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Notice2021-16281

Epidemiology Program for American Indian/Alaska Native Tribes and Urban Indian Communities

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Published

July 30, 2021

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Health and Human Services DepartmentIndian Health Service

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<title>Federal Register, Volume 86 Issue 144 (Friday, July 30, 2021)</title>
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[Federal Register Volume 86, Number 144 (Friday, July 30, 2021)]
[Notices]
[Pages 41058-41073]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-16281]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Epidemiology Program for American Indian/Alaska Native Tribes and
Urban Indian Communities

Announcement Type: New and Competing Continuation.
Funding Announcement Number: HHS-2021-IHS-EPI-0001.
Assistance Listing (Catalog of Federal Domestic Assistance or CFDA)
Number: 93.231.

Key Dates

Application Deadline Date: September 1, 2021.
Earliest Anticipated Start Date: September 30, 2021.

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting applications for a
cooperative agreement for Tribal Epidemiology Centers (TECs) serving
American Indian/Alaska Native (AI/AN) Tribes and Urban Indian
communities. This program is authorized under: The Snyder Act, 25
U.S.C. 13; the Transfer Act, 42 U.S.C. 2001(a); and the Indian Health
Care Improvement Act (IHCIA), as amended, 25 U.S.C. 1621m. This program
is described in the Assistance Listings located at <a href="https://beta.sam.gov">https://beta.sam.gov</a>
(formerly known as Catalog of Federal Domestic Assistance) under
93.231.

Background

The TEC program was authorized by Congress in 1996 as a way to
provide public health support to multiple Tribes and Urban Indian
communities in each of the IHS Administrative Areas. The funding
opportunity announcement is open to currently funded TECs.
TECs are uniquely positioned within Tribes, Tribal organizations,
and Urban Indian organizations (UIO) to conduct disease surveillance,
research, prevention, and control of disease, injury, or disability,
and to assess the effectiveness of AI/AN public health programs. Some
of the existing TECs have already developed innovative strategies to
monitor the health status of Tribes and Urban Indian communities,

[[Page 41059]]

including development of Tribal health registries and use of
sophisticated record linkage computer software to correct existing
state data sets for racial misclassification.
TECs provide critical support for activities that promote Tribal
Self-Governance and effective management of Tribal and Urban Indian
health programs. Data generated locally and analyzed by TECs enable
Tribes and Urban Indian communities to effectively plan and make
decisions that best meet the needs of their communities. In addition,
TECs can immediately provide feedback to local data systems, which will
lead to improvements in Indian health data overall.
As more Tribes choose to operate health programs in their
communities, TECs ultimately will provide additional public health
services such as disease control and prevention programs. Some existing
TECs provide assistance to Tribal and Urban Indian communities in such
areas as sexually transmitted disease (STD) control and cancer
prevention.
They also assist Tribes and Urban Indian communities to establish
baseline data for successfully evaluating intervention and prevention
activities.
Sexually transmitted infections (STIs) remain a major public health
challenge in the United States (U.S.) with an estimated 20 million new
infections occurring each year; half of them occur among adolescents
and young adults ages 15-24. Many STIs, like chlamydia and gonorrhea,
can be asymptomatic; however, if left untreated, STIs can lead to
infertility and increase the risk of acquiring other STIs. For pregnant
women, there are additional risks of ectopic pregnancy, miscarriage,
stillbirth, and early infant death.
Although widespread across the U.S. among all populations, the STI
epidemic disproportionately affects certain racial and ethnic groups,
including AI/AN people. Such disparities in STI incidence are complex
to understand but may be rooted in a number of social factors such as
poverty, inadequate access to health care, lack of education, social
inequality, and cultural influences. Recent surveillance data
demonstrate that STI rates continue to increase in Indian Country. The
latest surveillance report showed that AI/AN people have 3.8 times the
incidence rate of chlamydia compared with whites and a 4.4 times higher
rate of gonorrhea. For more information, please visit <a href="https://www.ihs.gov/epi/includes/themes/responsive2017/display_objects/documents/STI/Indian_Health_Surveillance_Report_STI_2015.pdf">https://www.ihs.gov/epi/includes/themes/responsive2017/display_objects/documents/STI/Indian_Health_Surveillance_Report_STI_2015.pdf</a>. AI/AN
people have the second highest rates for both chlamydia and gonorrhea
compared to other races/ethnicities. Gonorrhea rates have continued to
increase since 2011. Regional differences in STIs in Indian Country are
observed. Recurrent STIs can increase the likelihood of human
immunodeficiency virus (HIV) transmission, and gonorrhea and syphilis
often present as co-morbid conditions with HIV diagnosis, particularly
among men who have sex with men (MSM).
AI/AN youth and AI/AN women, particularly women of reproductive
age, have a disparate and increased STI burden. In addition, recent
outbreaks of syphilis have been observed among AI/AN communities,
resulting in a dramatic increase in congenital syphilis cases in recent
years. Some of these outbreaks are also connected to the use of
injection drugs and methamphetamines. Particularly concerning is the
dramatic increase in syphilis cases among AI/AN women and the rise in
congenital syphilis (CS) cases. The CDC national STI surveillance
report demonstrated that from 2014 to 2018 CS cases, among all races,
in the U.S. increased from 462 to 1,306 (183 percent). In 2018, AI/AN
mothers had the highest rate of reported CS cases nationally. The rate
of increase in reported CS cases among AI/AN mothers is higher than for
any other race or ethnicity in the U.S. (from 13.2 cases per 100,000
live births in 2014 to 79.2 in 2018).
Untreated CS can cause miscarriage, stillbirth, prematurity, low
birth weight, or death shortly after birth. The impact of CS depends on
when a pregnant woman contracts syphilis and whether she has access to
treatment for the infection. Up to 40 percent of babies born to
pregnant women with untreated syphilis may be stillborn or die from the
infection as a newborn. According to CDC data, analysis of CS cases
born to AI/AN mothers in 2018 identified gaps in prenatal care and
access to timely and appropriate treatment.
The STI National Strategic Plan, released on December 17, 2020,
aims to reverse the recent dramatic rise in STIs in the U.S. Please
visit <a href="https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf">https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf</a> for the most recent documents, outlining the
following goals and selected objectives:
1. Goal 1: Prevent New STIs
a. Objective 1.1--Increase awareness of STIs and sexual health.
b. Objective 1.2--Expand implementation of quality, comprehensive
STI primary prevention activities.
c. Objective 1.3--Increase completion rates of routinely
recommended human papillomavirus (HPV) vaccination.
d. Objective 1.4--Increase the capacity of public health, health
care delivery systems, and the health workforce to prevent STIs.
2. Goal 2: Improve the Health of People by Reducing Adverse
Outcomes of STIs
a. Objective 2.1--Expand high-quality affordable STI secondary
prevention, including screening, care, and treatment, in communities
and populations most impacted by STIs.
b. Objective 2.2--Work to effectively identify, diagnose, and
provide holistic care and treatment for people with STIs by increasing
the capacity of public health, health care delivery systems, and the
health workforce.
3. Goal 3: Accelerate Progress in STI Research, Technology, and
Innovation
a. Objective 3.4--Identify, evaluate, and scale up best practices
in STI prevention and treatment, including through translational,
implementation, and communication science research.
4. Goal 4: Reduce STI-Related Health Disparities and Health
Inequities
a. Objective 4.1--Reduce stigma and discrimination associated with
STIs.
b. Objective 4.2--Expand culturally competent and linguistically
appropriate STI prevention, care, and treatment services in communities
disproportionately impacted by STIs.
c. Objective 4.3--Address social determinants of health and co-
occurring conditions.
5. Goal 5: Achieve Integrated, Coordinated Efforts that Address the
STI Epidemic
a. Objective 5.1--Integrate programs to address the syndemic of
STIs, HIV, viral hepatitis, and substance use disorders.
b. Objective 5.2--Improve quality, accessibility, timeliness, and
use of data related to STIs and social determinants of health.
c. Objective 5.3--Improve mechanisms to measure, monitor, evaluate,
report, and disseminate progress toward achieving national STI goals.
Furthermore, the STI National Strategic Plan identifies the
following priority groups: Adolescents and young adults; MSM; and,
pregnant women.
The STI National Strategic Plan also puts emphasis on other
subgroups including racial and ethnic minorities (including AI/AN
people) and geographic focus on regions with high STI burden. This
national plan outlines goals, objectives, and indicators that

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specifically focus on health disparities and particularly addresses
disparities in CS among Tribal communities. Applicants should create
their action plans in the context of these goals, objectives, and
indicators.
The TEC program will continue to enhance the ability of the Indian
health system to collect and manage data more effectively and to better
understand and develop the link between public health problems and
behavior, socioeconomic conditions, and geography. The TEC program will
also support Tribal and Urban Indian communities by providing technical
training in public health practice and prevention-oriented research and
by promoting public health career pathways serving AI/AN populations.

Purpose

The purpose of this IHS cooperative agreement is to strengthen
public health capacity and to fund Tribes, Tribal organizations, and
UIOs, and inter-Tribal consortia in identifying relevant health status
indicators and priorities to support Public Health interventions that
reduce morbidity and mortality in the population using sound
epidemiologic principles. Work plans submitted in response to this
announcement must incorporate the applicant's desired objectives and
all of the required activities of the program's four goal sets, which
are combined from the seven TEC core functional areas as outlined in
the Indian Health Care Improvement Act (IHCIA) at 25 U.S.C. 1621m(b).
The seven core functions of the TECs are:
(1) Collect data relating to, and monitor progress made toward
meeting, each of the health status objectives of the Service, the
Indian Tribes, Tribal organizations, and UIOs in the service area;
(2) Evaluate existing delivery systems, data systems, and other
systems that impact the improvement of Indian health;
(3) Assist Indian Tribes, Tribal organizations, and UIOs in
identifying highest-priority health status objectives and the services
needed to achieve those objectives, based on epidemiological data;
(4) Make recommendations for the targeting of services needed by
the populations served;
(5) Make recommendations to improve health care delivery systems
for Indians and Urban Indians;
(6) Provide requested technical assistance to Indian Tribes, Tribal
organizations, and UIOs in the development of local health service
priorities and incidence and prevalence rates of disease and other
illness in the community; and
(7) Provide disease surveillance and assist Indian Tribes, Tribal
organizations, and Urban Indian communities to promote public health.
The seven core functions, included in the four goal sets are:
Goal Set 1: Public Health Promotion
Collect health status data, provide disease surveillance and assist
Tribes, Tribal organizations, and UIOs to promote public health.
Goal Set 2: Evaluation
Evaluate existing delivery systems, data systems, and other systems
that impact the improvement of Indian health.
Goal Set 3: Recommendation
Assist Indian Tribes, Tribal organizations, and UIOs in identifying
highest-priority health status objectives and the services needed to
achieve those objectives, based on epidemiological data. Make
recommendations for the targeting of services needed by the populations
served. Make recommendations to improve health care delivery systems
for Indians and Urban Indians.
Goal Set 4: Technical Assistance
Provide technical assistance to Indian Tribes, Tribal
organizations, and UIOs in the development of local health service
priorities and determine incidence and prevalence rates of disease and
other illness in the community.
Applicant objectives may include activities beyond the required
activities but must address them. Additional activities must still fall
within the seven core functions and the four Goal sets.
Required activities under the core funding are: Community Health
Profiles (CHP); Data collection and Disease Surveillance; Public Health
Preparedness and Response; STD Activities; technical assistance to
Indian Tribes, Tribal organizations, and UIOs; evaluate and support
Area-wide interventions that promote severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) vaccine uptake; and, evaluate and support
Area-wide interventions that promote SARS-CoV-2 outbreak response and
recovery.
See Section I: Required, Optional, and Allowable Activities for
full details.
It is the intent of IHS to fund sufficient TECs to serve Tribes and
Urban Indian communities in all 12 IHS administrative areas.
Each TEC selected for funding will act under a cooperative
agreement with the IHS. During funded activities, the TECs may receive
Protected Health Information (PHI) for the purpose of preventing or
controlling disease, injury, or disability, including, but not limited
to, reporting of disease, injury, vital events, such as birth or death,
and the conduct of public health surveillance, public health
investigation, and public health interventions for the Tribal and Urban
Indian communities that they serve. TECs acting under a cooperative
agreement with IHS are public health authorities for which the
disclosure of PHI by covered entities is authorized by the Privacy
Rule, 45 CFR 164.512(b).
Required, Optional, and Allowable Activities
Goal Set 1: Collect health status data, provide disease
surveillance, and assist Tribes, Tribal organizations, and UIOs to
promote public health (Core Functions 1 and 7).
Required Activities under Goal Set 1:
(1) CHPs
a. Develop culturally appropriate community health assessments
encompassing all the Tribal and/or Urban Indian communities served by
the TEC.
b. CHPs should include information appropriate to allow Tribal and
Urban Indian leaders to make informed decisions, prioritize health
problems, and develop, implement, and evaluate their community health
improvement plans.
c. Provide and enact a plan that includes a project overview,
specific health indicators, and means of dissemination for both Tribe-
specific and regional CHPs.
d. Participate in local, regional, and national committees that
address public health priorities and, as appropriate, with other
Federal agencies.
e. Establish and maintain an advisory council that can provide
overall program direction and guidance. The advisory council should
include some members with technical expertise in epidemiology and
public health (e.g., from state health departments or county health
departments) and include representation from the Tribal health and
Urban Indian health programs within the TECs regional area.
f. Translate available data and/or results of analyses on disease
incidence/prevalence and determined risk factors into useful products,
messaging, and outreach to effectively guide stakeholders'
interventions addressing public health priorities.
(2) Data collection and Disease Surveillance

[[Page 41061]]

a. Establish and maintain data sharing agreements and Memorandums
of Understanding (MOU) to support data collection and analysis.
Agreements may be needed with local organizations, Tribal governments,
state authorities, and Federal agencies.
b. Provide disease surveillance and assist Indian Tribes, Tribal
organizations, and UIOs to promote public health.
Optional Activities with Budget Support under Goal Set 1:
(1) IHS-funded UIOs Technical Assistance
These activities are eligible for a supplemental budget of up to
$100,000 per award.
The grantee will support 41 IHS-funded UIOs located in 22 states
through the following activities:
a. Providing training and technical assistance on planning,
conducting, and implementing community health needs assessment;
b. developing new and updating existing CHPs; and
c. providing ongoing training and tutorials on how to interpret
data, such as the Census and American Community Survey data.
These activities have additional reporting requirements including
quarterly progress reports that are due within 30 days after the budget
period ends. 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.
(2) Group A HIV/STI Activities
These activities are eligible for a supplemental budget of up to
$100,000 per awardee.
Activities under this supplement are organized under the
operational strategies of the Ending the HIV Epidemic: A Plan for
America initiative (EHE).
TEC sites serving areas that do not include the EHE Phase One
priority Geographic area(s) and Location(s) are eligible to apply for
this supplemental funding. For a list of Phase One priority Geographic
Areas and Locations, please visit <a href="https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one">https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one</a>.
Coordination Operational Strategy
a. Grantees will send at least one representative to the annual HIV
Coordination meeting, scheduled in September of each year to coincide
with the U.S. Conference on HIV/acquired Immunodeficiency syndrome
(AIDS). The budget should include travel and associated costs for
participation.
b. Grantees will participate in the IHS National AI/AN STI
Prevention workgroup.
Diagnosis Operational Strategy
c. The TECs will provide technical assistance and/or disease
surveillance support to Tribal and Urban communities by developing
analytical reports to examine the burden of HIV and other relevant
comorbidities such as STIs and hepatitis C virus (HCV) in Tribal and
Urban communities.
Treatment Operational Strategy
d. The TECs will provide support to Tribal and Urban communities in
the development of enhanced activities and expanded capacity to better
identify AI/AN people who are not in care, including those who were
never linked to care following an HIV, STI, or HCV diagnosis and those
who have fallen out of care.
Respond Operational Strategy
e. Respond rapidly to detect and characterize growing HIV, STI, or
HCV clusters and prevent new infections. TECs will provide technical
assistance and/or direct support to Tribal and Urban communities on the
following activities:
i. Develop or accelerate the refinement of HIV, STI, and HCV
community plans that are customized for AI/AN communities. Extensive
community engagement in this process will help ensure that community-
specific social norms and unique epidemic attributes are addressed.
ii. Develop collaborative partnerships among Tribal, state, and
local health departments, the clinical community, and community-based
organizations to expand and routinize HIV diagnosis, treatment,
prevention, and response.
(3) Group B HIV/STI Activities
These activities are eligible for a supplemental budget of up to
$250,000 per awardee.
Applicants may either request Group A or Group B activities based
on their geographic service area. Applicants should not apply for both
Group A and Group B activities.
Activities under this supplement are organized under the
operational strategies of the EHE.
TEC sites serving areas that do include the EHE Phase One priority
Geographic area(s) and Location(s) are eligible to apply for this
supplemental funding.
For a list of Phase One priority Geographic Areas and Locations,
please visit <a href="https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one">https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one</a>.
Applications for Group B HIV Activities must include the following
activities.
Coordination Operational Strategy
a. Grantees will send at least one representative to the annual HIV
Coordination meeting scheduled in September of each year to coincide
with the U.S. Conference on AIDS. The budget should include travel and
associated costs for participation.
b. Grantees will participate in the IHS National AI/AN STI
Prevention workgroup.
Diagnosis Operational Strategy
c. The TECs will provide technical assistance and/or disease
surveillance support to communities by developing analytical reports to
examine the burden of HIV and other relevant comorbidities such as STIs
and HCV in Tribal communities.
Treatment Operational Strategy
d. The TECs will provide support to communities in the development
of enhanced activities and expanded capacity to better identify people
who are not in care, including those who were never linked to care
following an HIV, STI, or HCV diagnosis and those who have fallen out
of care.
Respond Operational Strategy
e. Respond rapidly to detect and characterize growing HIV, STI, or
HCV clusters and prevent new infections. TECs will provide technical
assistance and/or direct support to communities on the following
activities:
i. Develop or accelerate the development and/or refinement of
community plans that are customized for AI/AN communities. Extensive
community engagement in this process will help ensure that community-
specific social norms and unique epidemic attributes are addressed.
ii. Develop collaborative partnerships among Tribal, state, and
local health departments, the clinical community, and community-based
organizations to expand and routinize HIV diagnosis, treatment,
prevention, and response.
Further Activities under this Supplement
Applications are required to address the above activities, and must
propose activities addressing at least two of the additional
operational strategies below.
Diagnosis Operational Strategy
a. Diagnose all people with HIV, STIs, and HCV as early as possible
after infection and connect them to immediate treatment. The TECs will
provide technical assistance and/or direct support to AI/AN communities
on the following activities:
i. Implementing HIV testing recommendations through the rapid
replication of proven or innovative HIV screening models;
ii. Developing and implementing innovative testing and health care

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engagement strategies focused on meeting the needs of groups at higher
risk, including MSM, transgender individuals, high-risk heterosexuals,
and persons who inject drugs.
Protection Operational Strategy
b. Protect people at risk for HIV using potent and proven
prevention interventions, including Pre-Exposure Prophylaxis (PrEP), a
medication that can prevent new HIV infections. The TECs will provide
technical assistance and/or direct support to communities on the
following activities:
i. Support efforts to increase the awareness of, access to, and
utilization of PrEP among identified populations;
ii. Support efforts to incentivize providers and community-based
health care organizations to integrate HIV testing, linkage, and
referral to care, and linkage or referral to medical prevention (i.e.,
PrEP) services into primary care services, particularly for their
higher-risk patients;
iii. Raise awareness about the prevention benefits of ``Treatment
as Prevention'' (TasP) and ``Undetectable = Untransmittable'' (U=U)
among providers, people living with and at risk for HIV, and the
general population;
iv. As an entry point to recovery services and overdose and
infection prevention, support the development, expansion,
implementation, and evaluation of harm-reduction services for people
who inject drugs.
v. Evaluate the local acceptability and opportunities for
establishing or increasing syringe services programs (SSPs) including:
Linkage to substance use disorder treatment; access to and disposal of
sterile syringes and injection equipment; and vaccination, testing, and
linkage to care and treatment for infectious diseases.
vi. Promote early identification of individuals with recurrent STI
events with focus on chlamydia, gonorrhea, and syphilis through
analysis of clinical or other locally available data.
vii. Promote linkage to care including PrEP or other appropriate
services to aid the prevention of HIV and other infectious disease
transmission, especially for those diagnosed with STIs.
viii. Promote and support Expedited Partner Therapy (EPT) for
individuals diagnosed with chlamydia and gonorrhea to control
transmission.
ix. Promote enhanced STI screening among youth and MSM and engage
providers in adopting best practices, such as obtaining a thorough
sexual history and promoting an adolescent-friendly clinic environment.
Respond Operational Strategy
c. Respond rapidly to detect and characterize growing HIV, STI, or
Viral hepatitis clusters and prevent new infections. The TECs will
provide technical assistance and/or public health surveillance support
to communities on the following activities:
i. Establish and support boots-on-the-ground public health
workforce capacity that is culturally competent and committed to
ensuring implementation of community-based HIV, STI, and/or Viral
hepatitis control plans, including facilitating and troubleshooting
collaborative community-wide disease control efforts;
ii. Develop or expand the capacity to detect and respond to all
established or emerging HIV, STI, and/or Viral hepatitis clusters to
reduce disease transmission.
Allowable Activities Under Goal Set 1:
(1) Enhance or develop disease surveillance systems. Surveillance
systems can address infectious and chronic diseases, record linkage
studies to improve existing surveillance systems, suicide data
tracking, regional health registries, influenza surveillance, among
others.
(2) Carry out at least one new disease surveillance activity per
cycle, complete with evaluation and the use of measurable outcomes.
Goal Set 2: Evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health (Core
Function 2).
Required Activities under Goal Set 2: None required.
Optional Activities with Budget Support under Goal Set 2:
(1) Annual Cancer Survivorship Leadership Training
This activity is eligible for a supplemental budget of up to
$85,000 per awardee. One award is anticipated.
This activity supports the CDC National Center for Chronic Disease
Prevention and Health Promotion activity Annual Cancer Survivorship
Leadership Training. Grantee will organize and implement at least two,
three-day cancer support leadership trainings for 15-25 AI/AN
participants, nationally. The training will be designed to give
participants a unique opportunity to work together in a safe,
supportive environment to learn and practice skills to help people
affected by cancer in their communities. The training will be based on
the model, A Gathering of Cancer Support, using the Gathering of Native
Americans (GONA) teaching methods.
Outcome:
Participants will show change in knowledge/understanding of the
below elements:
Wellness from a Native American Perspective
a. Using a group discussion method such as Rez Caf[eacute],
identify two AI/AN core values that support wellness and healing.
b. Using a group discussion method such as Rez Caf[eacute],
identify two AI/AN core values to draw from to help facilitate a
support group.
Cancer 101
c. Describe two ways to take personal action to reduce cancer risk
Exploring Emotional Peer Support Skills and How to Start Up Cancer
Support in Your Community.
d. Determine best role for self in setting up cancer support.
e. Identify at least two steps for starting up cancer support in
your community.
(2) Tribal Public Health Departments
This activity is eligible for a supplemental budget of up to
$150,000 per awardee. Six awards are anticipated.
a. Conduct Ecological Assessments on Tribal public health programs
and services in your Area.
b. Develop plans with specific Tribes on strengthening Tribal
public health programs and services.
c. Support the establishment and/or expansion of one or more Tribal
public health department(s) in your Area.
Allowable Activities Under Goal Set 2:
(1) Evaluate sufficiency of IHS electronic health record data to
determine AI/AN health status, to create seamless data linkages, and to
meet the health information needs for Tribes and Tribal programs. This
should include an assessment of the ability for the health information
systems to meet those needs, create seamless data linkages, and meet
data access needs for Tribes and Tribal organizations.
Goal Set 3: Assist Indian Tribes, Tribal organizations, and UIOs in
identifying highest-priority health status objectives and the services
needed to achieve those objectives, based on epidemiological data.
Make recommendations for the targeting of services needed by the
populations served.
Make recommendations to improve health care delivery systems for
Indians and Urban Indians (Core Functions 3, 4, and 5).
Required Activities Under Goal Set 3:
(1) Public Health Preparedness and Response
a. Strengthen Tribally-focused surveillance systems and data.
b. Conduct outbreak investigations and response.

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c. Lead community assessments for disaster preparedness, response,
and recovery.
d. Develop response plans for major public health emergencies.
e. Lead, coordinate, or participate in Federal, Tribal, state, or
local emergency response exercises and activities.
f. Promote and facilitate planning and response activities among
Tribes.
g. Build partnerships among government agencies, Tribes, and other
organizations to advance emergency preparedness in Indian country.
(2) STD Activities
The grantees will conduct activities in this announcement to
support the above STI National Strategic Plan goals and indicators
pertaining to chlamydia, gonorrhea, Primary and Secondary Syphilis and
congenital syphilis. While the STI National Strategic Plan includes HPV
as an additional focus, applicants should not emphasize HPV in their
application. However, HPV-related activities can be incorporated into
project plans as a secondary focus if desired, as appropriate and if
relevant or complementary to primary work.
a. Community Profiles
In year 1 of award, the grantees will develop an assessment of the
overall burden of the following STIs: Chlamydia, gonorrhea, primary and
secondary syphilis, and congenital syphilis within the communities they
serve.
To support the profile, the grantees will analyze current, existing
data or generate their own data related to STI burden with particular
emphasis on priority groups listed above and any other priority groups
identified during the assessment phase. When analyzing existing data,
grantees will ensure analyses are novel and not duplicative of analytic
approaches or products available from other sources. Data may include
publically available data, surveillance data, clinical data,
qualitative data, or other relevant health data source. Applicants
should prioritize data that describe STI burden in Tribal communities
within their jurisdiction, such as through partnerships with public
health authorities at the Tribal, local or state level. Although
historic data may be reviewed, analysis must incorporate data on the
burden of STIs generated within the last 5 years. The applicants are
encouraged to create assessments that examine STI burden at different
Tribal communities and report those results accordingly; regional or
IHS Area level results or national level results can be used for
comparison purposes.
Special focus should be on indicators and priority areas outlined
in the STI National Strategic Plan.
The assessment will serve as a living document and will be updated
minimally on year 3 and year 5 of the award.
During years, 2-5 of the award the grantees should: (1) Work to
obtain information from community members and Tribal leaders on
defining gaps and opportunities to further improve STI prevention and
care and (2) conduct relevant interventions to improve STI prevention
and care services. The grantees will create a report describing the
findings from their community engagement and outlining any relevant
feasibility, gaps, and opportunities identified in the interventions
conducted. Interventions can be expanded to more communities depending
on results, feasibility, and acceptability.
b. Communication of findings
At the end of year one grantees will create a report outlining
analytic findings of the community profile assessments and also create
and include a strategic plan and road map on how to address STI burden
within the supported AI/AN communities. Applicants are encouraged to
align their strategic approach with the vision and goals of the
National STI Strategic Plan and implementing the objectives and
strategies most relevant to their role and communities. In addition,
applicants should use available data to identify where their resources
will have the most impact and to determine indicators and targets best
suited to measure their progress towards selected goals. The applicant
strategic plan is meant to serve as a living document and be updated
based on inputs from supported communities and lessons learned as the
work progresses. Please visit <a href="https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf">https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf</a> for further background.
The grantees will create or adapt communication materials for
appropriate audiences (community members, Tribal leaders, health care
providers) and convene meetings to share findings with community
members and other stakeholders such as Tribal leadership, medical
providers, public health partners, etc.
The grantees will work with selected communities to create detailed
strategic plans on how to improve STI prevention with specific focus on
aligning to any STI National Strategic plan goals, objectives, and
indicators and convene a coalition with diverse partners (community
members, public health professionals, trainers, health care providers
and others). Communities can self-identify or be selected in
collaboration with the applicant based on available epidemiologic
evidence. Each grantee will work with at least two communities.
c. Meetings
Grantees will meet with IHS Division of Epidemiology and Disease
Prevention (DEDP) staff quarterly to discuss activity progress and
garner technical assistance.
Grantees will regularly participate in IHS National STI program
workgroup meetings. Each grantee is requested to present once a year on
their activities relating to this announcement at these meetings.
Grantees are encouraged to share knowledge gained by presenting
findings at Tribal meetings, regional meetings and/or publishing in
peer-reviewed journals.
Grantees will attend one national STI-focused meeting such as the
National Coalition of STD Directors annual meeting or the National STD
conference and are strongly encouraged to submit abstracts for
presentations. When such meetings are held in person, applicant's
budget should include travel costs for up to three staff to attend.
d. Outcomes
The applicant will provide evidence of direct dissemination of
assessment results to Tribal communities including Tribal leadership.
Dissemination could include meetings, online reports (and number of
views), media releases, and newsletters.
Optional Activities with Budget Support under Goal Set 3:
(1) Targeted STD Activities
This activity is eligible for a supplemental budget of up to
$150,000 per awardee. Six awards are anticipated.
To qualify for targeted STD activities, the applicant must
demonstrate an increased incidence of congenital syphilis or syphilis
among women of reproductive age within their jurisdiction.
The STI National Strategic Plan specifically outlines a focus on
congenital syphilis (CS) in Tribal communities and includes a disparity
indicator to reduce CS rate among AI/AN people/communities.
In order to achieve a reduction in CS rates among AI/AN people, a
comprehensive approach to reduce syphilis rates among women of
reproductive age is necessary. Grantees will conduct activities in one
or more of the following domains with the goal to address the STI
Disparity Indicator focusing on the reduction of CS cases among AI/AN
people. Applicants can propose additional relevant work to address CS
among their communities.

[[Page 41064]]

Activities are intended to complement and expand from required STD
activities and develop a logic model specific to this activity apart
from the program-wide logic model.
a. Linkage to prenatal care
Applicants will address gaps in prenatal care that contribute to
late maternal syphilis screening and treatment. Applicants should
prioritize hard to reach populations, including, but not limited to,
persons experiencing homelessness and Persons Who Inject Drugs (PWID),
and design interventions to link these populations to care. Applicants
will determine whether third trimester screening is occurring within
their jurisdictions and evaluate its ability to (a) avert cases before
birth; and (b) detect and treat additional CS cases. Applicants may
partner with health care providers to test different scalable
interventions; for example, the feasibility and impact of Electronic
Health Record reminders and/or screening at delivery.
b. Surveillance
Applicants will design activities to address surveillance gaps to
capture and accurately report syphilis cases among AI/AN women
(particularly women of reproductive age) and understand risk factors
associated with transmission.
c. Outbreak response plans and trainings
Applicants will assess gaps in current practices to respond to
syphilis outbreaks within their jurisdiction. Applicants will develop
comprehensive syphilis outbreak response plans that incorporate and
enhance health education and training for providers and disease
investigators serving the community. Feasibility of response plans will
be assessed with Tribes and Tribal leadership within their
jurisdiction. Applicants can include other STIs in outbreak response
plans. Applicants will assess training needs and identify providers/
Disease Intervention Specialists in need of training and arrange or
develop resources. Applicants will connect with existing resources like
the STD Prevention Training Centers to create trainings for providers
in their community that are tailored to local needs and that are
culturally appropriate. Applicants may find more information on the STD
Prevention Training Centers at <a href="https://www.nnptc.org/">https://www.nnptc.org/</a>.
d. Screening in alternative locations
Applicants will create an inventory of any screening currently
conducted in alternative locations within their jurisdiction and pilot
novel screening programs for syphilis (but also including other STIs)
that may reach heterosexual populations. Applicants will evaluate the
effectiveness of such interventions at case-finding and treatment. This
could include jails, inpatient or Emergency Department settings, and
substance abuse treatment centers.
e. Communication of findings
The grantee will create a report outlining findings and develop a
local strategic plan and road map on how to address CS and syphilis
burden within the supported AI/AN communities. This plan will
differentiate from the work conducted under Part A activities.
The grantees will create or adapt communication materials for
appropriate audiences (community members, Tribal leaders, health care
providers) and convene meetings to share findings with community
members and other stakeholders such as Tribal leadership, medical
providers, public health partners, etc.
Grantee will convene a coalition with diverse partners (community
members, public health professionals, trainers, health care providers
and others) to create concrete action steps to target CS in their
jurisdiction and to inform further adaptation of the local strategic
plan.
f. Meetings and Reporting
Grantees will meet with IHS DEDP staff quarterly to discuss
activity progress and garner technical assistance.
Grantees will provide reports two times a year summarizing progress
towards outcomes in Logic Model.
Grantees will participate in any IHS National STI program workgroup
meetings focusing on CS and share their activities with other
participants.
Grantees will present on their CS activities minimally once per
year.
Grantees are encouraged to share knowledge gained by presenting
findings at Tribal, regional, or national meetings and/or publishing in
peer-reviewed journals.
g. Outcomes
Demonstrated improvement in capturing of syphilis cases among women
of reproductive age and ascertainment of CS cases. Demonstrated
improvement of linkage to care and screening for syphilis with
particular emphasis on hard to reach populations, including, but not
limited to, persons experiencing homelessness and PWID.
The grantees will provide evidence of direct dissemination of
findings to Tribal communities including Tribal leadership.
Dissemination could include meetings, online reports (and number of
views), media releases, and newsletters.
Allowable Activities Under Goal Set 3:
(1) Public Health Response
Grantees may conduct further activities not addressed above
including:
a. Infectious Disease control.
b. Outbreak Response.
c. Assess and support Environmental Health emerging needs of local
communities.
Goal Set 4: Provide technical assistance to Indian Tribes, Tribal
organizations, and UIOs in the development of local health service
priorities and to determine incidence and prevalence rates of disease
and other illness in the community (Core Function 6).
Required Activities Under Goal Set 4:
(1) Provide culturally appropriate training and technical support
based on the needs of Indian Tribes, Tribal organizations, and UIOs
served. Topics may include but are not limited to program evaluation,
data analysis, data quality, survey design and administration, program
planning, community health assessment, and outbreak response.
a. Implement and evaluate at least one public health intervention
(conducted by grantee or by supported community) to promote health or
address disparities in AI/AN communities.
(2) Evaluate and support Area-wide interventions that promote SARS-
CoV-2 vaccine uptake. Assess community attitudes/knowledge/beliefs
around vaccine availability, vaccine coverage, and uptake among AI/AN
populations and the IHS/Tribal/Urban health care workforce. Address
sufficiency and/or gaps regarding vaccine messaging and public
communication campaigns and develop implementation strategies to
maximize vaccine coverage among AI/AN communities.
This requirement will have a separate budget of $250,000 per TEC.
a. Explain how the TEC will develop, maintain and strengthen
relationships with other public health authorities (e.g., Tribal,
county, state) in order to facilitate Public Health assessment,
response, communications and dissemination relevant to vaccine
implementation to enhance uptake and overall coverage.
b. The TEC will develop a comprehensive needs assessment relevant
to the ongoing SARS-CoV-2 vaccine implementation efforts within their
relevant IHS Area.
i. Assessment should include implementation gaps and opportunities
for improvement in local vaccination activities.
ii. Based on needs assessment findings, develop and implement
intervention strategies to address gaps

[[Page 41065]]

and enhance opportunities related to improving local vaccine
implementation, uptake, and communications.
iii. Perform ongoing evaluation of activities to determine
effectiveness and impacts and to inform future efforts.
c. Perform an assessment of existing vaccination capacity,
implementation, and uptake for years 1-3 of this funding cycle. Plans
for years 4-5 should use this assessment to continue, adapt, and
evaluate changes in local conditions and respond to ongoing vaccination
needs and goals.
(3) Evaluate and support Area-wide interventions that promote
coronavirus disease 2019 (COVID-19) pandemic response, mitigation, and
recovery.
This requirement should have a budget of at least $1,000,000 per
site.
(a) Explain how the TEC will develop, maintain, and strengthen
relationships with other public health authorities (e.g., Tribal,
county, state) in order to facilitate collaborative pandemic outbreak
response activities at the local and regional level.
(b) These COVID funds are to meet immediate needs in the response,
mitigation, and recovery from the COVID-19 pandemic. Plans for
activities should be explicitly tied to measurable pandemic response,
mitigation, and recovery outcomes.
Optional Activities with Budget Support under Goal Set 4
(1) SASP/DVP/FHC Technical Assistance
This activity is eligible for a supplemental budget of up to
$265,000 per awardee.
Twelve awards are anticipated.
Objective: To provide Technical Assistance (TA) to the Substance
Abuse and Suicide Prevention (SASP), Domestic Violence Prevention
(DVP), and Forensic Health Care (FHC) projects funded within their
regional area. Technical Assistance (TA) should apply to Tribes, Tribal
organizations, UIOs, and Federal facilities that receive grants from
IHS Behavioral Health. TA should assist projects in meeting required
reporting activities.
a. Cross-Site/Group TA
i. Representatives from TECs participate in monthly calls with IHS
Division of Behavioral Health (DBH) program staff.
ii. The TECs will facilitate or participate in scheduled Area
Project Officer (APO) monthly conference calls/webinars to include all
grantees within their respective IHS Area.
iii. Organize and facilitate quarterly webinars related to the
expectations and required activities of the SASP, DVP and FHC grant
programs.
iv. Provide at least one opportunity per year for individual
grantees to meet with local TEC annually at regional or national
meeting forum (for example, regional behavioral health conferences).
v. Coordinate in-person, virtual, or teleconference peer-to-peer
support opportunities for grantees.
b. Individualized Training and Technical Assistance (TTA)
i. Engage in regular communication with grantee project directors
and/or project coordinators, providing individualized TTA to SASP/DVP/
FHC grantees based on the needs of individual grant community to meet
the expectations and required activities of the grant program.
ii. Provide monthly, individual virtual site visits.
iii. Document individual one-on-one meetings that occurred at
regional or national meetings, such as regional behavioral health
conferences.
iv. Develop an individualized data collection tracker to assist
grantees with local data collection.
v. TECs will work with grantees to establish baseline data related
to the SASP/DVP/FHC funded projects, DBH Alcohol and Substance Abuse
(ASA) Government Performance and Results Act (GPRA) measures and other
IHS Strategic Plan Goals.
vi. Technical assistance provided by TECs in this cooperative
agreement are limited to efforts that support grantee submission of the
required DBH annual progress report (APR) and grantee-specific
interventions outlined in the applicant project narrative.
vii. TECs should outline available resources and technology,
including software technology for project data analysis and management.
TECs may use resources available to them to enhance TA support
including software, maintenance, and storage capabilities. However, it
is recommended that these activities include an established agreement
between the TEC and the grantee.
c. Development of Resources
i. Support grantee development of publications and/or presentation
for use in their program.
ii. Provide subject matter expertise, tools, and resources to
enhance grantee development of culturally competent, community-based
methods for local evaluation and data collection plans.
iii. Create individualized training plans for use with grantees.
iv. Support development of MOUs related to project needs (e.g.,
provide templates for establishing data collection plans and data
sharing agreements, partnerships, and/or services).
v. Develop TTA material including public health messages, and aid
in public health messaging practice guides to assist grantees in
developing documents identified as grant required activities.
(2) Zero Alcohol and Substance Abuse (ASA) Suicide Initiative
Technical Assistance
This activity is eligible for a supplemental budget of up to
$125,000 per awardee.
One award is anticipated.
Objective: To provide technical assistance that supports the data
collection and data analysis requirements of local projects funded
under the two IHS Alcohol and Substance Abuse Pilot Project
Initiatives; the Community Opioid Intervention Pilot Project (COIPP)
and the Youth Regional Treatment Center (YRTC) Aftercare Pilot Project.
Technical assistance should apply to Tribes, Tribal organizations, UIOs
and Federal facilities that receive grants from IHS Behavioral Health.
a. Data Collection, Analysis, and Reporting
i. Support local grantee efforts to develop data plans that will
support grant objectives, project activities and evaluation efforts.
Each grantee was highly recommended to develop a logic/model or theory
of change as part of their project description.
1. Technical assistance provided by TECs in this cooperative
agreement shall support data collection, analysis, and reporting. Data
shall be coordinated and submitted with local grantee evaluation
efforts and required annual progress reports.
2. Work with grantees to establish baseline data related to pilot
project.
3. Work with grantees to establish a local data collection plan,
including project data collection tracker related to proposed
activities and evaluation efforts. Data will include a compilation of
quantitative and qualitative data that addresses the project impact
including outcomes such as performance measures related to evaluation
outcomes and intended results.
4. TECs will assist grantees to include and prioritize the
collection and reporting of DBH ASA GPRA measures and other IHS
Strategic Plan Goals.
ii. Technical assistance provided by TECs in this cooperative
agreement shall support grantee submission of the required DBH APR.
iii. TECs should outline available resources and technology,
including software technology for project data analysis and management.
TECs may use resources available to them to enhance TA support
including software,

[[Page 41066]]

maintenance, and storage capabilities. However, it is recommended that
these activities include an established agreement between the TEC and
the grantee.
b. Individualized TTA
i. Engage in regular communication with grantee project directors
and/or project coordinators, providing individualized TTA based on the
needs of individual pilot project and Tribal community to meet the
expectations and required activities of the grant program.
ii. Provide monthly, individual virtual site visits.
iii. Document individual one-on-one meetings that occurred at
regional or national meetings, such as regional behavioral health
conferences.
c. Development of Resources
i. Support grantee development of publications and/or presentation
for use in their program.
ii. Provide subject matter expertise, tools, and resources to
enhance grantee development of culturally competent, community-based
methods for local evaluation and data collection plans.
iii. Support development of MOUs related to project needs (e.g.,
provide templates for establishing data collection plans and data
sharing agreements, partnerships, and/or services).
(3) Diabetes Activities
This activity is eligible for a supplemental budget of up to
$100,000 per awardee.
One award is anticipated.
a. Provide data technical assistance to the Urban Indian Health
Organization (UIHO) Special Diabetes Program for Indians (SDPI)
grantees to support their diabetes prevention and treatment services.
b. Develop the annual Urban Diabetes Care and Outcomes Summary
Report, which provides an overview of the UIHO data submitted into the
IHS Diabetes Care and Outcomes Audit. These reports provide data on the
diabetes care provided as well as the outcomes achieved in the UIHO
patient population, including identifying areas for improvement.
Allowable Activities under Goal Set 4: None additional.
Pre-Conference Grant Requirements
The awardee is required to comply with the ``HHS Policy on
Promoting Efficient Spending: Use of Appropriated Funds for Conferences
and Meeting Space, Food, Promotional Items, and Printing and
Publications,'' dated January 23, 2015 (Policy), as applicable to
conferences funded by grants and cooperative agreements. The Policy is
available at <a href="https://www.hhs.gov/grants/contracts/contract-policies-regulations/efficient-spending/index.html?language=es">https://www.hhs.gov/grants/contracts/contract-policies-regulations/efficient-spending/index.html?language=es</a>.
The awardee is required to:
Provide a separate detailed budget justification and narrative for
each conference anticipated. The cost categories to be addressed are as
follows: (1) Contract/Planner, (2) Meeting Space/Venue, (3)
Registration website, (4) Audio Visual, (5) Speakers Fees, (6) Non-
Federal Attendee Travel, (7) Registration Fees, and (8) Other (explain
in detail and cost breakdown). For additional questions please contact
Lisa C. Neel at (301) 443-4305 or email at <a href="/cdn-cgi/l/email-protection#93fffae0f2bdfdf6f6ffd3fafbe0bdf4fce5">[email&#160;protected]</a>.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
The total funding identified for fiscal year (FY) 2021 is
approximately $30,750,000. Individual award amounts for the first
budget year are anticipated to be between $1,070,000 and $3,000,000.
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.
Funding for this award will be provided through: The IHS Office of
Public Health Support, the IHS Office of Urban Indian Health Programs,
the IHS Office of Clinical and Preventive Services, National Human
Immunodeficiency Virus (HIV) & Viral Hepatitis C (HCV) Program in
partnership with the U.S. Department of Health and Human Services (HHS)
Minority HIV/AIDS Fund (MHAF), the Centers for Disease Control and
Prevention's (CDC) National Center for Chronic Disease Prevention and
Health Promotion, and the National Institutes of Health's (NIH)
National Institute on Minority Health and Health Disparities (NIMHD).
The authorities for CDC and NIH funding will be exercised through an
Intra-Departmental Delegation of Authority (IDDA) with IHS. The
administration will be carried out through an Intra-agency Agreement
(IAA) between CDC, NIH, and IHS. Portions of this award will be funded
by the Office of the Assistant Secretary for Health, HHS, as authorized
under the statutory earmark for minority AIDS prevention and treatment
activities, and are to be carried out pursuant to Title III of the
Public Service Act. The funding is being made available through an IDDA
to award specific funding for fiscal year (FY) 2021.
Anticipated Number of Awards
Approximately 12 awards will be issued under this program
announcement.
Period of Performance
The period of performance is for five years.
Cooperative Agreement
Cooperative agreements awarded by the HHS are administered under
the same policies as a grant. However, the funding agency (IHS) is
anticipated to have substantial programmatic involvement in the project
during the entire award segment. Below is a detailed description of the
level of involvement required for the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
(1) Provide funded TECs with ongoing consultation and technical
assistance to plan, implement, and evaluate each component as described
under Recipient Activities. Consultation and technical assistance may
include, but not be limited to, the following areas:
(a) Interpretation of current scientific literature related to
epidemiology, statistics, surveillance, Healthy People 2030 objectives,
and other public health issues;
(b) Design and implementation of each program component such as
surveillance, epidemiologic analysis, outbreak investigation,
development of epidemiologic studies, development of disease control
programs, and coordination of activities; and
(c) Overall operational planning and program management.
(2) Coordinate all IHS epidemiologic activities on a national scope
including development and management of disease surveillance systems,
generation of related reports, and investigation of disease outbreaks.
(3) Conduct routine site visits to TECs and/or coordinate TEC
visits to IHS to assess work plans and ensure data security; confirm
compliance with applicable laws and regulations; assess program
activities; and to mutually resolve problems, as needed.
(4) Participate in annual TEC meeting for information sharing,
problem solving, or training.
(5) Provide training in the use of data from the Epidemiology Data
Mart (EDM) and other IHS systems for the purposes of creating reports
for disease surveillance, epidemiologic analysis, and epidemiologic
studies. Training can be provided online or onsite, depending on staff
availability.

[[Page 41067]]

(6) Coordinate opportunities for training of TEC staff where
applicable. Examples include webinars on the EDM and data use,
technical assistance, use of statistical software, and fellowship
opportunities.

III. Eligibility Information

1. Eligibility

To be eligible for this FY 2021 funding opportunity applicants
must:
A. Be one of the following as defined by 25 U.S.C. 1603:
1. 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 U.S. to
Indians because of their status as Indians.
2. A Tribal organization as defined by 25 U.S.C. 1603(26). The term
``Tribal organization'' has the meaning given the term in section 4 of
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
5304): ``Tribal organization'' means the recognized governing body of
any Indian Tribe; any legally established organization of Indians which
is controlled, sanctioned, or chartered by such governing body or which
is democratically elected by the adult members of the Indian community
to be served by such organization and which includes the maximum
participation of Indians in all phases of its activities: Provided
that, in any case where a contract is let or grant made to an
organization to perform services benefiting more than one Indian Tribe,
the approval of each such Indian Tribe shall be a prerequisite to the
letting or making of such contract or grant. Applicant shall submit
letters of support and/or Tribal Resolutions from the Tribes to be
served.
3. An Intertribal Consortium or Indian organization as defined by
25 U.S.C. 1621m(d)(2) as: (A) Incorporated for the primary purpose of
improving Indian health; and (B) representative of the Indian Tribes or
Urban Indian communities residing in the area in which the Intertribal
consortium is located.
B. Demonstrate that they have complied with previous terms and
conditions of the Epidemiology Program for AI/AN Tribes and Urban
Indian Communities grant in order to receive funding under this
announcement; and
C. Represent or serve a population of at least 60,000 AI/AN people
or 70 percent of the Tribal governments in the Area to be eligible, as
demonstrated by Tribal Resolutions, blanket Tribal Resolutions, Tribal
Letters of Support (LoS) or LoS from Urban Indian clinic directors and/
or Chief Executive Officers (CEOs). Applicants must describe the
population of AI/AN people and Tribes that will be represented. The
number of AI/AN people served must be substantiated by documentation
describing IHS user populations, U.S. Census Bureau data, clinical
catchment data, or any method that is scientifically and
epidemiologically valid. Resolutions or LoS from each Tribe, AN village
and LoS from each Urban Indian community represented must be included
in the application package. Resolutions or LoS must be current (e.g.,
not pre-date inception of the applicant epidemiology center) and
express explicit support for the applicant epidemiology center.
Collaborations with IHS Areas, Federal agencies such as the CDC, state,
academic institutions, or other organizations are encouraged (letters
of support and collaboration should be included in the application). If
applicants do not have 100 percent Tribal support for their work,
applicants must report the proportion and estimated population of the
Tribes in their Area that do not support their work explicitly through
LoS or resolution.
The DEDP 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 non-profit 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 will be considered not
responsive and will not be reviewed. The Division of Grants Management
(DGM) will notify the applicant.
Tribal Resolution
The DGM must receive an official, signed Tribal Resolution prior to
issuing a Notice of Award (NoA) to any applicant selected for funding.
An Indian Tribe or Tribal organization that is proposing a project
affecting another Indian Tribe must include resolutions from all
affected Tribes to be served. However, if an official, signed Tribal
Resolution cannot be submitted with the application prior to the
application deadline date, a draft Tribal Resolution must be submitted
with the application by the deadline date in order for the application
to be considered complete and eligible for review. The draft Tribal
Resolution is not in lieu of the required signed resolution, but is
acceptable until a signed resolution is received. If an application
without a signed Tribal Resolution is selected for funding, the
applicant will be contacted by the Grants Management Specialist (GMS)
listed in this funding announcement and given 90 days to submit an
official, signed Tribal Resolution to the GMS. If the signed Tribal
Resolution is not received within 90 days, the award will be forfeited.
Tribes organized with a governing structure other than a Tribal
council may submit an equivalent document commensurate with their
governing organization.

IV. Application and Submission Information

1. Obtaining Application Materials

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

2. Content and Form Application Submission

The applicant must include the project narrative as an attachment
to the application package. Mandatory documents for all applicants
include:
<bullet> Abstract (one page) summarizing the project.
<bullet> Application forms:
1. SF-424, Application for Federal Assistance.
2. SF-424A, Budget Information--Non-Construction Programs.
3. SF-424B, Assurances--Non-Construction Programs.
<bullet> Project Narrative (not to exceed 12 pages). See Section
IV.2.A Project Narrative for instructions.
1. Background information on the organization.
2. Proposed scope of work, objectives, and activities that provide
a description

[[Page 41068]]

of what the applicant plans to accomplish.
<bullet> Proposed logic model.
<bullet> Budget Justification and Narrative (not to exceed five
pages). See Section IV.2.B Budget Narrative for instructions.
<bullet> One-page Timeframe Chart.
<bullet> Tribal Resolution(s) or Letters of Support.
<bullet> Letters of Support from organization's Board of Directors.
<bullet> 501(c)(3) Certificate, if applicable.
<bullet> Biographical sketches for all Key Personnel.
<bullet> Contractor/Consultant resumes or qualifications and scope
of work.
<bullet> Disclosure of Lobbying Activities (SF-LLL).
<bullet> Certification Regarding Lobbying (GG-Lobbying Form).
<bullet> Copy of current Negotiated Indirect Cost rate (IDC)
agreement (required in order to receive IDC).
<bullet> Organizational Chart (optional).
<bullet> 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 <a href="https://harvester.census.gov/facdissem/Main.aspx">https://harvester.census.gov/facdissem/Main.aspx</a>.
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 <a href="https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html">https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html</a>.
Requirements for Project and Budget Narratives
A. Project Narrative
This narrative should be a separate document that is no more than
12 pages and must: (1) Have consecutively numbered pages; (2) use black
font 12 points or larger; (3) be single-spaced; (4) and be formatted to
fit standard letter paper (8\1/2\ x 11 inches).
Be sure to succinctly answer all questions listed under the
evaluation criteria (refer to Section V.1, Evaluation Criteria) and
place all responses and required information in the correct section
noted below or they will not be considered or scored. If the narrative
exceeds the page limit, the application will be considered not
responsive and will not be reviewed. The 12-page limit for the
narrative does not include the work plan, standard forms, Tribal
Resolutions or LoS, budget, budget justifications, narratives, and/or
other items.
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--3 pages)
Section 1: Introduction and Need for Assistance
Must include the applicant's background information, a description
of epidemiological service, epidemiologic capacity, and history of
support for such activities. Applicants need to include current public
health activities, what program services are currently being provided,
and interactions with other public health authorities in the region
(state, local, or Tribal).
Section 2: Organizational Capabilities
The applicant must describe staff capabilities or hiring plans for
the key personnel with appropriate expertise in epidemiology, health
sciences, and program management. The applicant must also demonstrate
access to specialized expertise such as a doctoral level epidemiologist
and/or a biostatistician. Applicants must include an organizational
chart and provide position descriptions and biographical sketches of
key personnel including consultants or contractors. The position
description should clearly describe each position and its duties.
Resume should indicate that proposed staff is qualified to carry out
the project activities.
Section 3: User Population
The number of AI/AN people served must be substantiated by
documentation describing IHS user populations, U.S. Census Bureau data,
clinical catchment data, or any method that is scientifically and
epidemiologically valid.
Part 2: Program Planning and Evaluation (Limit--5 pages)
Section 1: Program Plans
Applicant must include a work plan that describes program goals,
objectives, activities, timeline, and responsible person for carrying
out the objectives/activities. The applicant must include at least a
minimum of four of the seven core functions of the IHCIA and other
activities listed under the Required, Optional, and Allowable
Activities.
Section 2: Program Evaluation
Applicant must define the criteria to be used to evaluate
activities listed in the work plan under the Grantee Cooperative
Agreement Award Activities. Criteria must include the collection,
management, and reporting of established TEC IHS GPRA measures. They
must explain the methodology that will be used to determine if the
needs identified for the objectives are being met and if the outcomes
identified are being achieved and describe how evaluation findings will
be disseminated to the IHS, co-funders, and the population served. The
evaluation plan must include a logic model (not counted in the page
limit) with at least one measurable outcome per required activity.
Applicants are strongly encouraged to base their logic model on the
Draft Logic Model supplied with this notice.
Part 3: Program Report (Limit--4 pages)
Section 1: Describe Major Accomplishments Over the Last 24 Months
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.
Section 2: Describe Major Activities Over the Last 24 Months
Please identify and summarize recent, major project activities
related to the work proposed in the last 24 months.
Section 3: Describe Epidemiology Activities Over the Last 5 Years
Please identify and summarize substantial epidemiology center
activities conducted over the last five years, especially those you
propose to continue.
B. Budget Narrative (Limit--5 pages)
Provide a budget narrative that explains the amounts requested for
each line item of the budget from the SF-424A (Budget Information for
Non-Construction Programs). The budget narrative should specifically
describe how each item will support the achievement of proposed
objectives. Be very careful about showing how each item in the
``Other'' category is justified. For subsequent budget years (see
Multi-Year Project Requirements in Section V.1. Application Review
Information, Evaluation Criteria), the narrative

[[Page 41069]]

should highlight the changes from year 1 or clearly indicate that there
are no substantive budget changes during the period of performance. Do
NOT use the budget narrative to expand the project narrative.

3. Submission Dates and Times

Applications must be submitted through <a href="http://Grants.gov">Grants.gov</a> 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.
<a href="http://Grants.gov">Grants.gov</a> will notify the applicant via email if the application is
rejected.
If technical challenges arise and assistance is required with the
application process, contact <a href="http://Grants.gov">Grants.gov</a> Customer Support (see contact
information at https://www.grants.gov). If problems persist, contact
Mr. Paul Gettys (<a href="/cdn-cgi/l/email-protection#ca9aabbfa6e48dafbebeb3b98aa3a2b9e4ada5bc">[email&#160;protected]</a>), Acting Director, DGM, by
telephone at (301) 443-2114 or (301) 443-5204. Please be sure to
contact Mr. Gettys at least ten days prior to the application deadline.
Please do not contact the DGM until you have received a <a href="http://Grants.gov">Grants.gov</a>
tracking number. In the event you are not able to obtain a tracking
number, call the DGM as soon as possible.
IHS will not acknowledge receipt of applications.

4. Intergovernmental Review

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

5. Funding Restrictions

<bullet> 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.
<bullet> The available funds are inclusive of direct and indirect
costs.
<bullet> Only one cooperative agreement will be awarded per
applicant.

6. Electronic Submission Requirements

All applications must be submitted via <a href="http://Grants.gov">Grants.gov</a>. Please use the
<a href="https://www.Grants.gov">https://www.Grants.gov</a> website to submit an application. Find the
application by selecting the ``Search Grants'' link on the homepage.
Follow the instructions for submitting an application under the Package
tab. No other method of application submission is acceptable.
If the applicant cannot submit an application through <a href="http://Grants.gov">Grants.gov</a>, a
waiver must be requested. Prior approval must be requested and obtained
from Mr. Paul Gettys, Acting Director, DGM. A written waiver request
must be sent to <a href="/cdn-cgi/l/email-protection#692e1b08071d1a390605000a102900011a470e061f">[email&#160;protected]</a> with a copy to
<a href="/cdn-cgi/l/email-protection#6838091d04462f0d1c1c111b2801001b460f071e">[email&#160;protected]</a>. The waiver request must: (1) Be documented in
writing (emails are acceptable) before submitting an application by
some other method, and (2) include clear justification for the need to
deviate from the required application submission process.
Once the waiver request has been approved, the applicant will
receive a confirmation of approval email containing submission
instructions. A copy of the written approval must be included with the
application that is submitted to the DGM. Applications that are
submitted without a copy of the signed waiver from the Acting Director
of the DGM will not be reviewed. The Grants Management Officer of the
DGM 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 <a href="http://Grants.gov">Grants.gov</a> 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:
<bullet> Please search for the application package in <a href="https://www.Grants.gov">https://www.Grants.gov</a> by entering the Assistance Listing (CFDA) number or the
Funding Opportunity Number. Both numbers are located in the header of
this announcement.
<bullet> If you experience technical challenges while submitting
your application, please contact <a href="http://Grants.gov">Grants.gov</a> Customer Support (see
contact information at https://www.grants.gov).
<bullet> Upon contacting <a href="http://Grants.gov">Grants.gov</a>, 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.
<bullet> Applicants are strongly encouraged not to wait until the
deadline date to begin the application process through <a href="http://Grants.gov">Grants.gov</a> as
the registration process for SAM and <a href="http://Grants.gov">Grants.gov</a> could take up to 20
working days.
<bullet> Please follow the instructions on <a href="http://Grants.gov">Grants.gov</a> to include
additional documentation that may be requested by this funding
announcement.
<bullet> Applicants must comply with any page limits described in
this funding announcement.
<bullet> After submitting the application, the applicant will
receive an automatic acknowledgment from <a href="http://Grants.gov">Grants.gov</a> that contains a
<a href="http://Grants.gov">Grants.gov</a> tracking number. The IHS will not notify the applicant that
the application has been received.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
Applicants and grantee organizations are required to obtain a DUNS
number and maintain an active registration in the SAM database. The
DUNS number is a unique 9-digit identification number provided by D&B
that uniquely identifies each entity. The DUNS number is site specific;
therefore, each distinct performance site may be assigned a DUNS
number. Obtaining a DUNS number is easy, and there is no charge. To
obtain a DUNS number, please access the request service through <a href="https://fedgov.dnb.com/webform">https://fedgov.dnb.com/webform</a>, or call (866) 705-5711.
The Federal Funding Accountability and Transparency Act of 2006, as
amended (``Transparency Act''), requires all HHS recipients to report
information on sub-awards. Accordingly, all IHS grantees must notify
potential first-tier sub-recipients that no entity may receive a first-
tier sub-award unless the entity has provided its DUNS number to the
prime grantee organization. This requirement ensures the use of a
universal identifier to enhance the quality of information available to
the public pursuant to the Transparency Act.
System for Award Management (SAM)
Organizations that are not registered with SAM must have a DUNS
number first, then access the SAM online registration through the SAM
home page at <a href="https://www.sam.gov/SAM/">https://www.sam.gov/SAM/</a> (U.S. organizations will also
need to provide an Employer Identification Number from the Internal
Revenue Service that may take an additional 2-5 weeks to become
active). Please see <a href="http://SAM.gov">SAM.gov</a> 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 <a href="https://www.sam.gov/SAM/">https://www.sam.gov/SAM/</a>.
Additional information on implementing the Transparency Act,
including the specific requirements for DUNS and SAM, are available on
the DGM Grants Management, Policy Topics web page: <a href="https://www.ihs.gov/dgm/policytopics/">https://www.ihs.gov/dgm/policytopics/</a>.

V. Application Review Information

Possible points assigned to each section are noted in parentheses.
The 12-page project narrative should include only the first year of
activities; information for multi-year projects should be included as
an appendix. See ``Multi-year Project Requirements'' at the end of this
section for more information. The narrative section

[[Page 41070]]

should be written in a manner that is clear to outside reviewers
unfamiliar with prior related activities of the applicant. It should be
well organized, succinct, and contain all information necessary for
reviewers to understand the project fully. Points will be assigned to
each evaluation criteria adding up to a total of 100 possible points.
Points are assigned as follows:

1. Evaluation Criteria

The instructions for preparing the application narrative also
constitute the evaluation criteria for reviewing and scoring the
application. Points are assigned as follows:
A. Introduction and Need for Assistance (10 points)
a. Describe the applicant's current public health activities
including programs or services currently provided, interactions with
other public health authorities in the regions (state, local, or
Tribal) and how long it has been operating. Specifically describe
current epidemiologic capacity and history of support for such
activities.
b. Provide a physical location of the TEC and area to be served by
the proposed program, including a map (include the map in the
attachments) and specifically describe the office space and how it is
going to be paid for.
c. Describe the applicant's user population. The applicant must
demonstrate AI/AN people will be served and must be substantiated by
using documentation describing IHS user populations, U.S. Census Bureau
data, clinical catchment data, or any method that is scientifically and
epidemiologically valid data.
B. Project Objectives, Work Plan, and Approach (35 points)
a. State in measurable and realistic terms the objectives and
appropriate activities to achieve each objective for the projects as
listed in the Required, Optional, and Allowable Activities. The work
plan needs to include the grantees desired objectives and must
demonstrate a minimum of four of the seven TEC core functional areas as
outlined in the IHCIA.
b. Identify the expected results, benefits, and outcomes or
products to be derived from each objective of the project.
c. Include a work plan for each objective that indicates when the
objectives and major activities will be accomplished and who will
conduct the activities.
C. Program Evaluation (10 points)
a. Define the criteria to be used to evaluate activities listed in
the work plan under the Required, Optional, and Allowable Activities.
b. Explain the methodology that will be used to determine if the
needs identified for the objectives are being met and if the outcomes
identified are being achieved. Be explicit about how the logic model
relates to the objectives and activities. Include the logic model in
the appendix.
c. Explain how the organization will participate in cross-
organization evaluation activities, as needed.
d. Describe how evaluation findings will be disseminated to
stakeholders.
D. Organizational Capabilities, Key Personnel, and Qualifications (10
points)
a. Explain both the management and administrative structure of the
organization, including documentation of current certified financial
management systems from the Bureau of Indian Affairs, IHS, or a
Certified Public Accountant and an updated organizational chart
(include in appendix).
b. Describe the ability of the organization to manage a program of
the proposed scope.
c. Provide position descriptions and biographical sketches of Key
Personnel, including those of consultants or contractors in the Other
Attachments form in <a href="http://Grants.gov">Grants.gov</a>. Position descriptions should very
clearly describe each position and its duties, indicating desired
qualification and experience requirements related to the project.
Resumes should indicate that the proposed staff is qualified to carry
out the project activities. Applicants with expertise in epidemiology
will receive priority.
d. Applicant must at least have two epidemiologists as part of the
proposal.
E. Epidemiology Center Capacity (30 points)
a. Applicant must demonstrate current capacity and successes over
time (five years) in providing epidemiology center services to Tribes
and Tribal populations in their area.
F. Categorical Budget and Budget Justification (5 points)
a. The five points for Categorical Budget only applies to Year 1.
Provide a line item budget and budget narrative for Year 1.
b. Provide a justification by line item in the budget including
sufficient cost and other details to facilitate the determination of
cost allowance and relevance of these costs to the proposed project.
The funds requested should be appropriate and necessary for the scope
of the project. Be aware of and incorporate budget limits and
requirements listed in the Required, Optional, and Allowable Activities
in Section I.
i. IHS recommends that applicants review <a href="https://www.ihs.gov/dper/evaluation/evaluation-policy/">https://www.ihs.gov/dper/evaluation/evaluation-policy/</a> and plan their budget proposals in
compliance with the general Evaluation Policy of IHS.
c. If use of consultants or contractors are proposed or
anticipated, provide a detailed budget and scope of work that clearly
defines the deliverables or outcomes anticipated.
d. If the applicant will be hosting a conference, the applicant
must include a separate detailed budget justification and narrative for
the conference. The cost categories to be addressed are as follows: (1)
Contract/Planner, (2) Meeting Space/Venue, (3) Registration website,
(4) Audio Visual, (5) Speakers Fees, (6) Non-Federal Attendee Travel,
(7) Registration Fees, and (8) Other (explain in detail and cost
breakdown).
e. Applicant is required to submit a line item budget and budget
narrative by category for years 2-5 as an appendix to show the five-
year plan of the proposal.
Multi-Year Project Requirements
Applications must include a brief project narrative and budget (one
additional page per year) addressing the developmental plans for each
additional year of the project. This attachment will not count as part
of the project narrative or the budget narrative.
Additional documents can be uploaded as Appendix Items in
<a href="http://Grants.gov">Grants.gov</a>.
<bullet> Work plan, logic model, and/or timeline for proposed
objectives.
<bullet> Position descriptions for key staff.
<bullet> Resumes of key staff that reflect current duties.
<bullet> Consultant or contractor proposed scope of work and letter
of commitment (if applicable).
<bullet> Current Indirect Cost Rate Agreement.
<bullet> Organizational chart.
<bullet> Map of area identifying project location(s).
<bullet> Logic model.
<bullet> 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

[[Page 41071]]

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

3. Notifications of Disposition

All applicants will receive an Executive Summary Statement from the
IHS Office of Public Health Support 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 grant, the terms and conditions of the
award, the effective date of the award, and the budget/project period.
Each entity approved for funding must have a user account in
GrantSolutions in order to retrieve the NoA. Please see the Agency
Contacts list in Section VII for the systems contact information.
B. Approved but Unfunded Applications
Approved applications not funded due to lack of available funds
will be held for one 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

Cooperative agreements are administered in accordance with the
following regulations and policies:
A. The criteria as outlined in this program announcement.
B. Administrative Regulations for Grants:
<bullet> 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 <a href="https://www.govinfo.gov/content/pkg/CFR-2020-title45-vol1/pdf/CFR-2020-title45-vol1-part75.pdf">https://www.govinfo.gov/content/pkg/CFR-2020-title45-vol1/pdf/CFR-2020-title45-vol1-part75.pdf</a>.
<bullet> Please review all HHS regulatory provisions for
Termination at 45 CFR 75.372, at <a href="https://www.ecfr.gov/cgi-bin/retrieveECFR?gp&amp">https://www.ecfr.gov/cgi-bin/retrieveECFR?gp&amp</a>;SID=2970eec67399fab1413ede53d7895d99&amp;mc=true&amp
;n=pt45.1.75&amp;r=PART&amp;ty=HTML&amp;se45.1.75_1372#se45.1.75_1372.
C. Grants Policy:
<bullet> HHS Grants Policy Statement, Revised 01/07, at <a href="http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf">http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf</a>.
D. Cost Principles:
<bullet> Uniform Administrative Requirements for HHS Awards, ``Cost
Principles,'' at 45 CFR part 75, subpart E.
E. Audit Requirements:
<bullet> Uniform Administrative Requirements for HHS Awards,
``Audit Requirements,'' at 45 CFR part 75, subpart F.
F. As of August 13, 2020, 2 CFR 200 has been updated to include a
prohibition on certain telecommunications and video surveillance
services or equipment. This prohibition is described in 2 CFR 200.216.
This will also be described in the terms and conditions of every IHS
grant and cooperative agreement awarded on or after August 13, 2020.

2. Indirect Costs

This section applies to all recipients that request reimbursement
of indirect costs (IDC) in their application budget. In accordance with
HHS Grants Policy Statement, Part II-27, IHS requires applicants to
obtain a current IDC rate agreement and submit it to the DGM prior to
the DGM issuing an award. The rate agreement must be prepared in
accordance with the applicable cost principles and guidance as provided
by the cognizant agency or office. A current rate covers the applicable
grant activities under the current award's budget period. If the
current rate agreement is not on file with the DGM at the time of
award, the IDC portion of the budget will be restricted. The
restrictions remain in place until the current rate agreement is
provided to the DGM.
Per 45 CFR 75.414(f) Indirect (F&A) costs, ``any non-Federal entity
[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 (MTDC) 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 non-Federal entity chooses to negotiate for a rate, which
the non-Federal entity 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 (DCA) at <a href="https://rates.psc.gov/">https://rates.psc.gov/</a> or the
Department of the Interior (Interior Business Center) at <a href="https://ibc.doi.gov/ICS/tribal">https://ibc.doi.gov/ICS/tribal</a>. For questions regarding the indirect cost
policy, please call the GMS listed under ``Agency Contacts'' or the
main DGM office at (301) 443-5204.

3. Reporting Requirements

The grantee must submit required reports consistent with the
applicable deadlines. Failure to submit required reports within the
time allowed may result in suspension or termination of an active
grant, withholding of additional awards for the project, or other
enforcement actions such as withholding of payments or converting to
the reimbursement method of payment. Continued failure to submit
required reports may result in the imposition of special award
provisions, and/or the non-funding or non-award of other eligible
projects or activities. This requirement applies whether the
delinquency is attributable to the failure of the awardee organization
or the individual responsible for preparation of the reports. Per DGM
policy, all reports must be submitted electronically by attaching them
as a ``Grant Note'' in GrantSolutions. Personnel responsible for
submitting reports will be required to obtain a login and password for
GrantSolutions. Please see the Agency Contacts list in Section VII for
the systems contact information.

[[Page 41072]]

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 Cash Transaction Reports are due 30 days after the close of
every calendar quarter to the Payment Management Services at <a href="https://pms.psc.gov">https://pms.psc.gov</a>. Failure to submit timely reports may result in adverse
award actions blocking access to funds.
Federal Financial Reports are due 30 days after the end of each
budget period, and a final report is due 90 days after the end of the
Period of Performance.
Grantees are responsible and accountable for reporting accurate
information on all required reports: The Progress Reports, the Federal
Cash Transaction Report, and the Federal Financial Report.
C. Data Collection and Reporting
Based on the required activities in Section II, describe how
grantee plans to collect data for the proposed project and activities.
Identify any type(s) of evaluation(s) that will be used and how you
will collaborate with partners to complete any evaluation efforts or
data collection. Progress reports will include compilation of
quantitative data (e.g., number served; screenings completed) and
qualitative or narrative (text) data. Reporting elements should be
specific to activities/programs, processes, and outcomes such as
performance measures and other data relevant to evaluation outcomes,
including intended results (i.e., impact and outcomes). Grantees will
be required to collect and submit responses to specific data calls upon
request, as well as semi-annual and annual progress reports.
D. Post Conference Grant Reporting
The following requirements were enacted in Section 3003 of the
Consolidated Continuing Appropriations Act, 2013, Public Law 113-6, 127
Stat. 198, 435 (2013), and; Office of Management and Budget Memorandum
M-17-08, Amending OMB Memorandum M-12-12: All HHS/IHS awards containing
grants funds allocated for conferences will be required to complete a
mandatory post award report for all conferences. Specifically: The
total amount of funds provided in this award/cooperative agreement that
were spent for ``Conference X,'' must be reported in final detailed
actual costs within 15 calendar days of the completion of the
conference. Cost categories to address should be: (1) Contract/Planner,
(2) Meeting Space/Venue, (3) Registration website, (4) Audio Visual,
(5) Speakers Fees, (6) Non-Federal Attendee Travel, (7) Registration
Fees, and (8) Other.
E. 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 1 70.
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.
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 <a href="https://www.ihs.gov/dgm/policytopics/">https://www.ihs.gov/dgm/policytopics/</a>.
F. Compliance With Executive Order 13166 Implementation of Services
Accessibility Provisions for All Grant Application Packages and Funding
Opportunity Announcements
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. This includes ensuring programs are accessible to
persons with limited English proficiency. The HHS Office for Civil
Rights provides guidance on complying with civil rights laws enforced
by HHS. Please see <a href="https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html">https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html</a> and <a href="http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html">http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html</a>.
<bullet> Recipients of FFA must ensure that their programs are
accessible to persons with limited English proficiency. HHS provides
guidance to recipients of FFA on meeting their legal obligation to take
reasonable steps to provide meaningful access to their programs by
persons with limited English proficiency. Please see <a href="https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html">https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html</a> and <a href="https://www.lep.gov">https://www.lep.gov</a>. For further guidance on providing culturally and
linguistically appropriate services, recipients should review the
National Standards for Culturally and Linguistically Appropriate
Services in Health and Health Care at <a href="https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53">https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53</a>.
<bullet> Recipients of FFA also have specific legal obligations for
serving qualified individuals with disabilities. Please see <a href="http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html">http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html</a>.
<bullet> HHS funded health and education programs must be
administered in an environment free of sexual harassment. Please see
<a href="https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html">https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html</a>; <a href="https://www2.ed.gov/about/offices/list/ocr/docs/shguide.html">https://www2.ed.gov/about/offices/list/ocr/docs/shguide.html</a>; and <a href="https://www.eeoc.gov/eeoc/publications/fs-sex.cfm">https://www.eeoc.gov/eeoc/publications/fs-sex.cfm</a>.
<bullet> Recipients of FFA must also administer their programs in
compliance with applicable Federal religious nondiscrimination laws and
applicable Federal conscience protection and associated anti-
discrimination laws. Collectively, these laws prohibit exclusion,
adverse treatment, coercion, or other discrimination against persons or
entities on the basis of their consciences, religious beliefs, or moral
convictions. Please see <a href="https://www.hhs.gov/conscience/conscience-protections/index.html">https://www.hhs.gov/conscience/conscience-protections/index.html</a> and <a href="https://www.hhs.gov/conscience/religious-freedom/index.html">https://www.hhs.gov/conscience/religious-freedom/index.html</a>.
Please contact the HHS Office for Civil Rights for more information
about obligations and prohibitions under Federal civil rights laws at
<a href="https://www.hhs.gov/ocr/about-us/contact-us/index.html">https://www.hhs.gov/ocr/about-us/contact-us/index.html</a> or call 1-800-
368-1019 or TDD 1-800-537-7697.

[[Page 41073]]

G. 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 Federal Awardee Performance and Integrity
Information System (FAPIIS) at <a href="https://www.fapiis.gov">https://www.fapiis.gov</a> before making any
award in excess of the simplified acquisition threshold (currently
$250,000) over the period of performance. An applicant may review and
comment on any information about itself that a Federal awarding agency
previously entered. IHS will consider any comments by the applicant, in
addition to other information in FAPIIS, in making a judgment about the
applicant's integrity, business ethics, and record of performance under
Federal awards when completing the review of risk posed by applicants
as described in 45 CFR 75.205.
As required by 45 CFR part 75 Appendix XII of the Uniform Guidance,
non-Federal entities (NFEs) are required to disclose in FAPIIS any
information about criminal, civil, and administrative proceedings, and/
or affirm that there is no new information to provide. This applies to
NFEs that receive Federal awards (currently active grants, cooperative
agreements, and procurement contracts) greater than $10,000,000 for any
period of time during the period of performance of an award/project.
Mandatory Disclosure Requirements
As required by 2 CFR part 200 of the Uniform Guidance, and the HHS
implementing regulations at 45 CFR part 75, the IHS must require a non-
Federal entity 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.
Submission is required for all applicants and recipients, in
writing, to the IHS and to the HHS Office of Inspector General all
information related to violations of Federal criminal law involving
fraud, bribery, or gratuity violations potentially affecting the
Federal award. 45 CFR 75.113.
Disclosures must be sent in writing to: U.S. Department of Health
and Human Services, Indian Health Service, Division of Grants
Management, ATTN: Paul Gettys, Acting Director, 5600 Fishers Lane, Mail
Stop: 09E70, Rockville, MD 20857, (Include ``Mandatory Grant
Disclosures'' in subject line), Office: (301) 443-5204, Fax: (301) 594-
0899, Email: <a href="/cdn-cgi/l/email-protection#b9e9d8ccd597fedccdcdc0caf9d0d1ca97ded6cf">[email&#160;protected]</a>.
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: <a href="https://oig.hhs.gov/fraud/report-fraud/">https://oig.hhs.gov/fraud/report-fraud/</a>, (Include
``Mandatory Grant Disclosures'' in subject line), Fax: (202) 205-0604
(Include ``Mandatory Grant Disclosures'' in subject line) or, Email:
<a href="/cdn-cgi/l/email-protection#de93bfb0babfaab1aca799acbfb0aabbbb9ab7adbdb2b1adabacbbad9eb1b7b9f0b6b6adf0b9b1a8">[email&#160;protected]</a>.
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 parts 180 & 376).

VII. Agency Contacts

1. Questions on the programmatic issues may be directed to: Lisa C.
Neel, MPH, Public Health Advisor, Indian Health Service, Office of
Public Health Support, Division of Epidemiology & Disease Prevention,
Indian Health Service, 5600 Fishers Lane, Mailstop 09E10D, Rockville,
MD 20857, Phone: (301) 443-4305, Email: <a href="/cdn-cgi/l/email-protection#8ce0e5ffeda2e2e9e9e0cce5e4ffa2ebe3fa">[email&#160;protected]</a>.
2. Questions on grants management and fiscal matters may be
directed to: John Hoffman, Senior Grants Management Specialist, Indian
Health Service, Division of Grants Management, 5600 Fishers Lane,
Mailstop 09E70, Rockville, MD 20857, Phone: (301) 443-2116, Email:
<a href="/cdn-cgi/l/email-protection#33795c5b5d1d7b5c55555e525d735a5b401d545c45">[email&#160;protected]</a>.
3. Questions on systems matters may be directed to: Paul Gettys,
Acting Director, Indian Health Service, Division of Grants Management,
5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Phone: (301)
443-2114; or the DGM main line (301) 443-5204, E-Mail:
<a href="/cdn-cgi/l/email-protection#6838091d04462f0d1c1c111b2801001b460f071e">[email&#160;protected]</a>.

VIII. Other Information

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

Elizabeth A. Fowler,
Acting Director, Indian Health Service.
[FR Doc. 2021-16281 Filed 7-29-21; 8:45 am]
BILLING CODE 4165-16-P

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This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.