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Notice2023-06455

Addressing Dementia in Indian Country: Models of Care

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Published

March 29, 2023

Issuing agencies

Health and Human Services DepartmentIndian Health Service

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<title>Federal Register, Volume 88 Issue 60 (Wednesday, March 29, 2023)</title>
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[Federal Register Volume 88, Number 60 (Wednesday, March 29, 2023)]
[Notices]
[Pages 18558-18567]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-06455]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Addressing Dementia in Indian Country: Models of Care

Announcement Type: New.
Funding Announcement Number: HHS-2023-IHS-ALZ-0001.
Assistance Listing (Catalog of Federal Domestic Assistance or CFDA)
Number: 93.933.

Key Dates

Application Deadline Date: June 27, 2023.
Earliest Anticipated Start Date: August 11, 2023.

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting applications for
cooperative agreements for Addressing Dementia in Indian Country. This
program is authorized under the Snyder Act, 25 U.S.C. 13; the Transfer
Act, 42 U.S.C. 2001(a); and the Indian Health Care Improvement Act, 25
U.S.C. 1665a(c)(5)(F) and 1660e. This program is described in the
Assistance Listings located at <a href="https://sam.gov/content/home">https://sam.gov/content/home</a> (formerly
known as the CFDA) under 93.933.

Background

Alzheimer's disease and Alzheimer's disease-related dementias
affect lives in every Tribal and Urban Indian community. Alzheimer's
disease is the most common cause of dementia--a progressive cognitive
impairment that adversely affects function. Other forms of dementia
include vascular dementia, Lewy-Body Disease, Fronto-Temporal

[[Page 18559]]

Dementia, alcohol-related dementia, dementia related to traumatic brain
injury, and mixed dementia (attributable to more than one cause of
cognitive impairment). Age is the most significant risk factor for
Alzheimer's disease. Although the average age of the American Indian
and Alaska Native (AI/AN) population is younger than the United States
(U.S.) average population as a whole, the AI/AN group ages 65 and older
is growing more rapidly than the U.S. population. The Centers for
Disease Control and Prevention (CDC) notes that the number of AI/AN
aged 65 and older is expected to triple in the next 30 years, with the
oldest--those 85 years and older--increasing even more rapidly. While
age is the most substantial risk factor for Alzheimer's disease, early-
onset occurs in younger populations and in persons with Down Syndrome
or Trisomy 21, who are at markedly increased risk for Alzheimer's
Disease. Conditions such as diabetes, cardiovascular disease, chronic
kidney disease, chronic liver disease, and traumatic brain injury
increase the risk of dementia and can lead to a more rapid worsening.
Dementia of all types is under-recognized, underdiagnosed, and
undertreated in all populations in the U.S., and anecdotal evidence
suggests this is very much true for the AI/AN population. Many
individuals go unrecognized in the community, never seeking care and
living with impaired cognition that puts them at risk for financial
exploitation, poor health outcomes, and accidental injury. Individuals
and their families may not recognize the cognitive changes that
dementia brings. They may think the changes are due to normal aging or
may accept the changes and not seek care out of concern for the elder's
dignity. Failure to recognize dementia may also stem from the stigma
associated with dementia and from a lack of awareness of the resources
available. Often it takes a crisis or illness to bring attention to the
condition. Diagnosis of dementia is most often made in the primary care
office or clinic, with specialty referral needed when the presentation
is not typical or apparent. But primary care providers may lack the
confidence or knowledge to make the diagnosis or plan effective care.
They also may not have access to an interdisciplinary team to support
care or specialists through consultation or referral to support
diagnosis and management decisions. Effective management of dementia
crosses many boundaries, involving medical care, personal care, social
services, legal and financial services, and housing. Management of
dementia requires coordination between clinical services and community-
based services. Those living with dementia and their caregivers are too
often left to coordinate this complex care themselves. Most persons
living with dementia receive some care and assistance from caregivers
and sometimes from family members. Care for the person living with
dementia should include consideration for their caregivers;
unfortunately, this is not common.
Effective models for addressing dementia in Tribal and Urban Indian
communities will be supported by evidence and will emerge through
development or adaptation and evaluation from those communities. A
recent report by the Agency for Healthcare Research and Quality and the
National Academies of Science, Engineering, and Medicine points to the
Resources for Enhancing Alzheimer's Caregiver Health II (REACH II)
caregiver support intervention and models of coordinated care as
interventions that have evidence for benefit and are ready for
implementation and further evaluation.\1\ The REACH into Indian Country
initiative successfully trained public and community health nurses to
provide the REACH intervention in Tribal communities. Communities
across the country, including some Tribal communities, use the
Dementia-Friendly Communities approach to building community-based
efforts to improve care for persons living with dementia and their
families.\2\ A large number of evidence-based programs have been
cataloged online.\3\ The Alzheimer's and Dementia Care Program is one
example of an evidence-based program that works with primary care
providers to provide comprehensive and coordinated care to persons
living with dementia and their caregivers.\4\ The Healthy Brain
Initiative Roadmap for Indian Country, developed by the CDC and the
Alzheimer's Association, is designed to support discussion about
dementia and caregiving with Tribal communities and encourage a public
health approach as part of a larger holistic response.\5\ These and
other models and resources can help inform the design of Tribal and
Urban Indian health models.
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\1\ National Academies of Sciences, Engineering, and Medicine.
2021. Meeting the challenge of caring for persons living with
dementia and their care partners and caregivers: A way forward.
Washington, DC: The National Academies Press. <a href="https://doi.org/10.17226/26026">https://doi.org/10.17226/26026</a>.
\2\ Dementia Friendly America <a href="https://www.dfamerica.org">https://www.dfamerica.org</a> <a href="https://iasquared.org/news-release-ia2-is-now-a-national-dementia-friends-sub-licensee-for-american-indian-and-alaska-native-tribal-communities/">https://iasquared.org/news-release-ia2-is-now-a-national-dementia-friends-sub-licensee-for-american-indian-and-alaska-native-tribal-communities/</a>.
\3\ Best Practice Caregiving online database. <a href="https://bpc.caregiver.org/#searchPrograms">https://bpc.caregiver.org/#searchPrograms</a>.
\4\ The Alzheimer's and Dementia Care Program. <a href="https://www.adcprogram.org/">https://www.adcprogram.org/</a>.
\5\ Centers for Disease Control and Prevention. Road Map for
Indian Country. <a href="https://www.cdc.gov/aging/healthybrain/indian-country-roadmap.html">https://www.cdc.gov/aging/healthybrain/indian-country-roadmap.html</a>.
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Purpose

The purpose of this program is to support the development of models
of comprehensive and sustainable dementia care and services in Tribal
and Urban Indian communities that are responsive to the needs of
persons living with dementia and their caregivers. Awardees will:
1. Plan and implement a comprehensive approach to care and services
for persons living with dementia and their caregivers that addresses:
a. Awareness and Recognition. Enhance awareness and early
recognition of dementia in the community and increase referral to
clinical care for evaluation leading to diagnosis. The U.S. Preventive
Services Task Force has concluded that ``current evidence is
insufficient to assess the benefits and harms of screening for
cognitive impairment in older adults.'' Still, there is broad consensus
supporting case finding to promote early recognition and diagnosis of
dementia.
b. Accurate and Timely Diagnosis. Individuals and their families
should have confidence that concerns about potential cognitive
impairment will be evaluated thoroughly and lead to an accurate and
timely diagnosis. Most diagnoses of dementia can be made in primary
care, but clinical programs should have referral and consultation
mechanisms in place (either in person or via telehealth) to support
diagnosis when needed.
c. Interdisciplinary Assessment. Persons living with dementia will
have complex and evolving care needs. An interdisciplinary assessment
helps identify goals of care and gaps in services and sets the stage
for appropriate care and services. In best practice, this assessment
includes an attempt to understand the cultural, religious, and personal
values that will guide goals and preferences for care. It assesses
family and other caregiving resources, the needs and capabilities of
those partners in care, and housing security and safety risks.
d. Management and Referral. Care for the person living with
dementia is guided by the assessment and most often requires
coordination of health care and social services to meet their

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needs and support caregivers. Those living with dementia and their
caregivers often need support and assistance navigating the various
systems providing this care.
e. Support for Caregivers. Care for persons living with dementia
includes care for their caregivers. Families and other caregivers need
help navigating services and mobilizing respite care, help in
understanding what to expect and how to respond to the challenges of
living with dementia, and support for self-care. Interventions that
provide that care and support (e.g., REACH) and provide education and
training (e.g., Savvy Caregiver) have been adapted for use in Tribal
communities.
2. Develop, in collaboration with the IHS Alzheimer's Grant
Program, best and promising practices to include tools, resources,
reports, and presentations accessible to Federal, Tribal, and Urban
Indian health programs as they plan and implement their own programs.
3. Identify and implement reimbursement and funding streams that
will support service delivery and facilitate sustainability.
Opportunities for reimbursement and funding streams are dependent on
the specific interventions planned, but potential sources might
include:
a. Medicare reimbursement through the Physician Fee Schedule,
including Cognitive Assessment and Planning codes and Chronic and
Complex Care Management codes.
b. Medicaid and other state programs.
c. Purchased and Referred Care resources.
d. IHS and Third Party Revenue.
The IHS Alzheimer's Grant Program in the IHS Division of Clinical
and Community Services (DCCS) will provide technical assistance to
grantees in the development of a plan for sustainability.

Required, Optional, and Allowable Activities

Awardees must plan to participate in regular (not more than
monthly) web-based opportunities to share their experience and
expertise with other awardees and to participate in at least one
annual, one to two day in-person meeting in a location to be
determined. In addition, optional training and technical assistance
opportunities will be provided.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
The total funding identified for fiscal year (FY) 2023 is
approximately $1.2 million. Individual award amounts for the first
budget year are anticipated to be between $100,000 and $200,000. The
funding available for competing and subsequent continuation awards
issued under this announcement is subject to the availability of
appropriations and budgetary priorities of the Agency. The IHS is under
no obligation to make awards that are selected for funding under this
announcement.
Anticipated Number of Awards
Approximately six awards will be issued under this program
announcement.
Period of Performance
The period of performance is for 2 years.
Cooperative Agreement
Cooperative agreements awarded by the Department of Health and
Human Services (HHS) are administered under the same policies as
grants. However, the funding agency, IHS, is anticipated to have
substantial programmatic involvement in the project during the entire
period of performance. Below is a detailed description of the level of
involvement required of the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
1. The IHS DCCS Alzheimer's Grant Program, will collaborate with
recipients throughout the process of project planning and
implementation and assist in the identification of tools, resources,
reports, and presentations for dissemination to other Tribal, IHS, and
Urban Indian health programs. The IHS will also provide technical
assistance in evaluation plan implementation and developing a
sustainability plan, as needed.
2. The IHS will convene recipients periodically, not more often
than monthly, to share ideas, strategies, and tools to accelerate
design and implementation progress.
3. The IHS will link recipients with Federal agencies and non-
governmental organizations working to improve the care of persons
living with dementia and their caregivers.
4. The IHS will coordinate reporting (e.g., identified metrics
utilized, achieved goals, identified best practices, etc.) and
technical assistance (e.g., programmatic support to Tribal communities)
as required.

III. Eligibility Information

1. Eligibility

To be eligible for this funding opportunity, an applicant cannot be
an existing awardee under the Addressing Dementia in Indian Country
program. Also, under this announcement, an applicant must be one of the
following as defined under 25 U.S.C. 1603:
<bullet> 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.
<bullet> 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(l)): ``Tribal organization'' means the recognized
governing body of any Indian Tribe; any legally established
organization of Indians which is controlled, sanctioned, or chartered
by such governing body or which is democratically elected by the adult
members of the Indian community to be served by such organization and
which includes the maximum participation of Indians in all phases of
its activities: provided that, in any case where a contract is let or
grant made to an organization to perform services benefiting more than
one Indian Tribe, the approval of each such Indian Tribe shall be a
prerequisite to the letting or making of such contract or grant.
Applicant shall submit letters of support and/or Tribal Resolutions
from the Tribes to be served.
<bullet> An Urban Indian organization, as defined by 25 U.S.C.
1603(29). The term ``Urban Indian organization'' means a nonprofit
corporate body situated in an urban center, governed by an Urban Indian
controlled board of directors, and providing for the maximum
participation of all interested Indian groups and individuals, which
body is capable of legally cooperating with other public and private
entities for the purpose of performing the activities described in 25
U.S.C. 1653(a). Applicants must provide proof of

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nonprofit status with the application, e.g., 501(c)(3).
The Division of Grants Management (DGM) will notify any applicants
deemed ineligible.

Note: Please refer to Section IV.2 (Application and Submission
Information/Subsection 2, Content and Form of Application
Submission) for additional proof of applicant status documents
required, such as Tribal Resolutions, proof of nonprofit status,
etc.

2. Cost Sharing or Matching

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

3. Other Requirements

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

IV. Application and Submission Information

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

1. Obtaining Application Materials

The application package and detailed instructions for this
announcement are available at <a href="https://www.Grants.gov">https://www.Grants.gov</a>.
Please direct questions regarding the application process to
<a href="/cdn-cgi/l/email-protection#f1b5b6bcb1989982df969e87">[email&#160;protected]</a>.

2. Content and Form Application Submission

Mandatory documents for all applicants include:
<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.
4. Project Abstract Summary form (one page).
<bullet> Project Narrative (not to exceed 10 pages). See Section
IV.2.A, Project Narrative for instructions.
<bullet> Budget Narrative (not to exceed five pages). See Section
IV.2.B, Budget Narrative for instructions.
<bullet> Work plan chart.
<bullet> Tribal Resolution(s) as described in Section III,
Eligibility, if applicable.
<bullet> Letters of Support from organization's Board of Directors
(optional).
<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), if applicant
conducts reportable lobbying.
<bullet> Certification Regarding Lobbying (GG-Lobbying Form).
<bullet> Copy of current Negotiated Indirect Cost (IDC) rate
agreement (required in order to receive IDC).
<bullet> Organizational Chart.
<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://facdissem.census.gov/">https://facdissem.census.gov/</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
10 pages and must: (1) have consecutively numbered pages; (2) use black
font 12 points or larger (applicants may use 10 point font for tables);
(3) be single-spaced; and (4) be formatted to fit standard letter paper
(8-1/2 x 11 inches). Do not combine this document with any others.
Be sure to succinctly answer all questions listed under the
evaluation criteria (refer to Section V.1, Evaluation Criteria) and
place all responses and required information in the correct section
noted below or they will not be considered or scored. If the narrative
exceeds the overall page limit, the reviewers will be directed to
ignore any content beyond the page limit. The 10-page limit for the
project narrative does not include the accompanying work plan, standard
forms, Tribal Resolutions, budget, budget narratives, and/or other
items. Page limits for each section within the project narrative are
guidelines, not hard limits.
There are three parts to the project 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.

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Part 1: Program Information (Limit--4 Pages)
Section 1: Tribal or Organizational Overview
Provide a brief description of the Tribe, Tribal organization, or
Urban Indian health program, health care delivery system and resources,
elderly services and resources, long-term services and supports, and
other Tribal or community-based services that might be involved.
Section 2: Needs
Provide any data available about the number of persons living with
dementia, their needs, and the needs of their caregivers. If data is
not currently available, indicate this here and in Part 2 below, and
describe in detail how the applicant will obtain or develop this data
in the first year of the program.
Section 3: Other Funded Initiatives
Provide information about other funded initiatives addressing
dementia that the applicant is or will be participating in that are
relevant to this proposal. Indicate any HHS grants addressing dementia
(e.g., Dementia Capability in Indian Country Grant program of the
Administration for Community Living) the applicant has been awarded
whose period of performance may overlap the period of performance of
this grant opportunity.
Part 2: Program Planning and Evaluation (Limit--4 Pages)
Section 1: Program Plans
Describe fully and clearly the applicant's plan to implement a
comprehensive approach to care and services for persons living with
dementia and their caregivers and identify funding streams that will
support service delivery. State the purpose, goals, and objectives of
your proposed project. The plan should include a vision for a
comprehensive approach to care, recognizing that achieving the fully
implemented approach may not be feasible within the period of
performance.
Section 2: Program Evaluation
Describe fully and clearly the methods, data sources, and measures
that will be used to monitor the progress of the proposed activities
and determine effectiveness in implementing the plan and progress
towards achieving goals as described in Section 1. The evaluation plan
should include the specific measures, e.g., outputs and outcomes that
will be used to assess achievement. The evaluation plan should, at a
minimum, include performance measures about the number of persons newly
diagnosed with dementia, the number of persons living with a pre-
existing dementia diagnosis, screening measures, and case finding
efforts among their patient population. If the applicant intends to
obtain or develop data about the needs of persons living with dementia
and the needs of their caregivers as an element of this award, the
applicant should indicate those data elements and describe how that
data will be developed or acquired in the first year.
Part 3: Program Report (Limit--2 Pages)
Section 1
Identify and describe your organization's significant program
activities and accomplishments within the past five years associated
with developing and implementing clinical or community care and support
services for people living with dementia and their caregivers, if any.
Provide a comparison of actual accomplishments to the established
goals, where relevant. If applicable, provide justification for the
lack of or limited progress.
Section 2: Sharing With Other Tribes, Tribal Organizations, and Urban
Indian Organizations
Describe how your program will develop and share, in collaboration
with the IHS, best and promising practices that include tools,
resources, reports, and presentations accessible to stakeholders across
the Tribal health system including Tribal and Urban Indian health
partners.
B. Budget Narrative (Limit--5 Pages)
Provide a budget narrative table that explains the amounts
requested for each line item of the budget from the SF-424A (Budget
Information for Non-Construction Programs) for the first year of the
project. The applicant can submit with the budget narrative a more
detailed spreadsheet than is provided by the SF-424A (the spreadsheet
will not be considered part of the budget narrative). The budget
narrative should specifically describe how each item would support the
achievement of proposed objectives. Be very careful about showing how
each item in the ``Other'' category is justified. Do NOT use the budget
narrative to expand the project narrative.
3. Submission Dates and Times
Applications must be submitted through <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 <a href="https://www.Grants.gov">https://www.Grants.gov</a>). If problems persist, contact
Mr. Paul Gettys (<a href="/cdn-cgi/l/email-protection#a7e3e0eae7cecfd489c0c8d1">[email&#160;protected]</a>), Deputy Director, DGM, by telephone at
(301) 443-2114. Please be sure to contact Mr. Gettys at least 10 days
prior to the application deadline. Please do not contact the DGM until
you have received a <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.
The IHS will not acknowledge receipt of applications.
4. Intergovernmental Review
Executive Order 12372 requiring intergovernmental review is not
applicable to this program.
5. Funding Restrictions
<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 may 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 you cannot submit an application through <a href="http://Grants.gov">Grants.gov</a>, you must
request a waiver prior to the application due date. You must submit
your waiver request by email to <a href="/cdn-cgi/l/email-protection#e5a1a2a8a58c8d96cb828a93">[email&#160;protected]</a>. Your waiver request must
include clear justification for the need to deviate from the required
application submission process. The IHS will not accept any
applications submitted through any means outside of <a href="http://Grants.gov">Grants.gov</a> without
an approved waiver.
If the DGM approves your waiver request, you will receive a
confirmation of approval email containing submission instructions. You
must include a copy of the written approval with the application
submitted to the DGM. Applications that do not include a copy of the
signed waiver from the Deputy Director of the DGM will not be reviewed.
The Grants Management Officer of the DGM will notify the applicant via
email of this decision.

[[Page 18563]]

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 <a href="https://www.Grants.gov">https://www.Grants.gov</a>).
<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, you 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 you that the application has
been received.
System for Award Management
Organizations that are not registered with SAM must access the SAM
online registration through the SAM home page at <a href="https://sam.gov">https://sam.gov</a>.
Organizations based in the U.S. will also need to provide an Employer
Identification Number from the Internal Revenue Service that may take
an additional two to five 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://sam.gov">https://sam.gov</a>.
Unique Entity Identifier
Your <a href="http://SAM.gov">SAM.gov</a> registration now includes a Unique Entity Identifier
(UEI), generated by <a href="http://SAM.gov">SAM.gov</a>, which replaces the DUNS number obtained
from Dun and Bradstreet. <a href="http://SAM.gov">SAM.gov</a> registration no longer requires a DUNS
number.
Check your organization's <a href="http://SAM.gov">SAM.gov</a> registration as soon as you
decide to apply for this program. If your <a href="http://SAM.gov">SAM.gov</a> registration is
expired, you will not be able to submit an application. It can take
several weeks to renew it or resolve any issues with your registration,
so do not wait.
Check your <a href="http://Grants.gov">Grants.gov</a> registration. Registration and role
assignments in <a href="http://Grants.gov">Grants.gov</a> are self-serve functions. One user for your
organization will have the authority to approve role assignments, and
these must be approved for active users in order to ensure someone in
your organization has the necessary access to submit an application.
The Federal Funding Accountability and Transparency Act of 2006, as
amended (``Transparency Act''), requires all HHS awardees to report
information on sub-awards. Accordingly, all IHS awardees must notify
potential first-tier sub-awardees that no entity may receive a first-
tier sub-award unless the entity has provided its UEI number to the
prime awardee organization. This requirement ensures the use of a
universal identifier to enhance the quality of information available to
the public pursuant to the Transparency Act.
Additional information on implementing the Transparency Act,
including the specific requirements for SAM, are available on the DGM
Grants Management, Policy Topics web page at <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 project narrative and budget narrative should include only the
first year of activities. The project narrative should be written in a
manner that is clear to outside reviewers unfamiliar with prior related
activities of the applicant. It should be well organized, succinct, and
contain all information necessary for reviewers to fully understand the
project. Attachments requested in the criteria do not count toward the
page limit for the narratives. Points will be assigned to each
evaluation criteria adding up to a total of 100 possible points. Points
are assigned as follows:

1. Evaluation Criteria

A. Introduction and Need for Assistance (10 Points)
1. Description of the clinical services, elder services and
resources, long-term care services, and supports available through the
applicant's organization, either as a direct service or through
agreement, contract, or Purchased and Referred Care (PRC). Applicants
must be able to provide ambulatory care services directly or through
coordination with IHS Direct Services and must be able to coordinate
with elder services.
2. Description of the number of individuals living with dementia to
be served, any data available about the prevalence of risk factors for
dementia (including age as reflected in the population's demographics),
and any limitations of the data available.
3. Identification of the most urgent and pressing gaps in
availability or quality of care and services for persons living with
dementia and their families. If this information is not available, the
acquisition of this information should be a detailed part of the
Project Objective(s), Work Plan, and Approach.
4. If the applicant is the recipient of other HHS grants that will
provide funding to address dementia over the same time period (e.g.,
Dementia Capability in Indian Country Grant program of the
Administration for Community Living), address how funding under this
opportunity will address the need without overlapping the activities of
other funded awards, if applicable.
B. Project Objective(s), Work Plan, and Approach (30 Points)
1. The overall vision for a comprehensive approach to care and
services for persons living with dementia and their caregivers,
including:
<bullet> Awareness and recognition.
<bullet> Timely and accurate diagnosis.
<bullet> Multidisciplinary assessment.
<bullet> Management and referral.
<bullet> Caregiver Support.
2. The elements of this vision that the awardee anticipates
implementing, including planning activities and assessment of need, if
not already available.
3. Describe the approach to accomplishing the work plan, including
planning activities and assessment of need, if not already available.
This work plan should be responsive to the most urgent and pressing
gaps in availability and quality of care and services for persons
living with dementia and their families. This work plan must include,
at minimum, both the provision of clinical services, either directly or
through coordination with IHS Direct Services, and the engagement of
elder services.
4. The accompanying work plan and approach should include
developing

[[Page 18564]]

tools, resources, reports, and presentations to support the development
of programs by other Tribes, Tribal organizations, or Urban Indian
health programs.
5. If the applicant is the recipient of other HHS grants that will
provide funding to address dementia over the same time period (e.g.
Dementia Capability in Indian Country Grant program of the
Administration for Community Living), indicate how the work plan and
approach supported through this funding will complement and not
supplant or overlap that already-funded work.
C. Program Evaluation (30 Points)
1. Clearly identify a goal or goals and plans for program
evaluation to ensure that the objectives of the program are met at the
conclusion of the period of performance.
2. Include SMART (Specific, Measurable, Achievable, Relevant and
Time-based) objectives to establish a specific set of evaluation
criteria to ensure the goals are attainable within the period of
performance.
3. Evaluation should include metrics that provide insight into the
implementation of those elements of a comprehensive approach to care
and services for persons living with dementia and their families that
the applicant has proposed to implement. The evaluation plan should
include metrics about the number of persons newly diagnosed, persons
living with a pre-existing dementia diagnosis, screening measures, and
case finding efforts among their patient population. The evaluation
should also include metrics for important outcomes of care for persons
living with dementia and their family or caregiver(s), such as
avoidance of crisis-driven care (e.g., emergent transfers and undesired
out-of-home placement) and processes of care that contribute to better
outcomes (e.g., reduction of medications that impair cognition). If the
applicant intends to obtain or develop new data collection methods or
metrics as an element of this award, the applicant should describe how
that data will be developed or acquired in the first year. Please refer
to the draft logic model example in the appendix as a guide.
D. Organizational Capabilities, Key Personnel, and Qualifications (20
Points)
1. Include an organizational capacity statement that demonstrates
the ability to execute program strategies within the period of
performance.
2. Project management and staffing plan. Detail that the
organization has the current staffing and expertise to address each of
the program activities. If capacity does not exist, please describe the
applicant's actions to fill this gap within a specified timeline.
3. Identify any partnerships or collaborations that will be needed
to implement the work plan and include letters of support or intent to
coordinate or collaborate with those partners.
4. Demonstrate that the applicant has previous successful
experience providing technical or programmatic support to Tribal
communities.
E. Categorical Budget and Budget Justification (10 Points)
Provide a detailed budget and accompanying narrative to explain the
activities being considered and how they are related to proposed
program objectives.
Additional documents can be uploaded as Other Attachments in
<a href="http://Grants.gov">Grants.gov</a>. These can include:
<bullet> 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> Additional documents to support narrative (i.e., data
tables, key news articles, etc.).

2. Review and Selection

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

3. Notifications of Disposition

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

Awards issued under this announcement are subject to, and are
administered in accordance with, the following regulations and
policies:
A. The criteria as outlined in this program announcement.
B. Administrative Regulations for Grants:
<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-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf</a>.
<bullet> Please review all HHS regulatory provisions for
Termination at 45 CFR 75.372, at the time of this publication located
at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf</a>.
C. Grants Policy:
<bullet> HHS Grants Policy Statement, Revised January 2007, at
<a href="https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf">https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf</a>.

[[Page 18565]]

D. Cost Principles:
<bullet> Uniform Administrative Requirements for HHS Awards, ``Cost
Principles,'' at 45 CFR part 75 subpart E, at the time of this
publication located at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf</a>.
E. Audit Requirements:
<bullet> Uniform Administrative Requirements for HHS Awards,
``Audit Requirements,'' at 45 CFR part 75 subpart F, at the time of
this publication located at <a href="https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf">https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf</a>.
F. As of August 13, 2020, 2 CFR part 200 was updated to include a
prohibition on certain telecommunications and video surveillance
services or equipment. This prohibition is described in 2 CFR part
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 awardees that request reimbursement of
IDC in their application budget. In accordance with HHS Grants Policy
Statement, Part II-27, the IHS requires applicants to obtain a current
IDC rate agreement and submit it to the DGM prior to the DGM issuing an
award. The rate agreement must be prepared in accordance with the
applicable cost principles and guidance as provided by the cognizant
agency or office. A current rate covers the applicable grant activities
under the current award's budget period. If the current rate agreement
is not on file with the DGM at the time of award, the IDC portion of
the budget will be restricted. The restrictions remain in place until
the current rate agreement is provided to the DGM.
Per 45 CFR 75.414(f) Indirect (F&A) costs,

any non-Federal entity (NFE) [i.e., applicant] that has never
received a negotiated indirect cost rate, . . . may elect to charge
a de minimis rate of 10 percent of modified total direct costs which
may be used indefinitely. As described in Section 75.403, costs must
be consistently charged as either indirect or direct costs, but may
not be double charged or inconsistently charged as both. If chosen,
this methodology once elected must be used consistently for all
Federal awards until such time as the NFE chooses to negotiate for a
rate, which the NFE may apply to do at any time.

Electing to charge a de minimis rate of 10 percent only applies to
applicants that have never received an approved negotiated indirect
cost rate from HHS or another cognizant Federal agency. Applicants
awaiting approval of their indirect cost proposal may request the 10
percent de minimis rate. When the applicant chooses this method, costs
included in the indirect cost pool must not be charged as direct costs
to the grant.
Available funds are inclusive of direct and appropriate indirect
costs. Approved indirect funds are awarded as part of the award amount,
and no additional funds will be provided.
Generally, IDC rates for IHS awardees are negotiated with the
Division of Cost Allocation 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 write to <a href="/cdn-cgi/l/email-protection#de9a99939eb7b6adf0b9b1a8">[email&#160;protected]</a>.

3. Reporting Requirements

The awardee must submit required reports consistent with the
applicable deadlines. Failure to submit required reports within the
time allowed may result in suspension or termination of an active
award, withholding of additional awards for the project, or other
enforcement actions such as withholding of payments or converting to
the reimbursement method of payment. Continued failure to submit
required reports may result in the imposition of special award
provisions and/or the non-funding or non-award of other eligible
projects or activities. This requirement applies whether the
delinquency is attributable to the failure of the awardee organization
or the individual responsible for preparation of the reports. Per DGM
policy, all reports must be submitted electronically by attaching them
as a ``Grant Note'' in GrantSolutions. Personnel responsible for
submitting reports will be required to obtain a login and password for
GrantSolutions. Please use the form under the Recipient User section of
<a href="https://www.grantsolutions.gov/home/getting-started-request-a-user-account/">https://www.grantsolutions.gov/home/getting-started-request-a-user-account/</a>. Download the Recipient User Account Request Form, fill it out
completely, and submit it as described on the web page and in the form.
The reporting requirements for this program are noted below.
A. Progress Reports
Program progress reports are required quarterly. The progress
reports are due within 90 days after the reporting period ends
(specific dates will be listed in the NoA Terms and Conditions). A
progress report template will be provided. 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 120
days of expiration of the period of performance.
B. Financial Reports
Federal Financial Reports are due 90 days after the end of each
budget period, and a final report is due 120 days after the end of the
period of performance.
Awardees are responsible and accountable for reporting accurate
information on all required reports: the Progress Reports and the
Federal Financial Report.
Failure to submit timely reports may result in adverse award
actions blocking access to funds.
C. Data Collection and Reporting
The grantee will participate in periodic (not more frequently than
monthly) web-based calls with the program office or designee and the
other recipients to share their progress, experience, and tools and
resource that might be useful for other recipients. The grantee will be
expected to work with the program office to develop a driver diagram
(an action-oriented logic model) that describes the comprehensive
approach to care and services for persons living with dementia and
their caregivers and identifies key performance metrics based on their
evaluation plan.
The grantee will be expected to share, on a quarterly basis, the
tools, resources, reports, and presentations produced that may support
the development of programs by other Tribes, Tribal organizations, or
Urban Indian health programs.
D. Federal Sub-Award Reporting System (FSRS)
This award may be subject to the Transparency Act sub-award and
executive compensation reporting requirements of 2 CFR part 170.
The Transparency Act requires the OMB to establish a single
searchable database, accessible to the public, with information on
financial assistance awards made by Federal agencies. The Transparency
Act also includes a requirement for awardees of Federal grants to
report information about first-tier sub-awards and executive
compensation under Federal assistance awards.
The IHS has implemented a Term of Award into all IHS Standard Terms
and Conditions, NoAs, and funding announcements regarding the FSRS
reporting requirement. This IHS Term of

[[Page 18566]]

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>.
E. Non-Discrimination Legal Requirements for Awardees of Federal
Financial Assistance (FFA)
The awardee must administer the project in compliance with Federal
civil rights laws, where applicable, that prohibit discrimination on
the basis of race, color, national origin, disability, age, and comply
with applicable conscience protections. The awardee must comply with
applicable laws that prohibit discrimination on the basis of sex, which
includes discrimination on the basis of gender identity, sexual
orientation, and pregnancy. Compliance with these laws requires taking
reasonable steps to provide meaningful access to persons with limited
English proficiency and providing programs that are accessible to and
usable by persons with disabilities. The HHS Office for Civil Rights
provides guidance on complying with civil rights laws enforced by HHS.
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="https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html">https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html</a>.
<bullet> Recipients of FFA must ensure that their programs are
accessible to persons with limited English proficiency. For guidance on
meeting your legal obligation to take reasonable steps to ensure
meaningful access to your programs or activities by limited English
proficiency individuals, see <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>.
<bullet> For information on your specific legal obligations for
serving qualified individuals with disabilities, including reasonable
modifications and making services accessible to them, see <a href="https://www.hhs.gov/civil-rights/for-individuals/disability/index.html">https://www.hhs.gov/civil-rights/for-individuals/disability/index.html</a>.
<bullet> HHS funded health and education programs must be
administered in an environment free of sexual harassment. 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>.
<bullet> For guidance on administering your program in compliance
with applicable Federal religious nondiscrimination laws and applicable
Federal conscience protection and associated anti-discrimination laws,
see <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>.
<bullet> 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.
F. Federal Awardee Performance and Integrity Information System
(FAPIIS)
The IHS is required to review and consider any information about
the applicant that is in the FAPIIS at <a href="https://www.fapiis.gov/fapiis/#/home">https://www.fapiis.gov/fapiis/#/home</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. The IHS will consider any
comments by the applicant, in addition to other information in FAPIIS,
in making a judgment about the applicant's integrity, business ethics,
and record of performance under Federal awards when completing the
review of risk posed by applicants, as described in 45 CFR 75.205.
As required by 45 CFR part 75 Appendix XII of the Uniform Guidance,
NFEs are required to disclose in FAPIIS any information about criminal,
civil, and administrative proceedings, and/or affirm that there is no
new information to provide. This applies to NFEs that receive Federal
awards (currently active grants, cooperative agreements, and
procurement contracts) greater than $10 million for any period of time
during the period of performance of an award/project.
Mandatory Disclosure Requirements
As required by 2 CFR part 200 of the Uniform Guidance, and the HHS
implementing regulations at 45 CFR part 75, the IHS must require an NFE
or an applicant for a Federal award to disclose, in a timely manner, in
writing to the IHS or pass-through entity all violations of Federal
criminal law involving fraud, bribery, or gratuity violations
potentially affecting the Federal award.
All applicants and awardees must disclose in writing, in a timely
manner, to the IHS and to the HHS Office of Inspector General all
information related to violations of Federal criminal law involving
fraud, bribery, or gratuity violations potentially affecting the
Federal award. 45 CFR 75.113.
Disclosures must be sent in writing to:
U.S. Department of Health and Human Services, Indian Health
Service, Division of Grants Management, ATTN: Marsha Brookins,
Director, 5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857,
(Include ``Mandatory Grant Disclosures'' in subject line), Office:
(301) 443-4750, Fax: (301) 594-0899, Email: <a href="/cdn-cgi/l/email-protection#05414248456c6d762b626a73">[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#a0edc1cec4c1d4cfd2d9e7d2c1ced4c5c5e4c9d3c3cccfd3d5d2c5d3e0cfc9c78ec8c8d38ec7cfd6">[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 part 180 and 2 CFR part
376).

VII. Agency Contacts

1. Questions on the program matters may be directed to: Dr. Jolie
Crowder, National Elder Services Consultant, Office of Clinical and
Preventive Services, Division of Clinical and Community Services,
Indian Health Service, 5600 Fishers Lane, Mailstop: 08N34-A, Rockville,
MD 20857, Phone: (301) 526-6592, Fax: (301) 594-6213, Email:
<a href="/cdn-cgi/l/email-protection#dcb6b3b0b5b9f2bfaeb3abb8b9ae9cb5b4aff2bbb3aa">[email&#160;protected]</a>.
2. Questions on grants management and fiscal matters may be
directed to: Donald Gooding, Grants Management Specialist, Indian
Health Service, Division of Grants Management, 5600 Fishers Lane, Mail
Stop: 09E70, Rockville, MD 20857, Phone: (301) 443-2298, Email:
<a href="/cdn-cgi/l/email-protection#62260d0c030e064c250d0d060b0c05220b0a114c050d14">[email&#160;protected]</a>.
3. For technical assistance with <a href="http://Grants.gov">Grants.gov</a>, please contact the
<a href="http://Grants.gov">Grants.gov</a> help desk at 800-518-4726, or by email at
<a href="/cdn-cgi/l/email-protection#13606663637c6167537461727d67603d747c65">[email&#160;protected]</a>.

VIII. Other Information

The Public Health Service strongly encourages all grant,
cooperative agreement, and contract awardees 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,

[[Page 18567]]

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.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-06455 Filed 3-28-23; 8:45 am]
BILLING CODE P

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