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FAQs for NOFO: CDC-RFA-DP18-1803- State Public Health Approaches to Addressing Arthritis

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This page lists and addresses questions that were anticipated or received related to the CDC-RFA-DP18-1803 Notice of Funding Opportunity (NOFO). Please view the question and answers (Q&As) below for responses to submitted questions.

Application Process

Do I need to submit a Letter of Intent?
A Letter of Intent (LOI) is strongly encouraged but not required as part of the application for this NOFO. LOI must be sent via email to Margaret Kaniewski, Project Officer at mgk6@cdc.gov by February 19, 2018. The following information is requested in the LOI:

  • Number and title of this NOFO.
  • Name, address, telephone number, and email address of the Principal Investigator or Project Director, or both and affiliated organization.
  • Name, address, telephone number, and e-mail address of the primary contact for writing and submitting this application.
  • Name of State applicant is representing.
  • Names of the interventions being proposed for Strategy 1.
  • Name of the walking initiative or program being proposed for Strategy 2.

 

Is the Letters of Intent information on page 27 under item 6 correct?
No, there is a small error related to the strategy number. Item 6 should read as follows: Name of the walking initiative(s) or program(s) being proposed for Strategy 3.

What size and type of Font should be used? What Font size can be used for Tables?
Use size 12 Font for all narrative. There are no restrictions on the type of font. Alternately, any legible size font can be used for tables and graphs.

In the past, we have combined all of the required attachments into one document with page numbers and a comprehensive table of contents. For this NOFO, should we attach all of the documents listed on p. 46 separately?
Applicants may submit their application as a single, cohesive document or individual PDF documents as outlined on page 46 of the NOFO. It is most important that an applicant submits a table of contents that covers all of the required components and clearly indicates where each section can be found.

Does CDC require a template or format for the Narrative?
Page 27 of the NOFO describes the Project Narrative requirements. No specific formatting is requested, nor is a template provided. The project narrative required for the work plan as described on page 19 also does not require a specific template or format.

Is a Data Management Plan (p. 33) expected to be a separate document, or should it be included within the text of the narrative?
The Data Management Plan must be included in the project narrative and will count against the 20-page limit for the project narrative. It should be labeled “Data Management Plan” and placed with the performance plan.

Are there reporting requirements that are not noted in the NOFO (i.e. reach and partner tables collected under CDC-RFA-DP12-1210)?
No, only requirements/expectations listed in NOFO DP18-1803 are applicable for this funding opportunity.

Does the budget narrative, references or the Data Management Plan count against project narrative 20-page limit?
No, budget information, including its narrative and references, do not count against the 20 page limit. The Data Management Plan should be included in the project narrative and not be added as a separate document. The DMP is part of the 20 page limit.

Does the sample work plan that is to be included in the narrative have to be 12 font size, or can applicant use a smaller font size?
Applicant can use a smaller legible font size for the work plan.

Can an applicant add a bibliography or list of references as an attachment, outside the project narrative 20-page limit?
Yes, applicants can add separate attachments outside of the Project Narrative 20-page limit, such as a bibliography or a list of references.

Can an applicant include a logic model(s) for the four strategies outside the project narrative 20-page limit?
A logic model is not required. However, if applicant chooses to include a logic model, it should ideally be included within the Project Narrative 20-page limit.  Information referenced outside the Project Narrative should not be an expansion of the Project Narrative, but solely supportive information for the Project Narrative. Attachments should not be used as a way to extend/exceed page limits associated with the Project Narrative.

In follow-up to the question asked regarding including the Data Management Plan (DMP) within the 20-page project narrative, can you provide some clarification on the level of detail that needs to be included?  Do all five topics referenced need to be included in the narrative for each data source or can some of that detail be attached?
If an applicant is proposing to collect only the BRFSS data associated with the NOFO performance measures requirements, then a DMP is not required. A DMP for this NOFO would only be needed if a new data set is being proposed to address proposed outcome measures.

If applicant determines a DMP is not required, the applicant should include one sentence from the following language in the Project Narrative:  “A DMP is not being submitted for one or more of the following reasons (select only those applicable):

1) Applicant is collecting only the required BRFSS data;

2) Applicant is using other publically available data;

3) Applicant is only collecting data for program improvement, and not for decision making or generalizability;

4) Applicant proposes to utilize other available data sets.”

If an applicant determines that a DMP is required, it is acceptable to include very limited, basic information addressing the key components within the Project Narrative and provide additional details only if and when an award is granted. Detail beyond basic information may be provided in attachments, but is not required at the time of application.

Do letters of support count towards the allowable page limit?
No, letters of support, similar to Memorandum of Understanding, do not count against project narrative 20-page limit and should be included in attachments as described on page 46 of the NOFO.

Can a list of acronyms be added to the list of attachments described on page 46 of the NOFO?
No, applicant is only allowed to attach what is described on page 46 of the NOFO and the additional allowed items mentioned previously in the NOFO FAQ webpage: bibliography and references. Applicant is expected within the Project Narrative to include the full term followed by the acronym(s) that then can be used throughout the narrative.

Page 19 of the RFP mentions that applicants are expected to provide a detailed project narrative and work plan for the first year of the project period and then also “a high level plan in narrative form (no more than 3 pages in length) for subsequent years in support of NOFO outcomes as part of the application package.”  The FAQs repeat this language but do not make very clear if this is supposed to be part of the 20-page limit. Also, does the information on subsequent years need to be contained to a single section labeled as such, or can the information be addressed throughout the narrative?
A high level plan in narrative form (no more than 3 pages in length) for years 2-5 is to be included as part of the 20 page Project Narrative limit. The information on years 2 through 5 can be addressed in a single section or throughout the narrative, at the applicant’s discretion, but should be labeled to clearly indicate which project years are being covered or addressed.

The HHS Checklist form in the grant application package in Grants.gov asks in Part B, “Has a Public Health System Impact Statement for the proposed program/project been completed and distributed as required?”  We are wondering if this statement is required for our application.  Our sponsored programs staff person found the information below online (see List of Additional Requirements), which seems to indicate it is required only of “community-based non-governmental organizations”—which we are not.  We do anticipate having some sub-recipients that might be considered community-based non-governmental organizations, however.  Can you please confirm whether or not a Public Health System Impact Statement is required? 
A Public Health System Impact Statement is based on Intergovernmental Review (E.O. 12372) which does not apply to this program. Therefore A Public Health System Impact Statement is not required for this NOFO.

I am unable to determine where certain documents need to be attached. Is it ok to submit the following items as “Other Attachments”:  Table of Contents, Assurances and Certifications, Report on Programmatic, Budgetary and Commitment Overlap, Resumes, Position Descriptions, Letters of Support, MOA/MOU?
It is fine to submit the documents listed in the question above under Other Attachments. It is very important that your Table of Contents clearly indicate where the various components of the application are located and/or how they are organized. A list of acceptable attachments is provided on page 46 of the NOFO.

Is it ok to submit the CVs and Letters of Support in one file or do you want them separate?
It is fine to submit them either way. It is very important that your Table of Contents clearly indicate where everything is located, whether it be under one attachment or a series of separate, distinctly labeled attachments.

On page 46 of the NOFO, under H. Other Information, there isn’t a category for allowing us to upload Appendices as attachments. It also states, “Applicants may not attach documents other than those listed; if other documents are attached, applications will not be reviewed”. In the NOFO FAQ, appendices are mentioned and it sounds like the are allowable. If so, what category will we upload them in?
Appendices may be uploaded to the Other Attachments category. It is important that your Table of Contents clearly indicate where the various components of the application are located and/or how they are organized. A list of acceptable attachments is provided on page 46 of the NOFO.

Two of the FAQs seem to imply that applicants CAN include attachments not listed on p. 46 of the NOFO. We have some charts that we would like to include as attachments, but do not want our application to be tossed out for inclusion of these. The application stands alone without them. They do not present new information, but organize information scattered throughout in a way that makes it easier to see and understand for a reviewer. My question is, are we allow to attach things like this?
The charts described in the question could be included within the Project Narrative, and counted within the 20 page limit for the Project Narrative, but not as separate appendices. Applicants are expected to stay within the list of acceptable attachments indicated on p. 46 of the NOFO.  There is one exception to the list on page 46: Applicants may also add a separate attachment outside of the Project Narrative 20-page limit for a bibliography or a list of references. Further guidance about this and the one exception is available on the FAQs page under the ‘Application Process’ tab.

Page 25 of the NOFO states that applications are due by 11:59 pm on 4/2/18. However, on the grants.gov synopsis page it indicates 5pm as the due time. Do we have until 11:59 pm to submit an application since the NOFO  indicates the later time?  
Yes. Applicants have until 11:59 pm on 4/2/18 to submit applications for the DP18-1803 NOFO.

Funding and Budget

Can funds be spent on leader, master training, or program materials for arthritis appropriate evidence-based interventions (AAEBI) such as CDSMP, Enhance Fitness, or Walk with Ease?
Yes, funds can be spent on leader, master training, and/or materials for arthritis appropriate evidence-based interventions (AAEBI) such as CDSMP, Enhance Fitness, or Walk with Ease. It is up to the applicant to decide, within the NOFO parameters, how to allocate cooperative agreement funds to support grant activities. Applicants should keep in mind, in making decisions about what to support in NOFO applications, that the average award is expected to be $280,000 annually and that funded projects are expected to have statewide impact as measured via the BRFSS performance measures described in the NOFO and be sustainable.

Does the cost of the Behavioral Risk Factor Surveillance System (BRFSS) questions come “out of” the 10% that can be spent on evaluation?
Yes, evaluation should not exceed 10% of the annual total budget, including the ability to collect and use BRFSS data and partner with or within the state health department if/as needed to accomplish NOFO activities.

Can funds be used for food, incentives, leader stipends?
Applicants should review the HHS Grants Policy Statement[1,355 KB] on the HHS website. It provides specific details on allowable costs on pages II-30 through II-43. Specific to this NOFO, meals/food and incentives will not be allowed. Funds can be spent on leader, master training, and/or materials for arthritis appropriate evidence-based interventions (AAEBI) such as CDSMP, Enhance Fitness, or Walk with Ease.

Should applicants budget for an annual grantee meeting?
Applicants can budget for a grantee meeting for the first year. CDC hopes to hold a grantee meeting late in the first grant year.

Should we submit an application for the ceiling of $500,000?
For the first year, CDC does not expect to have funding available to support each individual award at $500,000, however, applicants may request up to this amount to support their proposed strategies and activities. The average expected award will most likely be around $280,000 per recipient. CDC’s project officers will work with each recipient in making appropriate changes to the work-plan and budget should the award be less than the originally submitted budget.

Our current budget period started 7/1 and ends 6/30. The NOFO states that the estimated award date is 6/29/18, rather than 7/1. Does this mean that the budget period will run 6/29 through 6/28?
The NOFO stated an estimated award date of 6/29/2018. The Notice of Award that will be issued will indicate the official start date of 7/01/2018 for budget and project period. Grant project period is from 7/01/2018 through 6/30/2023.

Can applicants exceed the 10% limit for evaluation to account for BRFSS costs that exceed or use most of this amount? With the optional arthritis module, that is asked every other year, the BRFSS questions costs can be significant, vary across states, and may leave insufficient funds to cover the cost of staff needed to carry out evaluation activities. Given that CDC efforts to have the questions added to the core will not be resolved by the time applications are due, can you please advise as to how to proceed?
For the purpose of application submission, applicant should submit a budget justification that includes the necessary costs for the needed BRFSS arthritis questions and other evaluation activities. If the costs exceed the 10% limit, applicant is to provide a strong justification as to why the additional proposed costs are necessary and provide a detailed description of the costs. CDC project officers will work with each awardee during the first six months of Year 1 to resolve budget issues related to BRFSS questions and/or other evaluation matters.

Since some BRFSS questions are bi-annual does applicant need to fund annual questions?
CDC is proposing to add the BRFSS Arthritis Management Module bi-annual questions relevant to the NOFO to the BRFSS Core Arthritis questions offered annually. We hope that this will be available for the 2019 BRFSS Core questionnaire. We therefore expect that funding will be needed to support annual Core questions only, if funding is required by the state health department. An applicant will need to work with the state BRFSS coordinator to determine how much support may be needed annually.

Can the Program Manager 1.0 FTE position be divided among more than one person?
Yes, more than one person can serve the roll of a program manager but cannot exceed 1.0 FTE in total.

Are we penalized if budget is less in the first year versus the following years that make up the remaining four years of the overall 5-year project period?
No, the applicant’s budget is not being scored and therefore no penalty will result if the applicant budgets less in the first year versus the following years.

Is a detailed budget required only for Project Year 1, or for all project years?  If the former, do we need to include an estimate of total funding needed each year for Project Years 2–5 (because there are required fields in the SF424A Budget and Project Abstract/Summary Forms that ask for this)?  Or can we enter “0” or “n/a” in those fields?
A detailed budget is only required for Project Year 1. Further, an applicant will need to provide an estimated funding amount for year 2-5. That amount should be about the same amount requested for year 1, based on an assumption of the same-funding-level throughout the 5-year project period.

Staffing

Does CDC have specific expectations about staffing?
Applicant is to refer to pages 37 and 38 of the NOFO, under Applicant’s Organizational Capacity to Implement the Approach, and address the minimum requirements described. These include: 1) having 1.0 FTE dedicated for a program manager (can be more than one person) and; 2) identifying a process for evaluation (which should include any staffing deemed necessary by the applicant) not to exceed the 10% of annual total budget (including direct and indirect costs) for the evaluation process. No additional staffing guidance is provided. Applicant’s overall budget, including a staffing plan, and project activities are expected to produce a state-wide impact over the 5-year period.

Can the Program Manager 1.0 FTE position be divided among more than one person?
Yes, more than one person can serve the roll of a program manager but cannot exceed 1.0 FTE in total.

Can funds be spent on leader, master training, or program materials for arthritis appropriate evidence-based interventions (AAEBI) such as CDSMP, Enhance Fitness, or Walk with Ease?
Yes, funds can be spent on leader, master training, and/or materials for arthritis appropriate evidence-based interventions (AAEBI) such as CDSMP, Enhance Fitness, or Walk with Ease. It is up to the applicant to decide, within the NOFO parameters, how to allocate cooperative agreement funds to support grant activities. Applicants should keep in mind, in making decisions about what to support in NOFO applications, that the average award is expected to be $280,000 annually and that funded projects are expected to have statewide impact as measured via the BRFSS performance measures described in the NOFO and be sustainable.

Can applicants exceed the 10% limit for evaluation to account for BRFSS costs that exceed or use most of this amount? With the optional arthritis module, that is asked every other year, the BRFSS questions costs can be significant, vary across states, and may leave insufficient funds to cover the cost of staff needed to carry out evaluation activities.Given that CDC efforts to have the questions added to the core will not be resolved by the time applications are due, can you please advise as to how to proceed?
For the purpose of application submission, applicant should submit a budget justification that includes the necessary costs for the needed BRFSS arthritis questions and other evaluation activities. If the costs exceed the 10% limit, applicant is to provide a strong justification as to why the additional proposed costs are necessary and provide a detailed description of the costs. CDC project officers will work with each awardee during the first six months of Year 1 to resolve budget issues related to BRFSS questions and/or other evaluation matters.

Within the FAQ webpage it indicates that funding can support a leader or master trainer. Does “leader” mean the teacher of programs?
Leader or master trainer, as indicated under the Staffing section on the NOFO FAQ webpage, refers to the individual that trains program instructors. However, NOFO funds can be spent on AAEBI training or certification for master/leader trainers and instructors/course leaders. As stated previously, it is up to the applicant to decide, within the NOFO parameters, how to allocate cooperative agreement funds to support grant activities. Applicants should keep in mind that the average award is expected to be $280,000 annually and that funded projects are expected to have statewide impact as measured via the BRFSS performance measures described in the NOFO and be sustainable.

Eligibility

Who can apply for this NOFO?
This NOFO is available for full and open competition and any organization may apply. Applicants should carefully review the NOFO requirements and expectations for this funding opportunity.

What is meant by “unrestricted” for the eligibility criteria?
Unrestricted eligibility means that this NOFO is available for full and open competition and any organization type may apply. Applicants should carefully review the NOFO requirements and expectations for this funding opportunity.

Is there a limit to the number of applications you will accept from a single institution?
As stated in the NOFO, CDC will issue no more than one award per state, however, the NOFO has no limit on the number of applications that may be submitted by an institution or organization.

Is the expected 1.4% direct access to adults per year or over the five year period?
Applicant is to demonstrate having access to a minimum of 1.4% of adults in its state at the time of application submission as described on page 52.

To meet the 1.4% direct access expectation as defined on page 52, can an applicant apply jointly with another organization?
Yes, applicant is expected to provide formal documentation of the partnership and address the additional details described on page 36 about stakeholders/collaborators/partners expectations.

How does one determine 1.4% direct access?
This term is relevant for Strategy 1. At minimum, specifically for Strategy 1, the applicant is expected to demonstrate existing capacity that ensures direct access to at least 1.4% of total adults (18 and older) residing in the applicant’s state to disseminate Arthritis-Appropriate Evidence-Based Intervention(s) and carry out related activities of this grant. For example, if the applicant is a large employer, insurer, health care system, or health service provider located in the state of Georgia, the applicant will employ, insure, treat, or directly serve at least 109,000 adults in Georgia. There are approximately 7.8 Million adult residents in Georgia per 2016 US Census Bureau information, and 1.4% of 7.8 million is calculated to be approximately 109,000 adults and therefore indicative of the minimum number of adults to whom the applicant should be able to disseminate the AAEBIs-related cooperative agreement activities. Additionally, per this example, the applicant, based on the nature of their relationship to the population as an employer, insurer, health care system, or health service provider, would therefore have direct access and sufficient capacity to reach and serve at least 109,000 adults in the state. Applicants are not restricted to the organization types and roles listed in the Georgia example, but should have comparable access and reach into the adult population within a state.

Can applicant apply jointly with a partner and combine the access to adults for both to meet the 1.4% state-wide access to adults expectation?
Yes, an applicant can apply jointly and can combine the co-applicant’s access numbers to adults to meet the 1.4% state-wide access expectation. However, only one organization can serve as the fiscal agent.

Is it 1.4% state-wide access for each of the four strategies or a total of 1.4% for all four strategies?
The 1.4% minimum direct access is an expectation specifically for Strategy 1. However, for all strategies, state-wide impact is expected.

What is the difference between access and reach, are these two terms interchangeable?
Applicant is to demonstrate having access to a minimum of 1.4% of adults in its state at the time of application submission as described on page 52, and describe intended reach to meet defined project milestones for the first year and over the 5-year project period. Achievement of performance measure outcome targets is expected within 5 years; therefore milestones reflective of incremental progress should be set for years 1-4 leading up to the achievement of the performance outcomes (as measured by the BRFSS survey questions outlined in the NOFO) by the end of the 5-year cooperative agreement.

Can the audience size reached by radio ad spots meet the 1.4% direct access expectation for Strategy 1?
No, this would not meet the definition of the 1.4% direct access expectation intended for Strategy 1 and described on page 52, however, it may for Strategy 4.

Project Narrative

Does CDC require a template or format for the Narrative?
Page 27 of the NOFO describes the Project Narrative requirements. No specific formatting is requested, nor is a template provided. The project narrative required for the work plan as described on page 19 also does not require a specific template or format.

Is a Data Management Plan (p. 33) expected to be a separate document, or should it be included within the text of the narrative?
The Data Management Plan must be included in the project narrative and will count against the 20-page limit for the project narrative. It should be labeled “Data Management Plan” and placed with the performance plan.

Does the sample work plan that is to be included in the narrative have to be 12 font size, or can applicant use a smaller font size?
Applicant can use a smaller legible font size for the work plan.

It appears that information about the outcome measures needs to be included in three places throughout the application- the outcomes section, the evaluation and performance measurement section, and the work plan. Given the short page limit and the need to embed the work plan within that, the redundancy of listing the outcomes multiple times will take up valuable space.  Can the information about the outcomes be streamlined or only included in select sections? 
The applicant is to submit a project Narrative that must include all of the following headings (including subheadings as indicated): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach, and Work Plan. The applicant may choose to refer to other sections of the Project Narrative to save space/ reduce redundancy if it does not compromise the Project Narrative headings and subheadings and their requirements.

Can CDC provide clarification regarding the level of detail to be included in the work plan as compared to the project narrative?  Does the work plan need to be embedded within the narrative (for example: narrative description of Strategy 1 (S1) activities followed by work plan chart for S1 activities) or should it be presented as one contiguous plan? 
The Project Narrative requires a separate subheading for the Work Plan, therefore the Work Plan needs to be a distinct, contiguous subsection of the narrative which includes: Background, Approach, Applicant Evaluation and Performance Measurement Plan, the Organizational Capacity of Applicants to Implement the Approach, and Work Plan. The NOFO provides a sample template of the work plan. An applicant is not required to use the provided template, but should capture the items provided in the template. The Work Plan should cover the activities to occur in grant year 1. However, the project narrative should cover the activities to occur in grant year 1 (in sufficient detail for objective reviewers to understand and assess the merit of the plan) and a high level plan (no more than 3 pages) for subsequent years. The applicant may choose to refer to other sections of the Project Narrative to save space/ reduce redundancy if it does not compromise the Project Narrative headings and subheadings and their requirements.

On page 46 of the NOFO, optional attachments, outside of the project narrative 20-page limit, include resumes, position descriptions, letters of support, organization charts, MOAs, and MOUs. It states that “applicants may not attach documents other than those listed; if other documents are attached, applications will not be reviewed.” Does this mean a project map cannot be attached?
Similar to a previous answer provided regarding inclusion of a logic model, a project map should ideally be included within the Project Narrative 20-page limit. Information referenced outside the Project Narrative should not be an expansion of the Project Narrative, but solely supportive information for the Project Narrative. Attachments should not be used as a way to extend/exceed page limits associated with the Project Narrative.

Is there any possibility CDC could extend the page limit for the Project Narrative, and/or allow applicant to include the work plan as an appendix?
Twenty pages are allotted to the Project Narrative, which includes 5 headings (and subheadings): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach, and Work Plan. There is no page length minimum for a section or subsection. Although applicants are to use size 12 Font (any type) for all narrative, any legible size font can be used for tables and graphs. The applicant may choose to refer to other sections of the Project Narrative to save space/ reduce redundancy if it does not compromise the Project Narrative headings and subheadings and their requirements.
Appendices can be used to supply other information. However, information referenced outside the Project Narrative should not be an expansion of the Project Narrative, but solely supportive information for the Project Narrative. Attachments should not be used as a way to extend/exceed page limits associated with the Project Narrative.

In follow-up to the question asked regarding including the Data Management Plan (DMP) within the 20-page project narrative, can you provide some clarification on the level of detail that needs to be included?  Do all five topics referenced need to be included in the narrative for each data source or can some of that detail be attached?
If an applicant is proposing to collect only the BRFSS data associated with the NOFO performance measures requirements, then a DMP is not required. A DMP for this NOFO would only be needed if a new data set is being proposed to address proposed outcome measures.

If applicant determines a DMP is not required, the applicant should include one sentence from the following language in the Project Narrative:  “A DMP is not being submitted for one or more of the following reasons (select only those applicable):

1) Applicant is collecting only the required BRFSS data;

2) Applicant is using other publically available data;

3) Applicant is only collecting data for program improvement, and not for decision making or generalizability;

4) Applicant proposes to utilize other available data sets.”

If an applicant determines that a DMP is required, it is acceptable to include very limited, basic information addressing the key components within the Project Narrative and provide additional details only if and when an award is granted. Detail beyond basic information may be provided in attachments, but is not required at the time of application.

Work Plan

Does applicant need to submit a work plan for first year only or for each year?
The work plan provided on page 19 is an example of the type of information and detail that should be submitted for Year 1, only. In addition, a Year 1 project narrative is expected. Project narrative for Year 1 should be provided at the beginning of the work plan. For Years 2-5, the applicant is expected to provide a high-level plan in narrative form (no specific format) and to not exceed 3 pages in length. Cooperative agreement awardees will provide detailed plans for subsequent years (i.e. years 2-5), as part of an annual performance reporting process.

What sections must be included in the work plan? Does an applicant need to use the sample template included in the NOFO?
The NOFO provides a sample template of the work plan to demonstrate how an applicant can capture and track annual progress of applicant’s strategies and activities toward meeting project outcome measures and targets. An applicant is not required to use the provided template, but should capture the items provided in the template.

Does the sample work plan that is to be included in the narrative have to be 12 font size, or can applicant use a smaller font size?
Applicant can use a smaller legible font size for the work plan.

Can CDC provide clarification regarding the level of detail to be included in the work plan as compared to the project narrative?  Does the work plan need to be embedded within the narrative (for example: narrative description of Strategy 1 (S1) activities followed by work plan chart for S1 activities) or should it be presented as one contiguous plan? 

The Project Narrative requires a separate subheading for the Work Plan, therefore the Work Plan needs to be a distinct, contiguous subsection of the narrative which includes: Background, Approach, Applicant Evaluation and Performance Measurement Plan, the Organizational Capacity of Applicants to Implement the Approach, and Work Plan. The NOFO provides a sample template of the work plan. An applicant is not required to use the provided template, but should capture the items provided in the template. The Work Plan should cover the activities to occur in grant year 1. However, the project narrative should cover the activities to occur in grant year 1 (in sufficient detail for objective reviewers to understand and assess the merit of the plan) and a high level plan (no more than 3 pages) for subsequent years. The applicant may choose to refer to other sections of the Project Narrative to save space/ reduce redundancy if it does not compromise the Project Narrative headings and subheadings and their requirements.

Recipient Strategies and Activities

Is the Diabetes Prevention Program (DPP) considered an “Other Self-Management Intervention”?
Yes, any proposed other self-management intervention must have evidence of effectiveness for its intended purpose (e.g., physical activity, pain management, etc.) and have a delivery and implementation infrastructure in place. Additionally, a proposed self-management intervention must be intended for adults, and primarily focused on physical activity, self-management education, injury prevention (e.g. occupational), and/or weight-management strategies. DPP does meet these requirements and can be considered an “other self-management intervention”. (Refer to Attachment 1).

What is meant by “address the unique needs and barriers of adults with arthritis”?
CDC provides information about barriers faced by adults with arthritis on the following webpage: https://www.cdc.gov/arthritis/data_statistics/comorbidities.htm. Most adults face the following common barriers to physical activity:

  • Lack of time.
  • Competing responsibilities.
  • Lack of motivation.
  • Difficulty finding an enjoyable activity.

Adults with arthritis may face the following additional, disease-specific barriers:

  • Concerns about making arthritis pain worse.
  • Fear about causing further joint damage.
  • Uncertainty about which types and amounts of activity are safe for their joints.

Would Walk with Ease (group-led) and Walk with Ease (self-directed) programs be considered one or two arthritis appropriate evidence based interventions (AAEBIs) for Strategy 1?
For the purpose of the DP18-1803 NOFO, group-led and self-directed Walk with Ease programs are considered as two separate interventions, therefore it would be considered as two AAEBIs for Strategy 1.

Under Strategy 3, are we required to promote a specific walking program statewide, rather than promoting walking in general for people with arthritis?
A specific program is not required for Strategy 3. An applicant can promote, leverage and/or expand any walking initiative(s)/program(s) as long as they are ongoing (i.e., not an one-time event) and sustainable effort(s) in their state, inclusive of and appropriate for adults with arthritis and are likely to have a state-wide impact. Some examples are provided in Attachment 2.

Is the Worksite Chronic Disease Self-Management Program (WCDSMP) considered a CDC recommended or promising arthritis appropriate evidence-based intervention (AAEBI), or is it considered an other self-management intervention?
WCDSMP, for the purpose of this NOFO, is considered an other self-management intervention (OSMI) and may be utilized as directed under the guidance for OSMIs in NOFO Attachment 1.

Is the Walk with Ease (WWE) in Spanish considered a recommended or promising arthritis appropriate evidence-based intervention (AAEBI), or is it considered an other self-management intervention?
The WWE (Spanish), for the purpose of this NOFO, is considered an other self-management intervention.

Can an applicant implement Walk with Ease (WWE) for both Strategies 1 and 3?
Yes, but it is not required. An applicant can support any walking initiative(s)/program(s) for Strategy 3 that are ongoing (i.e., not a one-time event), inclusive of and appropriate for adults with arthritis, sustainable, and likely to have a state-wide impact. Some examples are provided in Attachment 2. Further, an applicant may implement any interventions that meet the requirements provided in Attachment 1 of the NOFO to address Strategy 1.

Is the Geri-Fit® strength training physical activity program for older adults considered an appropriate “other” self-management intervention under this NOFO?
Yes.

Can applicants focus their activities on major metropolitan areas or MMSAs?
It is up to an applicant to decide how and where to focus their efforts and applicants are expected to describe how their activities will yield state-wide impact. This is a strategy that can be used. Applicant may opt to consult with the state BRFSS coordinator for information about the state’s sampling procedures if applicant plans to take this approach.
How can I obtain technical support or information about webinars for the promising or recommended arthritis appropriate evidence based interventions (AAEBI)?

Attachment 1 on the CDC NOFO webpages provides links for each AAEBI for more information, including technical support for some.

Does an applicant have to do all the activities indicated under each Strategy?
Yes.

In activity, 1.1, do we commit to making the dissemination plan using language provided? Or is the language asking us to create our own for the application based on the examples provided in Attachment 2?
Applicant is to propose their own dissemination plan to initiate, sustain, and expand availability of selected AAEBIs using evidence based dissemination strategies. Attachment 2 includes examples of appropriate evidence based dissemination strategies for consideration when developing the applicant’s own dissemination plan.

Can an applicant propose Silver Sneakers as a walking initiative(s)/program(s) for Strategy 3?
Silver Sneakers is a fitness intervention that for the purposes of this NOFO, can be considered as an other self-management intervention (OSMI). It is appropriate for Strategy 1 related to the OSMI and sustainability expectation.

Can applicant primarily target adults with arthritis 45 years and older without excluding adults with arthritis 18-44 years, while achieving state-wide impact as measured by the evaluation plan? 

Yes, the applicant can primarily target adults with arthritis 45 years and older without excluding adults with arthritis 18-44 years, and must demonstrate direct access to a minimum of 1.4% of total adults in the state.

Would an 8-week walking program that is offered across the state once a year be considered “ongoing,” and “sustainable,” if it’s been running for several years?
Yes, a recurring statewide walking program such as the one described would be considered sustainable and an appropriate walking initiative for NOFO Strategy 3.

One of the questions and answers on the FAQ page states that Workplace CDSMP (wCDSMP) is considered an “other self-management intervention”. Has the wCDSMP been released for implementation? Do you have any more information on this?
The wCDSMP can be selected as an “other self-management intervention” for Strategy 1. Workplace CDSMP information can be found on the Self-Management Resource Center webpage (SMRC). Please contact SMRC at smrc@selfmanagementresource.com for more information on the program’s availability and process of its implementation. It is also important to note the guidance and limits related to OSMIs described in NOFO Attachment 2: If an applicant opts to select an OSMI related to Strategy 1, among the requirements, the applicant must “describe how the self-management intervention is already being disseminated with an implementation infrastructure in place (see Attachment 2 under Strategy 1.1 for examples) and how it will leverage these existing activities.”

Evaluation and Performance Measurement

Is it acceptable to include database support (e.g., data collection, reporting to partners, cross-referral, provider feedback) in the budget? Would that fall under the 10% evaluation portion? Can it be contractual?
Funding can be used to support a database for evaluation purposes and should fall under the 10% evaluation funding limit. If the costs exceed the 10% limit, applicant is to provide a strong justification as to why the additional proposed costs are necessary to successfully deliver on the applicant’s proposed strategies, activities and outcomes, and provide a detailed description of the costs. CDC will not require data collection beyond the BRFSS measures described in the NOFO. It is at the discretion of the applicant to propose data collection and evaluation activities beyond this. No preferences or limitations are placed on the type of funding mechanism (.i.e. contractual or other) to use to support evaluation activities. Applicant’s overall budget and project activities is expected to produce a state-wide impact over the 5-year period. CDC project officers will work with each awardee during the first six months of Year 1 to resolve budget issues, BRFSS questions and/or other evaluation matters.

Are there reporting requirements that are not noted in the NOFO (i.e. reach and partner tables collected under CDC-RFA-DP12-1210).
No, only requirements/expectations listed in NOFO DP18-1803 are applicable for this funding opportunity.

Should we anticipate that CDC will have us develop an evaluation and performance plan that will include data collection/reporting of program capacity (i.e., reach counts- number of people counseled on physical activity, number of patients referred to programs, etc.)?
No. CDC will work with awardees’ submitted work plan, outcome measures and performance measurement strategy based on the NOFO requirements and expectations listed on pages 14-17 and 19-21. Additional requirements will not be imposed on awardee during the grant cycle. However, CDC project officers will work with awardees during the first 6 months of first grant year to make adjustments as needed in the awardees originally proposed work plan and evaluation and performance plan.

What kind of data “counts” as requiring a data management plan?
Data is defined by the applicant under the Evaluation and Performance Measurement section. If the applicant will collect data other than the Behavioral Risk Factor Surveillance System data as part of their evaluation and performance measure plan, a Data Management Plan (DMP) must be submitted. See web link for additional information: https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Can applicants exceed the 10% limit for evaluation to account for BRFSS costs that exceed or use most of this amount? With the optional arthritis module, that is asked every other year, the BRFSS questions costs can be significant, vary across states, and may leave insufficient funds to cover the cost of staff needed to carry out evaluation activities. Given that CDC efforts to have the questions added to the core will not be resolved by the time applications are due, can you please advise as to how to proceed?
For the purpose of application submission, applicant should submit a budget justification that includes the necessary costs for the needed BRFSS arthritis questions and other evaluation activities. If the costs exceed the 10% limit, applicant is to provide a strong justification as to why the additional proposed costs are necessary and provide a detailed description of the costs. CDC project officers will work with each awardee during the first six months of Year 1 to resolve budget issues related to BRFSS questions and/or other evaluation matters.

What is CDC using as the cut off point for severe joint pain for the BRFSS question associated with the severe joint pain performance measure: “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be?”
BRFSS cut point for determination of severe joint pain is a report of 7 or higher on the 10 point scale.

Since some BRFSS questions are bi-annual does applicant need to fund annual questions?
CDC is proposing to add the BRFSS Arthritis Management Module bi-annual questions relevant to the NOFO to the BRFSS Core Arthritis questions offered annually. We hope that this will be available for the 2019 BRFSS Core questionnaire. We therefore expect that funding will be needed to support annual Core questions only, if funding is required by the state health department. An applicant will need to work with the state BRFSS coordinator to determine how much support may be needed annually.

What are expectations for a large state as far as outcome measures and BRFSS questions, and what if more than 10% of total budget is needed to conduct evaluation activities?
The expectations regarding performance measures are the same, regardless of state size and outcomes are based on changes in percentages and not absolute numbers. If the costs exceed the 10% budget limit for the evaluation process, applicant is to provide a strong justification as to why the additional proposed costs are necessary and provide a detailed description of the costs. CDC project officers will work with each awardee during the first six months of Year 1 to resolve budget issues related to, BRFSS questions and/or other evaluation matters.

Data for some arthritis BRFSS questions will not be available for 2018, can an applicant use 2019 BRFSS data as performance measures baselines?
Applicants may use 2017 BRFSS data for their baseline to report on performance measures that are not on the BRFSS core survey. If 2017 data are not available, applicants may use 2019 data for their baseline for these measures.

Can applicants focus their activities on major metropolitan areas or MMSAs?
It is up to an applicant to decide how and where to focus their efforts and applicants are expected to describe how their activities will yield state-wide impact. This is a strategy that can be used. Applicant may opt to consult with the state BRFSS coordinator for information about the state’s sampling procedures if applicant plans to take this approach.

Can an applicant combine years when looking at the BRFSS measures? Especially since rural locations/disparate populations confidence bounds can be larger than what is seen at the CDC/U.S. data level.
Applicant may not need to combine data years to develop credible estimates for sub-populations given arthritis’ high prevalence. If an applicant chooses to combine data for baseline, the applicant would then need to combine years throughout the 5-year project period to produce prevalence estimates. A 5-year project period many not be enough time to capture adequate progress, using combined years, especially given the delay in access to BRFSS data.

If we are choosing to do a physical activity program should applicant prioritize the outcomes measures CDC has supplied in the NOFO?
Yes, CDC expects the applicant to achieve and report on the first three (3) outcome measures (OM1 – OM3) from the list of outcome measures on page 14-15, as well as one (1) or more of the additional outcome measures (OM4 – OM6) listed on page 15, as applicable to the applicant’s proposed strategies and activities. The applicant may also propose other outcome measures appropriate for their proposed strategies and activities, and consistent with the intended NOFO outcomes. The applicant has no limits on how many or what kind of other outcome measures to propose.

With the activities that are provided, does that mean CDC is not interested in SMART objectives included in the work plan and narrative, or are those strategies and activities as well as outcome measures all guidance for writing objectives?
Applicants are encouraged to propose SMART strategies/objectives and aligned activities to ensure that the objective panel reviewers have sufficient information about what the applicant is proposing to properly assess the application. Each strategy and activity described in the NOFO is expected to be addressed by the applicant described on pages 7-10, but applicant is not expected to reiterate the content. The applicant is expected to tailor and provide greater detail for their own strategies and activities based on the strategies and activities described in the NOFO. The strategies and activities are to accomplish annual outcome measures and targets as described on pages 14-16.

For the baseline and outcome measures, are we supposed to use crude estimates or age-adjusted estimates?
An applicant can use either or both crude estimates and age-adjusted estimates.

Can or should the Year 1 milestones that an applicant writes into its work plan be the same as the Short-term Outcomes listed on page 5 of the NOFO?
Yes they can be the same. However, ideally, Grant Year 1 (GY1) milestones should reflect preliminary accomplishments or achievements that are expected to occur in GY1 that, if achieved, will serve as indicators that the work plan activities are on track and being successfully carried out to achieve short-term and future outcomes.
The short term outcomes themselves might be considered milestones towards meeting mid-term outcomes. The short term outcomes listed in the NOFO are expected to occur within approximately the first 2 years of the cooperative agreement and help lead to the achievement of medium and long-term outcomes. Milestones should be indicators of progress towards outcomes and a part of an applicant’s performance measurement plan. Your performance measurement plan will drive the work plan. You must follow the instructions on pages 14 and 15 regarding outcome measures and minimum expectations for the performance measurement plan. Applicant’s proposed outcome measures will drive annual milestones. The short-term outcomes described in the logic model are there to help guide the applicant in creating their own short-term outcomes and milestones. They are not required. Applicant can propose other or additional short-term outcomes. The short-term outcomes listed on page 5 can also be used as milestones, particularly for medium and long-term outcomes.

Can applicant primarily target adults with arthritis 45 years and older without excluding adults with arthritis 18-44 years, while achieving state-wide impact as measured by the evaluation plan?

Yes, the applicant can primarily target adults with arthritis 45 years and older without excluding adults with arthritis 18-44 years, and must demonstrate direct access to a minimum of 1.4% of total adults in the state.

It appears that information about the outcome measures needs to be included in three places throughout the application- the outcomes section, the evaluation and performance measurement section, and the work plan. Given the short page limit and the need to embed the work plan within that, the redundancy of listing the outcomes multiple times will take up valuable space.  Can the information about the outcomes be streamlined or only included in select sections?
The applicant is to submit a project Narrative that must include all of the following headings (including subheadings as indicated): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach, and Work Plan. The applicant may choose to refer to other sections of the Project Narrative to save space/ reduce redundancy if it does not compromise the Project Narrative headings and subheadings and their requirements.

Based on the 1% improvements on each outcome measure over the 5 year grant period: Can CDC confirm the 1% target is absolute and not relative? E.g., if our baseline for percent of adults with arthritis who report no physical activity is 35%, the target should be 34% and not 34.65%?
On pages 14 -15, outcome measures #2, #4 and #5 are expected to have targets indicating a 1% increase over the 5-year grant period. The 1% increase or greater if desired, should be indicated as an absolute number, or as a full 1 percentage point change (e.g., if baseline for percent of adults with arthritis who report no physical activity is 35%, the target should be 34%, not 34.65%).

Regarding the Data Management Plan (DMP), does CDC expect a description of how applicant will maintain, collect, distribute etc. data or is CDC looking for a full-fledged DMP? If you are looking for a full Data Management Plan, is there a template we could follow?
The DMP for the submission of this application should briefly address the information described on page 16 section ii. under the fourth bullet. A full-fledged DMP is not expected at this time. CDC and the recipient will spend the first 6-months of year one making any changes or additions to the evaluation and performance measurement plan, including DMP if applicable.

In follow-up to the question asked regarding including the Data Management Plan (DMP) within the 20-page project narrative, can you provide some clarification on the level of detail that needs to be included?  Do all five topics referenced need to be included in the narrative for each data source or can some of that detail be attached?
If an applicant is proposing to collect only the BRFSS data associated with the NOFO performance measures requirements, then a DMP is not required. A DMP for this NOFO would only be needed if a new data set is being proposed to address proposed outcome measures.

If applicant determines a DMP is not required, the applicant should include one sentence from the following language in the Project Narrative:  “A DMP is not being submitted for one or more of the following reasons (select only those applicable):

1) Applicant is collecting only the required BRFSS data;

2) Applicant is using other publically available data;

3) Applicant is only collecting data for program improvement, and not for decision making or generalizability;

4) Applicant proposes to utilize other available data sets.”

If an applicant determines that a DMP is required, it is acceptable to include very limited, basic information addressing the key components within the Project Narrative and provide additional details only if and when an award is granted. Detail beyond basic information may be provided in attachments, but is not required at the time of application.

Other

I am having technical problems registering and inputting information into Grants.gov. Can you help?
For assistance with technical difficulties with the Grants.gov system, please contact:

GRANTS.GOV Applicant Support
1-800-518-4726
support@grants.gov

How can I find out about current arthritis activities in my state? Who can I contact in a state health department involved in arthritis state activities?
Every state may not have an arthritis program or an arthritis contact at the state health department. CDC currently funds 12 states for arthritis activities. State health department contacts and information for these 12 funded projects are available at: https://www.cdc.gov/arthritis/partners/funded-states.htm. You may also reach out to the National Association of Chronic Disease Directors (NACDD) Representative Member to obtain information on other states’ arthritis contacts. To find the NACDD Representative Member go here – http://www.chronicdisease.org/page/About_NACDD_Member, and select “Representative Member Directory”. From there scroll down and click to get contact information, or click on the “Representative Directory Map” and select the appropriate state.

Does CDC have specific expectations about staffing?
Applicant is to refer to pages 37 and 38 of the NOFO, under Applicant’s Organizational Capacity to Implement the Approach, and address the minimum requirements described. These include: 1) having 1.0 FTE dedicated for a program manager (can be more than one person) and; 2) identifying a process for evaluation (which should include any staffing deemed necessary by the applicant) not to exceed the 10% of annual total budget (including direct and indirect costs) for the evaluation process. No additional staffing guidance is provided. Applicant’s overall budget, including a staffing plan, and project activities are expected to produce a state-wide impact over the 5-year period.

Can the Program Manager 1.0 FTE position be divided among more than one person?
Yes, more than one person can serve the roll of a program manager but cannot exceed 1.0 FTE in total.

Will an applicant be penalized if they list more AAEBIs in their letter of intent than they write into their application submission?
No, changes can be me as long as they meet the requirements and expectations of the NOFO.

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