[Federal Register Volume 87, Number 233 (Tuesday, December 6, 2022)]
[Notices]
[Pages 74638-74647]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-26480]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Tribal Management Grant Program

    Announcement Type: New.
    Funding Announcement Number: HHS-2023-IHS-TMD-0001.

[[Page 74639]]

    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.228.

Key Dates

    Application Deadline Date: March 6, 2023.
    Earliest Anticipated Start Date: April 20, 2023.

I. Funding Opportunity Description

Statutory Authority
    The Indian Health Service (IHS) is accepting applications for 
grants for the Tribal Management Grant (TMG) 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 Self-Determination and Education 
Assistance Act (ISDEAA), Public Law 93-638, as amended, 25 U.S.C. 
5322(b)(2) and 25 U.S.C. 5322(e). This program is described in the 
Assistance Listings located at https://sam.gov/content/home (formerly 
known as the CFDA) under 93.228.
Background
    The TMG Program is a competitive grant program that is capacity 
building and developmental in nature and has been available for 
federally recognized Indian Tribes and Tribal Organizations (T/TOs) 
since shortly after enactment of the ISDEAA in 1975. The TMG Program 
was established to assist T/TOs to prepare for assuming all or part of 
existing IHS programs, functions, services, and activities (PFSAs) and 
further develop and improve Tribal health management capabilities. The 
TMG Program provides competitive grants to T/TOs to establish goals and 
performance measures for current health programs, assess current 
management capacity to determine if new components are appropriate, 
analyze programs to determine if a T/TO's management is practicable, 
and develop infrastructure systems to manage or organize PFSAs.
Purpose
    The purpose of this program is to enhance and develop health 
management infrastructure and assist T/TOs in assuming all or part of 
existing IHS PFSAs through a Title I ISDEAA contract and assist 
established Title I ISDEAA contractors and Title V ISDEAA compactors to 
further develop and improve management capability. In addition, Tribal 
Management Grants are available to T/TOs under the authority of 25 
U.S.C. 5322(e) for the following:
    1. Obtaining technical assistance from providers designated by the 
T/TOs (including T/TOs that operate mature contracts) for the purposes 
of program planning and evaluation, including the development of any 
management systems necessary for contract management, and the 
development of cost allocation plans for indirect cost rates.
    2. Planning, designing, monitoring, and evaluating Federal programs 
serving T/TOs, including Federal administrative functions.

II. Award Information

Funding Instrument--Grant
Estimated Funds Available
    The total funding identified for fiscal year (FY) 2023 is 
approximately $2,465,000. Individual award amounts for the first budget 
year are anticipated to be between $50,000 and $150,000. 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 14-16 awards will be issued under this program 
announcement.
Period of Performance
    The TMG Project period of performance varies based on the project 
type selected. Period of performance is from 1 to 3 years. Please see 
the next section for additional details.
Eligible TMG Project Types, Maximum Funding Levels, and Periods of 
Performance
    The TMG Program consists of four project types:
    1. Feasibility study.
    2. Planning.
    3. Evaluation study.
    4. Health management structure.
    Applicants may submit applications for one project type only. An 
application must state the project type selected. Any application that 
addresses more than one project type will be considered ineligible and 
will not be reviewed. The maximum funding levels noted must include 
both direct and indirect costs. Application budgets may not exceed the 
maximum funding level or period of performance identified for a project 
type. Any application with a budget or period of performance that 
exceeds the maximum funding level or period of performance will be 
considered ineligible and will not be reviewed. Please refer to Section 
IV.5, ``Funding Restrictions,'' for further information regarding 
ineligible project activities.
    1. FEASIBILITY STUDY (Maximum funding/project period: $70,000/12 
months) A feasibility study must include a study of a specific IHS 
program or segment of a program to determine if Tribal management of 
the program is possible. The study shall present the planned approach, 
training, and resources required to assume Tribal management of the 
program. The study must include the following four components:
     Health needs and health care service assessments that 
identify existing health care services and delivery systems, program 
divisibility issues, health status indicators, unmet needs, volume 
projections, and demand analysis.
     Management analysis of existing management structures, 
proposed management structures, implementation plans and requirements, 
and personnel staffing requirements and recruitment barriers.
     Financial analysis of historical trends data, financial 
projections, new resource requirements for program management costs, 
and analysis of potential revenues from Federal/non-Federal sources.
     Decision statement/report that incorporates findings 
(sustainability, etc.), conclusions, and recommendations. The study and 
recommendations report is to be presented to the Tribal governing body 
for determination regarding whether Tribal program assumption is 
desirable or warranted.
    2. PLANNING (Maximum funding/project period: $50,000/12 months) 
Planning projects involve data collection to establish goals and 
performance measures for health programs operation or anticipated PFSAs 
under a Title I contract. Planning projects will specify the design of 
health programs and the management systems (including appropriate 
policies and procedures) to accomplish the health priorities of the T/
TO. For example, planning projects could include the development of a 
Tribe-specific health plan or a strategic health plan, etc. Please note 
that updated Healthy People information and Healthy People 2020 
objectives are available in electronic format at https://www.healthypeople.gov/2020/topics-objectives. The United States (U.S.) 
Public Health Service encourages applicants submitting strategic health 
plans to address specific objectives of Healthy People 2020.
    3. EVALUATION STUDY (Maximum funding/project period: $50,000/12

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months) An evaluation study must include a systematic collection, 
analysis, and interpretation of data for the purpose of determining the 
impact of a program. The extent of the evaluation study could relate to 
the goals and objectives, policies and procedures, or programs 
regarding targeted groups. The evaluation study could also be used to 
determine the effectiveness and efficiency of a T/TO's program 
operations (i.e., direct services, financial management, personnel, 
data collection and analysis, third-party billing, etc.), as well as to 
determine the appropriateness of new components of a T/TO's program 
operations that will assist efforts to improve Tribal health care 
delivery systems.
    4. HEALTH MANAGEMENT STRUCTURE (Average funding/project period: 
$100,000/12 months; maximum funding/project period: $300,000/36 months) 
The first year funding level is limited to $150,000 for multi-year 
projects. The Health Management Structure component allows for 
implementation of systems to manage or organize PFSAs. Management 
structures include health department organizations, health boards, and 
financial management systems, including systems for accounting, 
personnel, third-party billing, medical records, management information 
systems, etc. This includes the design, improvement, and correction of 
management systems that address weaknesses identified through quality 
control measures, internal control reviews, and audit report findings 
under required financial audits and ISDEAA requirements.
    For the minimum standards for the management systems used by a T/TO 
when carrying out Self-Determination contracts, please see 25 CFR part 
900, Contracts Under the ISDEAA, Subpart F--``Standards for Tribal or 
Tribal Organization Management Systems,'' 900.35-900.60. For 
operational provisions applicable to carrying out Self-Governance 
compacts, please see 42 CFR part 137, Tribal Self-Governance, Subpart 
I,--``Operational Provisions,'' 137.160-137.220.

III. Eligibility Information

1. Eligibility

    ``Indian Tribes'' and ``Tribal Organizations'', as defined by the 
Indian Health Care Improvement Act (IHCIA), are eligible to apply for 
the TMG Program. The definitions for each entity type are outlined 
below. To be eligible for this funding opportunity for ``New Applicants 
Only,'' an applicant cannot be an existing TMG awardee under this 
program.
     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 ISDEAA (25 U.S.C. 5304(l)): ``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 Tribal Resolutions from the Tribes to 
be served.
    Please note that Tribes prohibited from contracting pursuant to the 
ISDEAA are not eligible for the TMG program. See section 424(a) of the 
Consolidated Appropriations Act, 2014, Public Law 113-76, as amended by 
section 428 of the Consolidated Appropriations Act, 2018, Public Law 
115-141, and section 1201 of the Consolidated Appropriations Act, 2021, 
Public Law 116-260.
    The Division of Grants Management (DGM) 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 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 Tribe or Tribal organization 
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.
    Applicants 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.
Additional Required Documentation for Specific TMG Project Types
    A. Federally recognized Indian Tribes applying for technical 
assistance and/or training grants must provide a Tribal Resolution; or 
a designated Tribal Organization applying on behalf of the Indian Tribe 
and/or Tribes it intends to serve must also provide a Tribal 
Resolution.
    B. Documentation for Priority I participation requires a copy of 
the Federal Register notice or letter from

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the Bureau of Indian Affairs verifying establishment of recognized 
Tribal status within the past 5 years. The date on the documentation 
must reflect that Federal recognition was received during or after 
March 2016.
    C. Documentation for Priority II participation requires a copy of 
the most current transmittal letter and Attachment A from the 
Department of Health and Human Services (HHS), Office of Inspector 
General (OIG), National External Audit Review Center (NEAR). See 
``Funding Priorities'' for more information. If an applicant is unable 
to provide a copy of the most recent transmittal letter or needs 
assistance with audit issues, information or technical assistance may 
be obtained by contacting the IHS Office of Finance and Accounting, 
Division of Audit by telephone at (301) 443-1270, or toll-free at the 
NEAR help line at (800) 732-0679 or (816) 426-7720. Recognized T/TOs 
not subject to Single Audit Act requirements must provide a financial 
statement identifying the Federal dollars received in the footnotes. 
The financial statement must also identify specific weaknesses/
recommendations that will be addressed in the TMG proposal and that are 
related to 25 CFR part 900, subpart F--Standards for Tribal or Tribal 
Organization Management Systems.
    D. Documentation of Consortium participation--If an applicant is a 
member of an eligible intertribal consortium, the Tribe must:
    1. Identify the consortium.
    2. Demonstrate that the Tribe's application does not duplicate or 
overlap any objectives of the consortium's application.
    3. Identify all consortium member Tribes.
    4. Identify if any of the consortium member Tribes intend to submit 
a TMG application of their own.
    5. Demonstrate that the consortium's application does not duplicate 
or overlap any objectives of other consortium members who may be 
submitting their own TMG application.
    Funding Priorities: The IHS has established the following funding 
priorities for TMG awards:
     PRIORITY I--Any Indian Tribe, or Tribal Organization 
representing that Indian Tribe, that has received Federal recognition 
(including restored, funded, or unfunded) within the past 5 years, 
specifically received during or after March 2016, will be considered 
Priority I.
     PRIORITY II--Indian Tribes and Tribal Organizations 
submitting a new application or a competing continuation application 
for the sole purpose of addressing audit material weaknesses will be 
considered Priority II. Priority II participation is only applicable to 
the Health Management Structure project type. For more information, see 
``Eligible TMG Project Types, Maximum Funding Levels, and Project 
Periods,'' in Section II.
     PRIORITY III--Eligible Direct Service and T/TOs with a 
Title I ISDEAA contract with the IHS submitting a new application or a 
competing continuation application will be considered Priority III.
     PRIORITY IV--Eligible T/TOs with a Title V ISDEAA compact 
with the IHS submitting a new application or a competing continuation 
application will be considered Priority IV.
    The funding of approved Priority I applicants will occur before the 
funding of approved Priority II applicants. Priority II applicants will 
be funded before approved Priority III applicants. Priority III 
applicants will be funded before approved Priority IV applicants. Funds 
will be distributed until depleted.
    The following definitions are applicable to the PRIORITY II 
category:
    Audit finding--deficiencies that the auditor is required by 45 CFR 
75.516 to report in the schedule of findings and questioned costs.
    Material weakness--``Statements on Auditing Standards 115'' defines 
material weakness as a deficiency, or combination of deficiencies, in 
internal control, such that there is a reasonable possibility that a 
material misstatement of the entity's financial statements will not be 
prevented, or detected and corrected on a timely basis.
    Significant deficiency--``Statements on Auditing Standards 115,'' 
defines significant deficiency as a deficiency, or a combination of 
deficiencies, in internal control that is less severe than a material 
weakness, yet important enough to merit attention by those charged with 
governance.
    The audit findings are identified in Attachment A of the 
transmittal letter received from the HHS/OIG/NEAR. Please identify the 
material weaknesses to be addressed by underlining the item(s) listed 
in Attachment A.
    Indian Tribes and Tribal Organizations not subject to Single Audit 
Act requirements must provide a financial statement identifying the 
Federal dollars received in the footnotes. The financial statement 
should also identify specific weaknesses/recommendations that will be 
addressed in the TMG proposal and that are related to 25 CFR part 900, 
subpart F, Standards for Tribal and Tribal Organization Management 
Systems.
    Note: A decision to award a TMG does not represent a determination 
from the IHS regarding the T/TO's eligibility to contract for a 
specific PFSA under the ISDEAA. An application for a TMG does not 
constitute a contract proposal.

IV. Application and Submission Information

    Grants.gov uses a Workspace model for accepting applications. The 
Workspace consists of several online forms and three forms in which to 
upload documents--Project Narrative, Budget Narrative, and Other 
Documents. Give your files brief descriptive names. The filenames are 
key in finding specific documents during the objective review and in 
processing awards. Upload all requested and optional documents 
individually, rather than combining them into a package. Creating a 
package creates confusion when trying to find specific documents. Such 
confusion can contribute to delays in processing awards, and could lead 
to lower scores during the objective review.

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 
[email protected].

2. Content and Form Application Submission

    Mandatory documents for all applicants include:
     Application forms:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
    4. Project Abstract Summary form.
     Project Narrative (not to exceed 15 pages). See Section 
IV.2.A, Project Narrative for instructions.
     Budget Justification and Narrative (not to exceed 5 
pages). See Section IV.2.B, Budget Narrative for instructions.
     One-page Timeframe Chart.
     Tribal Resolution(s) as described in Section III, 
Eligibility.
     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.

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     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost (IDC) rate 
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://facdissem.census.gov/ 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 15 pages and must: (1) have consecutively numbered 
pages; (2) use black font 12 points or larger (applicants may use 10 
point font for tables); (3) be single-spaced; and (4) be formatted to 
fit standard letter paper (8-1/2 x 11 inches). Do not combine this 
document with any others.
    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 overall page limit, the reviewers will be directed to 
ignore any content beyond the page limit. The 15-page limit for the 
narrative does not include the work plan, standard forms, Tribal 
Resolutions, budget, budget justifications, narratives, and/or other 
items. Page limits for each section within the project narrative are 
guidelines, not hard limits.
    There are three parts to the narrative: Part 1--Program 
Information; Part 2--Program Planning and Evaluation; and Part 3--
Program Report. 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--2 Pages)
    Section 1: Needs.
    Describe how the T/TO has determined the need to either enhance or 
develop Tribal management capability to either assume PFSAs or not in 
the interest of Self-Determination. Note the progression of previous 
TMG projects/awards if applicable.
Part 2: Program Planning and Evaluation (Limit--11 Pages)
    Section 1: Program Plans.
    Describe fully and clearly the direction the T/TO plans to take 
with the selected TMG Project type in addressing their health 
management infrastructure, including how the T/TO plans to demonstrate 
improved health and services to the community or communities it serves. 
Include proposed timelines.
    Section 2: Program Evaluation.
    Describe fully and clearly the improvements that will be made by 
the T/TO that will impact their management capability or prepare them 
for future improvements to their organization that will allow them to 
manage their health care system and identify the anticipated or 
expected benefits for the Tribe.
Part 3: Program Report (Limit--2 Pages)
    Section 1: Describe your organization's significant program 
activities and accomplishments over the past 5 years associated with 
the goals of this announcement.
    Please identify and describe significant program achievements 
associated with the delivery of quality health services. Provide a 
comparison of the actual accomplishments to the goals established for 
the project period, or if applicable, provide justification for the 
lack of progress.
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) for the first year of the project. The 
applicant can submit with the budget narrative a more detailed 
spreadsheet than is provided by the SF-424A (the spreadsheet will not 
be considered part of the budget narrative). 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. 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]), Deputy Director, DGM, by 
telephone at (301) 443-2114. 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 
costs.
     Only one grant may be awarded per applicant.
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 you cannot submit an application through Grants.gov, you must 
request a waiver prior to the application due date. This contact must 
be initiated prior to the application due date or your waiver request 
will be denied. Prior approval must be requested and obtained from Mr. 
Paul Gettys, Deputy Director, DGM. You must send a written waiver 
request to [email protected] with a copy to [email protected]. The waiver 
request must be documented in writing (emails

[[Page 74643]]

are acceptable) before submitting an application by some other method, 
and must include clear justification for the need to deviate from the 
required application submission process.
    If the DGM approves your waiver request, you will receive a 
confirmation of approval email containing submission instructions. You 
must include a copy of the written approval with the application 
submitted to the DGM. Applications that do not include 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 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 20 
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, you will receive an 
automatic acknowledgment from Grants.gov that contains a Grants.gov 
tracking number. The IHS will not notify you that the application has 
been received.
System for Award Management (SAM)
    Organizations that are not registered with SAM must access the SAM 
online registration through the SAM home page at https://sam.gov. 
Organizations in the U.S. 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.
Unique Entity Identifier
    Your SAM.gov registration now includes a Unique Entity Identifier 
(UEI), generated by SAM.gov, which replaces the DUNS number obtained 
from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS 
number.
    Check your organization's SAM.gov registration as soon as you 
decide to apply for this program. If your SAM.gov registration is 
expired, you will not be able to submit an application. It can take 
several weeks to renew it or resolve any issues with your registration, 
so do not wait.
    Check your Grants.gov registration. Registration and role 
assignments in Grants.gov are self-serve functions. One user for your 
organization will have the authority to approve role assignments, and 
these must be approved for active users in order to ensure someone in 
your organization has the necessary access to submit an application.
    The Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), requires all HHS awardees to report 
information on sub-awards. Accordingly, all IHS awardees must notify 
potential first-tier sub-awardees that no entity may receive a first-
tier sub-award unless the entity has provided its UEI number to the 
prime awardee 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.
    Additional information on implementing the Transparency Act, 
including the specific requirements for SAM, are available on the DGM 
Grants Management, Policy Topics web page at https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The project narrative and budget narrative should include only the 
first year of activities. 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 (20 Points)
    1. Describe the T/TO's current health operation. Include a list of 
programs and services that are currently provided (e.g., federally 
funded, state funded, etc.), information regarding technologies 
currently used (e.g., hardware, software, services, etc.), and identify 
the source(s) of technical support for those technologies (i.e., Tribal 
staff, Area office IHS, vendor, etc.). Include information regarding 
whether the T/TO has a health department and/or health board and how 
long it has been operating.
    2. Describe the population to be served by the proposed project. 
Include the total number of eligible IHS beneficiaries currently using 
the services.
    3. Describe the geographic location of the proposed project, 
including any geographic barriers to health care users in the area to 
be served.
    4. Identify all TMGs received since FY 2013, dates of funding, and 
a summary of project accomplishments. State how previous TMG funds 
facilitated the progression of health development relative to the 
current proposed project. (Copies of reports will not be accepted.)
    5. Identify the eligible project type and priority group of the 
applicant.
    6. Explain the need or reason for the proposed TMG project. 
Identify specific weaknesses and gaps in service or infrastructure that 
will be addressed by the proposal. Explain how these gaps and 
weaknesses will be assessed.
    7. If the proposed TMG project includes information technology 
(i.e., hardware, software, etc.), provide further information regarding 
measures that have occurred or will occur to ensure the proposed 
project will not create other gaps in services or infrastructure (e.g., 
negatively affect or impact IHS interface capability, Government 
Performance and Results Act reporting requirements, contract reporting 
requirements, Information

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Technology (IT) compatibility, etc.), if applicable.
    8. Describe the effect of the proposed TMG project on current 
programs (e.g., federally funded, state funded, etc.), and, if 
applicable, on current equipment (e.g., hardware, software, services, 
etc.). Include the effect of the proposed project on planned or 
anticipated programs and equipment.
    9. Address how the proposed TMG project relates to the purpose of 
the TMG Program by addressing the appropriate description that follows:
    a. Identify whether the T/TO is an IHS Title I contractor. Address 
if the Self-Determination contract is a master contract of several 
programs or if individual contracts are used for each program. Include 
information regarding whether or not the T/TO participates in a 
consortium contract (i.e., more than one Tribe participating in a 
contract). Address what programs are currently provided through those 
contracts and how the proposed TMG project will enhance the 
organization's capacity to manage the contracts currently in place.
    b. Identify if the T/TO is not an IHS Title I contractor. Address 
how the proposed TMG project will enhance the organization's management 
capabilities, what programs and services the organization is currently 
seeking to contract, and an anticipated date for contract.
    c. Identify if the T/TO is an IHS Title V compactor. Address when 
the T/TO entered into the compact and how the proposed project will 
further enhance the organization's management capabilities.
B. Project Objective(s), Work Plan, and Approach (40 Points)
    1. The proposed project objectives must be:
    a. measureable and (if applicable) quantifiable;
    b. results-oriented;
    c. time-limited.
    Example: By installing new third-party billing software, the Tribe 
proposes to increase the number of claims processed by 15 percent 
within 12 months.
    2. For each objective, address how the proposed TMG project will 
result in change or improvement in program operations or processes. 
Also, address what tangible products are expected from the project 
(i.e., policies and procedures manual, health plan, etc.).
    3. Address the extent to which the proposed project will build 
local capacity to provide, improve, or expand services that address the 
needs of the target population.
    4. Submit a work plan in the Other Attachments that includes the 
following:
    a. Provide action steps on a timeline for accomplishing the 
proposed project objectives.
    b. Identify who will perform the action steps.
    c. Identify who will supervise the action steps taken.
    d. Identify tangible products that will be produced during and at 
the end of the proposed project.
    e. Identify who will accept and/or approve work products during the 
duration of the proposed TMG project and at the end of the proposed 
project.
    f. Include a description of any training activities proposed. This 
description will identify the target audience and training personnel.
    g. Include work plan evaluation activities.
    5. If consultants or contractors will be used during the proposed 
project, please complete the following information in their scope of 
work. (If consultants or contractors will not be used, please make note 
in this section):
    a. Educational requirements.
    b. Desired qualifications and work experience.
    c. Expected work products to be delivered, including a timeline.
    If potential consultants or contractors have already been 
identified, please upload a resume for each consultant or contractor in 
the Other Attachments in Grants.gov.
    6. Describe updates that will be required for the continued success 
of the proposed TMG project (i.e., revision of policies/procedures, 
upgrades, technical support, etc.). Include a timeline of anticipated 
updates and source of funding to conduct the update and/or maintenance.
C. Program Evaluation (20 Points)
    Each proposed objective requires an evaluation activity (such as a 
logic model) to assess its progression and ensure completion. This 
should be included in the work plan.
    Describe the proposal's plan to evaluate project processes and 
outcomes. Outcome evaluation relates to the results identified in the 
objectives. Process evaluation relates to the work plan and activities 
of the project.
    1. For outcome evaluation, describe:
    a. The criteria for determining whether each objective was met.
    b. The data to be collected to determine whether the objective was 
met.
    c. Data collection intervals.
    d. Who will be responsible for collecting the data and their 
qualifications.
    e. Data analysis method.
    f. How the results will be used.
    2. For process evaluation, describe:
    a. The process for monitoring and assessing potential problems, 
then identifying quality improvements.
    b. Who will be responsible for monitoring and managing project 
improvements based on results of ongoing process improvements and their 
qualifications.
    c. Provide details with regards to the ways ongoing monitoring will 
be used to improve the project.
    d. Describe any products, such as manuals or policies, that might 
be developed and how they might lend themselves to replication by 
others.
    e. How the T/TO will document what is learned throughout the 
project period.
    3. Describe any additional evaluation efforts planned after the 
grant period has ended.
    4. Describe the ultimate benefit to the T/TO that is expected to 
result from this project. An example would be a T/TO's ability to 
expand preventive health services because of increased billing and 
third-party payments.
D. Organizational Capabilities, Key Personnel, and Qualifications (15 
Points)
    This section outlines the T/TO's capacity to complete the proposal 
outlined in the work plan. It includes the identification of personnel 
responsible for completing tasks and the chain of responsibility for 
completion of the proposed plan.
    1. Provide the organizational structure of the T/TO.
    2. Provide information regarding plans to obtain management systems 
if a T/TO does not have an established management system currently in 
place that complies with 25 CFR part 900, subpart F, Standards for 
Tribal or Tribal Organization Management Systems. State if management 
systems are already in place and how long the systems have been in 
place.
    3. Describe the ability of the T/TO to manage the proposed project. 
Include information regarding similarly sized projects in scope and 
financial assistance as well as other grants and projects successfully 
completed.
    4. Describe equipment (e.g., fax machine, telephone, computer, 
etc.) and facility space (i.e., office space) that will be available 
for use during the proposed project. Include information about any 
equipment not currently available that will be purchased through the 
grant.
    5. List key project personnel and their titles in the work plan.
    6. Provide the position descriptions and resumes for all key 
personnel as

[[Page 74645]]

Other Attachments in Grants.gov. The included position descriptions 
should: (1) clearly describe each position's duties; and (2) indicate 
desired qualifications and project associated experience. Each resume 
must include a statement indicating that the proposed key personnel is 
explicitly qualified to carry out the proposed project activities. If 
no current candidate for a position exists, please provide a statement 
to that effect in the Other Attachments.
    7. If an individual is partially funded by this grant, indicate the 
percentage of his or her time to be allocated to the project and 
identify the resources used to fund the remainder of that individual's 
salary.
    8. Address how the T/TO will sustain the proposal created positions 
after the grant expires. Please indicate if the project requires 
additional personnel (i.e., IT support, etc.). If no additional 
personnel are required, please indicate that in this section.
E. Categorical Budget and Budget Justification (5 Points)
    1. Provide a categorical budget for the first budget period.
    2. If indirect costs are claimed, indicate and apply the current 
negotiated rate to the budget. Include a copy of the rate agreement in 
the Other Attachments.
    3. Provide a narrative justification explaining why each 
categorical budget line item is necessary and relevant to the proposed 
project. Include sufficient cost and other details to facilitate the 
determination of cost allowability (e.g., equipment specifications, 
etc.).
    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 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.
     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, period of performance limit) 
will not be referred to the ORC and will not be funded. The program 
office will notify the applicant 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 Office of Direct Service and Contracting Tribes 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, the budget period, and period 
of performance. 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 
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-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf.
     Please review all HHS regulatory provisions for 
Termination at 45 CFR 75.372, at the time of this publication located 
at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf.
    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, at the time of this 
publication located at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, Audit 
Requirements, located at 45 CFR part 75 subpart F, at the time of this 
publication located at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf.
    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 
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

[[Page 74646]]

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 
write to [email protected].

3. Reporting Requirements

    The awardee 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 use the form under the Recipient User section of 
https://www.grantsolutions.gov/home/getting-started-request-a-user-account/. Download the Recipient User Account Request Form, fill it out 
completely, and submit it as described on the web page and in the form.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required semi-annually. 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 Financial Reports are due 90 days after the end of each 
budget period, and a final report is due 90 days after the end of the 
period of performance.
    Awardees are responsible and accountable for reporting accurate 
information on all required reports: the Progress Reports and the 
Federal Financial Report.
    Failure to submit timely reports may result in adverse award 
actions blocking access to funds.
C. 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/.
D. Non-Discrimination Legal Requirements for Awardees 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 
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.
     Health and education programs funded by the HHS 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://

[[Page 74647]]

www.hhs.gov/conscience/religious-freedom/index.html.
E. 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/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 million 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 OIG 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: Marsha Brookins, Director, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, MD 20857, (Include ``Mandatory Grant 
Disclosures'' in subject line), Office: (301) 443-4750, 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: Terri 
Schmidt, Director, Office of Direct Service and Contracting Tribes, 
Indian Health Service, 5600 Fishers Lane, Mail Stop: 08E17, Rockville, 
MD 20857, Phone: (301) 443-1104, email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Sheila A.L. Miller, Grants Management Specialist, Indian 
Health Service, Division of Grants Management, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, MD 20857, Phone: (240) 535-9308, 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, 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.

P. Benjamin Smith,
Deputy Director, Indian Health Service.
[FR Doc. 2022-26480 Filed 12-5-22; 8:45 am]
BILLING CODE 4165-16-P