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State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke – financed solely by Prevention and Public Health Funds - CDC-RFA-DP14-1422PPHF14

Please continue to check this FAQ page where responses will be posted as questions are received. Please check questions similar to ones you submitted, since not all questions will be posted verbatim and responses may be combined.

Click on the FAQ topic headings below to view an expanded list of questions and responses.

 

CDC appreciates your interest in this funding opportunity announcement. The FAQ section of the State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke – financed solely by Prevention and Public Health Funds - CDC-RFA-DP14-1422PPHF14 is where questions and answers from the past 12 weeks are posted. Unfortunately, the deadline to submit questions through our website was July 14, 2014 at 11:59 p.m. U.S. Eastern Daylight Time. We regret that we are no longer able to respond to questions.

For questions related to application submission please refer to the FOA. For all other questions please review the FAQ section of State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke – financed solely by Prevention and Public Health Funds - CDC-RFA-DP14-1422PPHF14.

 

CDC has received several questions asking about how to conduct a specific activity or task or what type of interventions would be appropriate for the FOA. These include questions such as:

  1. Please give an example of a "point of sale” communication strategy.
  2. Will CDC provide more information on an appropriate scope of work for the individual strategies?

We regret that we are unable to respond to these kinds of questions. The purpose of the FAQs is to provide clarification on the funding opportunity announcement, not to provide specific technical assistance.

 

Frequently Asked Questions

General

Purpose

Eligibility

Funding

Application Process

Review Process

Scoring

  • No Questions

Recipient Activities

Evaluation

Other

General


 

Please define Community Health Workers and the range of paraprofessionals that this title might include. Also, please define Community Health Care Systems and the range of health entities included.

The CHW Section of the American Public Health Association defines a CHW as a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community being served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

There are over 60 different titles for people who do the work under the umbrella title of CHW. Some of the most common titles include community health representative, outreach worker, community health advisor, promotora/promotores de salud (health promoters) peer counselor, peer coach, and patient navigators.

We want to have Co-Directors for 1422, but the application only allows one person to be designated as the Principal Investigator. What is the best way to identify this shared role?

You should identify one of the two people as the Principal Investigator and then describe the proposed Co-director arrangement in the project narrative.

What is the definition of a chain restaurant? How many restaurants constitute a chain? Are local chains included in this definition?

According to the Patient Protection and Affordable Care Act (ACA) (PL111-148) Provision 4205, a chain restaurant is a restaurant or similar retail food establishment that is part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items. Other localities, such as the Metropolitan King County Council, define chain restaurants as any restaurant with 10 or more food establishments under the same name in the United States. Please use the federal definition unless it is superseded or further restricted by a state or local definition.

My Company makes a tool that measures weight, height, BMT, etc. Could this tool be used to measure the effectiveness of this grant?

CDC does not endorse specific tools. As part of their application, grantees will propose methods to demonstrate impact on the performance measures.

Is the lead staff person listed for a component on the work plan required to be an FTE of the lead agency?

The Principal Investigator must be an employee of the funded state or city grantee, but may be part-time on this FOA. The grantee can propose different staffing arrangements for ensuring that the required work in the components are completed.

Please provide a definition for undiagnosed hypertension related to the FOA.

More than one elevated blood pressure measure within a specified timeframe.

How is the term "health care systems" defined for this FOA?

Health care systems are defined as health care delivery organizations and may include the following: Health Maintenance Organizations (HMOs), Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), Health Plans, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), Indian Health Service or Tribal Clinics, Hospital Systems with large primary care networks, Health Center Controlled Networks (HCCNs), state or local governments responsible for providing clinical care, and other clinical groups operating within the state. The health care systems must be serving the 4-8 communities selected by state grantees or the jurisdictions identified by the large city grantees.

How do you define the Principal Investigator? Is it the same as a Program Director? How is this role different than a Program Manager or Program Coordinator?

CDC defines a Principal Investigator/Project Director as the person designated by the applicant organization to direct the project or program to be supported by the grant. The PI/PD is responsible and accountable to applicant organization officials for the proper conduct of the project or program.

Can applicants apply for 2 or more of the 6 FOAs, or is it better to focus on one?

Organizations can apply for any of the FOAs for which they are eligible.

See page 48 - Phase II Review. The last five bullets under Program Management don't seem to apply to this section. Should they be under the work plan section on page 46 or deleted since they duplicate what is currently listed under the work plan section?

The last five bullets on page 48 of the Project Management section were erroneously included and should be disregarded.  Work plan criteria are listed on page 46.

How does FOA 14-1422 differ from FOA 13-1305, “State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health”?

While this program builds on and expands the work funded in “State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health,” there are some differences:

  • In addition to the general population targeted in State Public Health Actions, this program also targets priority population subgroups with uncontrolled high blood pressure or at high risk for type 2 diabetes that experience racial/ethnic or socioeconomic disparities, including inadequate access to care, poor quality of care, or low income.
  • State awardees will sub-award 50% of funding to 4-8 communities in their states to implement evidence-based whole population and priority (high burden/risk) population strategies.
  • In addition to states, large cities with populations over 900,000 may apply.
  • There are new activities to promote health and support lifestyle improvements in component 1.
  • While State Public Health Actions included school health which focused on youth, the focus of this program is adults.

How many awards will be made?

A total of 18-22 awards will be made of which 15-19 will go to states and 3-5 will go to large cities.

Is direct assistance (DA) for personnel available through this FOA?

No, DA is not available through this FOA.

What is the project period of the awards?

The project period is 4 years.

What is the start date of the awards?

Successful applicants can anticipate notice of funding by September 30, 2014 with a start date of September 30, 2014.

Do sub-recipients need to be selected and identified prior to submitting the grant proposal?

Applicants must include proposed criteria for selecting the 4-8 communities in which to focus the prevention efforts of both components, but the actual sub-recipients do not need to be included in the application. State awardees must sub-award 50% of funds to these 4-8 communities to contribute to the work and are encouraged to fully consider the capabilities of their local health departments for fulfilling the scope of work. Large city awardees are strongly encouraged to sub-award a portion of award funds to local entities to contribute to the work.

Do we need to implement a competitive process for selecting sub-recipients?

States must have an efficient and effective mechanism for making sub-awards to communities, jurisdictions, and other local organizations and for ensuring accountability of sub-awardees for demonstrating impact on the project period outcomes. The sub-recipient communities must have significant disease burden and sufficient combined populations to allow the strategies to reach significant numbers of people.  As long as this is met, the states may use their own internal procedures, competitive or otherwise, for selecting sub-recipients but must ensure their policies adhere to the guidance outlined in 45 CFR, Part 74 and 92.

The FOA requires that the communities selected for sub-awards must have significant disease burden and sufficient combined populations to allow the strategies supported by this FOA to reach significant numbers of people.  What is the definition of significant reach?  Is there a minimum number of people that must be reached?

A community in this FOA is defined as a county, Metropolitan Statistical Area (MSA), or a group of contiguous counties. A minimum target population size is not specified in the FOA since this will vary depending on the unique context of each state. The FOA also specifies that states must use data to identify populations at greatest risk and with the highest burden.  States will need to analyze this information and then, based on those data, identify communities eligible for sub-awards.  This could include rural areas and as well as more populous areas.  As long as the combined population of the 4-8 selected communities is commensurate with the total award request, the state will meet the requirements of the FOA.

How will FOA 14-1422, State and Local Public Health Actions, build on previous FOAs such as 13-1305, State Public Health Action initiatives?

Applicants must propose a cohesive work plan aligned with but not duplicative of DP13-1305 activities. The strategies in both components should be mutually reinforcing.

Is there a minimum target population size or location (for example, neighborhoods, communities, cities, states, multi-state)?

A community in this FOA is defined as a county, Metropolitan Statistical Area (MSA), or a group of contiguous counties. While a minimum target population size is not specified in the FOA, the FOA does specify that these communities must have significant disease burden and sufficient combined populations to allow the strategies supported by this FOA to reach significant numbers of people. State awardees will work within 4-8 communities in their states to implement evidence-based whole population and priority (high burden/risk) population strategies to prevent obesity, diabetes, and heart disease and stroke (through control of high blood pressure) among adults, and reduce disparities, using the program strategies in this FOA. Large city awardees will define the geographic area of focus within their jurisdiction (this may be the entire area). Applicants will propose criteria for community selection. 

What are the two components of this FOA? Can I apply for only one component?

Applicants must apply for both components. Both components must be included and be mutually reinforcing. The strategies in Component 1 are environmental and system approaches to promote health, support and reinforce healthful behaviors, and build support for lifestyle improvements. Strategies in Component 2 are health system interventions and community-clinical linkages that more directly focus on populations experiencing higher risk or disproportionate disease burden within the same geographic community as Component 1.

Can funds be used to support research?

No.

Can grantees collaborate with Prevention Research Centers on activities, such as evaluation, even though this is a non-research FOA?

Yes, grantees may collaborate with PRCs on evaluation.

Please define health equity as it relates to this FOA.

Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. (source: http://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=1&lvlid=34). Health equity as it relates to this FOA requires a strategy combining population-wide and high-risk approaches (dual action). The application should promote integrated approaches, evidence-based programs and best practices to reduce these disparities. (1305)

For the purposes of this FOA, how do you define infrastructure?

An infrastructure change includes establishing systems, procedures, and protocols within communities, institutions, and networks that support healthy behaviors. This includes improving linkages among service agencies, public health, and public health care systems. Note that this program is not authorized to conduct construction and/or modernization projects.

This FOA is focused on adults. Is the definition of adult 18 years of age and older?

Yes.

This FOA refers to CDC approved State Chronic Disease Plan. My state received funding for the Collaborative Chronic Disease, Health Promotion and Surveillance Program and one of the deliverables was a state chronic disease plan, is that what this is referring to?

Yes.

The FOA skips page numbers from 13-21, are there any pages missing?

There are no missing pages. There is a total of 59 pages. The page numbering is incorrect.

Regarding staffing, are applicants required to have all of the staffing positions identified on page 13 filled when the application is submitted or once the grant awards are made?

While applicants are required to identify staffing positions necessary to support the required activities in 1422, they are not required to have those positions filled at the time of application.  If the positions are not filled, applicants should identify a plan and proposed timeline for filling the positions should they successfully compete for an award.

The work plan sample template includes a number of elements, but is not consistent with some of the narrative descriptions.  Could you clarify?

The work plan that an applicant submits is only a portion of the full Project Narrative. Applicants must address all elements of the Project Narrative as described on pages 38-41 of this FOA, including a work plan.  The requested milestones are reflected in the sample work plan template as key, specific Activities which are time-phased (proposed Activity Completion Date).  The sample work plan template has a column to list Person Responsible. Whereas the narrative portion of the Project Narrative requires a succinct description of roles and functions, along with administration and assessment processes.

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Purpose


 

On page 10 of full announcement towards the top of the page it states “Applicants must address both components and all strategies”. But in the next paragraph it states that “Applicants should describe how selected strategies align with state priorities”.   Please clarify if indeed we must address all strategies.  What did CDC mean by “selected strategies” if we must select all?

Yes, applicants must address all strategies as depicted on the top of page 10 of the full announcement. The next paragraph occurs under “Collaborations with CDC funded programs”.  Applicants are expected to collaborate with other related CDC funded programs that can assist in achieving the outcomes of 1422. The context of the next paragraph relates to how particular strategies selected by the applicant for 1422 are aligned with other CDC funded programs. So, while the applicant must address all strategies in the 1422 application, the applicant is also expected to demonstrate in the application how some of these strategies are coordinated or working together with other CDC funded programs.

What is the purpose of the new Funding Opportunity Announcement (FOA)?

The purpose of the new FOA is to support implementation of population-wide and priority (high burden/risk) population approaches to prevent obesity, diabetes, and heart disease and stroke (through control of high blood pressure) and reduce health disparities in these areas among adults.  

What are the anticipated outcomes of this FOA?

The short-term outcomes are:

  • Increased community and large city environments that promote and reinforce healthful behaviors and practices related to obesity, diabetes prevention, cardiovascular health, including key settings that support physical activity and healthful foods and beverages.
  • Increased use and reach of strategies to build support for lifestyle change
  • Improved quality, effective delivery and use of clinical and other preventive services to increase  management of hypertension and prevention of type 2 diabetes
  • Increased community clinical linkages to support self-management and control of hypertension and prevention of type 2 diabetes

The intermediate outcomes are:

  • Increased consumption of nutritious food and beverages and increased physical activity
  • Increased engagement in lifestyle change
  • Improved medication adherence for adults with high blood pressure
  • Increased self-monitoring of high blood pressure tied to clinical support
  • Increased referrals to and enrollments in lifestyle change programs

The long-term outcomes are:

  • Reduce death and disability due to diabetes, heart disease and stroke by 3% in the implementation area
  • Reduce the prevalence of obesity by 3% in the implementation area.

What is meant by priority populations in this FOA?

High risk, high burden populations are referred to as “priority populations” and are those population subgroups with pre-diabetes or uncontrolled high blood pressure who experience racial/ethnic or socioeconomic health disparities including inadequate access to care, poor quality of care, or low income.

Do public institutions include public colleges?

Yes.

Under the Strategies and Activities section (page 10) of the FOA it states “Applicants must address both components and all strategies”. However, in the Collaborations with CDC funded programs section below it states “Applicants should describe how selected strategies align with state priorities”.  Do we need to address all strategies?

Yes, applicants must address all strategies as depicted on the top of page 10 of the full announcement. The next paragraph occurs under “Collaborations with CDC funded programs”.  Applicants are expected to collaborate with other related CDC funded programs that can assist in achieving the outcomes of 1422. The context of the next paragraph relates to how particular strategies selected by the applicant for 1422 are aligned with other CDC funded programs. So, while the applicant must address all strategies in the 1422 application, the applicant is also expected to demonstrate in the application how some of these strategies are coordinated or working together with other CDC funded programs.

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Eligibility


 

We are a county health department serving approximately 1,000,000 residents in 5 municipalities and the unincorporated county. There are no city health departments in our state. Are we eligible to apply in a fashion similar to the Large City Health Department designation?

No.

My state is a "home rule" state, in that case would a LHD be eligible as a bona fide agent of a State Health Department?

No. Only the state health department or its bone fide agent is eligible.

The eligibility statement clearly describes the requirements for large city and state departments of health. Is a COUNTY health department in a county with a population over 900,000 eligible to apply for the grant, assuming it is in partnership with and provides a letter of support from the state department of health? Can a county taxing district that provides health insurance coverage to county residents apply for the grant?

The only county health departments eligible to apply for this grant are those serving one of the ten eligible large cities. County taxing districts are not eligible to apply.

Is a local Department of Veterans Affairs eligible for a 1422 grant?

Eligibility for 1422 funds is limited to State health departments or their bona fide agents (includes the District of Columbia) and selected Large city health departments or their bona fide agents, with populations of at least 900,000 (using July 2012 U.S. Census Estimates). However, the local Department of Veterans Affairs might be eligible for a sub-award from a state if the state was selected for a 1422 award, and if the state identified the community where the local VA is located as one of the 4-8 communities they planned to target with these grant funds.  

If a Metropolitan Statistical Area (MSA) covers a 4 county area and there are multiple city health departments but no county health departments within the MSA, can a state sub-award to only the largest city health department and limit jurisdiction to that city?  

Yes, the largest city health department within an MSA could be a sub-awardee and could limit jurisdiction to the city. State awardees must subaward 50% of funds to 4-8 communities to contribute to the work and are encouraged to fully consider the capabilities of their local health departments for fulfilling the scope of work. Large city awardees are strongly encouraged to sub-award a portion of award funds to local entities to contribute to the work. The primary recipient of this funding will have major responsibility for providing leadership and technical assistance to selected communities and will ensure overall coordination.

If a Metropolitan Statistical Area (MSA) covers a 4 county area and there are multiple city health departments but no county health departments, can one entity apply for a sub-award on behalf of the MSA or a county within the MSA?  Would that entity have to provide jurisdiction for the entire MSA, or could they limit it to a portion of the jurisdiction? 

Sub-awards can be made up of groups of contiguous counties, including all or a subset of counties within an MSA. The state grantee will determine the criteria for sub-awards, but the state may choose to allow sub-awardees to limit jurisdiction within a county, MSA, or group of contiguous counties.

Will a multi-state proposal from several states with a few eligible counties be accepted?

We are only accepting applications from individual states and large cities.  States may collaborate post-award.

The FOA calls for applicants to propose criteria to select 4-8 communities in which to focus the prevention efforts of both components. A community in this FOA is defined as a county, Metropolitan Statistical Area (MSA), or a group of contiguous counties. My state has 3 counties and one MSA, which is the same area as one of the 3 counties. An award would allow us to cover the entire state but would not have the minimum of 4 "communities" as defined in the FOA. Is this a problem that can be addressed?  

Yes. Your state is eligible to apply and propose to include the three counties in the state as sub-awardees. This meets the intent of this provision which was to ensure that the selected communities have significant disease burden and sufficient combined populations to allow the strategies supported by this FOA to reach significant numbers of people.

Does a large health district with over 900,000 residents that is not a city qualify for this grant? The health district has a population of over 1.1 million residents. Although not a city by statute, the health district operates independently from the state health department.

No.  Only large cities with populations over 900,000 are eligible to apply in the large city category of this FOA (DP14-1422). A state could propose to work with all or a portion of the health district as a sub-awardee.

Who is eligible to apply for funding?

Eligibility for this FOA is limited to all 50 States or their bona fide agents and the District of Columbia, and Large Cities with populations over 900,000 (using July 2012 U.S. Census Estimates). The two groups will be competed separately.

Are non-profits which are not designated as a 501(c)(3) organization eligible to apply?

No.

May a non-profit foundation with 501(c)(3) designation serve as the applicant organization on behalf of an organization that does not have this designation?

No.

Regarding the definition of large cities, it currently says over 900,000. Would a health district be considered that includes a large city and two counties, but does not meet that population limit?

Health districts are not eligible to apply. The eligible applicants are:  New York City, New York; Los Angeles, California; Chicago, Illinois; Houston, Texas; Philadelphia, Pennsylvania; Phoenix, Arizona; San Antonio, Texas; San Diego, California; Dallas, Texas; and San Jose, California.

If one of those ten cities is served by a large county health department, would we need to restrict our intervention area to that city or could we include two other large cities that are included within our county? My city doesn’t have its own health department. The county provides services.

County health departments may be the applicant for those large cities that do not have independent city health departments.  However, the jurisdiction for the use of 1422 grant funds must be limited to all or part of the geographic area of the city, not of the county.

There are health department jurisdictions that include cities under 900,000, but that serve over 2 million people. Is there any intention to expand the pool to include those places?

Not at this time. We will clarify the eligibility for those large cities that are served by county health departments, but we will not expand eligibility.

There are big multi-state communities that cross state lines, where the population doesn’t exceed 900,000 on either side. Is it possible for these communities to be included directly or through some partnership method?

The state needs to have jurisdiction in the counties for which it is administering a sub-award. If both states were funded and both states chose to sub-award to a city that crosses state lines, there would be joint jurisdiction and you could join together in your efforts. The 900,000 limit is only for the large city applicants funded directly. A state may select communities of any size to be among the required 4-8 communities for the interventions.

The FOA states that eligible applicants include large city health departments or their bona fide agents with populations of at least 900,000 using the July 2012 US Census Estimates.  Can you tell us which particular city health departments are eligible?

Ten city health departments are eligible: New York, Los Angeles, Chicago, Houston, Philadelphia, Phoenix, San Antonio, San Diego, Dallas, and San Jose.

What does "bona fide agent" mean? Is a nonprofit organization that often works with government agencies eligible to apply?

Bona fide agent (BFA) or designated agent arrangements are defined by CDC as instances in which “a foundation or nonprofit organization serves as the legal agent for applying for federal grants for the state or local health agency.” Organizations designated by a state or locality as a BFA stand in place of the health agency to receive the federal grant and implement the project awarded to it.  BFA arrangements have been used by some state and local health agencies as a way to more efficiently implement a federally funded program than may be possible within a state’s administrative systems.  BFA arrangements are contrasted with traditional contract arrangements in which the state health agency enters into an agreement directly with an organization to implement all or a portion of a public health program. The state or large city health departments eligible for 1422 will make their own determinations as to whether to use a BFA to apply for funds on their behalf.

Are fiscal agents for large cities eligible to apply?

Fiscal or bona fide agents of large cities are eligible to apply.

 

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Funding


 

We have a provisional indirect cost rate that is effective January 2013 until amended. A new rate is under review. Will the provisional rate agreement be acceptable for the application?

Yes.

Must the budget demonstrate exact 30/70 distributions within each component (1 and 2) or is there some allowance - e.g., 26/74 - 34/66, etc.?

The budget should come as close as possible to demonstrating an overall 30/70 allocation within components. Post award, CDC will work with grantees on completing required budget formats/templates.

If CDC is going to require 1422 budgets including justifications to be loaded into a tracking template such as the one provided for 1305, can CDC please provide that template now, for use in the original applications? Since the 50/50 Component split and the 30/70 split within each Component must be reflected in the budget submitted with the applications, it would be much more cost-efficient for us to build our original budget in the eventually-desired format rather than having to reformat it all later.

A budget template is not currently available. CDC will work with grantees post award on budget formats/templates. Applicants should use the 424 A Section B format when preparing their budgets. Applicants should also use their Budget Narrative to show the overall 50/50 split and 30/70 split within each Component. Budget preparation guidelines provided on the CDC website can be used as a reference (http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm).

Can funds be used to hire and/or support Community Health Workers (CHWs) for project partners? Or does CDC discourage this use of funds and wish us to concentrate more on the systemic issues that need to be resolved to make CHWs an accepted and financially supported part of the care team?

Funds should not be used to pay CHW salaries.

Is it required to break the budget down in each area by the 50/50, 70/30? If so, how would you like to see this breakdown?

There should be one budget for the application that reflects a 50/50 split between the two components and a 70/30 split within components. The splits apply only to the overall budget and not to each line item. The activities in the proposed work plan should reflect a level of effort commensurate with the budget allocations. Specific budget formats/templates will be provided post award. Applicants should use the 424 A Section B format when preparing their budgets. Applicants should also use their Budget Narrative to show the overall 50/50 split and 30/70 split within each Component. Budget preparation guidelines provided on the CDC website can be used as a reference (http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm).

Can for-profit organizations who are part of the grant partnership/alliance receive federal grant funds in the grant budget?

Funded state and city grantees will determine who receives sub-awarded funds. As long as federal and state laws, regulations, and procedures are followed, for-profit entities may be considered for sub-awarded funds.

If it is expected that community sub-recipients adhere to the same budget guidelines as the state (i.e. the 70/30 splits in components 1 and 2) please provide budgeting guidance in instances where the state proposes to undertake specific strategies and activities on behalf of sub-recipients. Note that in such scenario the sub-recipient would not be awarded funding to work on particular strategies or activities and could therefore not adhere to the same budget guidelines as the state recipient.

If a state is proposing to undertake specific work on behalf of the 4-8 communities, then the budget allocations at the community level may be adjusted accordingly. Further guidance will be provided post award.

If an applicant plans to use some proportion of staff time currently allocated to 1305 for 1422 in order to ensure a timely start-up of 1422 activities, does that renegotiation with the project officer and PGO on 1305 have to occur prior to the submission of the 1422 application?

There cannot be an overlap of effort or salary support with other projects. If so, the overlap must be resolved before the award.

Can FOA 14-1422 funds be used to pay for meeting space for CDC recognized lifestyle change programs?

Funds may be used to pay for meeting space for up to two years only as part of supporting local organizations to become CDC recognized lifestyle change programs or to expand the capacity of existing recognized lifestyle change programs.

Can funds be used to pay for meals for either National DPP participants or lifestyle coaches?

No.  

Can FOA 14-1422 funds be used to pay for P-Stat training?

Yes, 1422 funds may be used to pay for P-Stat trainings that relate to the specific strategies in 1422.

Can FOA 14-1422 funds be used to buy equipment for data collection purposes related to implementing DPP?

Funds may be used for equipment such as computers in some limited instances. Specific requests would need to be addressed with the Procurement and Grants Office (PGO) post award.

Can FOA 14-1422 funds be used to purchase incentives items for participating participants? If yes, then what is allowed as incentives items?

Guidance on allowable incentives will be provided post award. In general, grantees should work with partners to provide appropriate incentives such as grocery store vouchers.

Can funds be used to purchase self-monitoring blood pressure devices?

No

Can sub-awardees purchase Electronic Medical Record software such as EPIC, etc.?

No.

In Section 16 on Funding Restrictions, it states that "funds may not be used for clinical care." Can you please define clinical care? Would an HbA1C be considered clinical care?

Clinical care in this FOA is defined as health care services delivered by a health care provider such as screening, medical treatment, and lab services. Paying for an HbA1C test is prohibited.

What is the maximum amount of funding that a non-profit organization can apply for? What is the duration of the grant? Is it 1-2 years? Is there is a requirement for letter of intent in order to apply for this grant?

Only states, the District of Columbia, and the following 10 cities or their bona fide agents are eligible to apply for this grant: New York, Los Angeles, Chicago, Houston, Philadelphia, Phoenix, San Antonio, San Diego, Dallas, and San Jose. The duration of the grant is 4 years and the maximum award is $4,000,000. A letter of intent is not required for this grant.

Can funds be used by state grantees or only the 4-8 communities selected by state grantees to train and reimburse Diabetes Prevention Program (DPP) Lifestyle Coaches to implement programs?

Funds can only be used to train and reimburse DPP lifestyle coaches associated with new or existing programs in the 4-8 communities selected by state grantees or in the jurisdictions specified by the 10 eligible large cities.

Can 1422 funds be used to enhance and expand upon the work of 1305? For example, our 1305 funds only allow us to do very high-level work in food pantries, but we feel that 1422 funds could allow us to do far more impactful work in this setting.

Yes, 1422 funds may be used to enhance and expand work funded by 1305 as long as there is no duplication of effort.  

The FOA states "Applicants must propose a cohesive work plan, aligned with but not duplicative of DP13-1305 activities". What is the definition of duplicative?

While some of the strategies and activities will be the same in 1305 and 1422, the scope of those activities must be clearly delineated so that they are not being paid for twice with funds from both 1305 and 1422. Activities already funded in 1305 may be expanded and scaled with 1422 funds, but the additional populations being served in 1422 must be identified, as well as the additional outcomes attributable to the expanded and scaled effort (i.e. increased reach on the performance measures).

Can funding be used to support community health workers (CHWs) to conduct linkage activities at the local level or is that considered clinical care?

Yes, community funds can be used to support CHW linkage activities with health systems. However, to promote sustainability of such efforts, priority should be given to system approaches including identifying appropriate training for community health workers, setting up policies by which workers are hired, creating or strengthening referral systems, and working with partners to identify sustained funding for the implementation of the system.

Page 11 of the FOA states, “Applicants should allocate between 5% - 10% of their total funding award to evaluation and performance monitoring.” Is it acceptable for the state budget to include half of the evaluation cost and the communities’ budgets comprise the other half?

Yes, it is fine to allocate some of the total evaluation budget to communities. The proportion that is allocated to communities should reflect the specific evaluation activities (including performance measurement) that states will be requiring communities to complete. If a state plans to conduct some of the evaluation activities/performance monitoring on behalf of the communities, they may want to allocate a smaller proportion of the total evaluation budget directly to the communities.

Page 9 of the FOA states, “State applicants must sub-award 50% of funds to 4-8 large communities.” Must the sub-awards be split equally among the selected communities, or is it acceptable for the communities to receive awards of different values? Is it acceptable for the selected communities to allocate some of their funds in sub-awards at the local level, and if so, would those entities need to adhere to the allocations requirements within Component 1 and Component 2?

The sub-awards do not need to be equally split among the 4-8 communities. Yes, selected communities may sub-award funds at the local level. In general, the allocation requirements within Components 1 and 2 should be met. Further details on handling sub-awards made by sub-awarded communities will be provided post-award.  

Regarding allocation of funds, we understand that for states 50% will be allocated to communities and the remaining funding will be split equally between component 1 (50%) and component 2 (50%). Please clarify the 70%/30% within components 1 and 2. Will the communities follow the same breakdown? Is the sample chart we provided below correct?

Total award funds must be allocated equally to components 1 and 2, including the amounts that are sub-awarded to communities. The communities will also need to follow the 30/70 split within components. The sample chart below is correct. This is one example of how states could allocate funds based on guidance in the FOA, but not the only way to allocate funds.

Sub-Award 50% to 4-8 communities (this amount must be allocated equally to components 1 and 2 in each community)
State allocates remaining 50% equally between component 1 and 2
Component 1 (50%)
Funding Allocation (this applies to both the state award and the community subawards)Environmental strategies to promote health and support and reinforce healthful behaviors

30%

  • Implement food and beverage guidelines including sodium standards (i.e., food service guidelines for cafeterias and vending) in public institutions, worksites and other key locations such as hospitals

 

 

 

 

 

 

 

70%

  • Strengthen healthier food access and sales in retail venues (e.g., grocery stores, supermarkets, chain restaurants, and markets) and community venues (e.g. food banks) through increased availability (e.g. fruit and vegetables and more low/no sodium options), improved pricing, placement, and promotion
  • Strengthen community promotion of physical activity though signage, worksite policies, social support, and joint-use agreements
  • Develop and/or implement transportation and community plans that promote walking
Strategies to build support for lifestyle change, particularly for those at high risk, to support diabetes and heart disease and stroke prevention efforts (Note: these strategies include supporting the development and implementation of CDC-recognized lifestyle change programs in targeted communities as further outlined in the recipient activity FAQs.)
  • Plan and execute strategic data-driven actions through a network of partners and local organizations to build support for lifestyle change.
  • Implement evidence-based engagement strategies (e.g. tailored communications, incentives, etc.) to build support for lifestyle change
  • Increase coverage for evidence-based supports for lifestyle change by working with network partners
COMPONENT 2 (50%)
 Health System Interventions to Improve the Quality of Health Care Delivery to Populations with the Highest Hypertension and Pre-diabetes Disparities

 

 

 

 

 

 

70%

  • Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (e.g., implement advanced Meaningful Use data strategies to identify patient populations who experience CVD- related disparities)
  • Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level (e.g., use dashboard measures to monitor healthcare disparities and implement activities to eliminate healthcare disparities)
  • Increase engagement of non-physician team members (i.e. nurses, pharmacists, nutritionists, physical therapists and patient navigators/community health workers) in hypertension management in community health care systems
  • Increase use of self-measured blood pressure monitoring tied with clinical support
  • Implement systems to facilitate identification of patients with undiagnosed hypertension and people with pre-diabetes
 Community clinical linkage strategies to support heart disease and stroke and diabetes prevention efforts

 

 

 

30%

  • Increase engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with pre-diabetes or at high risk for type 2 diabetes

 

Can funds be used to train and reimburse Diabetes Prevention Program (DPP) Lifestyle Coaches to implement programs? Can funds be used to provide participant incentives?

Within the 4-8 communities selected by state grantees and within the jurisdictions of the large city grantees, funds may be used for up to two years to support local organizations to become CDC recognized lifestyle change programs or to expand the capacity of existing recognized lifestyle change programs. During this time period, funds may be used to train and reimburse lifestyle coaches associated with these programs and funds may also be used to recruit and enroll populations at high risk for type 2 diabetes in these programs. Additional guidance on allowable participant incentives will be provided post award.  

Can a grantee fund Diabetes Self-Management Education (DSME) programs for diabetes prevention counseling regarding weight loss and physical activity as a stopgap measure until there are more CDC recognized lifestyle change programs?

DSME programs within the 4-8 communities selected by states or within the jurisdiction of the large cities may be eligible to use 1422 funds only as follows. DSME programs that have recognition or pending recognition from CDC may use funds to expand capacity for up to two years. DSME programs without CDC recognition may use funds for up to two years to pursue recognition. Funds may not be used for DSME programs to provide general diabetes prevention counseling.  

Can a state sub-award 1422 funds to a community that also receives an award under DP14-1417?

Yes, this would be allowed as long as the funded activities are complementary and not duplicative.

Can funding be used to train and reimburse Diabetes Prevention Program (DPP) Lifestyle Coaches to implement programs? Can funds be used to provide participant incentives?

Within the 4-8 communities selected by state grantees and within the jurisdictions of the large city grantees, funds may be used for up to two years to support local organizations to become CDC recognized lifestyle change programs or to expand the capacity of existing recognized lifestyle change programs.  During this time period, funds may be used to train and reimburse lifestyle coaches associated with these programs and funds may also be used to recruit and enroll populations at high risk for type 2 diabetes in these programs. Additional guidance on allowable participant incentives will be provided post award.  

Can funding be used to support CHWs in the identified communities?

Yes. Under Component 2, there are two required strategies that include CHWs. The first is to increase engagement of non-physician team members, including community health workers, in hypertension management in community health care systems. The second is to increase the engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with prediabetes or at high risk for type 2 diabetes. Using this FOA’s funds to develop a system of community health workers (i.e., identify appropriate training for community health workers, set up policies by which workers are hired, create or strengthen referral systems, and work with partners to identify sustained funding for the implementation of the system) would be an appropriate use of funds.

How should the 50/50 split be represented in the budget? There is not space in the SF-424 document. There could be staff that work in both components. What is the best way to show this?

The budget narrative is the appropriate place to show that. You will need to indicate where resources are allocated in both areas, and you can determine the best way to do that.

Should the 50/50 split between components 1 and 2 and the 30/70 split within each component be reflected in the budget submitted with the application?

Yes, we are requesting that information with the application.

Will there be a tracking tool available to track expenses for the required splits – the 50/50 between components and the 30/70 within components?

We will provide that information post-award.

Most of our current staff are working on 1305 and are funded at 100% but would also be working on this grant, if funded. Can they work on both grants?

If your current staff is funded at 100% with 1305 funds, they cannot also be funded to work on 1422. Grant funding for employees cannot exceed 100%. You should ensure that any charges across grants for any individual do not exceed 100 percent of his/her time.

Can funding be used to hire consultants?

A. Yes, hiring consultants is appropriate if your organization allows it.

Regarding the FFR, do states submit just one annual FFR that will be due 90 days after the project period ends? See pg 55 0f the FOA

The annual FFR (Federal Financial Report) is due 90 days after the end of the calendar quarter in which the budget period ends.  The budget period for 1422 will be 09/30/2014 – 09/29/2015.  Therefore the FFR will be due 12/30/2015.

How much funding is available for the FOA?

The total funding available is $280,000,000 over the four year funding period. Approximately $70 million is available for year 1 of the four-year award.   

When will funds be made available to award recipients?

Successful applicants can anticipate notice of funding by September 30, 2014 with a start date of September 30, 2014.

What will be the average funding award for awardees?

The average annual funding award will be $3 million per awardee. Award amounts may range from $2 million to $4 million a year.

Should funds be budgeted for evaluation activities?

Applicants are encouraged to work with professional evaluators (either internal or external) to meet the evaluation requirements of this FOA. Applicants should allocate between 5% -10% of their total funding award to evaluation and performance monitoring.

Can I apply for more than the ceiling listed in the FOA?

Applicants may not apply for more than the $4 million ceiling listed in the award.

Are PPHF funds used to support this FOA?

Yes.

Should travel costs for required meetings be included in the budget?

There are no required meetings for this FOA.

Are matching funds required?

Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this FOA exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Can funds be used for construction?

This program is not authorized to conduct construction and/or modernization projects. Construction projects are applicable only to "construction" funding opportunity announcements under the Public Health Service Act (PHSA), Section 307(b)(10) [Section 307(b)(10)]. This authority does not apply to "program" specific FOA's. Therefore, recipients may not use 1422 funding for construction (including, but not limited to, labor or materials). 1422 funds may be used, for example, to assess support for a community initiative and educate community members, educate intervention population members, identify requirements for facilities, and conduct planning in preparation for construction. Any funds used for construction purposes would need to be provided by another source.

Can funds be used for the purchase of equipment?

In general, funds should not be used for equipment. Funds can be used to purchase equipment that directly benefits the grant supported project or program. Such items are required by grant personnel to operationalize the proposed activities and include such items as a computer or phone. Any such proposed spending must be identified in the budget.

Is there a requirement as to how much funding I subaward?

State awardees must subaward 50% of funds to 4-8 communities to contribute to the work and are encouraged to fully consider the capabilities of their local health departments for fulfilling the scope of work. Large city awardees are strongly encouraged to sub-award a portion of award funds to local entities to contribute to the work.  Grantees must maintain sufficient funding to provide oversight and monitoring of the award.

The FOA states that we should allocate funds equally to Components 1 and 2.  Are there any allocation requirements within Components?

Yes. For budgeting purposes, approximately 30% of the funds in Component 1 should be used for strategies addressing nutrition standards, including sodium.  These funds will be tracked by the Division for Heart Disease and Stroke Prevention.  The remaining 70% of funds in component 1 should be allocated to activities related to building lifestyle change and implementing environmental strategies related to physical activity and healthier food access and sales. These funds will be tracked by the Division of Diabetes Translation.

For Component 2, approximately 30% of the funds should be used for strategies addressing the prevention of diabetes (identification of people with prediabetes, engagement of CHWs, and bi-directional referral between community resources and health systems.) These funds will be tracked by the Division of Diabetes Translation. The remaining 70% of funds in component 2 should be allocated to activities related to health systems interventions and clinical-community linkages related to preventing heart disease and stroke. These funds will be tracked by the Division for Heart Disease and Stroke Prevention.

These guidelines also apply to awards made to sub-recipients.  

Example:

State X receives a total award of $3 million.  Fifty percent of this award needs to be sub-awarded to 4-8 communities.  The state will need to allocate the remaining $1.5 million equally to Components 1 and 2.  Of the $750,000 in Component 1, $225,000 (30%) will need to support strategies addressing nutrition standards including sodium.  Of the $750,000 in Component 2, $225,000 (30%) will need to support strategies addressing the prevention of diabetes.

If state X sub-awards 50% of its total award equally to 4 sub-recipients, then each sub-recipient would receive $375,000 (25% of $1.5 million).  This sub-award would then be divided equally between components 1 and 2. Of the $187,500 in component 1, $56,250 (30%) would be allocated to support nutrition standards including sodium and of the $187,500 in component 2, $56,250 (30%) would be allocated to support strategies to prevent diabetes.

Can a state applicant allocate more than 50% of total award to local communities?

Yes, a state can sub-award more than 50% of funds to local communities. There is no fixed cap on this amount as long as the state can meet their responsibilities to oversee the sub-awards, including tracking and reporting performance measures for the sub-awardees.

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Application Process


 

Are local public health agencies required to submit a logic model or this only a requirement for state applicants?

The state and large city applicants should submit one logic model for the grant. Post award, the state or large cities may establish their own requirements, including the submission of local logic models, for the communities receiving sub-awards.

Does the work plan need to include long term targets or strategies in order to conform to the 30 page limit in project narrative?

The work plan does not need to include baselines or targets for the long term measures, but strategies to address all measures should be included.

It is still unclear if attachments are allowed. I have re-read the FAQs and the guidance. Are attachments allowed?

Following is a list of acceptable attachments that applicants can upload as PDF files as part of their application at www.grants.gov. Applicants may not attach documents other than those listed; if other documents are attached, applications will not be reviewed.

  • Project Abstract
  • Project Narrative
  • Budget Narrative
  • CDC Assurances and Certifications
  • Work Plan
  • Table of Contents for Entire Submission
  • Resumes/CVs
  • Letters of Support
  • Organizational Charts
  • Non-profit organization IRS status forms, if applicable
  • Indirect Cost Rate, if applicable
  • Memorandum of Agreement (MOA)
  • Memorandum of Understanding (MOU)
  • Bona Fide Agent status documentation, if applicable

Do we submit the SF424A form for Year 1 only? What about for years 2-4? Do we complete forms for these years as well or just include in the budget justification?

The SF424A should be completed for the current budget period only (Year 01) for which you are applying, not for the future years.

For some reason I cannot access the grant application. Can you please send it to me?

The application must be accessed at grants.gov and submitted through grants.gov. As noted on the grants.gov website, you must have the correct version of Adobe Reader to download the application. The Adobe Reader software is available on the website.

If a particular activity in the work plan will be accomplished by a partner agency or an entity the applicant will contract with, how much detail do we have to provide when listing the Person Responsible? Do we have to list a specific position or can we just list the agency?

For purposes of the application, the partner agency will be sufficient.

On page 46 of the FOA instructions it states that the Work Plan must provide a general summary of activities for Years 2-5. Is the addition of year 5 an error and should it say Years 2- 4?

Yes, it should say Years 2-4.

Should tables and figures included in the project narrative conform to the Calibri 12 point font requirement.

Yes.

Is there a way that we can identify when new questions and responses have been added to this page?

New questions and answers are added every day and will continue to be accepted until July 14. The most recent questions and answers are at the top of the list under each of the categories.

The FOA states: "Applicants must submit the work plan in a separate file, name this file "Work Plan" and upload it as a PDF file at www.grants.gov." Should this file be attached to the application on the Project Narrative File(s) page as an "Optional Project Narrative File," or at the end as an "Optional Other Attachment"? The same question applies to CV/Resume, Organizational Chart, and Letters of Support files.

The Work Plan should be attached as part of the "Optional Project Narrative File." The CV/Resume/Organization Chart/ and Letters of Support should be attached as "Optional Other Attachments."

One response indicated that an acronym list was not an approved attachment and may be included in the narrative, may an acronym list be included as part of the table of contents?

An acronym list may be part of the project narrative, but it will count toward the 30 page limit. It cannot be part of the Table of Contents and excluded from the page limit for the narrative.

The required names of the attachments listed on pages 40 and 41 of the FOA include forward slashes. Microsoft Word and Adobe do not allow file names to contain forward slashes. Are there alternate names we can use?

You do not need to use a forward slash in the file name. The forward slash is listed in the example to indicate that you would choose either the state OR the large city name. Large cities may just use their name and do not also have to include the state name. Once you choose, there is no need for a forward slash.

Is each work plan we create for a specific program we will implement or does each work plan address a program strategy from the logic model? In another FAQ, it states we must address all the items (i.e. signage, worksite policies, etc.). Is that something we would address in the activities if each work plan is for a program strategy from the logic model?

The application should include just one workplan that addresses all of the strategies in the table on pp. 21-30. Key activities for each strategy should be listed. If it is easier, you may repeat the template separately for each strategy so that the activities correspond directly with specific strategies. If you choose this option and an activity applies to more than one strategy, you do not need to repeat it in full, but may note it briefly (i.e. see activity #1 under Strategy X.) If there are multiple components to a strategy, you should indicate high level activities to address those in the workplan.

The work plan template indicates that activities can align with multiple strategies. Does this mean that activities that align with more than one strategy can just be listed once under the strategies they are aligned with, or does every strategy have to have one or more activities listed under it?

Yes. Every strategy should have one or more activities listed under it. If the activity has previously been listed under a different strategy that may be briefly noted using a numbering system (i.e. See activity #1 under Strategy X).

On page 12 of the FOA it says, "Applicants must report on measures for all strategies in each of the two components." Does this mean that in the application work plan data sources must be defined and a target calculated for all short, intermediate, and long-term measures? Or, in the work plan, do we describe what and how the data sources will be obtained and outcomes calculated?

If a data source is available, it should be listed and targets for the short and intermediate term measures should also be entered on the work plan template. If data sources are not available, then the applicant should describe how data sources will be obtained. If the applicant is unable to calculate targets for the short and intermediate term measures based on existing data sources, then the applicant should briefly describe how they will do this post award.

Can we submit either a hyperlink or graphic in the application? If we can use a graphic, does it have to be in 12 font?

You may include a graphic, but it will count toward the 30 page limit for the application narrative. It will need to be in 12 font. You can submit a hyperlink, but the reviewers are not required to read hyperlinks and will not be able to score the application based on additional information in a hyperlink.

Do we need to enter both short and intermediate performance measures into the work plan template or due to limited space, can we enter short term only?

Both the short and intermediate term performance measures must be included on the work plan template. You may use a numbering system for the measures to save space.

Can you provide clarification for the sample work plan template categories of "target" and "timeframe" referenced on pg. 32 of the FOA? Specifically are the targets aimed at 1 year and is the timeframe projected out for intermediate and long term performance measures over the entire grant period or only for year 1 or only short and intermediate performance measures?

Each of the 15 required strategies and all of the associated short-term and intermediate term performances for each strategy must be addressed on the work plan template. (Note: once an intermediate term measure has been addressed, it does not need to be repeated for subsequent strategies.) The targets and timeframes for each performance measure should align. Where the timeframes for the short and intermediate term measures exceed one year, a one year target must still be established.

In the Organizational Capacity of Awardees to Execute the Approach section on pg. 30 of the FOA it says applicants must describe organizational capacity to carry out the strategies outlined in both Component 1 and 2. For a state applicant that plans to sub-award more than 50% of the total funding to local health departments, does the applicant refer to the local health department's capacity or State Health Department to carry out the strategies outlined in Component 1 and 2?

The organizational capacity requirements apply to the grantee (the state or large city.) The grantee will be responsible for ensuring that communities that receive sub-awards also meet appropriate organizational capacity requirements.

In the example work plan, the column titled "Activities" has three sub-columns. Can you elaborate on the usage of the three sub-columns?

The three sub-columns are typos. There should just be one column for activities.

In the work plan template, for "Expected Outcome(s) for the Project Period," is the expected outcome(s) the Project Period Objectives listed on page 6, intermediate performance measures, or other outcomes?

Grantees will need to complete the work plan template for each strategy. For each strategy, the expected outcomes for the project period should align with corresponding short- and intermediate-term outcomes on the logic model.

Do all strategies need to be addressed in the logic model or only those strategies where the state can demonstrate synergy in the implementation approach?

The logic model should provide a high level illustration of the state’s approach to implementing the required strategies for 1422. Complementary strategies may be addressed as a group; the logic model does not need to address each individual strategy separately, as long as each strategy is addressed in the work plan. A focus on synergy would be helpful and is the preferred approach.  

FOA page 39 indicates that evidence based program strategies be explicitly referenced when possible. Is there a specific format for providing those references?

Page 39 of the FOA asks applicants, whenever possible, to propose activities based on the Community Guide and to note when it is the source of an activity. Applicants can just include the words "Community Guide" if it is the source of an activity.

Do we have to apply the same font size, font type, and margin guidelines for the logic model?

No. You may use whatever font size, font type or margins that you need to use to keep the logic model to one page.

On Page 32, the sample work plan template includes a column labeled “timeframe.” Is this referring to the timeframe for beginning and completing the activities?

There are two places on the work plan template that require dates. The column labeled timeframe refers to the program strategy/performance measure (i.e. when will the target be achieved?) The column labeled activity completion date refers to anticipated completion dates for the major activities aligned with the program strategies that are expected to lead to accomplishment of the respective Performance Measures. Activities and targets may have different dates. For example, there may be start-up activities in year 1 that will not result in outcomes on the measures until year 2.

Would the National Heart, Lung and Blood Institute's curriculum for culturally appropriate multi-session intervention program, "Your Heart, Your Life: A Lay Health Educator™s Manual" be an acceptable lifestyle change program for the HTN aspect of lifestyle change?

Guidance on specific evidence-based lifestyle change programs to address the prevention and control of high blood pressure will be provided post award.

We would like to include an acronym list in the application. Can you tell us where to include that in the application package?

Acronym lists are not acceptable attachments (see p. 57 of the FOA.) However, you may include an acronym list as part of the project narrative. It will count toward the 30 page limit.  

I noticed that the sample work plan is not in 12-point font, but 10-point font. Can we develop our sample work plan in smaller font as is illustrated on page 32 of the FOA?

No, the work plan should be single spaced, Calibri 12 point, 1-inch margins.

Are Organizational Charts included in the 30-page-limit for the Project Narrative and Work Plan?

No.

Where in the Project Narrative do we include content related to readiness?

Please include content related to readiness under the Organizational Capacity heading in the Project Narrative.  

Should the 1422 work plan specifically reference and crosswalk to the 1305 work plan?

The applicant should briefly indicate where proposed 1422 activities will build on or expand current 1305 activities, but a detailed crosswalk with the 1305 work plan will be addressed post award.

On the sample work plan template, are performance measures and data sources required for activities?

Performance measures and data sources are required for program strategies, and not for activities.

The instructions indicate that we must work on ALL of the listed strategies, and that the strategies, associated performance measures, and data sources must be listed in the work plan. Do these items have to be listed verbatim from the FOA or can we use our own numbering system?

You may use a system to number or reference the strategies, associated performance measures, and data sources to simplify their inclusion in the template and meet the 30 page limit.

If you are a state with a large city that is eligible to apply for DP14, is it appropriate for the state Health Department to include that city in their application?

Applicants do not need to pre-identify communities in their application. However, applicants must identify criteria for selecting their communities based on disease and risk factor burden data and potential to impact large numbers of adults. CDC will work with grantees post-award to ensure the large cities and states with their selected communities meet criteria for significant reach and impact.

Can a coalition of contiguous counties be included in the sub-awards?

The relationship of the sub-awardee is up to the recipient. CDC is not dictating criteria for sub-awardees. The FOA’s definition of state applicant sub-awardee communities includes “a group of contiguous counties.”

Can a sub-awardee be defined not geographically but by a population that is located in different counties?

No, we have defined it in geographical terms.

We have a centralized system for public health departments. Can funds given to local health departments be considered as going to locals, even given our centralized structure?

Yes.

We have identified a 19 county geographic area that has a 10-year lower life expectancy. Can we make sub-awards to 4-8 counties within these contiguous 19 counties?

Yes. We ask that you look at burden data in making your selections for sub-awards.

The FOA requires that the target population should be geographic. Would an approach linking Medicaid and other social programs be appropriate?

We certainly encourage collaboration with Medicaid, but this is a place-based FOA so any collaboration would need to take place in the geographically defined community.

If a state is working with contiguous counties, can the sub-award go to a non-government agency such as a hospital chain or statewide association?

That is appropriate as long as the sub-awardee is serving the population of the contiguous counties.

Do you have a definition of significant reach for rural states?

We made the decision not to be specific about that, to allow maximum flexibility for those states.

If a large city subcontracts a portion of the work, does the 50/50 split between components 1 and 2 apply? Does the 30/70 split within components also apply?

The city is the entity that must meet the 50/50 split between components and the 30/70 split within components, regardless of whether they complete the work themselves or award some portion to subcontractors. Individual subcontractors do not need to meet the required splits.  

We understand that tribes are not eligible to apply for this FOA. However, in some states tribes have a significant disease burden. Are they eligible to be included the 4-8 communities?

Yes. Tribes would be eligible if they were defined by a geographical location. A state can select 4-8 communities, which may be single counties or groups of contiguous counties, but within those areas you can drill down to populations at especially high risk. So there is latitude to craft those groups of counties. If you are planning to work with tribes as sub-awardees, make sure you have their support.

When are applications due, and when will awards be announced?

The application Deadline: July 22, 2014, 11:59 p.m. U.S. Eastern Daylight Time, on www.grants.gov. The approximate Date When Awards will be Announced: September 30, 2014.

How can people ask questions about the FOA?

Applicants can participate on a pre-application conference call that will occur on May 29, 2014, 4:00 pm–5:30 pm Eastern Daylight Time, Call-in number: 1-877-784-3233 (toll free), Participant passcode: 9833862.

CDC encourages inquiries concerning this FOA. All inquiries should be directed to:
www.cdc.gov/chronicdisease/about/statelocalpublichealthactions-prevCD.htm

Do I need to provide letters of support?

Letters of support, including from Medicaid, are encouraged, though not required. However,
large city applicants are required to include a letter of support from the state health department or its
bone fide agent documenting activities proposed in DP14-1422 are being coordinated with the state’s
DP13-1305 activities.

Should the letters of support be sent directly to CDC? Who should the letters be addressed to?

The letters should not be sent directly to CDC. They should be included with the application.
The letters of support should be addressed to a designated person at the organization applying for funds.

Is a Letter of Intent required?

There is no requirement for a letter of intent.

Is there a page limit for the project narrative?

The page limit for the project narrative is 30 pages and includes the work plan.

Is the budget included as part of the total page limit for applications? Is there a page limit specific to the budget narrative?

The budget is not part of the narrative page limit. There is no page limit on the budget narrative.

Should the work plan be included in the narrative or as an attachment? Do attachments count towards the 30 page limit for the narrative?

Applicants must submit the work plan in a separate file, name this file “Work Plan” and upload it as a PDF file at www.grants.gov. The work plan is included in the narrative 30 page limit.

Will the conference call meeting notes be available to those unable to make the call?

Yes, the scripts from the conference calls will be made available online at www.cdc.gov/chronicdisease/about/statelocalpubhealthactions-prevCD. Audio recordings are not available.

Are applicants required to submit detailed budgets for sub-awardees as a part of the application?

State applicants are required to sub-award 50% of the full award to 4-8 communities. This should be reflected in the budget.

On page 41, can you please clarify the naming convention for the work plan? As a state applicant, we wouldn't have a city health department name.

You would just use the state name. The large city naming convention is for the large cities eligible to apply for these grant funds in addition to the state applicants.

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Review Process

 

 

What type of review process will occur for this competition?

Applications will be reviewed in three phases.

  • During phase I, all applications will be reviewed for completeness by CDC PGO staff and will be reviewed jointly for eligibility by the CDC National Center for Chronic Disease Prevention and Health Promotion and PGO. Incomplete applications and applications that do not meet the eligibility criteria will not advance to Phase II review.
  • During phase II, an objective review panel will evaluate complete, eligible applications in accordance with the “Criteria” section of the FOA.  
  • During phase III, applications will be funded in order by score and rank determined by the review panel. The Selecting Official shall rely on the rank order established by the objective review as the primary factor in making awards. However, in order to maximize the reach and impact of federal funding, the Selecting Official may depart from the rank order to achieve a balance of awards representing different 1) geographic areas of the United States, or 2) specific project foci within Component 2.

Where are the application review criteria in the FOA?

The review criteria are identified in Section E of the FOA on page 46.

Will states and cities compete against each other for funding?

No, states and cities will be competed separately.

 

 

Scoring


 

No Questions

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Recipient Activities

 

Are state health departments allowed to fund more than one sub-award per county?

Yes.

For the performance measures related to CDC-recognized lifestyle change programs for persons with pre-diabetes or at high risk for type 2 diabetes, will the CDC Diabetes Prevention Recognition Program (DPRP) provide states with community-level data for the selected 1422 communities? Also, what will be the frequency of DPRP reporting to states?

CDC will work with grantees post-award to provide available data from the DPRP. At a minimum, data will be provided annually for reporting on the intermediate and long-term performance measures.

Will CDC consider the 1305 enhanced performance measures related to 1422 activities? Should applicants use 1305 performance measures when they apply? Is CDC planning to develop additional performance measures for this grant?

The performance measures for 1422 are listed in the table on pp. 21-30. Applicants should use these measures. CDC will work with the states to operationalize the measures post award. To the extent possible, similar measures in 1305 and 1422 will be operationalized in the same way. CDC is not planning to develop additional performance measures for 1422.

Can supplies include materials like mileage markers, signage, play scapes, park benches, trees, water fountains, lights for security, etc.? We would not provide labor--it will be donated. The communities we are targeting are very poor.

Yes, per the FOA, awardees may use funds only for reasonable program purposes, including personnel, travel, supplies, and services. Supplies such as signage or other design components to promote physical activity and any such proposed spending must be clearly identified in the budget. The following resource may be helpful.
http://www.thecommunityguide.org/pa/environmental-policy/index.html
. Grantees will need to work with their Project Officer post- award to determine what specific supplies are allowable.

Food Banks are mentioned as a community venue in the second strategy under component 1. Does that extend to food pantries and soup kitchens, or is it strictly meant at the regional food bank level?

Grant funds are intended to support systems and environmental changes with significant reach and impact. In general, food banks tend to be the regional storehouse for millions of pounds of food that are distributed to the community, and are the preferred priority for this strategy.

For the strategy regarding joint use agreements, are these agreements limited to schools or can they include other community settings, such as churches and rec centers?

A joint use agreement is a formal agreement between two separate entities–often a school and a city or county–setting forth the terms and conditions for shared use of property or facilities. Joint use agreements are not restricted to schools and local government agencies and may be established with recreation centers or churches or other entities with property or facilities that can be used to address community promotion of physical activity.

Do all 15 strategies have to be completed by the 4-8 communities, or are states expected to assume responsibility for some strategies on behalf of the communities?

The intent of this FOA is to support a) environmental and system approaches to promote health, support and reinforce healthful behaviors, and build support for lifestyle improvements, and b) health system interventions and community-clinical linkages within the same community. These strategies were designed to be comprehensive and mutually reinforcing. Grant funds should support local improvements in selected communities as well as the statewide efforts needed to support those local improvements.

States are expected to assume responsibility for overall coordination, providing leadership and technical assistance to subawardees; states may undertake strategies and activities on behalf of the selected communities. They may do this directly or with assistance from contractors and/or consultants. The amount of leadership and technical assistance provided by states to selected communities may vary by strategy, depending on the level of experience that communities have with specific strategies. State technical assistance should fill in the gaps where communities have less capacity in order to ensure that communities are able to provide the comprehensive package of strategies required in 1422.

In Component 1, states may assume leadership for:

  • Establishing/strengthening a statewide network and developing, revising or linking to a state strategic plan to build support for evidence-based lifestyle change, including working with network partners to increase health benefit coverage for evidence-based lifestyle change programs. Communities may be members of the statewide network, but would not be required to establish individual networks in each community.
  • Developing/guiding engagement strategies that communities could implement at the local level.  
  • Developing/guiding healthy eating and physical activity policies designed to improve population health that could be implemented in the communities.
  • Developing/strengthening partnerships with organizations that create supportive environments for healthy living and work conditions.
  • Compiling and disseminating data for use in community program planning.
  • Providing technical assistance, subject matter expertise, and developing community resources to strengthen community level action to support healthy eating and physical activity.

In Component 2, states may assume leadership for:

  • Coordinating learning networks and building/strengthening partnerships at the state level that will assist communities to increase use of EHRs, health information exchanges, and standardized reporting of aggregate clinical quality measures.
  • Developing/using dashboards and surveillance systems for monitoring of clinical quality measures.
  • Creating CHW certification programs and working with payers to influence uptake of evidence-based strategies such as coverage for CHWs, self-measured blood pressure support, and team-based care.
  • Creating bi-directional referral systems such as 800 or 211 numbers.
  • Working with health systems to implement screening programs to identify people with prediabetes or at high risk for type 2 diabetes.

 

Do all 15 strategies have to be addressed in year 1 or can they be allocated over the entire project period?

There needs to be some level of activity on each of the required strategies in each year of the project period. The level of activity on individual strategies may vary from year to year depending on various factors such as the stage of development, partner involvement, and complementary activities being conducted under related funding agreements.

The effectiveness of this FOA’s approach depends on communities’ commitment to improving both aspects described in the FOA (environmental and health system) at the same time. Communities may tailor the intensity of strategies, depending upon community needs, but should strive to incorporate both component 1 and 2 activities in each year of the project period. (REVISED)

Could you please explain the intermediate performance measure for the first strategy within Component 1 on page 21, "Data source is purchase data from participating venues"? Is there a requirement to purchase specific data sets?

There is not a requirement to purchase specific data sets. Grantees should work with participating venues to arrange for existing purchase data to be voluntarily shared. (Purchase data, i.e. venue specific data voluntarily provided by participating grocery stores, supermarkets, chain restaurants, and markets on the purchase of fruits, vegetables, and healthy drinks.)

If this is not feasible, CDC will work with the grantee to determine an appropriate data source for this measure. You may find it helpful to refer to the Healthier Food Retail resource posted on the FOA website entitled Healthier Food Retail: Beginning the Assessment Process in Your State or Community.

We know we must address all strategies in both components, but must we address all items in each strategy? For example, strategy 3 under component 1: “Strengthen community promotion of physical activity through signage, worksite policies, social support, and joint-use agreements.” Must we address all four: signage, worksite policies, social support, and joint-use agreements?

Yes, grantees are expected to address each item, i.e., signage, worksite policies, social support, and joint-use agreements, to strengthen community promotion of physical activity. Grantees can target items to the appropriate setting, for example, social support might take place at a senior center, joint use agreements at schools, signage at parks, and worksite policies at worksites. Grantees are encouraged to leverage existing structures and systems designed to promote physical activity and support diabetes and heart disease and stroke prevention efforts.

What is a “network self-assessment”? This is mentioned as a short-term performance measure for lifestyle change networks.

The performance measure on participation of network partners in self-assessment has two purposes. First, participation is a common measure of coalition performance; one example is tracking meeting attendance. Second, regular self-assessment is a feature of “adaptive capacity,” which is an evidence-based indicator of coalition success.

There are many different checklists and scoring systems with a range of depth and formality. Post award, CDC will provide options for networks to choose from or adapt. At the informal end, networks may simply tally verbal responses to a question posed at the end of a meeting, such as “plus/delta”—asking attendees to list things that are working (plus) or need change or improvement (delta) with respect to network performance. In this case, the participation rate for the assessment would be the proportion of members represented at that particular meeting. On the more formal end are various online surveys that produce a score and may be analyzed quantitatively by member characteristics and over time. If networks choose to self-assess more frequently than annually, then average response rates during the period may be used for annual reporting for purposes of this FOA.

Is there a minimum number of health systems we must work with for component 2?

No. However, as described in the FOA, applicants should strive to reach significant numbers of people, including through health systems serving the designated communities.

Can you define community health systems? The FOA defines health systems but not community.

Health systems serving populations in the designated 4-8 communities.

Are we allowed to promote AHA’s Heart 360 as part of the strategy to increase use of self-measured blood pressure monitoring tied to clinical support?

Yes.

Can you define community pharmacy? Are 340B pharmacies included in this definition of community pharmacy?

Component 2 refers to pharmacists in two strategies, one in health system settings (team-based care) and a second in community settings (as health care extenders). We consider community pharmacies to be either a chain or independent retail pharmacy. However, we understand that people obtain outpatient pharmacy services at sites other than retail settings, such as an in-house pharmacy that is part of a health clinic, and those would be considered under the definition of community pharmacy if a State’s pharmacy licensing authority recognizes them as such. It would be appropriate to engage 340B pharmacies under either strategy, depending on the nature of the pharmacist’s work. (REVISED)

If we are funding the creation of electronic referrals in several communities through other funding sources, but want to expand to new communities/new community-based organizations (e.g., weight watchers), is this an allowable activity?

Yes, if it is within the selected 4-8 communities or serving populations in those communities.

Can you provide examples of appropriate activities for the strategy to implement nutrition and beverage standards? Are there expectations of how component 1 funds should be used for this strategy?

CDC has received several questions inquiring how to implement strategies. We have provided general guidance in the resources section of the web site. For resources related to Food and Beverage Guidelines, please see: http://www.cdc.gov/chronicdisease/about/statelocalpubhealthactions-prevcd/general-information.htm

We will be unable to provide further details on specific strategies. The purpose of the FAQs is to provide clarification on the funding opportunity announcement, not to provide specific technical assistance.

What is the definition of lifestyle change programs for hypertension?  Specifically, is there a role for the Stanford Chronic Disease Self-Management Program (CDSMP)?

People with hypertension should be referred to evidence-based lifestyle programs that can increase hypertension control. These programs should promote the following elements: reduce weight, adopt DASH (Dietary Approaches to Stop Hypertension) eating plan principles including lower sodium intake, and engage in regular physical activity. For its designed general self-management purpose CDSMP has strong evidence, but it is not intended to increase control of high blood pressure.

Is it acceptable to have a strategy focused on specific areas within a city that impacts the overall cardiovascular hospitalization rate?

Yes.

Regarding the work plan, the FOA states that applicants must include all strategies and performance measures. Some performance measures are in multiple strategies. Can selected performance measures be associated with a specific strategy/activity, as long as all performance measures from the FOA are covered in the work plan?

When developing the work plan, all performance measures must be included for each strategy as indicated in the FOA table of performance measures on pages 21 - 30.

By CDC recognized lifestyle change programs, do you mean the National Diabetes Prevention Program (National DPP)? If there are others please list them.

CDC recognized lifestyle change programs are programs that are recognized by the National Diabetes Prevention Recognition Program, which is part of the National DPP.

Regarding guidance found on page 22 of the FOA (component 1, 3rd strategy) can you provide any information on promotion of physical activity through signage that has been demonstrated to be effective?

There is strong evidence that point-of-decision prompts increase stair use and physical activity levels and are effective in a range of settings among a variety of population subgroups. The largest effects have been shown for individuals who are obese. Applicants can also propose activities to strengthen community promotion of physical activity, for example, create signage with community input to promote use of parks and trails across communities. For additional guidance to strengthen community promotion of physical activity through signage, please refer to the CDC Guide to Strategies to Increase Physical Activity in the Community http://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf [PDF 1.9MB]

In the FAQ example below about how to allocate funds for the components, please add to the example how the 10% evaluation requirement would be allocated.
Example: State X receives a total award of $3 million. Fifty percent of this award needs to be sub-awarded to 4-8 communities. The state will need to allocate the remaining $1.5 million equally to Components 1 and 2. Of the $750,000 in Component 1, $225,000 (30%) will need to support strategies addressing nutrition standards including sodium. Of the $750,000 in Component 2, $225,000 (30%) will need to support strategies addressing the prevention of diabetes. If state X sub-awards 50% of its total award equally to 4 sub-recipients, then each sub-recipient would receive $375,000 (25% of $1.5 million). This sub-award would then be divided equally between components 1 and 2. Of the $187,500 in component 1, $56,250 (30%) would be allocated to support nutrition standards including sodium and of the $187,500 in component 2, $56,250 (30%) would be allocated to support strategies to prevent diabetes.

The FOA states on p. 12 that applicants should allocate between 5-10% of their total funding award to evaluation and performance monitoring. Applicants are asked to consider both developmental and implementation costs for evaluation. As noted in the FOA, the fixed costs of developing an evaluation plan will likely consume a higher percentage of resources for states and large cities receiving awards at the lower end of the funding range. Evaluation implementation costs will likely decrease proportionately with the size of the award.  

In the example above, if a state receives a total award of $3 million, $150,000-$300,000 should be allocated for evaluation. This amount should be allocated proportionately to components 1 and 2 as noted above: $75,000-$150,000 for each component. An allocation at this level is sufficient for the application process. Post-award, further details will be provided on how to prioritize the selection of strategies within components for evaluation. Evaluation will not be required for each strategy within a component, although grantees will have to report on the required performance measures for all strategies.

There appear to be discrepancies with the 4-8 communities requirement. For large city applicants, does that requirement apply, or is it only for states? Would large cities be required to include selection criteria?

The requirement to sub-award funds to 4-8 communities is specific to states. Large cities are encouraged to sub-award some of their funds, but are not required to include selection criteria in their application.

Can you clarify whether the 4-8 sub-awardees must commit to doing all the components? The FOA could be read that the state commits to all the components, but enlists different partners to do one or a few.

The expectation is that all communities will do all components.

In Component 1, is the strategy working with network partners specific to diabetes and hypertension?

The strategy to plan and execute strategic data-driven actions through a network of partners and local organizations to build support for lifestyle change is a required strategy for the prevention of diabetes and an optional strategy for the prevention of high blood pressure. If the grantee chooses to address both conditions, they may either use the same network or two different networks. In either case, when implementing a network approach, partners should have clear roles and responsibilities.  

In component 1 there is a strategy for working with network partners (pg. 23-24). Can you give an example of a network?

We expect grantees to assemble a variety of partners including insurance companies, employers community-based organizations, and other partners that will work as a cohesive unit to coordinate and organize how you will be building support for lifestyle change in the state or large city.

In Component 1 (pages 21-24) some of the strategies say “and/or”. Does that mean you can choose or do you have to address all the examples?

Those are specific examples that you may read as “or.”

For the strategy on strengthening healthier food access, are farmers markets considered community venues?

Farmers markets are supported in 1305 but are not supported in this FOA. The focus of this FOA is retail venues, such as grocery/convenience stores, supermarkets, and corner stores.

Can you define “community venue” and provide some examples other than food banks?

Our definition of community venues is intentionally broad so that applicants may propose to work with various organizations serving the targeted communities. This category was added to prevent the exclusion of organizations that work to increase the availability of healthier food for priority populations, but do not qualify as retail venues.

Specifically, we wanted to include projects such as The Healthy Food Bank Hub which is jointly sponsored by Feeding America, the Academy of Nutrition and Dietetics and the National Dairy Council®. The Feeding America network consists of 200+ food banks and 61,000 agencies. The Healthy Food Bank Hub supports efforts to increase access to healthful foods. Please see this link for more information: http://healthyfoodbankhub.feedingamerica.org/?_ga=1.184787887.700736063.1401384783

Applicants do not have to identify specific organizations in community venues in their application. However, they must specify how they will identify potential organizations if an award is made.

For Strategy 4 under Component 1 (page 22, Develop transportation and community plans that promote walking), would a jurisdiction-wide complete streets plan or ordinance qualify?

Yes, it would qualify.

For Strategy 4 under Component 1 (page 22, Develop transportation and community plans that promote walking), would a long-range plan of a metropolitan planning agency or a regional plan qualify?

Yes.

In relation to expansion vs. duplication of efforts, if we’re currently working with Federally Qualified Health Centers (FQHCs) for 1305, can we expand our efforts to work with family medicine practices in this new FOA?

Yes, that is appropriate.

A performance measure on page 29 is “number of persons with high blood pressure who enroll in an evidence-based lifestyle change program.” Does this mean that persons with HTN should be referred to National Diabetes Prevention Programs? Or is there another program that people with HTN should go to? Or should we be focusing on persons with HTN and pre-diabetes as our priority population for NDPPs?

Persons with high blood pressure should be referred to enroll in evidence-based lifestyle change programs which have evidence of increasing control of high blood pressure.  The following factors should be considered:

  • Effective lifestyle programs generally follow a standardized curriculum, including multiple sessions, and incorporate face-to-face interaction.
  • Some appropriate programs are offered by TOPS Club, Inc. (Take Off Pounds Sensibly), and Weight Watchers.
  • Medication therapy management by pharmacists that includes educational information on physical activity and nutrition may be appropriate.
  • For any other proposed programs for referral, a justification/rationale should be provided of why these are expected to increase control of high blood pressure.

If persons with high blood pressure also meet the criteria for participating in the National DPP, it is appropriate for them to be referred to that program.

Please clarify what you mean by strategies to build support for lifestyle change in Component 1.

The main strategy in Component 1 to build support for lifestyle change is supporting the development and implementation of CDC-recognized lifestyle change programs in targeted communities. This is an educational intervention to help people at high risk for type 2 diabetes make behavior changes to lower their risk. These behavior changes include increasing physical activity and making healthier food choices. Implementing environmental strategies in Component 1 (such as strengthening healthier food access and developing community plans to promote walking) in the same communities will provide further support for people enrolled in lifestyle change programs.

In particular, 1422 is focused on supporting programs that serve disparate populations, including the Medicaid population. While disparate populations have a disproportionate burden of risk, the organizations that serve disparate populations may have fewer initial resources to invest in programs that could substantially reduce that burden. Using 1422 funds to build and initially deliver CDC recognized lifestyle change programs for priority populations is critically important to the elimination of disparities.  

How can grant funds be used to support the development and implementation of CDC-recognized lifestyle programs that serve populations at high risk for type 2 diabetes?

Grant funds may be used in two major ways. First, they may be used to recruit and enroll populations that are at high risk for type 2 diabetes in existing CDC-recognized lifestyle change programs. Recruitment and delivery of the program cannot discriminate on the basis of sex, race, or ethnicity.

Second, they may be used to help local organizations that serve populations that are high risk for type 2 diabetes become CDC-recognized lifestyle programs. Funds used to support local organizations, such as local health departments and community-based organizations, to become CDC recognized lifestyle change programs may be available for up to two years. (Please note that these funds are subject to the limitations in section II B 12 of the FOA which details criteria for continued funding after the first year.) Work must begin immediately to secure a permanent funding source; grant funds may not be a long-term funding source for the delivery of lifestyle programs. For the initial 2 years, funds may be used to pay for the delivery of the intervention for priority populations.    

Please clarify what you meant by engagement strategies.

Engagement strategies are intended to increase enrollment in and attendance at structured lifestyle change programs for priority populations. State, local, and large city grantees should incorporate insights from behavioral and social science into health marketing campaigns, enrollment approaches, and tests of other behaviorally grounded engagement strategies.

 

Can you provide examples of evidence-based engagement strategies?

Strategies grounded in insights from behavioral and social science are those that make it easy for people to achieve their goals, draw attention to health messages, motivate people through the behavior of others, or make things timely and relevant at key moments and decision points. An easy way to remember these key points is the acronym “EAST”—engagement should be Easy, Attractive, Social and Timely. Simple examples from work funded by CMS already underway include leveraging social networks, such as senior support groups, to increase the lifestyle change program enrollment and attendance (making it social); or ensuring a “warm hand-off” to a CHW who can help a patient enroll in the lifestyle change program before he or she leaves their medical appointment (making it timely).

Do you have specific engagement strategies that you will be directing grantees to implement?

The evidence-base for engagement strategies is evolving. HHS and CDC are currently supporting a White House initiative on “Behavioral Insights.” This effort is designed to bring evidence from social and behavioral sciences, including behavioral economics, to Federal programs, as part of a larger effort to promote evidence-based policy. Under this FOA, we will provide technical assistance and examples to help awardees apply and evaluate promising practices to increase engagement in lifestyle change programs. In addition, grantees are encouraged to propose and test engagement strategies specifically designed for the priority populations they will be targeting with these funds.

For component 1, the strategies 1 and 2 (nutrition standards and healthier food access on page 21) includes a list of examples of locations in parentheses followed by AND. Could you clarify if all venues need to be addressed or if we can choose appropriate venues? Do the same settings/venues need to be addressed in all 4-8 communities?

Under component 1, for strategy 1, food and beverage guidelines including sodium standards should be implemented in both cafeterias “AND” vending in public institutions, worksites “OR” other key locations, such as hospitals. For strategy 2, strengthening healthier food access and sales should occur in retail venues, such as grocery stores, supermarkets, chain restaurants, “OR” corner/convenience stores/markets “AND” community venues (e.g. food banks) through increased availability (e.g. fruit and vegetables and more low/no sodium options), improved pricing, placement, and promotion.

For state applicants, the same settings/venues do not need to be addressed in all 4-8 communities. The state is expected to work with communities to select settings/venues as appropriate for the community.

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Evaluation


 

Since grantees are responsible for reporting on the short-term and intermediate term performance measures, do we need to include long-term measures in the work plan? If we do need to include long-term measures in the work plan, should we include data source, targets and timeframes for long-term measures?

Long-term measures do not need to be included in the workplan.

Do we need to report a baseline for each performance measure in the application or can this be established if and after the grant is awarded and communities are identified?

Baselines may be established post award for the selected communities

Since the communities have not been established (which is not required to apply), we do not have baseline data to accurately select targets. Are we still required to submit targets for each performance measure in the application?

Targets may be established post award for the selected communities.

For the long-term measures on the logic model, can you clarify whether the 3% reduction in obesity prevalence and the 3% reduction in death and disability due to diabetes, heart disease and stroke is an absolute or relative reduction? For examples, if our current obesity prevalence rate is 33%, would our target be 30% or 32% (3% of 33%)?

Grantees funded by 1422 are responsible for reporting on the short-term and intermediate term performance measures; CDC will report on the long-term measures. CDC will work with the states to operationalize all measures post award. The long-term reductions are percent reductions and not percentage point reductions.

The FOA requires that a 25-page evaluation plan will be required within 6 months after the award. In the application, can we provide a description of that plan? And should that be counted as part of the 30-page limit?

In the application, you should address the required elements of the evaluation plan at a high level within the 30-page limit.

Can you provide clarification on the long-term outcomes around reducing death and disability? Is it at the state, local or national level?

These are goals across all of the six FOAs that CDC is releasing.  The work that you do in your state and communities, and the work that the other FOAs are contributing to in their jurisdictions, together will all contribute to long-term goals. You will have responsibility for the short-term and intermediate performance measures in this FOA.

In regards to the budget for evaluation, should we take the evaluation off the top and then split 50/50 or split the evaluation among the 2 components?

The result is the same for either scenario. There will be further guidance on evaluation plans, which will have to address both components equally.

Should the applicant submit an evaluation plan? If so, are there guidelines as to what it should cover?

Applicants must provide an overall jurisdiction or community-specific evaluation and performance measurement plan that is consistent with the CDC Evaluation and Performance Measurement Strategy section of the CDC Project Description of this FOA. Data collected must be used for ongoing monitoring of the award to evaluate its effectiveness, and for continuous program improvement.

The plan must:

  • Describe how key program partners will be engaged in the evaluation and performance measurement planning processes.
  • Describe the type of evaluations to be conducted (i.e., process and/or outcome).
  • Describe key evaluation questions to be answered.
  • Describe potentially available data sources and feasibility of collecting appropriate evaluation and performance data.
  • Describe how evaluation findings will be used for continuous program and quality improvement.
  • Describe how evaluation and performance measurement will contribute to development of that evidence base, where program strategies are being employed that lack a strong evidence base of effectiveness.

Awardees will be required to submit a more detailed evaluation and performance measurement plan within the first six months of the project.

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Other


 

Can you clarify whether the additional 1305 awards will be competitive? Are both basic and enhanced states eligible?

We will be looking at awarding enhanced funding to the current basic states on the approved but unfunded list as well as at providing additional funds to the 32 current enhanced awardees. That information will be forthcoming very soon.

Do we need to identify our key milestones in the work plan table?

Yes. Please provide specific, major Activities aligned with the strategies in the FOA logic model that are expected to lead to accomplishment of the respective Performance Measures. The Activities should have an anticipated Completion Date (see example work plan template, page 32) to make these time-phased.

Are sub-accounts needed for the two components?

We will provide this information post-award.

In terms of documentation that sub-awardees are spending the money in the disease-specific categories, will there be multiple notices of grant award?

There will be one notice of award.

Will sub-awardees be expected to do time-keeping or would states manage that via work plans?

Sub-awardees will not be required to do time-keeping. The state could manage this process by primarily relying on the sub-awardee work plans.

Can this FOA support staff?

Yes.

It is very unlikely that our state will be able to hire new staff, so could existing employees reduce their level of effort, FTE-wise, toward 1305 and then also work on this grant?

In order to do this, a state would have to inform PGO of requested changes to key personnel and work with their 1305 Project Officer to renegotiate the percentage of time staff are spending on the 1305 grant. The state would need to be able to show their Project Officer how they will continue to meet the requirements of 1305 with a reduced staffing level.

What are the lobbying restrictions concerning this grant? Can a 501(c)(3) organization conduct lobbying activities and apply for a grant?

Federal funds cannot be used for lobbying. Successful applicants must comply with the requirements set out in Section 503, Division F, Title V, FY12 Consolidated Appropriations Act and Additional Requirement (AR) 12, which is CDC policy as well as a term and condition of the FOA with respect to lobbying restrictions placed on award recipients.

In addition, please note that grantee activities are not restricted under Section 503 if the grantee is using funding sources other than Federal appropriations to engage in those activities. At the same time, grantee activities may be limited by state law or other applicable restrictions, such as provisions in the Internal Revenue Code. Grantees may wish to consult their tax and/or accounting advisors for assistance.

For additional information, please refer to Anti Lobbying Restrictions for CDC Grantees at http://www.cdc.gov/od/pgo/funding/grants/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf

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