[Federal Register Volume 87, Number 74 (Monday, April 18, 2022)]
[Pages 22908-22917]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-08250]



Indian Health Service

Ending the HIV/HCV Epidemics in Indian Country: A Program for 
American Indian/Alaska Native Tribes and Urban Indian Communities

    Announcement Type: New.
    Funding Announcement Number: HHS-2022-IHS-ETHIC-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.933.

Key Dates

    Application Deadline Date: June 17, 2022.
    Earliest Anticipated Start Date: August 1, 2022.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for a 
cooperative agreement for the Ending the Human Immunodeficiency Virus 
(HIV) and Hepatitis C Virus (HCV) Epidemics in Indian Country (ETHIC) 
program. 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. 1621q, 1660e. This program is described in 
the Assistance Listings located at https://sam.gov/content/home 
(formerly known as the CFDA) under 93.933.


    In February 2019, the White House announced a new initiative, 
Ending the HIV Epidemic in the U.S. (EHE). This 10-year initiative 
beginning with fiscal year (FY) 2020, seeks to achieve the critical 
goal of reducing new HIV infections in the United States (U.S.) to less 
than 3,000 per year by 2030. The first phase of the initiative focuses 
on 48 counties, Washington, DC, San Juan, Puerto Rico, and seven states 
with a substantial rural HIV burden. By focusing on these geographic 
focus areas (see https://files.hiv.gov/s3fs-public/Ending-the-HIV-Epidemic-Counties-and-Territories.pdf) in the first phase of the 
initiative, the U.S. Department of Health and Human Services (HHS) 
plans to reduce new HIV infections by 75 percent within five years. To 
reduce new HIV infections in the U.S. by 75 percent by 2025 and 90 
percent by 2030, EHE focuses on four key strategies that together can 
end the HIV epidemic in the U.S.: Diagnose, Treat, Prevent, and 
Respond. In this cooperative agreement, the IHS directs applicants to 
implement activities specific to strategies one, two, and three: 
Diagnose, Treat, and Prevent.
    EHE is a collaboration of HHS agencies, primarily the Health 
Resources and Services Administration, the Centers for Disease Control 

[[Page 22909]]

Prevention (CDC), the National Institutes of Health, the IHS, and the 
Substance Abuse and Mental Health Services Administration. HHS recently 
released two national strategic plans, and the IHS expects applicants 
to adopt these plans as they design and carry out activities toward HIV 
and HCV elimination: (1) The HIV National Strategic Plan: A Roadmap to 
End the Epidemic in the United States (2022-2025); \1\ and (2) The 
Viral Hepatitis National Strategic Plan for the U.S.: A Roadmap to 
Elimination 2021-2025.\2\

    \1\ https://hivgov-prod-v3.s3.amazonaws.com/s3fs-public/NHAS-2022-2025.pdf Accessed 3/11/2022
    \2\ https://www.hhs.gov/sites/default/files/Viral-Hepatitis-National-Strategic-Plan-2021-2025.pdf Accessed 3/11/2022.

    The HIV National Strategic Plan (2021-2025) is a 5-year plan that 
details principles, priorities, and actions to guide the national 
response to the HIV epidemic. The IHS promotes robust advances and 
innovations in HIV health care using the HIV National Strategic Plan to 
end the epidemic as its framework. Therefore, to the extent possible, 
activities funded by the IHS focus on addressing these four goals:
    (1) Reduce new HIV infections;
    (2) Increase access to care and improve health outcomes for people 
with HIV;
    (3) Reduce HIV-related health disparities and health inequities;
    (4) Achieve a more coordinated national response.
    To achieve these shared goals, recipients should align their 
organization's efforts to ensure that people with HIV are linked to and 
retained in high-quality HIV care and have timely access to HIV 
treatment and the supports needed (e.g., mental health and substance 
use disorders services) to achieve HIV viral suppression.
    The Viral Hepatitis National Strategic Plan for the U.S.: A Roadmap 
to Elimination 2021-2025, released on January 7, 2021, is a new phase 
in the fight against viral hepatitis in the U.S. Building on three 
prior National Viral Hepatitis Action Plans over the last 10 years, the 
Viral Hepatitis National Strategic Plan is the first to aim to 
eliminate viral hepatitis as a public health threat in the U.S.
    The Viral Hepatitis Plan sets forth a clear vision for how the U.S. 
will be a place where new viral hepatitis infections are prevented, 
every person knows their status, and every person with viral hepatitis 
has high-quality health care and treatment and lives free from stigma 
and discrimination. Both the HIV and viral hepatitis national strategic 
plans include AI/AN people in their priority populations.
    In addition, for resources specific to AI/AN communities, the 
Northwest Portland Area Indian Health Board, with funding from the IHS 
and the Minority HIV/AIDS Fund, designed a document to help AI/AN 
health advocates, decision makers, and medical providers address the 
HCV epidemic in their communities through programmatic and policy 
changes. IHS encourages applicants to review the Hepatitis C 
Elimination Strategy for AI/AN Communities \3\ document's objectives 
which describes the rationale and program design, and provides a tool 
kit for implementing an HCV micro-elimination program in an AI/AN 
community--Tribal or IHS clinic, hospital, or health system.

    \3\ https://www.npaihb.org/wp-content/uploads/2020/08/HCV-Elimination-Strategy-for-AIAN-Communities.pdf Accessed 3/11/2022.

    A 2019 CDC analysis \4\ shows that the vast majority (about 80 
percent) of new HIV infections in the U.S. in 2016 came from the nearly 
40 percent of people who either did not know they had HIV or who 
received a diagnosis but were not receiving HIV care and treatment. 
This highlights the need to increase the proportion of people with HIV 
or HCV who are aware of their status and help them get into care and 

    \4\ http://www.cdc.gov/nchhstp/newsroom/2019/hiv-vital-signs.html.

    Diagnosing AI/AN people with HIV or HCV, linking those with HIV or 
HCV to primary care, and achieving viral suppression are necessary 
public health steps toward ending the HIV and HCV epidemics in Indian 
Country. The HIV/HCV care continuum has five main ``steps'' or stages 
that include (1) diagnosis, (2) linkage to care, (3) retention in care, 
(4) adherence to therapy (ART), and (5) viral suppression (HIV)/viral 
clearance (HCV). The care continuum depicts a series of stages in which 
people with HIV or HCV engage in care from initial diagnosis through 
their successful treatment with medication. It also demonstrates the 
proportion of individuals living with HIV or HCV who are engaged at 
each stage. The care continuum allows recipients and planning groups to 
measure progress and direct resources most effectively. For this 
funding opportunity, the IHS requires applicants to address, implement, 
and measure the HIV and HCV continuum of care. For example, applicants 
should be prepared to collect data on the number of new diagnosis of 
HIV, numbers of positive cases linked to care, how many of those linked 
to care are retained in care and adhering to therapy, and the number of 
those achieving an undetectable viral load.
    Federal health care facilities in an administrative area of the IHS 
conducted a review to identify and address gaps in HCV treatment. 
Facilities generally treated HCV with a strong pharmacy component using 
a collaborative practice agreement and HCV telehealth services to 
external specialists. These data indicate that: (1) Rural clinics can 
be successful providing HCV diagnosis and treatment; (2) pharmacists 
can play a key role in HCV clinical services; (3) the outcomes of each 
step in the treatment process at the facility level can vary widely due 
to local factors; and (4) the barriers to HCV care that persist are 
nonclinical.\5\ In a study published in The Journal of the American 
Medical Association,\6\ the Cherokee Nation Health Services HCV 
elimination program demonstrated that implementation of a community-
based HCV elimination program was associated with an improved cascade 
of care. In this cohort study, first-time HCV screening coverage 
increased from 20.9 percent to 38.2 percent from 3 years before to 22 
months into implementation.\7\ This information may serve other 
organizations planning to implement similar programs in large rural 

    \5\ A Regional Analysis of Hepatitis C Virus Collaborative Care 
With Pharmacists in Indian Health Service Facilities https://journals.sagepub.com/doi/full/10.1177/2150132718807520.
    \6\ Evaluation of the Cherokee Nation Hepatitis C Virus 
Elimination Program in the First 22 Months of Implementation, Mera, 
Williams, Essex; et al https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2774323.
    \7\ Evaluation of the Cherokee Nation Hepatitis C Virus 
Elimination Program in the First 22 Months of Implementation, Mera, 
Williams, Essex; et al https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2774323.


[[Page 22910]]

    For nearly four decades, the national investments in HIV have shown 
remarkable results in preventing new infections, improving health 
outcomes, and reducing deaths in hundreds of thousands of Americans. 
Despite this, progress has plateaued, and additional effort is needed 
to ensure that all affected groups benefit equally. Some groups, like 
AI/AN people, African American and Latino gay and bisexual men, 
transgender individuals, or people living in the South, have a higher 
burden of HIV and experience health disparities at each stage of the 
HIV care continuum. Southern states today account for an estimated 44 
percent of all people living with an HIV diagnosis in the U.S.,\8\ 
despite having only about one-third (37 percent) of the overall U.S. 
population.\9\ Diagnosis rates for people in the South are higher than 
for Americans overall. Eight of the ten states and all ten metropolitan 
statistical areas with the highest rates of new HIV diagnoses are in 
the South. In addition to the severe burden in the South, nationally 
there is a high incidence of HIV among transgender individuals, high-
risk heterosexuals, and persons who inject drugs.\10\

    \8\ Centers for Disease Control and Prevention. HIV Surveillance 
Report, 2019; vol.32. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2021.
    \9\ U.S. Census Bureau. Annual Estimates of the Resident 
Population: 2010-2020. Available at https://www.census.gov/programs-surveys/popest/technical-documentation/research/evaluation-estimates/2020-evaluation-estimates/2010s-totals-national.html.
    \10\ Department of Health and Human Services, Centers for 
Disease Control and Prevention. HIV in the U.S. and dependent areas 
https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Updated 
January 29, 2019. Accessed February 5, 2019.

    The U.S. has an unprecedented opportunity to end the HIV and HCV 
epidemics in America. We have access to the most powerful HIV and HCV 
prevention and treatment tools in history and new technology that 
allows us to pinpoint where infections are spreading most rapidly. By 
effectively equipping all vulnerable AI/AN communities with these 
tools, we can end the HIV and HCV epidemics in Indian Country. This 
ETHIC funding opportunity acts boldly on this unprecedented opportunity 
by providing the hardest-hit AI/AN communities with resources to 
implement the additional expertise, technology, and resources required 
to address the HIV and HCV epidemics in their communities.
    HHS recently developed a set of critical health priorities for the 
nation known as ``Leading Health Indicators'' \11\ (or LHIs) that are a 
call to action in critical public health areas. The IHS will use the 
LHIs to assess the health of the AI/AN population over the next decade, 
to facilitate collaboration among diverse groups, and to motivate 
individuals and communities to take action to improve their health. The 
following LHIs also will be used by the IHS and public health 
professionals to track progress in local AI/AN communities as they work 
toward meeting these key national health goals:

    \11\ https://health.gov/healthypeople/objectives-and-data/leading-health-indicators Accessed 3/11/2020.

    (1) Diagnose 95 percent of persons living with HIV or HCV who are 
aware of their status by 2025, working from a baseline of 85.8 percent 
in 2016.
    (2) Treat 95 percent of persons via linkage to appropriate care 
within one month of diagnosis by 2025, working from a baseline of 78.3 
percent in 2017.
    (3) Treat 95 percent of persons diagnosed with HIV or HCV via 
sufficient viral suppression/viral clearance by 2025, working from a 
baseline of 61.5 percent in 2016.
    (4) Prevent new HIV infections by achieving 25 percent pre-exposure 
prophylaxis (PrEP) coverage among those for whom PrEP was indicated by 
    There are notable concerns in new HIV diagnoses in AI/AN 
populations: (1) New HIV diagnoses among AI/AN populations increased by 
18 percent from 2015 to 2019; (2) rates of new HIV diagnoses among AI/
AN adolescents increased by 53 percent; and (3) both male and female 
AI/AN individuals had the highest percent of estimated diagnoses of HIV 
infection attributed to injection drug use.\12\ Mortality data also 
found that AI/AN individuals have significantly higher death rates from 
HIV/AIDS than whites, which could be attributable to later diagnosis, 
lack of linkage to care, difficulty accessing care, challenges to 
treatment adherence, or other factors or combination of factors.

    \12\ Centers for Disease Control and Prevention. HIV 
Surveillance Report, 2019; vol.32. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2021.

    HCV is a common co-morbidity for bloodborne HIV infections. In 
2009, approximately 21 percent of HIV-infected adults who were tested 
for past or present HCV infection tested positive, although co-
infection prevalence varies substantially according to HIV-infected 
risk group (e.g., men who have sex with men (MSM), high-risk 
heterosexuals, and persons who inject drugs).\13\ \14\ \15\ As HCV is a 
bloodborne virus, primarily transmitted through direct contact with the 
blood of an infected person, coinfection with HIV and HCV is common 
among HIV-infected injection-drug users.\16\ \17\ \18\ Although 
transmission via injection drug use remains the most common mode of HCV 
acquisition in the U.S., sexual transmission is an important mode of 
acquisition among certain groups, including HIV-infected MSM with 
certain risk factors.\19\ Data have shown that HCV disproportionately 
affects AI/AN people, with HCV-related mortality more than double the 
national rate.\20\ In a recent IHS survey, almost 50 percent of the AI/
AN individuals diagnosed with HCV were born after 1965 and were younger 
than the targeted birth cohort for HCV screening campaigns (1945-1965, 
`Baby Boomers'). Untreated HCV can lead to a myriad of extrahepatic 
manifestations and cirrhosis with complications such as portal 
hypertension, end stage liver disease, and hepatocellular carcinoma 
(HCC). Early diagnosis and treatment of HCV infection prevents the 
development of extrahepatic manifestations and progressive liver 
disease including cirrhosis. Recently developed treatments for HCV are 
more accessible and highly effective at greatly reducing HCV- and HCC-

[[Page 22911]]

mortality. Treatment for HCV can be highly successful at the primary 
care level with appropriate planning and support.

    \13\ Garg S, Brooks J, Luo Q, Skarbinski J. Prevalence of and 
Factors Associated with Hepatitis C Virus (HCV) Testing and 
Infection Among HIV-infected Adults Receiving Medical Care in the 
U.S. Infectious Disease Society of America (IDSA). Philadelphia, PA, 
    \14\ Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, 
Berry SA, et al. Hepatitis C virus testing in adults living with 
HIV: A need for improved screening efforts. PLoS ONE 
2014;9(7):e102766. https://pubmed.ncbi.nlm.nih.gov/25032989/.
    \15\ Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis 
C virus infection among patients in the HIV Outpatient Study, 1996-
2007. J Acquir Immune Defic Syndr 2010;53:388-396.
    \16\ Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, 
Berry SA, et al. Hepatitis C virus testing in adults living with 
HIV: A need for improved screening efforts. PLoS ONE 
2014;9(7):e102766. https://pubmed.ncbi.nlm.nih.gov/25032989.
    \17\ Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis 
C virus infection among patients in the HIV Outpatient Study, 1996-
2007. J Acquir Immune Defic Syndr 2010;53:388-396.
    \18\ Centers for Disease Control and Prevention. Centers for 
Disease Control and Prevention. HIV Surveillance Report, 2019; 
vol.32. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2021. Atlanta: U.S. Department of 
Health and Human Services, Centers for Disease Control and 
Prevention; 2017.
    \19\ Panel on Opportunistic Infections in HIV-Infected Adults 
and Adolescents. Guidelines for the prevention and treatment of 
opportunistic infections in HIV-infected adults and adolescents: 
Recommendations from the Centers for Disease Control and Prevention, 
the National Institutes of Health, and the HIV Medicine Association 
of the Infectious Diseases Society of America. Available at https://www.ncbi.nlm.nih.gov/pubmed/19357635. July 6, 2018.
    \20\ https://aspe.hhs.gov/system/files/pdf/260026/HepC.pdf.

    Data also show that sexually transmitted infection (STI) rates 
remain elevated in Indian Country. Recurrent STIs can increase the 
likelihood of HIV transmission. Gonorrhea and syphilis often present as 
co-morbid conditions with HIV diagnosis, particularly among MSM. The 
latest Indian Health Surveillance Report: Sexually Transmitted Diseases 
2015 \21\ showed that AI/AN people have 3.8 times the incidence rate of 
whites for chlamydia and 4.4 times the rate of whites for gonorrhea. 
AI/AN people have the second highest rates for both chlamydia and 
gonorrhea compared to other races/ethnicities. Gonorrhea rates have 
continued to increase drastically since 2011. Regional differences in 
STI incidence in Indian Country are also observed. AI/AN youth and AI/
AN women, particularly women of reproductive age, have a disparate and 
increased STI burden. In addition, recent outbreaks of syphilis have 
been observed among AI/AN communities. Some of these outbreaks are 
connected to the use of injection drugs and methamphetamines, all known 
risk factors for HIV transmission.

    \21\ 2015 Indian Health Surveillance Report Sexually Transmitted 
Infections https://www.cdc.gov/std/stats/ihs/18IHS-DEDP102_REPORT_STD_M_508.pdf.

    Finally, treatment for substance use disorders can be difficult to 
access in IHS catchment areas, as the appropriated budget includes 
fewer dollars per patient compared to other Federal direct-care 
networks. Untreated substance use disorders can exacerbate risk-taking 
behavior and reduce adherence to treatment. IHS recommends 
collaboration whenever possible between behavioral health services and 
HIV/HCV/STI prevention and care.
    Confronting these intersecting epidemics requires collaboration 
across sectors and disciplines and the use of existing public health 
and clinical infrastructures. Lasting changes to these trends for HIV 
and related co-morbidities among AI/AN communities will also require 
innovative new approaches, incorporating existing and new data sources, 
all driven by community input. IHS recommends applicants research 
evidence-based approaches or identify culturally appropriate 
interventions as best-practices for collaborative efforts.


    The purpose of this program is to support communities in reducing 
new human HIV infections and relevant co-morbidities, specifically STI 
and HCV infections, improve HIV-, STI-, and HCV-related health 
outcomes, and reduce HIV-, STI-, and HCV-related health disparities 
among AI/AN people. In two separate but related parts, this initiative 
aims to implement effective and innovative strategies, interventions, 
approaches, and services to reduce new HIV and HCV infections among AI/
AN communities in the U.S. This initiative's overarching goals are to: 
(1) Reduce new HIV infections in the U.S. to less than 3,000 per year 
by 2030; and (2) achieve a 90 percent reduction in new HCV infections 
and a 65 percent reduction in mortality, compared to a 2015 

    \22\ https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for FY 2022 is approximately 
$2,480,000. Individual award amounts are anticipated to be between 
$160,000 and $200,000. The funding available for competing and 
subsequent 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 14 awards will be issued under this program 
Period of Performance
    The period of performance is for 3 years.
Cooperative Agreement
    Cooperative agreements awarded by the 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
    A. The IHS Office of Clinical and Preventive Services (OCPS), 
Division of Clinical and Community Services (DCCS) will provide ongoing 
consultation and technical assistance to plan, implement, and evaluate 
each component as described under Recipient Activities (see Section 
V.1.B, Application Review Information, Evaluation Criteria, Project 
Objective(s), Work Plan, and Approach).
    B. The IHS will conduct site visits to recipient sites and/or 
coordinate recipient visits to IHS facilities to assess work plans and 
ensure data security, confirm compliance with applicable laws and 
regulations, assess program activities, and to resolve problems, as 
needed mutually.
    C. DCCS will provide a forum for outreach and education to advance 
this program's goals through existing and new partnerships. The IHS 
will facilitate the formation of an IHS National HIV/HCV/STI Prevention 
workgroup, from clinical, public health, advocacy, and education 
sectors working in HIV/HCV/STI control. The pupose of the workgroup is 
to align IHS efforts with the HIV, Viral Hepatitis, and STI National 
    D. DCCS will coordinate the various internal IHS and external HHS 
required reporting activities and provide recipients with program-
related technical assistance as appropriate to provide leadership, 
advocacy, and support.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity, an applicant must be 
one of the following as defined under 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

[[Page 22912]]

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 nonprofit 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 Tribal or Tribal organization 
applicant selected for funding. An applicant 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 10 pages). See Section 
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 five 
pages). See Section IV.2.B, Budget Narrative for instructions.
     Tribal Resolution(s), if applicable.
     Letters of Support from organization's Board of Directors, 
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).
     Work plan with timeline for proposed activities.
     Logic model.
     Map of area identifying project location(s).
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Organizational Chart.
     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://facdissem.census.gov/.
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 
10 pages and must: (1) Have consecutively numbered pages; (2) use black 
font 12 points or larger (tables may be done in 10 point font); (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

[[Page 22913]]

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 10-page limit for the 
narrative does not include the work plan, standard forms, Tribal 
Resolutions, budget, budget justifications, narratives, and/or other 
    There are three parts to the narrative: Part 1--Program 
Information; Part 2--Program Planning and Evaluation; and Part 3--
Previous HIV/HCV Prevention, Care, or Treatment Work. See below for 
additional details about what must be included in the narrative.
    The page limits below are for each narrative and budget submitted.
Part 1: Program Information (Limit--3 Pages)
Section 1: Community Infrastructure
    Describe the applicant's current health program activities, how 
long it has been operating, and what programs or services the 
organization is currently providing. Describe how the applicant has 
determined it has the administrative infrastructure to support the 
activities proposed.
Part 2: Program Planning and Evaluation (Limit--3 Pages)
Section 1: Program Plans
    Describe fully and clearly the applicant's plans to conduct 
activities that lead to increased HIV and Hepatits C diagnoses, 
enhanced prevention, and to recruit and retain people in HIV and 
Hepatits C treatment.
Section 2: Program Evaluation
    Describe fully and clearly the improvements that will be made by 
the applicant to meet the public health needs of the community in the 
context of the funding requirements.
Part 3: Previous HIV/HCV Prevention, Care, or Treatment Work (Limit--4 
Section 1
    Describe your organization's significant program activities and 
accomplishments over the past five years associated with HIV/HCV 
prevention, care, and/or treatment to enhance quality health care 
B. Budget Narrative (Limit--5 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 can include a more 
detailed spreadsheet than is provided by the SF-424A. 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 (see Multi-Year Project Requirements in Section V.1, Application 
Review Information, Evaluation Criteria), the narrative should 
highlight the changes from the first year 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 

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 
    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]), Deputy Director, DGM, by 
telephone at (301) 443-2114 or (301) 443-5204. Please be sure to 
contact Mr. Gettys at least 10 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.
    The 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 
     Only one cooperative agreement may be awarded per 

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, Deputy 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 Deputy Director 
of the DGM will not be reviewed. The Grants Management Officer of the 
DGM 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 
    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 
     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 20 
working days.
     Please follow the instructions on Grants.gov to include 
additional documentation that may be requested by this funding 

[[Page 22914]]

     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 recipient 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 recipients 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 recipient 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://sam.gov (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://sam.gov.
    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 project narrative 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 fully understand the project. 
Attachments requested in the criteria do not count toward the page 
limit for the narratives. 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

A. Introduction and Need for Assistance (10 Points)
    Must include the applicant's background information, a description 
of HIV and/or HCV service, capacity, and history of support for such 
activities. Applicants need to include current public health 
activities, what program services are currently being provided, and 
interactions with other public health authorities in the region (state, 
local, or Tribal).
    Please describe how the applicant will make improvements in 
capacity to address the IHS, Tribal, and urban (I/T/U), local-level, 
and/or Area-level HIV/HCV/STI burden. In order to significantly reduce 
transmission of HIV/HCV/STI, I/T/U need baseline and annual 
measurements of HIV/HCV/STI diagnoses, linkage to care, and viral load 
measurements, as applicable. Applicants will also help evaluate 
geographies with higher burden of HIV/HCV/STI and assist communities in 
targeting interventions.
B. Project Objective(s), Work Plan, and Approach (25 Points)
    a. Clearly identify the operational strategies to be addressed by 
the applicant. Include objectives that are Specific, Measurable, 
Attainable, Relevant, and Time-bound (also known as SMART). In 
addition, the IHS encourages applicants to assume relevant objectives 
from (1) The National Strategic Plan: A Roadmap to End the Epidemic for 
the United States [verbar] 2021-2025; \23\ and (2) The Viral Hepatitis 
National Strategic Plan for the U.S.: A Roadmap to Elimination 2021-

    \23\ https://hivgov-prod-v3.s3.amazonaws.com/s3fs-public/HIV-National-Strategic-Plan-2021-2025.pdf.
    \24\ https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html.

    b. Activities in at least two of three ETHIC's key operational 
strategies (Diagnose, Treat, Prevent) must be planned for completion 
within the program period (indicate these two activities in bold).
    c. Applicants will outline their approach for addressing the 
operational strategies in the work plan or logic model. Outline 
overarching activities, short-term, and long-term outcomes. Make note 
of proposed timelines and partners who will be involved in each 
Recipient Activities
    Proposals must include the following activities:
1. Coordination Operational Strategy
    i. Recipients will send at least one representative to the annual 
IHS HIV meeting. The budget should include travel and associated costs 
for participation.
    ii. Recipients will participate in the IHS National AI/AN STI 
Prevention workgroup.
    iii. Recipients will provide technical assistance and/or support to 
AI/AN communities by developing or sharing analytical reports that 
examine the burden of HIV/HCV and other relevant co-morbidities such as 
STIs in Native communities.
2. Diagnosis Operational Strategy
    The recipients will collaborate with communities to increase local 
capacity to expand the availability of HIV/HCV/STI testing in health 
centers, emergency departments, substance abuse prevention and 
treatment programs, mobile units, as well as community-based 
organizations and non-traditional settings such as bars, parks, and 
during community festivals to diagnose all people with HIV/HCV/STIs as 
early as possible.
3. Treatment Operational Strategy
    The recipients will provide support to communities in the 
development of enhanced activities and expanded capacity to identify 
and better serve people who are not in HIV/HCV/STI care by working with 
health care providers, Ryan White clinics and I/T/U health centers, 
state and local health departments, and other partners to expand 
capacity, strengthen systems, establish new programs and services, and 
forge new partnerships to tailor and implement these approaches as 
appropriate in their communities.
4. Prevention Operational Strategy
    The recipients will develop local plans with community member input 
to guide the scale-up of proven prevention interventions and strategies 
that increase the access to and availability of PrEP and safe syringe 
programs (SSPs)--

[[Page 22915]]

where permitted by local laws--in the communities where these services 
are needed most.
    PrEP is a pill that reduces the risk of getting HIV when taken as 
prescribed. However, of the estimated 1 million Americans at 
substantial risk for HIV who could benefit from PrEP, fewer than 1 in 4 
actually use it. HHS agencies will support states and local communities 
to implement strategies to increase access to and use of PrEP--
especially among populations disproportionately affected by HIV.
C. Program Evaluation (30 Points)
    a. Clearly identify plans for program evaluation to ensure that 
objectives of the program are met at the conclusion of the funding 
    b. Include evaluation criteria based on SMART objectives.
    c. Evaluation should minimally include summaries of activities in 
each of the proposed key operational strategies.
D. Organizational Capabilities, Key Personnel, and Qualifications (30 
    a. Include an organizational capacity statement that demonstrates 
the ability to execute program strategies within the program period.
    b. Provide a project management and staffing plan. Detail that the 
organization has the current staffing and expertise to address each of 
the program activities. If current capacity does not exist, please 
describe the actions that the applicant will take to fulfill this gap 
within a specified timeline.
    c. Applicant must demonstrate a plan to work with Tribal 
Epidemiology Centers and local partners on the proposed efforts.
    d. Demonstrate that the applicant has previous successful 
experience providing technical or programmatic support to Tribal 
E. Categorical Budget and Budget Justification (5 Points)
    a. Provide a detailed budget and accompanying narrative to explain 
the activities being considered and how they are related to proposed 
program objectives.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Work plan, logic model, and timeline for proposed 
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Rate Agreement (if applicable).
     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 DCCS 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 
A. The criteria as outlined in this program announcement
B. Administrative Regulations for Grants
     Uniform Administrative Requirements, Cost Principles, and 
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&
C. Grants Policy
     HHS Grants Policy Statement, Revised January 2007, at 
D. Cost Principles
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' at 45 CFR part 75 subpart E.
E. Audit Requirements
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' 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 IDC in their application budget. In accordance with HHS Grants 
Policy Statement, Part II-27, the IHS requires applicants to obtain a 
current IDC rate agreement and submit it to the DGM prior to the DGM

[[Page 22916]]

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 recipients 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 recipient 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 awardee 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 quarterly. The progress 
reports are due within 30 days after the reporting 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. A final report must be 
submitted within 90 days of expiration of the period of performance.
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. Recipients are responsible and accountable for 
reporting accurate information on all required reports: the Progress 
Reports, the Federal Cash Transaction Report, and the Federal Financial 
C. Data Collection and Reporting
    The recipient must report their progress quarterly towards data 
points in their ETHIC objectives and activities via a standardized form 
co-developed with the IHS program officer.
    The recipient and the IHS will jointly develop the report for the 
data and objectives proposed in the application. The recipient will 
then report on these data points annually. Due dates for these reports 
will be included in the Terms & Conditions in the NoA. The recipient 
will participate in quarterly calls with the program office.
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. Non-Discrimination Legal Requirements for Recipients of Federal 
Financial Assistance
    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

[[Page 22917]]

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/civil-rights/for-individuals/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 
    The IHS is required to review and consider any information about 
the applicant that is in the FAPIIS at https://www.fapiis.gov/fapiis/#/home 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. The 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 of 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, Deputy 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].


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 

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: Mr. 
Rick Haverkate, Public Health Advisor, Office of Clinical and 
Preventive Services, Division of Clinical and Community Services, 
Indian Health Service, 5600 Fishers Lane, Mailstop: 08N34A, Rockville, 
MD 20857, Phone: (954) 909-4834, Email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Willis Grant, Grants Management Specialist, Indian Health 
Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop: 
09E70, Rockville, MD 20857, Phone: (301) 443-2214, Email: 
[email protected].
    3. Questions on systems matters may be directed to: Paul Gettys, 
Deputy Director, 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, 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. 2022-08250 Filed 4-15-22; 8:45 am]