OT18-1803 Work Plan.docx

Center for State, Tribal, Local, and Territorial Support Health Department Program Branch

YEAR 2 WORK PLAN

CDC-RFA-OT18-18030202SUPP20

SUPPLEMENTAL NOTICE OF FUNDING OPPORTUNITY (NOFO) for CDC-RFA-OT18-1803: Tribal Public Health Capacity-Building and Quality Improvement Umbrella

Directions: Please complete the following template for the CSTLTS Project Plan for which you will submit a response. The items marked with a red asterisk (*) are required for submission.

Please note: For the purpose of this supplemental NOFO, the Work Plan represents the “Project Narrative.” Applicants must complete a work plan for the CSTLTS Project Plan for which they would like to apply. The completed work plan should be submitted as an individual file in the “Project Narrative” section on Grants.gov.

APPLICANT INFORMATION

Applicant Name* (Enter the same name used when applying to CDC-RFA-OT18-1803.)

Applicant Award Number*

Applicant POC Name*

Applicant POC Phone Number*

Applicant POC Email Address*

Applicant POC Mailing Address

Applicant POC Backup Name*

Applicant POC Backup Email Address*

Applicant Geographic Category* (Select the same Geographic Category used when applying to CDC-RFA-OT18-1803.)

PROJECT TITLE

Project Title* (Select the CSTLTS Project Plan title this Work Plan addresses.)

· COVID-19 Tribal Nation Preparedness and Response

· COVID-19 Tribally Designated Organization Preparedness and Response

PROJECT APPROACH

Describe the target population to receive the capacity-building and quality improvement assistance under the CSTLTS Project Plan, as well as the key strategies to accomplish the objectives of the project. (275 words max).

Target Population Description* (This should be consistent with the target population identified in the CSTLTS Project Plan [25 words max].)

☐ Data management ☐ Distribution and use of medical material ☐ Emergency operations and coordination ☐ Epidemiology ☐ Equipment, supplies, and shipping ☐ Infection control ☐ Laboratory services ☐ Public health management and risk assessment of travelers and other persons with potential COVID-19 exposures ☐ Risk communication ☐ Surge staffing ☐ Surveillance ☐ Travelers health

WORK PLAN

Due to the urgency of the COVID-19 Emergency Response, this announcement only requires a high-level description of program strategies, activities, and outputs. Recipients have until May 21, 2020 (45 days from the date of award) to modify and submit work plans. (5,000 words max). Please use bullets.

Program Strategies* Please use bullets (1,000 words max)

Activities*

Outputs*

Performance Measures Measurable outcomes of the program will be in alignment with the project activities and will be developed in coordination with the Center for State, Tribal, Local, and Territorial Support (CSTLTS) Evaluation Team within the first 60 days of award.

Process Measures*

Outcome Measures*

ORGANIZATIONAL CAPACITY*

Describe your capacity to successfully complete this project. Include your organization’s relevant staffing, systems, and resources. (1,000 words max)

PROGRAM EXPERIENCE*

Describe your experience as it relates to this project. Include products developed; services, training, and technical assistance provided; and relevant target populations supported. (1,000 words max)

COLLABORATIVE WORK*

Describe your plan for collaboration as it relates to this project. Include specific organizations or entities as applicable. (1,000 words max)

SUB-CONTRACTUAL WORK*

Describe your plan for sub-contractual work. Include recommended criteria for identifying and selecting subcontractors. (1,000 words max)

BUDGET INFORMATION

Due to the urgency and significant workload related to the COVID-19 Emergency Response, this announcement only requires initial submission of high-level budget information; an SF-424 Application for Federal Domestic Assistance Version 2, including the “Consolidated Application/Plan/Funding Request Explanation, which serves as a summary budget narrative; and an SF-424A Budget Information-Non-Construction report. The summary budget narrative should be a short description of the BP2 funding request.

Enter the whole dollar amount for each field. Ensure the proposed budget is reasonable and consistent with the approach outlined in the work plan. Recipients have until May 21, 2020 (45 days from the date of award) to modify and submit an itemized budget and budget narrative.

PERSONNEL SALARIES AND WAGES TOTAL*

FRINGE BENEFITS TOTAL*

CONSULTANT BENEFITS TOTAL*

EQUIPMENT TOTAL*

SUPPLIES TOTAL*

TRAVEL TOTAL*

OTHER TOTAL*

CONTRACTUAL TOTAL*

DIRECT COSTS TOTAL*

INDIRECT COSTS TOTAL*

BUDGET TOTAL*

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