[Federal Register: November 25, 2002 (Volume 67, Number 227)]
[Notices]
[Page 70602-70611]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25no02-65]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Program Announcement 03017]
Systems-Based Diabetes Prevention and Control Programs (DPCPs);
Notice of Availability of Funds
A. Authority and Catalog of Federal Domestic Assistance Number (CFDA)
This program is authorized under section 301(a) and 317(k)(2)of the
Public Health Service Act, (42 U.S.C. section 241(a) and 247b(k)(2), as
amended). The Catalog of Federal Domestic Assistance number is 93.988.
B. Purpose
The Centers for Disease Control and Prevention (CDC), announces the
availability of fiscal year (FY) 2003 funds for a cooperative agreement
program for Systems-Based Diabetes Prevention and Control Programs
(DPCPs). This program addresses the ``Healthy People 2010'' focus areas
of Diabetes, Immunization, Access to Quality Health Services, Chronic
Kidney Disease, Heart Disease and Stroke, Vision and Hearing, Nutrition
and Overweight, Physical Activity and Fitness, and Public Health
Infrastructure.
Measurable outcomes of the program will be in alignment with the
following performance goal for the National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP): Increase the capacity of
state diabetes control programs to address the prevention of diabetes
and its complications at the community level.
The Program will continue to emphasize prevention of complications
and premature mortality among people with diabetes (i.e. secondary and
tertiary prevention). Further, the Program will continue to incorporate
a model of influence by linking new programs and existing programs that
support social and environmental policies for the promotion of wellness
in both people with diabetes, and those at risk for diabetes. In the
future, CDC plans (pending available resources) to turn increasing
attention to the identification and dissemination of lifestyle
interventions proven to be effective in preventing or delaying Type 2
diabetes among people with impaired fasting glucose or impaired glucose
tolerance.
For additional background information please see attachment II of
this announcement as posted on the CDC web site at: www.cdc.gov.
C. Eligible Applicants
Assistance will be provided only to the health departments of
states or their bona fide agents, and Territories, including the
District of Columbia, the Commonwealth of Puerto Rico, the Virgin
Islands, the Commonwealth of the Northern Mariana Islands, American
Samoa, Guam, the Federated States of Micronesia, the Republic of the
Marshall Islands, and the Republic of Palau. Competition is limited to
health departments or their bona fide agents because they are uniquely
positioned to perform, oversee and coordinate diabetes prevention and
control activities in public health settings and as part of a larger
public health system. All States and Territories are currently
receiving funding for diabetes programs under prior CDC announcements
97064, 98034, and/or 99078.
(Note: Throughout this document the use of the term ``State'' or
``statewide'' also refers to the Territories described above.)
For the first year, states currently receiving CDC funds for
Comprehensive Programs (funded under program announcements 97064,
98034, and 99078) are entitled to apply for Comprehensive Program
funding only.
States currently receiving CDC funds for Core Programs (funded
under program announcement 99078) are eligible to apply for either Core
or Comprehensive Program funding. Applicants will receive only a Core
or Comprehensive award.
[[Page 70603]]
Current Core programs applying for Core funding will undergo a
technical review of their application and will be funded pending
receipt and approval of a technically acceptable application.
Current Comprehensive Programs and Core Programs applying for
Comprehensive funding must submit an application which will undergo a
competitive review process by an independent objective review panel. As
a contingency, currently funded Core programs applying for
Comprehensive awards should submit two separate work plans, with budget
line items and budget justifications, one for a Core Program and one
for a Comprehensive Program.
All applications received from current grant recipients under
Program Announcements 97064, 98034, and 99078 will be funded for either
a Core or a Comprehensive Program.
After the first year, Tier 2 DPCPs (see explanation of Tier 2 in
section ``E. Program Requirements'') will be eligible to compete for
Special Projects of National Significance based on availability of
funds in years two through four. Eligibility will be limited to high
performing Tier 2 DPCPs that demonstrate multi-system integration of
public health services and partnerships into a comprehensive, highly
functioning, and accountable program. A number of key innovative
strategies, implemented by these DPCPs, have been sustained or
institutionalized, documented in public health reports or scientific
literature and disseminated to other programs as appropriate.
Note: Public Law 104-65 states that an organization described in
section 501(c) (4) of the Internal Revenue Code of 1986 which
engages in lobbying activities shall not be eligible for the receipt
of Federal funds constituting an award, grant, loan or any form.
D. Funding
Availability of Funds
Approximately $23 million is available in FY 2003 to fund 59
awards. It is estimated that approximately $10 million will be
available to fund approximately 41 Core awards. It is expected that the
average federal contribution to the Core award will be $244,000,
ranging from $50,000 to $400,000. Approximately $13 million will be
available to fund approximately 18 Comprehensive awards. It is expected
that the average federal contribution to the Comprehensive award will
be $725,000 ranging from $400,000 to $900,000.
It is expected that the awards will begin on or about March 30,
2003, and will be made for a 12-month budget period within a project
period of up to five years. Funding estimates may vary depending on
availability of funds.
Continuation awards within an approved project period will be made
on the basis of satisfactory demonstration of accomplishment of
proposed activities, performance improvement plans and results, and the
availability of funds.
Direct Assistance
You may request Federal personnel as direct assistance, in lieu of
a portion of financial assistance.
Use of Funds
Resources available under this program announcement may not be used
to: (1) Support direct patient care services, screening services,
individual health services, or the treatment of diabetes; (2) duplicate
existing efforts the federal system has established for outpatient
diabetes education reimbursement for the Medicare population through
the Diabetes Education Program Recognition administered by the Centers
for Medicaid and Medicare Services (CMS); or (3) supplant existing
State or Federal funding including the Preventive Health and Health
Service block grant or other sources.
Programs that have adequately addressed the program key components
(see attachment IV of this announcement as posted on the CDC web site)
and are high performing comprehensive (or Tier 2 in years 2-5) programs
may dedicate a portion of the resources available under this program
announcement to conduct research projects. Funded research projects
involving human subjects will be governed by 45 Code of Federal
Regulations, part 46.
Applicants are encouraged to identify and leverage opportunities
which will enhance their work with other State health department
programs that address related chronic diseases or risk factors. This
may include cost sharing to support shared staff positions, such as a
chronic disease epidemiologist, program evaluator, health communication
specialist, etc. Other cost sharing activities that cut across chronic
disease programs and are directly related to recipient program
activities may also be appropriate.
Recipient Financial Participation
Matching funds are required for this program. Matching funds are
required from non-Federal sources in an amount not less than $1 for
each $5 of Federal funds awarded to Core programs and; $1 for each $4
for Comprehensive programs. The matching funds may be cash or its
equivalent in-kind or donated services, fairly evaluated. The
contribution may be made directly or through donations from public or
private entities. Match requirements may change for Tier levels in
years two through five. Matching funds must be consistent with the work
plan activities that are submitted and approved.
Matching funds may not be met through: (1) The payment of treatment
services or the donation of treatment, or direct patient diabetes
education services; (2) services assisted or subsidized by the Federal
Government; or (3) the indirect or overhead of an organization.
Funding Preference
Due to resource limitations, preference in funding Comprehensive
Programs will be given to states with:
1. A larger burden of diabetes and related complications.
2. A larger proportion of residents experiencing racial and ethnic
disparities in diabetes prevalence and diabetes related complications.
3. Varied geographic representation across the United States.
4. Varied distribution of population density among funded programs.
E. Program Requirements
In conducting activities to achieve the purpose of this program,
both Core and Comprehensive DPCPs will be responsible for the
activities under 1. Recipient Activities (except where otherwise
noted), and CDC will be responsible for the activities under 2. CDC
Activities. It is expected that Comprehensive Programs will demonstrate
a more intensive level of effort in each category of recipient
activities.
1. Recipient Activities
a. Define the burden of diabetes in a manner that informs and
influences public health decision making: Maintain a state specific
diabetes surveillance system. This should be accomplished through
previously established surveillance systems and ensuring that the
Behavioral Risk Factor Surveillance System (BRFSS), Diabetes Module (or
other appropriate surveillance system for the Territories), is
conducted yearly. Yearly administration of the Diabetes Module is a
requirement. The surveillance system should support and inform public
health decision making. At a minimum, this data should be used to
generate performance-based outcome measures specific to recommended
foot and eye exams, immunizations, and
[[Page 70604]]
annual Hemoglobin A1C (A1C) tests. It should also be used to guide
program activities. Systems should monitor trends, disseminate data and
information, and support evaluation efforts. Comprehensive Programs are
expected to implement special surveillance strategies (e.g., over-
sampling, special surveys, sentinel surveillance systems) that address
unmet surveillance needs.
b. Establish and maintain a presence for diabetes prevention and
control within the State Health Department. Implement the following
critical functions of fiscal management, performance management,
program assessment, and strategic planning to carry out the program by
working through the respective State and Territorial Health Department
infrastructure.
(1). Fiscal Management: Develop a Fiscal Management system that
supports the program. This system should have the following capacity:
accurate and timely tracking of expenditures and sources of match
support; accurate projection of categorical balances; and the
prevention of excessive unobligated balances by having the flexibility
to reallocate funds into appropriate budget categories if priorities
change or if staffing patterns change. DPCPs need to establish linkages
with appropriate state fiscal management staff, and develop a process
for regularly assessing program needs and monitoring expenditures.
(2). Performance Management: The DPCP should engage health
department leadership to develop a performance management system that
incorporates capacity improvement processes and strategic
accountability measures. For Comprehensive Programs, a written plan of
this performance management system should be in place. This should
assist health department officials to create accountability processes
within state programs. This will enable them to introduce rewards for
good performance and consequences for poor performance. The performance
management system should also be linked to the evaluation system and
the budget process.
(3). Program Assessment: DPCPs are expected to conduct reflective,
partner-included assessments to identify strengths and needs in the
DPCP's public health infrastructure. Efforts to strengthen identified
essential public health services, deemed particularly important in
achieving the program's goals, should follow the assessments by
developing a performance improvement plan based on identified services
that need strengthening. DPCPs will assess and continuously improve
public health services so that policies and legislation related to
issues such as access to quality care and environmental conditions
encourage positive health outcomes. Further, DPCPs will support
participatory community efforts promoting systems and community-based
approaches aimed at increasing years of healthy life and eliminating
the disproportionate burden of diabetes borne by particular racial and
ethnic populations. The Ten Essential Public Health Services (see
attachment III of this announcement as posted on the CDC web site) will
provide the basis for assessment. More extensive involvement of
partners state-wide is expected of Comprehensive Programs. State public
health agencies may or may not be the lead agency for several specific
essential public health services. In these cases, identifying the role
of the state public health agency with a support role by the DPCP, will
help in prioritizing the essential public health services most relevant
to achieving the goals of the diabetes program. Performance improvement
plans will be implemented in year two and beyond. DPCPs will be
expected to demonstrate measurable results linked to performance
improvement plans annually.
(4). Strategic Planning: Develop or update a State Diabetes
Strategic Plan for diabetes prevention and control with the goal of
advancing the prevention and control of diabetes and its complications,
improving access to and the quality of diabetes services and care, and
eliminating disparities between population groups. The DPCP and its
partners should be involved in the development and implementation of
the State Diabetes Strategic Plan. The State Diabetes Strategic Plan
should also inform and guide the activities of the DPCP and its
partners. As they become available, the results of the Assessment
should guide the periodic update and improvement of the State Diabetes
Strategic Plan. For Comprehensive Programs, the plan should be
comprehensive in nature and reflective of the strategies and activities
of the diabetes health system in the state.
c. Program Design Enhancement: Expand the current DPCP program
model of influence. DPCPs should serve as a catalyst for change
positively impacting people with diabetes, their families, and their
communities. The DPCP should engage the State Diabetes Health System
(SDHS) which includes the DPCP, the state health agencies and other
health partners that contribute to diabetes services and programs at
the state level, in this effort. Activities include the current
population-based approaches for secondary and tertiary prevention for
people with diabetes. All activities described must be relevant,
complementary to, and consistent with ongoing national efforts such as
the National Diabetes Education Program (NDEP), and with national
priorities for eliminating racial and ethnic health disparities for
diabetes. Core Program activities aligned with the ten essential public
health services can include small scale pilots in selected geographic
areas or statewide interventions. Comprehensive Programs are expected
to have a wider scope of activities in all areas of influence.
Comprehensive Programs must also develop public health activities that
reach the entire State or implement an existing multifaceted intensive
program in a limited geographical area within a defined target
population. Allowable program activities that emerge from evolving
science will be addressed in future guidance documents which will
accompany each request for continuing application.
d. Establish and Maintain Effective Partnerships: Create a culture
of shared responsibility with the SDHS and other nontraditional
partners. The DPCP and partners should collectively plan, implement,
and evaluate goals and objectives and align resources to priorities.
The DPCP should engage the SDHS to measure the quality and
effectiveness of collective efforts and the DPCP's ability to establish
and maintain effective partnerships. The goal should be inclusiveness
rather than exclusiveness to achieve synergistic results. Within the
State Health Department, the DPCP should collaborate and coordinate
with partners such as nutrition, physical activity, tobacco,
cardiovascular health, maternal and child health, health promotion,
PHHS block grant, State Minority Health Program, Office of Women's
Health, Office On Aging, public information officer, as well as data
partners such as vital statistics and the State's BRFSS. Comprehensive
Programs must demonstrate a more extensive partnership base and more
significant level of engagement with those partners.
e. Evaluation: Conduct ongoing monitoring and evaluation of
diabetes prevention and control activities and strategies, including
process and impact evaluation. State evaluation efforts should
complement and be consistent with national program evaluation goals.
Comprehensive Programs are expected to submit an evaluation methodology
designed to demonstrate more in-depth, purposeful evaluation of program
activities.
f. Management Information System (MIS): The MIS will be used for
post
[[Page 70605]]
award administration, program monitoring, technical assistance, and
programmatic decision making. Programs are expected to ensure that
information is entered into the MIS in a timely manner. Office of
Management and Budget (OMB) clearance for the data collection initiated
under this cooperative agreement has been approved. (OMB No. 0920-0479.
Expiration date 7/31/2003.)
g. Protection of Human Subjects: Ensure that program activities
follow all applicable federal regulations concerning the protection of
human subjects and the confidentiality of personally identifiable data.
Year One
DPCPs will be awarded as either Core or Comprehensive Programs for
the first year.
1. Core programs are expected to establish and maintain a presence
in the health department for diabetes prevention and control; define
the burden of diabetes in the state and communicate it in a manner that
informs and influences public health decision making; establish and
maintain effective partnerships; develop a State Diabetes Strategic
Plan; and engage in small scale pilots in accordance with program
guidance.
2. Comprehensive programs are expected to meet all of the
requirements of a Core program and implement statewide interventions or
implement multifaceted intensive strategies in geographically defined
targeted populations to reduce or eliminate the burden of diabetes.
Years Two Through Five
In subsequent years (years two through five), DPCPs will be placed
in one of two Tier levels based on their performance as documented in
the interim progress reports, and on the availability of funds. The
award strategy is designed to support documented performance results
from quality intervention and performance improvement plans. Awards
will also be based on budget justification, alignment with CDC
strategies, and the ability of a state to continuously execute
performance improvement and intervention plans.
Tier 1
This Tier level is intended to support capacity-building programs
by establishing a performance management system; a state team with
multiple skill sets; an epidemiology-based State Diabetes Strategic
Plan to achieve program goals; highly functioning, accountable
partnerships; and program strategies and activities to reduce
documented burden of diabetes. In this Tier, culturally relevant small-
scale interventions at community and/or systems levels, with specific
priority audiences in particular communities or geographic areas, are
expected.
The performance expectations of this Tier include
1. Meeting minimum requirements outlined in the DPCP Key Components
document (see attachment IV of this announcement as posted on the CDC
web site).
2. Developing a performance improvement plan reflecting priority
areas identified in the diabetes public health assessment which is
based on the ten essential public health services.
3. Developing a work plan that meets program criteria (logic-
modeled) with budget justification.
4. Providing evidence of results based on proximal performance
measures which are anticipated to lead to the achievement of the CDC,
Division of Diabetes Translation's (DDT's) National Objectives.
Tier 2
DPCPs in this Tier level have a broader-based program capacity
supported by the elements of Tier 1, but with increasingly integrated
and highly functional partnerships and measurable effects. Programs in
this Tier systematically implement priority strategies and
interventions in priority communities throughout the state, consistent
with their State Diabetes Strategic Plan. They must have evidence of
improvement in the diabetes public health infrastructure. Program
impacts and results must be evident and measurable through the DPCP
performance management system. They have also demonstrated national
leadership, sharing lessons learned among local, state, and national
partners.
The performance expectations of this Tier include:
1. Demonstrating quality activities linked to the Ten Essential
Public Health Services with activities in each of the four indicators.
2. Demonstrating results in the implementation of improvement
plans.
3. Meeting the expectations of Tier 1.
4. Developing a work plan that meets Tier 2 criteria (logic-
modeled) with budget justification based on Tier 2 funding levels.
5. Demonstrating readiness in terms of capacity to take on a larger
scope of program activities (staffing, management support,
technological resources, partnerships, etc.).
6. Providing evidence of results based on proximal performance
measures which are anticipated to lead to the achievement of the CDC,
DDT's National Objectives.
Special Projects of National Significance
High performing Tier 2 programs will be eligible to request
additional funding to support projects of national significance. Tier 2
DPCPs who are awarded funds to carry out these Special Projects have
demonstrated multi-system integration of public health services and
partnerships into a comprehensive, highly functioning, and accountable
program. A number of key innovative strategies, implemented by these
DPCPs, have been sustained or institutionalized, documented in public
health reports or scientific literature and disseminated to other
programs as appropriate. It is anticipated that Special Projects will
be funded for a specified period of time and may include one or more of
the following: (1) Spreading successful population-based interventions
accomplished in earlier phases of the program to reach populations
still unserved; (2) Conducting projects which provide national
leadership in sharing and promoting processes and results. Helping CDC
to influence national policies based on emerging needs and discovery of
effective practices and policies; and (3) Developing and conducting
research projects of national significance, which appropriately
contribute to the emerging diabetes public health science base.
The performance expectations of the Special Projects will be
specific to the nature of the Project, with the expectation that the
Tier 2 programs that are conducting the Special Projects will:
1. Demonstrate quality activities linked to the Ten Essential
Public Health Services with activities in each of the four indicators.
2. Demonstrate results in the implementation of improvement plans.
3. Meet the expectations of Tier 2.
4. Develop a work plan that meets criteria for Tier 2 programs and
Special Projects with appropriate budget justification based on the
nature of the Project.
5. Demonstrate readiness in terms of capacity to take on a larger
scope of program activities required to implement Special Projects
(staffing, management support, technological resources, partnerships,
etc.).
6. Provide evidence of results based on proximal performance
measures which are anticipated to lead to the
[[Page 70606]]
accomplishment of the CDC, DDT's National Objectives.
2. CDC Activities.
a. Provide ongoing guidance, training, consultation, and technical
assistance in all aspects of diabetes prevention and control, as
described under Recipient Activities.
b. Provide up-to-date information that describes proven
interventions and current research in appropriate areas of diabetes
prevention and control.
c. Provide resources, tools, and technical assistance to improve
and enhance program evaluation efforts.
d. Provide resources and technical assistance to improve monitoring
and surveillance systems. Provide technical assistance in the
coordination of surveillance and other data systems to measure and
characterize the burden of diabetes.
e. Collaborate with the DPCPs and other appropriate partners to
develop and disseminate programmatic guidance and other resources for
specific interventions, health communication campaigns, and other
national initiatives.
f. Facilitate the adoption and adaptation of effective practices
through workshops, trainings, conferences, and electronic and verbal
communication among recipients of cooperative agreement awards under
this program announcement, and other diabetes prevention and control
partners.
g. Support the development and maintenance of a system for DPCP
input into planning and sharing of information.
h. Assist in and support the development and maintenance of
partnerships and networks with Federal and non-Federal, public and
private sector organizations to help implement diabetes prevention and
control programs, thereby maintaining a national infrastructure to
complement the infrastructure in the states and territories and their
local jurisdictions.
i. Facilitate effective communication and integration between NDEP
and state DPCPs. This includes, but is not limited to, NDEP training,
media, and other program products and tools.
j. Provide up-to-date information on the responsible conduct of
research and technical assistance for program activities involving
human subjects.
F. Content
The Program Announcement title and number must appear in the
application. Use the information in the Program Requirements, Recipient
Activities, Evaluation Criteria, and Other Requirements sections to
develop the application content. Your application will be evaluated on
the criteria listed, so it is important to follow them in laying out
your program plan. The applications (excluding forms and attachments)
should be no more than 50 pages, double-spaced, printed on one side,
with one-inch margins, and unreduced 12 point font. Necessary
supporting information (tables, organizational charts, position
descriptions, etc.) may be provided as attachments. A signed original
and two copies of the application must be mailed to the CDC Grants
Office.
Applicants are strongly encouraged to utilize the MIS. The format
of DDT's MIS complements the application content specified in this
announcement. Therefore, to avoid duplication of effort, the
application content may be entered into the DDT MIS. Hard copies will
be generated from the MIS for formal submission to the CDC Procurement
and Grants Office with the required signed forms. OMB clearance for the
data collection initiated under this cooperative agreement has been
approved. (OMB No. 0920-0479. Expiration date 7/31/2003.)
Applicants for comprehensive level funding must demonstrate optimal
core capacity as evidenced by the following: Established surveillance
systems; sound infrastructure and management (including fiscal
management, performance management, program assessment, and strategic
planning); proven experience with results in the implementation of well
designed small-scale pilot projects; effective partnerships; and sound
monitoring and evaluation of diabetes prevention and control activities
including process and impact evaluation. In addition, Comprehensive
Program applications must include a plan to develop public health
activities that reach the entire State, or to implement an existing
multifaceted intensive program in a limited geographical area within a
defined target population.
Both Core and Comprehensive Program applicants should respond to
items one through seven below. However, applicants should note that in
some areas different information is requested of applicants. Current
Core grantees applying for a Comprehensive award should provide two
separate applications, one Core application and one Comprehensive
application, and address the comprehensive component by describing
their planned or proposed comprehensive activities.
1. Background and Need:
a. Provide an estimate of the burden of diabetes and its
complications, and its geographic and demographic distribution within
the State. Reference the data sources that support these estimates.
Describe the challenges to diminishing the morbidity and mortality from
diabetes in your State.
b. Include a description of the populations that are at high risk
for diabetes in your State. If possible, describe the social,
ecological, or economic conditions that contribute to the
disproportionate burden of diabetes in the population, as well as
knowledge, attitudes, and beliefs that impact the health practices of
the population. If available, attach references for any studies or
sources from which this information was obtained.
c. Provide an analysis of the barriers to addressing the burden of
diabetes in the State.
2. Program Accomplishments and Proven Capacity:
a. Describe efforts to develop and incorporate diabetes
surveillance systems, including BRFSS, in monitoring and tracking
diabetes-related health status in the State. Include information on how
data is used in diabetes program planning and decision making.
b. Describe unique or significant advances toward achieving program
objectives and the CDC, DDT's National Objectives.
c. Provide findings, conclusions, or status of pilot projects and/
or statewide activities. Where appropriate, provide success stories of
program activities or other methods of determining success.
d. Provide examples of successful efforts to influence the
widespread application of accepted standards, policies, and protocols.
Describe the methodology for determining the success of these efforts.
e. Describe specific program activities and accomplishments in
addressing the needs of underserved populations, or populations at high
risk for diabetes in the State.
f. Describe how the DPCP engages partners, including their diabetes
advisory groups or coalitions, other Chronic Disease Programs, and non-
traditional partners, in program planning, implementation, coordinating
efforts and evaluation in support of the DPCP work plan objectives.
g. Describe how the DPCP has managed its fiscal and human resources
in the past five years (including history of unobligated balances, how
match requirements have been met, turnover in key staff positions,
professional development of DPCP staff, supportive leadership, etc.).
h. Provide letters of support that reflect the involvement of
diverse (traditional and non-traditional) organizations in planning the
response
[[Page 70607]]
to this program announcement. Include specific roles and
responsibilities of the partner providing the letter in the State
Diabetes Strategic Plan or activity/intervention that is pertinent.
i. If available, provide a state diabetes strategic plan, diabetes
advisory group or coalition by-laws, action plans, and any other
substantive work products from these partnerships that demonstrate
quality and effectiveness.
3. Program Work Plan:
Provide a clear work plan that addresses the items listed below.
Some objectives may reflect the process by which the program or
activity is developed, while others will reflect the actual public
health impact, output or outcome that results.
Each DPCP should state their measurable and time-phased objectives
for the project period that will help achieve the goal(s) of the
program. A ``logic model'' or causal relationship should be evident
among the long term objectives, process objectives, and activities.
a. Provide measurable and time-phased long term objectives for the
five-year project period that should mirror the following CDC, DDT's
National Objectives:
(1). By 2008, DPCPs should have demonstrated success in achieving
an increase in persons with diabetes who receive recommended foot
exams, eye exams, flu and pneumococcal immunizations, and A1C tests.
(2). By 2008, DPCPs should have demonstrated progress in
establishing linkages for the promotion of wellness and physical
activity for persons with diabetes.
(3). By 2008, all DPCPs should have demonstrated progress in
eliminating health disparities for high risk populations with respect
to diabetes prevention and control.
(4). Each DPCP should establish measurement procedures and
surveillance systems, including baseline and target measurements of the
percent of persons with diabetes receiving recommended foot exams, eye
exams, flu and pneumococcal immunizations and recommended A1C tests, as
a means of assessing program success. b. Provide measurable, specific
and time-phased one year budget period objectives that will help
achieve the stated time-phased long term objectives. c. Describe in
detail a plan for systems-based activities, and methods for achieving
each of the proposed one year budget period objectives.
4. Evaluation Plan:
Describe how progress, the achievement of program objectives and
the effectiveness of program activities will be monitored and
evaluated. Describe how data will be collected, analyzed, and used to
improve the program. Specify the person(s) responsible for designing
and implementing evaluation activities, collecting and analyzing data,
and reporting findings. DPCPs should incorporate the six steps of the
``CDC Framework for Program Evaluation'' when creating the DPCP
evaluation plan. The six connected steps assist in the planning and
evaluation of a variety of interventions. The CDC Evaluation Framework
steps are:
Step 1: Engage stakeholders: Include individuals and organizations
that are involved in program operations, served or affected by the
program, and the primary users of evaluation.
Step 2: Describe the program: Descriptions should be sufficiently
detailed to ensure understanding of program objectives and strategies.
Include a logic model that links program objectives and activities to
eventual outcomes/effects.
Step 3: Focus the evaluation design: Specify the questions to be
answered through the evaluation activities proposed. These questions
should guide the evaluation process and be directly linked to the
objectives stated above. Specify the methods for quantitative and
qualitative data collection, such as the use of questionnaires,
surveys, other data collection instruments, interviews, and focus
groups, etc. (Assure that appropriate Human Subjects Research
procedures and OMB requirements have been followed and documented.)
Step 4: Gather credible evidence: Specify the information (data)
that will be collected to answer the evaluation questions stated above.
Specify the sources of information (data) to be collected. Since this
evaluation is designed to measure change as a result of the
intervention, specify the baseline against which the change is being
measured.
Step 5: Justify conclusions: Specify the process to be used to
analyze, synthesize, and report the data.
Step 6: Ensure use and share lessons learned: Explain how the data
resulting from the evaluation will be used to improve or expand the
program. Discuss how the results of the evaluation will be reported and
who will receive the results.
More information about the six steps can be found at: http://
www.cdc.gov/eval/framework.htm.
Note: Include samples of data collection tools in the
attachments, if available.
In addition, the evaluation plan should document and describe
program successes, unmet needs, barriers, and problems encountered in
planning, implementing, or in coordinating activities.
5. Program Infrastructure and Management Plan: Describe how the
program will be effectively managed including:
a. Staffing: Minimal key staffing for the program should include a
full-time DPCP coordinator, a designated evaluation lead, and a
designated epidemiology/surveillance lead.
b. Staffing Responsibilities: Responsibilities of key staff should
include: a DPCP coordinator responsible for the overall program
operation and coordination; a designated evaluation lead responsible
for ensuring that the program and its projects are evaluated regularly
for process and impact measures and that results are appropriately
disseminated; and a designated epidemiology/surveillance lead who will
ensure the integrity of surveillance systems and other DPCP
epidemiological activities and facilitate intra and inter health
department exchange of epidemiological information. In addition, the
DPCP should designate a staff member to facilitate and oversee a
process for integrating other program components such as NDEP messages
and tools into program planning and implementation activities.
c. Management Plan and Organization Operations: Provide a copy of
the organizational chart that indicates the placement of the proposed
program. A description of clear and direct lines of authority within
the program staff and to the next two higher levels of supervisory
authority should be provided. Fiscal controls and their relationship to
program staff and management should be included. Discuss strategies for
ensuring timely and appropriate communication among staff on the status
of program implementation and related issues. The DPCP should receive
guidance and support from the State Chronic Disease Director or the
equivalent. The priority DPCP goals and objectives should be part of,
or incorporated in, the overall State Health Department strategic plan.
d. Qualifications: Describe the qualifications of the designated or
proposed staff. Provide abbreviated (one-to-two page) resumes and brief
job descriptions for designated staff, and brief job descriptions for
the proposed staff.
e. Responsibility: Identify key staff positions responsible for the
implementation of each program activity, especially the required full
[[Page 70608]]
time coordinator, the evaluation lead and the epidemiology/surveillance
lead.
f. Contingency plans: Describe plans for ongoing management and
operation of the project if there are unexpected vacancies, hiring
restrictions, or difficulty recruiting in key positions.
6. Financial Participation: Matching funds are required from non-
Federal sources in the amount of not less than $1 for each $5 of
Federal funds awarded to Core Programs under this program announcement.
Comprehensive Programs are required to match $1 for each $4 of Federal
funds awarded under this announcement. Match requirements may change in
years two through five. The applicant should identify and describe:
a. Sources of allowable matching funds for the program and the
estimated amounts from each.
b. Procedures for documenting and tracking the receipt and value of
noncash matching funds.
7. Budget and Narrative Justification:
a. Financial Assistance
Provide a detailed line-item budget and narrative justification for
all operating expenses consistent with and clearly related to the
proposed objectives and planned activities. Be precise about the
program purpose of each budget item and itemize calculations when
appropriate.
Applicants are required to attend the DDT Annual Conference and the
DPCP Project Directors' Meeting and should budget appropriately. DPCPs
are also encouraged to attend and participate in non-conference
training such as Diabetes Today and the Diabetes Collaborative, as
appropriate. Other travel which may be of relevance to the DPCP goals
and activities include the annual meetings of the following
organizations: National Diabetes Education Program Partnership Network,
ASTCDD (Chronic Disease Conference), American Diabetes Association
(ADA), American Association for Diabetes Educators (AADE), National
Association of Community Health Centers (NACHC), American Association
of Health Plans (AAHP) and American Public Health Association (APHA).
Travel budget should support other recipient activities as considered
necessary.
b. Direct Assistance
To request a Federal assignee, applicants must provide the
following information:
1). Number of assignees requested
2). Description of the position and proposed duties
3). Ability or inability to hire locally with financial assistance
4). Justification for request
5). Organizational chart and name of intended point of contact to
assignee
6). Opportunities for training, education, and work experiences for
assignees
7). Description of assignees' access to computer equipment for
communication with CDC (e.g., personal computer at home, personal
computer at workstation, shared computer at workstation on site, shared
computer at a central office).
G. Application Submission and Deadline
Application Forms
Submit the signed original and two copies of CDC Form 0.1246(E).
Forms are available at the following Internet address: http://
www.cdc.gov/od/pgo/forminfo.htm If you do not have access to the
internet, or if you have difficulty accessing the forms on-line, you
may contact the CDC Procurement and Grants Office Technical Information
Management Section (PGO-TIM) at: 770-488-2700. Application forms can be
mailed to you.
Submission Date, Time, and Address
Applications must be received by 4 p.m. Eastern Time January 9,
2003. Submit the application to: Technical Information Management--
PA03017, CDC Procurement and Grants Office, 2920 Brandywine
Road, Room 3000, Atlanta, Georgia 30341-4146.
CDC Acknowledgment of Application Receipt
A postcard will be mailed by PGO-TIM, notifying you that CDC has
received your application.
Deadline
Applications shall be considered as meeting the deadline if they
are received before 4 p.m. Eastern Time on the deadline date.
Applicants sending applications by the United States Postal Service or
commercial delivery services must ensure that the carrier will be able
to guarantee delivery of the application by the closing date and time.
If an application is received after closing due to: (1) carrier error,
when the carrier accepted the package with a guarantee for delivery by
the closing date and time, or (2) significant weather delays or natural
disasters, CDC will, upon receipt of proper documentation, consider the
application as having been received by the deadline.
Applications which do not meet the above criteria will not be
eligible for competition and will be discarded. Applicants will be
notified of their failure to meet the submission requirements.
H. Evaluation Criteria
Applicants are required to provide measures of effectiveness that
will demonstrate the accomplishment of the various identified
objectives of the cooperative agreement. Measures of effectiveness must
relate to the performance goal stated in section ``B. Purpose'' of this
announcement. Measures must be objective and quantitative and must
measure the intended outcome. These measures of effectiveness shall be
submitted with the application and shall be an element of evaluation.
An Objective Review Panel appointed by CDC will evaluate the
scientific and technical merit of Comprehensive Program applications
and their responsiveness to the information requested in the
``Application Content'' sections above. Core Program applications will
receive a technical review for acceptability. Each application will be
reviewed and evaluated against the following criteria:
Core Program Evaluation Criteria (100 Points Total)
1. Program Work Plan (75 points Total)
The extent to which the work plan addresses the following
information:
a. Long Term and Process Objectives (10 points)
Measurable, specific, time-phased five-year project period long
term objectives, and measurable, time-phased one-year budget period
process objectives that will help achieve the goals and objectives of
the program. The applicant used the State's latest data as baseline.
b. Program Work Plan Methodology (25 points)
The Program Work plan provides a detailed description of system-
based activities and methods for achieving each of the proposed one
year budget period objectives that appears reasonable and likely to be
successful.
c. Evaluation Plan (20 points)
The plan for evaluating progress, the effectiveness of activities
and attainment of each of the proposed objectives, to include a clear
description of the evaluation methodology and frequency of reporting,
appears adequate. The six steps of the CDC Framework for Program
Evaluations are used as a framework for the plan. (See section E. 4.
Evaluation Plan under Application Content section). Logic
[[Page 70609]]
models that link program objectives and activities to eventual
outcomes/effects should be included.
d. Program Infrastructure and Management Plan (20 points)
DPCP staffing pattern adequately supports the work plan proposed to
include the number and type of staff and their qualifications and
experience. The Management Plan describes a methodology for effective
management, to include a sound management structure, i.e. a full time
DPCP coordinator and designated evaluation and epidemiology/
surveillance leads; clear and direct lines of authority, supervisory
and fiscal controls; contingency plans for ongoing management in case
of unexpected staff disruption shall be included. Include a copy of the
organizational chart that indicates the placement of the DPCP, resumes
for designated staff, and job descriptions for the proposed staff.
Strategies for ensuring timely and appropriate communication among
staff on the status of program implementation and related issues are
included in the plan. Describe how the DPCP and its partners will
collaborate to collectively complete a diabetes specific assessment
based on the ten essential public health services. The results of the
assessment will assist in identifying specific areas of strength and
areas for improvement in developing an optimal public health diabetes
program in subsequent years.
2. Accomplishments and Proven Capacity of the Core Program (15 points)
Core program accomplishments and activities that make it appear
likely that the applicant will successfully carry out proposed
activities, to include:
a. Existing state-based diabetes surveillance system, including
annual administration of the Diabetes Module of the BRFSS.
b. Advances toward achieving the CDC, DDT's National Objectives
(provide data as evidence of progress).
c. Findings, conclusions, or status of pilot projects in health
systems, health communications, and community interventions.
d. Examples of successful efforts to influence the widespread
application of accepted standards, policies, and protocols, which
support diabetes prevention and control.
e. Accomplishments of any diabetes advisory groups or coalitions in
providing guidance to the DPCP in program planning, implementation,
coordinating efforts and evaluation (may include a copy of the by-
laws).
f. Activities and accomplishments in addressing the needs of
underserved populations and/or populations with a disparate burden of
diabetes and its related complications are included.
g. DPCP's management of its fiscal and human resources in the past
five years (including history of unobligated balances, how match
requirements have been met, turnover in key staff positions,
professional development of DPCP staff, supportive leadership, etc.)
are addressed.
3. Background and Need (10 points)
The extent to which the DPCP demonstrates the need for support.
Narrative should include:
a. Estimated prevalence of diabetes and its complications, and its
geographic and demographic distribution within the State.
b. Description of the high risk populations, including racial/
ethnic minorities, the elderly, and the indigent/disenfranchised
population. Description of the characteristics of the targeted
population relative to the social, ecological, or economic conditions
that contribute to the disproportionate burden of diabetes in the
population, as well as their knowledge, attitudes, beliefs, and health
practices relative to diabetes.
c. Analysis of the findings of (b) above in relation to known or
anticipated barriers to diabetes education, self management, preventive
community services and health care.
4. Budget and Justification (Reviewed but Not Scored)
The extent to which the line item budget justification is
reasonable and consistent with the purpose and program goal(s) and
objectives of the cooperative agreement. This includes both requests
for financial assistance and how the DPCP proposes to meet the match
requirement.
5. If any resources available under this program announcement will
be used to conduct research projects involving human subjects, the
application must adequately address Title 45 CFR Part 46. (Reviewed but
Not Scored, however an application can be disapproved if the research
risks are sufficiently serious and protection against risks is so
inadequate as to make the entire application unacceptable.)
6. The degree to which the applicant has met the CDC Policy
requirements regarding the inclusion of women, ethnic, and racial
groups in the proposed research. This includes: (1) The proposed plan
for the inclusion of both sexes and racial and ethnic minority
populations for appropriate representation; (2) The proposed
justification when representation is limited or absent; (3) A statement
as to whether the design of the study is adequate to measure
differences when warranted; and (4) A statement as to whether the plans
for recruitment and outreach for study participants include the process
of establishing partnerships with community(ies) and recognition of
mutual benefits. (Reviewed but Not Scored)
Comprehensive Program Evaluation Criteria (100 points total)
1. Program Work Plan (60 points total)
The Program Work plan provides a detailed description of system-
based activities and methods for achieving each of the proposed
objectives that appears reasonable and likely to be successful.
a. Long Term and Process Objectives (10 points) Measurable,
specific, time-phased five-year project period long term objectives,
and measurable, specific, time-phased one year budget period process
objectives, that will help achieve the time-phased long term objectives
of the program, are provided. The DPCP used the state's latest data as
baseline.
b. Program Work Plan Methodology (20 points) The Work Plan provides
a detailed description of systems-based activities and methods for
achieving each of the proposed one year budget period objectives that
appears reasonable and likely to be successful. Existing comprehensive
activities are described, including plans for maintaining or modifying
them. New Comprehensive program activities are adequately described and
justified.
c. Evaluation Plan (15 points) The plan for evaluating progress,
the effectiveness of activities and attainment of each of the proposed
objectives, to include a clear description of the evaluation
methodology and frequency of reporting, appears adequate. The plan
should incorporate the six steps of the CDC Framework for Program
Evaluation. (See section E. 4. Evaluation Plan under Application
Content section). Logic models that link program objectives and
activities to eventual outcomes/effects should be included.
d. Program Infrastructure and Management Plan (15 points)
DPCP staffing pattern adequately supports the work plan proposed to
include the number and type of staff and their qualifications and
experience. The Management Plan describes a methodology for effective
management,
[[Page 70610]]
to include a sound management structure, i.e. a full time DPCP
coordinator and designated evaluation and epidemiology/surveillance
leads; clear and direct lines of authority, supervisory and fiscal
controls; contingency plans for ongoing management in case of
unexpected staff disruption shall be included. A copy of the
organizational chart that indicates the placement of the DPCP, resumes
for designated staff and job descriptions for the proposed staff.
Strategies for ensuring timely and appropriate communication among
staff on the status of program implementation and related issues are
included in the plan. The management plan should demonstrate how the
DPCP will address increased program responsibility and fiscal and human
resources. Describe how the DPCP and its partners will collaborate to
collectively complete a diabetes specific assessment based on the ten
essential public health services. The results of the assessment will
assist in identifying specific areas of strength and areas for
improvement in developing an optimal public health diabetes program in
subsequent years.
2. Program Accomplishments and Proven Capacity To Serve as a
Comprehensive Program (35 points)
Program accomplishments and activities that make it appear likely
that the applicant will successfully carry out proposed comprehensive
activities to include:
a. Advanced and enhanced state-based diabetes surveillance system,
minimally including annual administration of the diabetes module of the
BRFSS.
b. Status and impact of statewide and other comprehensive program
activities in health systems, health communications, and community
interventions that have advanced the program toward achieving
improvements in the CDC, DDT's National Objectives. Data should be
provided to support program impact and as evidence of progress.
c. Description of evaluation activities and examples of efforts to
disseminate program activities and lessons learned to the broader
diabetes community.
d. Evidence of internal and external policy changes resulting from
comprehensive program efforts, including accomplishments of any
diabetes advisory groups or coalitions (may include a copy of the by-
laws).
e. Examples of successful efforts to influence the widespread
application of accepted standards, policies, and protocols which
support diabetes prevention and control.
f. Accomplishments in addressing the needs of underserved
populations and/or reducing health disparities in populations with a
disparate burden of diabetes and its related complications.
g. DPCP's management of its fiscal and human resources in the past
five years (including history of unobligated balances, how match
requirements have been met, turnover in key staff positions,
professional development of DPCP staff, supportive leadership, etc.)
are addressed.
3. Background and Need (5 points)
The extent to which the DPCP demonstrates the need for support.
Narrative should include:
a. Estimated prevalence of diabetes and its complications, and its
geographic and demographic distribution within the State.
b. Description of the high risk populations, including racial/
ethnic minorities, the elderly, and the indigent/disenfranchised
population. Description of the characteristics of the targeted
population relative to the social, ecological, or economic conditions
that contribute to the disproportionate burden of diabetes in the
population, as well as their knowledge, attitudes, beliefs, and health
practices relative to diabetes.
c. Analysis of the findings of b. above in relation to known, or
anticipated, barriers to diabetes education, self management,
preventive community services and health care.
4. Budget and Justification (reviewed but not scored)
The extent to which the line-item budget justification is
reasonable and consistent with the purpose and program goals and
objectives of the cooperative agreement. This includes both requests
for financial assistance and how the DPCP proposes to meet the match
requirement.
5. If any resources available under this program announcement will
be used to conduct research projects involving human subjects, the
application must adequately address title 45 CFR part 46. (Reviewed but
Not Scored, however, an application can be disapproved if the research
risks are sufficiently serious and protection against risks is so
inadequate as to make the entire application unacceptable.)
6. The degree to which the applicant has met the CDC Policy
requirements regarding the inclusion of women, ethnic, and racial
groups in the proposed research. This includes: (1) The proposed plan
for the inclusion of both sexes and racial and ethnic minority
populations for appropriate representation; (2) The proposed
justification when representation is limited or absent; (3) A statement
as to whether the design of the study is adequate to measure
differences when warranted; and (4) A statement as to whether the plans
for recruitment and outreach for study participants include the process
of establishing partnerships with community(ies) and recognition of
mutual benefits. (Reviewed but Not Scored)
I. Other Requirements
Technical Reporting Requirements
Provide CDC with a signed original and two copies of:
1. Interim progress reports, no less than 90 days before the end of
the budget periods. The format of the Division of Diabetes
Translation's (DDT) Management Information System (MIS) is aligned with
the interim progress report content. Therefore, to avoid duplication of
effort, the interim progress report content may be entered into the DDT
MIS and hard copies generated from MIS for formal submission to the CDC
Procurement and Grants Office. The content of the interim progress
report must be entered into the DDT MIS, by the grantee, within one
month of the due date of the interim progress report. The interim
progress report will serve as your non-competing continuation
application, and must contain the following broad elements (subject to
change as the program evolves): progress and performance for the first
eight months of the current budget period objectives/activities, the
proposed objectives/activities for the new year's budget period related
to Surveillance, Work Plan, Program Coordination, Program
Infrastructure, and Financial information (including a detailed line-
item budget and justification). Progress in implementing improvement
plans starting in year two, must be reported as part of the required
interim progress reports.
2. Financial status report, no more than 90 days after the end of
each budget period.
3. Final financial and performance reports no more than 90 days
after the end of the five year project period.
Send all reports to the Grants Management Specialist identified in
the ``Where to Obtain Additional Information'' section of this
announcement.
The following additional requirements are applicable to this
program. For a complete description of each, see Attachment I of this
announcement as posted on the CDC web site.
[[Page 70611]]
AR-1 Human Subjects Requirements
AR-2 Requirement for Inclusion of Women and Racial and Ethnic
Minorities in Research
AR-7 Executive Order 12372 Review
AR-9 Paperwork Reduction Act Requirements
AR-10 Smoke-Free Workplace Requirements
AR-11 Healthy People 2010
AR-12 Lobbying Restrictions
J. Where To Obtain Additional Information
This and other CDC announcements, the necessary applications, and
associated forms can be found on the CDC web site, Internet address:
http://www.cdc.gov. Click on ``Funding'' then ``Grants and Cooperative
Agreements.''
For general questions about this announcement, contact: Technical
Information Management, CDC Procurement and Grants Office, 2920
Brandywine Road, Room 3000, Atlanta, GA 30341-4146. Telephone (770)
488-2700.
For business management and budget assistance in the States,
contact: Angela Webb, Grants Management Specialist, Acquisition and
Assistance Branch B, Procurement and Grants Office, Centers for Disease
Control and Prevention (CDC), 2920 Brandywine Road, Room 3000, Atlanta,
GA 30341-4146. Telephone (770) 488-2784. Email address: AQW6@cdc.gov.
For business management and budget assistance in the Territories,
contact: Terri Brown, Grants Management Specialist, International &
Territories Acquisition and Assistance Branch, Procurement and Grants
Office, Centers for Disease Control and Prevention (CDC), 2920
Brandywine Road, Room 3000, Atlanta, Georgia 30341-4146. Telephone
(770) 488-2638. Email address: aie9@cdc.gov.
For program technical assistance, contact: Patricia L. Mitchell,
MPH, Health Comm. Section Chief, Program Development Branch, DDT,
NCCDPHP, Centers for Disease Control and Prevention (CDC), 4770 Buford
Highway, MS K10, Atlanta, GA 30341-3717. Telephone (770) 488-5634.
Email address: plm3@cdc.gov.
Dated: November 12, 2002.
Edward Schultz,
Acting Director, Procurement and Grants Office, Centers for Disease
Control and Prevention (CDC).
[FR Doc. 02-29837 Filed 11-22-02; 8:45 am]
BILLING CODE 4163-18-P