit--7 Pages)
    This section of the narrative should describe function of position 
and efforts to collect and report project data that will support and 
demonstrate ZSI activities. All ZSI grantees will be required to 
collect and report data pertaining to activities, processes, and 
outcomes that support the following core elements:
Improve
     Provide a clear, specific plan for how data will be 
collected, managed, analyzed, and reported.
     Identify which staff will be responsible for tracking the 
goals and measureable objectives associated with the award.
Lead
     Review of suicide care policies and procedures.
     Review of any MOUs, MOAs, commitment letters, etc.
     ZSI Implementation team participation.
     Engagement of those that have experienced suicidal 
thoughts, survived a suicide attempt, cared for someone through 
suicidal crisis, or been bereaved by suicide.
Improve
     Assessment of fidelity to the Zero Suicide model (to 
include periodic administering of Organizational Self-Study).
     Periodic assessment of staff development and training 
needs (to include the periodic administering of the Workforce Survey).
     Sustainability.
     Measurement-based screening tools.
     Review of EHR capability.
     Patient satisfaction.
    B. Budget Narrative (limit--4 pages). Provide a budget narrative 
that explains the amounts requested for each line item of the budget 
from the SF-424A (Budget Information for Non-Construction Programs). 
The budget narrative should specifically describe how each item will 
support the achievement of proposed objectives. Be very careful about 
showing how each item in the ``Other'' category is justified. For 
subsequent budget years, the narrative should highlight the changes 
from year 1 or clearly indicate that there are no substantive budget 
changes during the period of performance. Do NOT use the budget 
narrative to expand the project narrative.

3. Submission Dates and Times

    Applications must be submitted through Grants.gov by 11:59 p.m. 
Eastern Time on the Application Deadline Date. Any application received 
after the application deadline will not be accepted for review. 
Grants.gov will notify the applicant via email if the application is 
rejected.
    If technical challenges arise and assistance is required with the 
application process, contact Grants.gov Customer Support (see contact 
information at https://www.grants.gov). If problems persist, contact 
Mr. Paul Gettys ([email protected]), Acting Director, DGM, by 
telephone at (301) 443-2114 or (301) 443-5204. Please be sure to 
contact Mr. Gettys at least ten days prior to the application deadline. 
Please do not contact the DGM until you have received a Grants.gov 
tracking number. In the event you are not able to obtain a tracking 
number, call the DGM as soon as possible.
    IHS will not acknowledge receipt of applications.

4. Intergovernmental Review

    Executive Order 12372 requiring intergovernmental review is not 
applicable to this program.

5. Funding Restrictions

     Pre-award costs are allowable up to 90 days before the 
start date of the award provided the costs are otherwise allowable if 
awarded. Pre-award costs are incurred at the risk of the applicant.
     The available funds are inclusive of direct and indirect 
costs.
     Only one cooperative agreement may be awarded per 
applicant under this announcement.

6. Electronic Submission Requirements

    All applications must be submitted via Grants.gov. Please use the 
https://www.Grants.gov website to submit an application. Find the 
application by selecting the ``Search Grants'' link on the homepage. 
Follow the instructions for submitting an application under the Package 
tab. No other method of application submission is acceptable.
    If the applicant cannot submit an application through Grants.gov, a 
waiver must be requested. Prior approval must be requested and obtained 
from Mr. Paul Gettys, Acting Director, DGM. A written waiver request 
must be sent to [email protected] with a copy to 
[email protected]. The waiver request must: (1) Be documented in 
writing (emails are acceptable) before submitting an application by 
some other method, and (2) include clear justification for the need to 
deviate from the required application submission process.
    Once the waiver request has been approved, the applicant will 
receive a confirmation of approval email containing submission 
instructions. A copy of the written approval must be included with the 
application that is submitted to the DGM. Applications that are 
submitted without a copy of the signed waiver from the Acting Director 
of the DGM will not be reviewed. The Grants Management Officer of the 
DGM

[[Page 60889]]

will notify the applicant via email of this decision. Applications 
submitted under waiver must be received by the DGM no later than 5:00 
p.m., Eastern Time, on the Application Deadline Date. Late applications 
will not be accepted for processing. Applicants that do not register 
for both the System for Award Management (SAM) and Grants.gov and/or 
fail to request timely assistance with technical issues will not be 
considered for a waiver to submit an application via alternative 
method.
    Please be aware of the following:
     Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the 
Funding Opportunity Number. Both numbers are located in the header of 
this announcement.
     If you experience technical challenges while submitting 
your application, please contact Grants.gov Customer Support (see 
contact information at https://www.grants.gov).
     Upon contacting Grants.gov, obtain a tracking number as 
proof of contact. The tracking number is helpful if there are technical 
issues that cannot be resolved and a waiver from the agency must be 
obtained.
     Applicants are strongly encouraged not to wait until the 
deadline date to begin the application process through Grants.gov as 
the registration process for SAM and Grants.gov could take up to twenty 
working days.
     Please follow the instructions on Grants.gov to include 
additional documentation that may be requested by this funding 
announcement.
     Applicants must comply with any page limits described in 
this funding announcement.
     After submitting the application, the applicant will 
receive an automatic acknowledgment from Grants.gov that contains a 
Grants.gov tracking number. The IHS will not notify the applicant that 
the application has been received.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
    Applicants and grantee organizations are required to obtain a DUNS 
number and maintain an active registration in the SAM database. The 
DUNS number is a unique 9-digit identification number provided by D&B 
that uniquely identifies each entity. The DUNS number is site specific; 
therefore, each distinct performance site may be assigned a DUNS 
number. Obtaining a DUNS number is easy, and there is no charge. To 
obtain a DUNS number, please access the request service through https://fedgov.dnb.com/webform, or call (866) 705-5711.
    The Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), requires all HHS recipients to report 
information on sub-awards. Accordingly, all IHS grantees must notify 
potential first-tier sub-recipients that no entity may receive a first-
tier sub-award unless the entity has provided its DUNS number to the 
prime grantee organization. This requirement ensures the use of a 
universal identifier to enhance the quality of information available to 
the public pursuant to the Transparency Act.
System for Award Management (SAM)
    Organizations that are not registered with SAM must have a DUNS 
number first, then access the SAM online registration through the SAM 
home page at https://www.sam.gov/SAM/ (U.S. organizations will also 
need to provide an Employer Identification Number from the Internal 
Revenue Service that may take an additional 2-5 weeks to become 
active). Please see SAM.gov for details on the registration process and 
timeline. Registration with the SAM is free of charge but can take 
several weeks to process. Applicants may register online at https://www.sam.gov/SAM/.
    Additional information on implementing the Transparency Act, 
including the specific requirements for DUNS and SAM, are available on 
the DGM Grants Management, Policy Topics web page: https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The 30-page project narrative should include only the first year of 
activities; information for multi-year projects should be included as 
an appendix. See ``Multi-year Project Requirements'' at the end of this 
section for more information. The narrative section should be written 
in a manner that is clear to outside reviewers unfamiliar with prior 
related activities of the applicant. It should be well organized, 
succinct, and contain all information necessary for reviewers to 
understand the project fully. Points will be assigned to each 
evaluation criteria adding up to a total of 100 possible points. Points 
are assigned as follows:

1. Evaluation Criteria

    Applications will be reviewed and scored according to the quality 
of responses to the required application components in Sections A-E. 
The points listed after each heading is the maximum number of points a 
reviewer may assign to that section.
A. Statement of Need (10 Points)
    The criteria being evaluated is the quality of your strategic 
approach and logical steps to implement a Zero Suicide Initiative 
within your health system. The following aspects will be assessed:
    1. The degree to which the applicant's description of the service 
area/target population demonstrates the need for a systems approach to 
suicide care within the health and behavioral health systems.
    2. How well the applicant describes the unique characteristics of 
the service area and population and systems barriers/gaps that impact 
the delivery of comprehensive suicide care.
B. Implementation Approach & Work Plan (30 Points)
    1. A viable plan to address each of the 7 Elements of the Zero 
Suicide model and the required activities (described in Section 1) in a 
systematic, measureable, and interrelated manner. Develop strategy to 
collect, and analyze application of evidence-based practices to screen, 
assess, and treat individuals' use of culturally informed practices and 
activities. (See Resources for Native American and Alaska Native 
Populations at https://zerosuicide.edc.org/resources/populations/native-american-and-alaska-native).
    2. A clear description of strategies to engage the highest levels 
of leadership and a broad cross section of the behavioral/healthcare 
system in order to develop organizational commitment, participation and 
sustainability (Letters of Commitment, MOUs, MOAs, etc., should be 
included as attachments). If the program is to be managed by a 
consortium or Tribal organization, identify how the project office 
relates to the member community/communities. Should include how you 
plan to involve survivors of suicide attempts and suicide loss in 
assessing, planning, and implementing your project.
    3. Address how continuity will be maintained if/when there is a 
change in the operational environment (e.g., health care system 
leadership, staff turnover, change in project leadership, change in 
elected officials, etc.) to ensure project stability over the period of 
performance. Additionally, describe the long-term plan for 
sustainability of the ZSI model beyond the period of performance.
C. Organizational Capacity (30 Points)
    1. The extent to which the applicant describes experience 
(successes and/or challenges) with the Zero Suicide model

[[Page 60890]]

(e.g., attended a Zero Suicide Academy, etc.) or similar collaborative 
efforts (e.g., patient centered medical home, behavioral integration, 
trauma informed systems, and improving patient care, etc.), focused on 
a comprehensive approach to suicide care across a healthcare system.
    2. The extent to which the applicant describes experience with and 
capacity (or detailed plan) to provide culturally informed practices 
and activities for specific populations of focus. Must refer to Tribal 
Resolution.
    3. Identification of how all departments/units/divisions across the 
health care system will be involved in administering this project. May 
also include how applicant organization currently (or plans to) 
collaborate with other organizations and agencies to provide care, 
including critical transition of care.
    4. Describe the resources available to implement and sustain the 
proposed project (e.g., facilities, equipment, information technology 
systems, financial management systems, data sharing agreement, MOUs, 
etc.).
    Listing of all staff positions for the project, such as Project 
Director, project coordinator, and other key personnel, showing the 
role of each and their level of effort and qualifications. Demonstrate 
successful project implementation for the level of effort budgeted for 
Project Director, project coordinator, and other key staff.
    Include position descriptions as attachments to the application. 
Describe the function within each position providing services in 
suicide care, behavioral health and primary care and other health care 
services, quality and process improvement, and related work within the 
community/communities.
    5. Applicants previously funded by the IHS for ZSI implementation 
must report on the status of their goals/milestones in this section of 
the program narrative. If goals/milestones were not achieved by those 
applicants, they are expected to provide clear explanation of the 
barriers that prevented the achievement of previous goals/milestones.
D. Data Collection, Performance Assessment and Evaluation (25 Points)
    In this area, applicants need to clearly demonstrate the ability to 
collect and report on required data elements associated with Zero 
Suicide and this particular project, and engage in all aspects of local 
and national evaluation. The following aspects will be assessed:
     Ability to collect and report on the required performance 
measures specified in the Data Collection and Performance Management 
section.
     A clear, specific plan for data collection, management, 
analysis, and reporting. Indication of the staff person(s) responsible 
for tracking the measureable objectives that are identified above.
     Description of your plan for conducting the local 
performance assessment, as specified above, and evidence of your 
ability to conduct the assessment.
     Description of the quality improvement process that will 
be used to track progress towards your performance measures and 
objectives, and how these data will be used to inform the ongoing 
implementation of the project and beyond.
E. Categorical Budget and Budget Justification (5 Points)
    Applicants must provide a budget and narrative justification for 
the proposed project budget.
    1. Evidence of reasonable, allowable costs necessary to achieve the 
objective outlined in the project narrative.
    2. Description of how the budget aligns with the overall scope of 
work.
    3. Please use Budget/Budget Narrative Template Worksheet to support 
your responses in this section.
    The Timeline Chart, Local Data Collection Plan Worksheet, and 
Budget/Budget Narrative templates can be downloaded at the ZSI website 
at https://www.ihs.gov/zerosuicide/.
Multi-Year Project Requirements
    Applications must include a brief project narrative and budget (one 
additional page per year) addressing the developmental plans for each 
additional year of the project. This attachment will not count as part 
of the project narrative or the budget narrative.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Work plan, logic model, and/or timeline for proposed 
objectives.
     Position descriptions for staff.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Rate Agreement.
     Organizational chart.
     Map of area identifying project location(s).
     Additional documents to support narrative (i.e., data 
tables, key news articles, etc.).

2. Review and Selection

    Each application will be prescreened for eligibility and 
completeness as outlined in the funding announcement. Applications that 
meet the eligibility criteria shall be reviewed for merit by the 
Objective Review Committee (ORC) based on evaluation criteria. 
Incomplete applications and applications that are not responsive to the 
administrative thresholds (budget limit, project period limit) will not 
be referred to the ORC and will not be funded. The applicant will be 
notified of this determination.
    Applicants must address all program requirements and provide all 
required documentation.

3. Notifications of Disposition

    All applicants will receive an Executive Summary Statement from the 
IHS Division of Behavioral Health within 30 days of the conclusion of 
the ORC outlining the strengths and weaknesses of their application. 
The summary statement will be sent to the Authorizing Official 
identified on the face page (SF-424) of the application.
A. Award Notices for Funded Applications
    The NoA is the authorizing document for which funds are dispersed 
to the approved entities and reflects the amount of Federal funds 
awarded, the purpose of the award, the terms and conditions of the 
award, the effective date of the award, and the budget/project period. 
Each entity approved for funding must have a user account in 
GrantSolutions in order to retrieve the NoA. Please see the Agency 
Contacts list in Section VII for the systems contact information.
B. Approved but Unfunded Applications
    Approved applications not funded due to lack of available funds 
will be held for 1 year. If funding becomes available during the course 
of the year, the application may be reconsidered.

    Note: Any correspondence other than the official NoA executed by 
an IHS grants management official announcing to the project director 
that an award has been made to their organization is not an 
authorization to implement their program on behalf of the IHS.

VI. Award Administration Information

1. Administrative Requirements

    Awards issued under this announcement are subject to, and are 
administered in accordance with, the following regulations and 
policies:
    A. The criteria as outlined in this program announcement.
    B. Administrative Regulations for Grants:
     Uniform Administrative Requirements, Cost Principles, and

[[Page 60891]]

Audit Requirements for HHS Awards currently in effect or implemented 
during the period of award, other Department regulations and policies 
in effect at the time of award, and applicable statutory provisions. At 
the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/content/pkg/CFR-2020-title45-vol1/pdf/CFR-2020-title45-vol1-part75.pdf.
     Please review all HHS regulatory provisions for 
Termination at 45 CFR 75.372, at https://www.ecfr.gov/cgi-bin/retrieveECFR?gp&;SID=2970eec67399fab1413ede53d7895d99&mc=true&
;n=pt45.1.75&r=PART&ty=HTML&se45.1.75_1372#se45.1.75_1372.
    C. Grants Policy:
     HHS Grants Policy Statement, Revised January 2007, at 
https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
    D. Cost Principles:
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' located at 45 CFR part 75 subpart E.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' located at 45 CFR part 75 subpart F.
    F. As of August 13, 2020, 2 CFR 200 was updated to include a 
prohibition on certain telecommunications and video surveillance 
services or equipment. This prohibition is described in 2 CFR 200.216. 
This will also be described in the terms and conditions of every IHS 
grant and cooperative agreement awarded on or after August 13, 2020.

2. Indirect Costs

    This section applies to all recipients that request reimbursement 
of indirect costs (IDC) in their application budget. In accordance with 
HHS Grants Policy Statement, Part II-27, IHS requires applicants to 
obtain a current IDC rate agreement and submit it to the DGM prior to 
the DGM issuing an award. The rate agreement must be prepared in 
accordance with the applicable cost principles and guidance as provided 
by the cognizant agency or office. A current rate covers the applicable 
grant activities under the current award's budget period. If the 
current rate agreement is not on file with the DGM at the time of 
award, the IDC portion of the budget will be restricted. The 
restrictions remain in place until the current rate agreement is 
provided to the DGM.
    Per 45 CFR 75.414(f) Indirect (F&A) costs, ``any non-Federal entity 
(NFE) [i.e., applicant] that has never received a negotiated indirect 
cost rate, . . . may elect to charge a de minimis rate of 10 percent of 
modified total direct costs which may be used indefinitely. As 
described in Section 75.403, costs must be consistently charged as 
either indirect or direct costs, but may not be double charged or 
inconsistently charged as both. If chosen, this methodology once 
elected must be used consistently for all Federal awards until such 
time as the NFE chooses to negotiate for a rate, which the NFE may 
apply to do at any time.''
    Electing to charge a de minimis rate of 10 percent only applies to 
applicants that have never received an approved negotiated indirect 
cost rate from HHS or another cognizant Federal agency. Applicants 
awaiting approval of their indirect cost proposal may request the 10 
percent de minimis rate. When the applicant chooses this method, costs 
included in the indirect cost pool must not be charged as direct costs 
to the grant.
    Available funds are inclusive of direct and appropriate indirect 
costs. Approved indirect funds are awarded as part of the award amount, 
and no additional funds will be provided.
    Generally, IDC rates for IHS grantees are negotiated with the 
Division of Cost Allocation at https://rates.psc.gov/ or the Department 
of the Interior (Interior Business Center) at https://ibc.doi.gov/ICS/tribal. For questions regarding the indirect cost policy, please call 
the Grants Management Specialist listed under ``Agency Contacts'' or 
the main DGM office at (301) 443-5204.

3. Reporting Requirements

    The grantee must submit required reports consistent with the 
applicable deadlines. Failure to submit required reports within the 
time allowed may result in suspension or termination of an active 
grant, withholding of additional awards for the project, or other 
enforcement actions such as withholding of payments or converting to 
the reimbursement method of payment. Continued failure to submit 
required reports may result in the imposition of special award 
provisions and/or the non-funding or non-award of other eligible 
projects or activities. This requirement applies whether the 
delinquency is attributable to the failure of the grantee organization 
or the individual responsible for preparation of the reports. Per DGM 
policy, all reports must be submitted electronically by attaching them 
as a ``Grant Note'' in GrantSolutions. Personnel responsible for 
submitting reports will be required to obtain a login and password for 
GrantSolutions. Please see the Agency Contacts list in section VII for 
the systems contact information.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required annually. The progress 
reports are due within 30 days after the budget period ends (specific 
dates will be listed in the NoA Terms and Conditions). These reports 
must include a brief comparison of actual accomplishments to the goals 
established for the period, a summary of progress to date or, if 
applicable, provide sound justification for the lack of progress, and 
other pertinent information as required, and any other specific 
evaluation requirements described in this funding announcement. A final 
report must be submitted within 90 days of expiration of the period of 
performance. This final report must provide a comprehensive summary of 
accomplishments and outcomes over the period of performance as related 
to each of the stated goals.
B. Financial Reports
    Federal Cash Transaction Reports are due 30 days after the close of 
every calendar quarter to the Payment Management Services at https://pms.psc.gov. Failure to submit timely reports may result in adverse 
award actions blocking access to funds.
    Federal Financial Reports are due 30 days after the end of each 
budget period, and a final report is due 90 days after the end of the 
period of performance.
    Grantees are responsible and accountable for reporting accurate 
information on all required reports: The Progress Reports, the Federal 
Cash Transaction Report, and Federal Financial Report.
C. Data Collection and Reporting
    In addition to the annual progress reports, the IHS will compile 
and provide aggregate program statistics including associated 
community-level Government Performance Results Act health care facility 
data available in the National Data Warehouse, as needed.
    Awardees will be required to report on the following:
Treat
     Total number of patient visits; total number of patients 
screened for suicide risk;
     total number of patients assessed for suicide risk;
     total number of patients placed on suicide care pathway or 
registry;
     total number of patients hospitalized for suicide risk;

[[Page 60892]]

     total number of patients with safety plan;
     total number of patients counseled on access to lethal 
means.
Train
     Total number of staff trained, number of trainings, type 
of trainings and number of staff trained in each healthcare profession 
in evidenced-based treatment of suicide risk.
    Awardees will also be required to submit their annual progress 
reports into an online reporting system funded by the IHS.
D. Federal Sub-Award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The Transparency Act requires the OMB to establish a single 
searchable database, accessible to the public, with information on 
financial assistance awards made by Federal agencies. The Transparency 
Act also includes a requirement for recipients of Federal grants to 
report information about first-tier sub-awards and executive 
compensation under Federal assistance awards.
    The IHS has implemented a Term of Award into all IHS Standard Terms 
and Conditions, NoAs, and funding announcements regarding the FSRS 
reporting requirement. This IHS Term of Award is applicable to all IHS 
grant and cooperative agreements issued on or after October 1, 2010, 
with a $25,000 sub-award obligation threshold met for any specific 
reporting period.
    For the full IHS award term implementing this requirement and 
additional award applicability information, visit the DGM Grants 
Management website at https://www.ihs.gov/dgm/policytopics/.
E. Compliance With Executive Order 13166 Implementation of Services 
Accessibility Provisions for All Grant Application Packages and Funding 
Opportunity Announcements
    Should you successfully compete for an award, recipients of Federal 
financial assistance (FFA) from HHS must administer their programs in 
compliance with Federal civil rights laws that prohibit discrimination 
on the basis of race, color, national origin, disability, age and, in 
some circumstances, religion, conscience, and sex (including gender 
identity, sexual orientation, and pregnancy). This includes ensuring 
programs are accessible to persons with limited English proficiency and 
persons with disabilities. The HHS Office for Civil Rights provides 
guidance on complying with civil rights laws enforced by HHS. Please 
see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html.
     Recipients of FFA must ensure that their programs are 
accessible to persons with limited English proficiency. For guidance on 
meeting your legal obligation to take reasonable steps to ensure 
meaningful access to your programs or activities by limited English 
proficiency individuals, see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html and https://www.lep.gov.
     For information on your specific legal obligations for 
serving qualified individuals with disabilities, including reasonable 
modifications and making services accessible to them, see https://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.
     HHS funded health and education programs must be 
administered in an environment free of sexual harassment. See https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html.
     For guidance on administering your program in compliance 
with applicable Federal religious nondiscrimination laws and applicable 
Federal conscience protection and associated anti-discrimination laws, 
see https://www.hhs.gov/conscience/conscience-protections/index.html 
and https://www.hhs.gov/conscience/religious-freedom/index.html.
F. Federal Awardee Performance and Integrity Information System 
(FAPIIS)
    The IHS is required to review and consider any information about 
the applicant that is in the FAPIIS at https://www.fapiis.gov before 
making any award in excess of the simplified acquisition threshold 
(currently $250,000) over the period of performance. An applicant may 
review and comment on any information about itself that a Federal 
awarding agency previously entered. IHS will consider any comments by 
the applicant, in addition to other information in FAPIIS, in making a 
judgment about the applicant's integrity, business ethics, and record 
of performance under Federal awards when completing the review of risk 
posed by applicants as described in 45 CFR 75.205.
    As required by 45 CFR part 75 Appendix XII of the Uniform Guidance, 
NFEs are required to disclose in FAPIIS any information about criminal, 
civil, and administrative proceedings, and/or affirm that there is no 
new information to provide. This applies to NFEs that receive Federal 
awards (currently active grants, cooperative agreements, and 
procurement contracts) greater than $10,000,000 for any period of time 
during the period of performance of an award/project.
Mandatory Disclosure Requirements
    As required by 2 CFR part 200 of the Uniform Guidance, and the HHS 
implementing regulations at 45 CFR part 75, the IHS must require an NFE 
or an applicant for a Federal award to disclose, in a timely manner, in 
writing to the IHS or pass-through entity all violations of Federal 
criminal law involving fraud, bribery, or gratuity violations 
potentially affecting the Federal award.
    All applicants and recipients must disclose in writing, in a timely 
manner, to the IHS and to the HHS Office of Inspector General all 
information related to violations of Federal criminal law involving 
fraud, bribery, or gratuity violations potentially affecting the 
Federal award. 45 CFR 75.113.
    Disclosures must be sent in writing to:

U.S. Department of Health and Human Services, Indian Health Service, 
Division of Grants Management, ATTN: Paul Gettys, Acting Director, 5600 
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857. (Include 
``Mandatory Grant Disclosures'' in subject line), Office: (301) 443-
5204, Fax: (301) 594-0899, Email: [email protected].

AND

U.S. Department of Health and Human Services, Office of Inspector 
General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 
Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 
20201, URL: https://oig.hhs.gov/fraud/report-fraud/. (Include 
``Mandatory Grant Disclosures'' in subject line), Fax: (202) 205-0604 
(Include ``Mandatory Grant Disclosures'' in subject line) or, Email: 
[email protected].

    Failure to make required disclosures can result in any of the 
remedies described in 45 CFR 75.371 Remedies for noncompliance, 
including suspension or debarment (see 2 CFR part 180 and 2 CFR part 
376).

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: LCDR 
Monique Richards, MSW, LICSW,

[[Page 60893]]

Public Health Advisor, Indian Health Service, Division of Behavioral 
Health, 5600 Fishers Lane, Mail Stop: 08N70C, Rockville, MD 20857, 
Telephone: (240) 252-9625, Fax: (301) 443-5610, Email: 
[email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Sheila Miller, Grants Management Specialist, Indian Health 
Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop: 
09E70, Rockville, MD 20857, Phone: (240) 535-9308, Fax: (301) 594-0899, 
Email: [email protected].
    3. Questions on systems matters may be directed to: Paul Gettys, 
Acting Director, Division of Grants Management, Indian Health Service, 
Division of Grants Management, 5600 Fishers Lane, Mail Stop: 09E70, 
Rockville, MD 20857, Phone: (301) 443-2114; or the DGM main line (301) 
443-5204, Fax: (301) 594-0899, email: [email protected].

VIII. Other Information

    The Public Health Service strongly encourages all grant, 
cooperative agreement, and contract recipients to provide a smoke-free 
workplace and promote the non-use of all tobacco products. In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of the facility) in 
which regular or routine education, library, day care, health care, or 
early childhood development services are provided to children. This is 
consistent with the HHS mission to protect and advance the physical and 
mental health of the American people.

Elizabeth A. Fowler,
Acting Director, Indian Health Service.
[FR Doc. 2021-24039 Filed 11-3-21; 8:45 am]
BILLING CODE 4165-16-P