CDC-RFA-EH20-2002.pdf

Centers for Disease Control and Prevention

National Center for Environmental Health

Promoting Asthma Friendly Environments Through Partnerships and Collaborations

CDC-RFA-EH20-2002

Application Due Date: 04/30/2020

Promoting Asthma Friendly Environments Through Partnerships and Collaborations

CDC-RFA-EH20-2002

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- EH20-2002. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Promoting Asthma Friendly Environments Through Partnerships and Collaborations C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

New- Type 1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-EH20-2002

E. Assistance Listings (CFDA) Number:

93.070 F. Dates:

1. Due Date for Letter of Intent (LOI): 03/20/2020

2. Due Date for Applications: 04/30/2020, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

The LOI is requested but not required. The purpose of an LOI is to allow CDC program staff to estimate the number of and plan for the review of submitted applications. LOI must be sent via e-mail to Paige Welch, CDC/Division of Environmental Health Science and Practice (Email: pwelch@cdc.gov) by March 20,2020, 11:59 p.m. U.S. Eastern Standard Time.

3. Date for Informational Conference Call:

CDC will conduct an informational conference call regarding the NOFO on March 23, 2020 at 2:00 p.m., U.S. Eastern Standard Time. The call-in information is: (877) 954-4821 Passcode: 57457322#. Questions and responses from this conference call will be posted at https ://wwwdev.cdc.gov/asthma/test-q-a-page.htm.

G. Executive Summary:

1. Summary Paragraph:

https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov https://wwwdev.cdc.gov/asthma/test-q-a-page.htm https://wwwdev.cdc.gov/asthma/test-q-a-page.htm

The Centers for Disease Control (CDC) announces availability of Fiscal Year 2020 funds for NOFO EH20-2002, Promoting Asthma Friendly Environments Through Partnerships and Collaborations. The purpose of this NOFO is to promote evidence-based asthma strategies and interventions through partnerships and collaborations. Recipients will develop partnerships and collaborations using health education and communication strategies that will result in measurable impacts. These strategies are outlined in the CDC asthma technical package, EXHALE. Recipients will strengthen existing programs to expand the reach of services through six EXHALE strategies.

Efforts will be supported by core public health activities: partnership engagement, workforce development, guidance and support for programmatic efforts, strategic communication, and evaluation. Infrastructure activities will support communication and education interventions tailored to multiple audiences, such as people with asthma, caregivers, school personnel, and health care providers. Recipients will provide clear, consistent, and straightforward guidance on the delivery of asthma education for people with asthma and health professionals, and explain how optimal interactions between these groups and other relevant professionals (e.g., schools, policy-makers) should be established and maintained. Recipients should focus on populations most vulnerable to the effects of asthma.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 4

d. Total Period of Performance Funding: $4,000,000

e. Average One Year Award Amount: $200,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 09/01/2020

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Asthma in the United States is both common and costly. According to recent estimates, more than

25.2 million Americans have asthma, including 6.2 million children and 19.0 million adults. In https://www.cdc.gov/asthma/pdfs/EXHALE_technical_package-508.pdf addition (this is from 2016 data available at https://www.cdc.gov/asthma/most_recent_national _asthma_data.htm or https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm ), asthma accounts for 1.8 million emergency department visits, 9.8 million physician office visits and 189,000 hospitalizations. Asthma is responsible for 13.8 million missed school days and 14.2 million missed workdays annually. [1] In spite of available drugs to treat and control asthma, 10 people die of asthma each day. [2] Asthma places a significant economic burden on the United States. Estimates from 2008-2013 Medical Expenditure Panel Survey household data showed that the cost of treating asthma was $50.3 billion annually, while the total cost of asthma, including costs incurred by absenteeism and mortality, amounted to $81.9 billion. [3] Asthma also affects certain sub-populations disproportionately, rendering significant disparities. For example, asthma is more common and more severe among children, women, low-income, inner-city residents, and African American and Puerto Rican communities, who have higher rates of emergency department visits, hospitalizations, and deaths. [4] American Indian/Alaska Native children are 60 percent more likely to have asthma than non-Hispanic White children. [5] The reasons for these disparities are complex but cannot be attributed to genetic differences alone. Economic, social, and cultural factors-ranging from lack of access to quality health care to differences in health beliefs between patients and their doctors add to the greater asthma burden among these groups. Individuals may also face housing and work conditions that place them at greater risk for frequent and prolonged exposure to environmental allergens and irritants that worsen asthma.[4] This NOFO builds upon work of non-governmental agencies supported by CDC through funding opportunity announcement CDC-RFA-EH15-1503.

This NOFO is based on a technical package known as EXHALE, which is comprised of six evidence-based strategies selected for their potential of having the greatest collective impact on controlling asthma. To reduce the burden of asthma and help advance CDC's CCARE (Controlling Childhood Asthma Reducing Emergencies) goal of preventing 500,000 hospitalizations and emergency department visits among children with asthma, this NOFO requires strong leadership and enhanced program infrastructure.

Recipients will support these strategies as a package and promote that strategies are conducted in the same, high-burden geographic location or population so that strategies complement and reinforce each other.

Footnotes 1 - Hsu J, Sircar K, Herman E, Garbe P. (2018). EXHALE: A Technical Package to Control Asthma. Atlanta, GA: National Center for Environmental Health, Centers for Disease Control and Prevention 2 - https://www.aafa.org/asthma-facts 3 - https://www.atsjournals.org/doi/10.1513/AnnalsATS.201703-259OC 4 - https://www.nhlbi.nih.gov/health-pro/resources/lung/naci/discover/disparities.htm 5 - https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=30 https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm

b. Statutory Authorities This program is authorized under Section 317 (k)(2) and 317I of the Public Health Service Act, [42 U.S.C. Sections 247b and 247b-10], as amended.

c. Healthy People 2030 https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030 /Proposed-Framework

d. Other National Public Health Priorities and Strategies This NOFO aligns with The National Prevention Strategy; clinical guidelines for the diagnosis and management of asthma from the National Asthma Education and Prevention Program, Expert Panel Report-3 (NAEPP EPR-3) https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthg dln_1.pdf;

Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities https://www .epa.gov/sites/production/files/2014-08/documents/federal_asthma_disparities_action_plan.pdf ;

The Guide to Community Preventive Services http://www.thecommunityguide.org/asthma/index .html; and the Institute of Medicine (IOM) report Primary Care and Public Health http://www .nationalacademies.org/hmd/Reports/2012/Primary-Care-and-Public-Health.aspx

e. Relevant Work The National Asthma Control Program (NACP) has partnered with Non-Governmental Organizations (NGOs) since 2002 to create and deliver communications and education strategies focused on trigger reduction and other environmental strategies to diminish the burden of asthma.

Since its inception, NACP has funded state and territorial public health departments to promote a comprehensive approach to asthma control [1]. NACP also funds NGOs to expand its efforts to promote adherence to NAEPP, EPR-3 guidelines [2].

NACP's involvement in the 6|18 initiative has aligned evidence-based practices with emerging value-based payment and delivery models [3]. NACP recently started the CCARE initiative to improve asthma outcomes in children.

Footnotes:

1 - https://www.cdc.gov/asthma/nacp.htm 2 - http://www.thecommunityguide.org/asthma/multicomponent.html 3 - https://www.cdc.gov/sixeighteen/asthma/index.htm

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Evaluation and performance measurements help demonstrate achievement of program outcomes;

build a stronger practice base for specific program strategies; clarify applicability of the https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Proposed-Framework https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Proposed-Framework https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf https://www.epa.gov/sites/production/files/2014-08/documents/federal_asthma_disparities_action_plan.pdf https://www.epa.gov/sites/production/files/2014-08/documents/federal_asthma_disparities_action_plan.pdf http://www.thecommunityguide.org/asthma/index.html http://www.thecommunityguide.org/asthma/index.html http://www.nationalacademies.org/hmd/Reports/2012/Primary-Care-and-Public-Health.aspx http://www.nationalacademies.org/hmd/Reports/2012/Primary-Care-and-Public-Health.aspx https://www.cdc.gov/asthma/nacp.htm http://www.thecommunityguide.org/asthma/multicomponent.html https://www.cdc.gov/sixeighteen/asthma/index.htm evidence-based interventions to different populations, settings, and contexts; and support continuous program improvement. Monitoring, evaluation and performance measurement also can determine if program activities are scalable and effective at reaching priority populations.

The NACP evaluation strategy is grounded in CDC's Evaluation Framework for Public Health, MMWR, September 18, 1999, Vol. 48 / No. RR-11, as well as in the utilization-focused and participatory approach described in Learning and Growing Through Evaluation: State Asthma Program Evaluation Guide.

Throughout the five-year period of performance, CDC will work individually and collectively with recipients to 1) increase the efficiency, effectiveness, and reach of their strategies; and 2) build and share lessons learned regarding effective strategies. Further, CDC will encourage active use and sharing of evaluation findings.

CDC will evaluate the success of this NOFO using a combined approach of reviewing recipient use of evaluation findings for program improvement, and performance measures. Key CDC evaluation questions for this NOFO are:

1. To what extent have CCARE and EXHALE communication and education messages reached intended individuals (e.g., people with asthma, practitioners, health care providers, decision makers)?

2. To what extent has the recipient established, maintained, and/or built relationships with strategic community partners, asthma programs, other NGOs and CDC to take action to achieve the CCARE goal?

3. To what extent has the recipient implemented and/or supported individual EXHALE interventions and the comprehensive package of EXHALE?

Recipients will modify existing evaluation plans to include these evaluation questions and describe how data, including performance measure data, will be collected, managed and used.

Recipients will be required to report on CDC-developed performance measures in the table below. Measures should be collected annually using the format specified in post-award guidance.

CDC will work with recipients in the first year of the cooperative agreement to further define these measures, identify available and feasible data sources for them, and establish recipient-specific targets for each measure.

https://www.cdc.gov/mmwr/PDF/RR/RR4811.pdf https://www.cdc.gov/mmwr/PDF/RR/RR4811.pdf http://www.cdc.gov/asthma/program_eval/guide.htm

CDC will discuss performance measures and monitoring and evaluation findings in one-on-one technical assistance with a focus on using findings for program improvement. CDC will manage and analyze the required performance measure data submitted by recipients. The analysis of performance measures and synthesis of monitoring and evaluation findings across recipients will guide CDC's technical assistance approach and will support the creation of a community of practice in which recipients use data and share successful models as well as program challenges.

CDC will develop aggregate performance measure reports and CCARE products that will be disseminated by multiple methods to recipients and additional audiences, including federal partners, non-funded partners, and policy makers, as appropriate. At the end of the five-year project period, CDC will report relevant process and outcome data from the analyses of performance measures.

To ensure that data collection resources are used effectively, CDC will periodically review the use of performance measures and may revise measures based on recipient feedback and what measures are informative.

i. Purpose This NOFO supports progress toward expanding the reach, quality, effectiveness, and sustainability of asthma control services by strengthening leadership and other essential infrastructure components and increasing the promotion and implementation of CDC's EXHALE strategies. Applicants are encouraged to implement EXHALE strategies in a coordinated manner and in the same high-burden areas or populations to accelerate progress toward goals, including the CCARE goal. This NOFO contributes to coordinated care, lower health care costs, and reduced morbidity and mortality due to asthma.

ii. Outcomes Short-Term Outcomes:

Established and/or maintained relationships with strategic community partners, asthma programs, other NGOs and CDC.

Increased equitable implementation of EXHALE interventions by engaging partners representing underserved communities.

Intermediate outcome:

Increased depth of relationships with community partners, asthma programs, other NGOs and CDC, as evidenced by increased communication, collaboration, and shared-decision making.

Long-term Outcome:

Increased implementation of EXHALE comprehensive package.

iii. Strategies and Activities Communication and Education

Develop and disseminate messages about CCARE initiative and EXHALE technical package and interventions in alignment with CDC. Use CDC messages regarding CCARE and EXHALE as core themes when building additional messages, and coordinate dissemination strategies with CDC o Use culturally and linguistically appropriate channels to reach important audiences including people with asthma and their families, asthma care providers, and decision-makers.

o Coordinate messages and work with partners to increase the understanding of the importance of providing and receiving high-quality asthma services: 1) people with asthma and their families know to seek and accept optimal asthma care; 2) asthma care providers have the skills and resources to provide high quality, guidelines based care; and 3) decision-makers at all levels encourage policies and procedures that support high-quality asthma services.

Strategic Relationships

Engage strategic community partners, including those who can provide access to communities that experience a disparate burden of asthma. Work with these partners to assure relevance and effectiveness of tailored programs, curricula, and messages.

Engage asthma control programs at multiple levels, including those funded through CDC-

RFA-EH19-1902

o Foster collaborations with appropriate partners to expand and leverage CCARE initiative and/or EXHALE technical package or its individual components

Coordinate efforts with other NGOs and CDC o Coordinate with other programs and partners to assure comprehensive, non-duplicative activities are undertaken

Support and/or Implement EXHALE Interventions

Develop and disseminate training and program support materials (curricula, certification programs, guides, infographics) o Work with appropriate partners, including subject matter experts and intended audience members to assure materials are technically accurate and are culturally and linguistically appropriate

Provide coaching and technical assistance Promote implementation of EXHALE interventions o Directly or through partners, provide training and technical assistance and other support to increase reach and quality of initiatives related to the EXHALE technical package or its individual components o Promote collaborations to achieve comprehensive, high-quality EXHALE services Document Implementation o Collect data related to activities and interventions, including data on the burden of asthma. Analyze these data and map information to determine geographic areas where successes occur and where needs exist to guide decisions for expanding services.

In all strategies and activities, contribute to the assessment of population needs and reduce asthma disparities by working with partners that can broker access to appropriate communities.

Encourage use of local data to highlight areas of greatest burden. Promote culturally and linguistically appropriate resources to build the expectation of, demand for, and delivery and use of EXHALE interventions.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Recipients are required to collaborate with the following CDC-funded programs:

Asthma Programs funded under EH19-1902. Examples of this collaboration include activities related to audience identification and assessment as well as resource dissemination. Resources created under this announcement must be in the public domain.

Other recipients funded under this announcement. Collaboration should ensure that activities, resources, messages, etc., are in alignment and not duplicative or redundant.

When interests and activities align, recipients are encouraged to collaborate with other public health programs funded through other CDC programs, for example, the National Center for Chronic Disease Prevention and Health Promotion or the National Institute for Occupational Safety and Health. Examples would be educating decision makers on the impact of smoking in public places on people with asthma and the effectiveness of smoke-free policies at reducing asthma attacks.

CDC Disability and Health Programs, for the purpose of fully engaging people with disabilities into activities regarding asthma management and control.

b. With organizations not funded by CDC:

Recipients are encouraged to collaborate with organizations external to CDC such as media outlets, asthma programs not funded by CDC, Medicaid and other governmental programs, professional organizations, educational institutions, health care organizations, and other NGOs that can support interventions and/or the dissemination of messages about the importance of guidelines-based care and supportive environments for people with asthma.

2. Target Populations Recipients should focus activities so that they ultimately impact adults and children with asthma that is not well-controlled, who are most likely to live, work, or play in unhealthy environments, and who are least likely to receive guidelines-based care due to social determinants of health including insurance status, socioeconomic, educational, or immigrant status.

a. Health Disparities By focusing on those with the highest burden of poor asthma control, recipients can ultimately contribute to the reduction of health disparities in hospitalization and emergency department visits due to asthma. Recipients should help identify and disseminate or adapt existing resources for special populations, such as those with limited health literacy or non-English speaking, and when available, leverage effective strategies for hard to reach populations, such as rural or geographically isolated areas, and those with low rates of insurance coverage, or people with disabilities.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Evaluation and performance measurements help demonstrate achievement of program outcomes;

build a stronger practice base for specific program strategies; clarify applicability of the evidence-based interventions to different populations, settings, and contexts; and support continuous program improvement. Monitoring, evaluation and performance measurement also can determine if program activities are scalable and effective at reaching priority populations.

The NACP evaluation strategy is grounded in CDC's Evaluation Framework for Public Health, MMWR, September 18, 1999, Vol. 48 / No. RR-11, as well as in the utilization-focused and participatory approach described in Learning and Growing Through Evaluation: State Asthma Program Evaluation Guide.

Throughout the five-year period of performance, CDC will work individually and collectively with recipients to 1) increase the efficiency, effectiveness, and reach of their strategies; and 2) build and share lessons learned regarding effective strategies. Further, CDC will encourage active use and sharing of evaluation findings.

CDC will evaluate the success of this NOFO using a combined approach of reviewing recipient use of evaluation findings for program improvement, and performance measures. Key CDC evaluation questions for this NOFO are:

1. To what extent have CCARE and EXHALE communication and education messages reached intended individuals (e.g., people with asthma, practitioners, health care providers, decision makers)?

2. To what extent has the recipient established, maintained, and/or built relationships with strategic community partners, asthma programs, other NGOs and CDC to take action to achieve the CCARE goal?

3. To what extent has the recipient implemented and/or supported individual EXHALE interventions and the comprehensive package of EXHALE?

Recipients will modify existing evaluation plans to include these evaluation questions and describe how data, including performance measure data, will be collected, managed and used.

Recipients will be required to report on CDC-developed performance measures in the table below. Measures should be collected annually using the format specified in post-award guidance.

CDC will work with recipients in the first year of the cooperative agreement to further define these measures, identify available and feasible data sources for them, and establish recipient-specific targets for each measure.

Performance Measures (PMs) and Associated Strategies/Activities and Outcomes https://www.cdc.gov/mmwr/PDF/RR/RR4811.pdf https://www.cdc.gov/mmwr/PDF/RR/RR4811.pdf

Bolded outcomes or activities are those linked to the PM.

Strategies/Activities Logic Model Outcomes Performance Measure

(PM)

Communication and Education

Develop and disseminate messages about CCARE initiative and EXHALE technical package and interventions in alignment with CDC

Increased awareness of CCARE and

EXHALE

Increased acceptance and expectations for effective care and practices

Shared vision for effective strategies (i.e., EXHALE) and goals

Increase demand for appropriate EXHALE services

1. Dissemination and Evaluation of CCARE and EXHALE Messages, by Channel and Reach

Strategic Relationships

Engage strategic community partners

Engage asthma control programs in state health departments

Coordinate efforts with other NGOs and CDC

ST: Established and/or maintained relationships with strategic community partners, asthma programs, other NGOs and CDC

Int: Increased depth of relationships with community partners, asthma programs, other NGOs and CDC

2. Relationships with and Evaluation of Asthma Programs and Other Partnerships

Support and/or Implement EXHALE Interventions

Develop and disseminate training and program support materials (curricula, certification programs, guides, infographics)

Provide coaching and technical assistance

Implement EXHALE

ST: Increased equitable implementation of EXHALE interventions

LT: Increased implementation of EXHALE comprehensive package

LT: Increased asthma friendly environments

LT: CCARE goal: preventing

3. Description, Location, Reach, and Evaluation of EXHALE Interventions interventions

500,000 hospitalizations and emergency department visits among children with asthma

CDC will discuss performance measures and monitoring and evaluation findings in one-on-one technical assistance with a focus on using findings for program improvement. CDC will manage and analyze the required performance measure data submitted by recipients. The analysis of performance measures and synthesis of monitoring and evaluation findings across recipients will guide CDC's technical assistance approach and will support the creation of a community of practice in which recipients use data and share successful models as well as program challenges.

CDC will develop aggregate performance measure reports and CCARE products that will be disseminated by multiple methods to recipients and additional audiences, including federal partners, non-funded partners, and policy makers, as appropriate. At the end of the five-year project period, CDC will report relevant process and outcome data from the analyses of performance measures.

To ensure that data collection resources are used effectively, CDC will periodically review the use of performance measures and may revise measures based on recipient feedback and what measures are informative.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO.

While not required, if the applicant chooses to include a new logic model in the evaluation plan, it must align with the logic model provided in this NOFO. CDC will work with recipients to focus monitoring and evaluation plans on key outcomes within the first 6 months of the award.

c. Organizational Capacity of Recipients to Implement the Approach Applicants must have a successful foundation with established and evaluated asthma education programs, public health messaging, developed asthma policy initiatives, and have revised programs according to user evaluations, and redistributed. Applicant must demonstrate that they have created tools, messages, and programs that are in compliance with the National Heart, Lung and Blood Institute's Expert Panel Review 3: Guidelines for the Diagnosis and Treatment of Asthma, and are currently or have previously been used by the NACP funded state health department grantees.

Applicants must have a repertoire of asthma programs that are national in scope and have expertise in the development and dissemination of asthma communication, education, and policy programs, with "national in scope" being defined as operating within all ten U.S. Department of Health and Human Services (HHS) regions. Successful applicants must have the current capacity to immediately reach a national audience; work with a wide array of partners to address asthma in a coordinated manner; work with partners to create and implement a plan; apply public health methods and approaches to bring about policy and systems changes; and assess the efficacy of activities, interventions, and policies.

Applicants must demonstrate their capacity to successfully carry out the communication and education strategies, the supporting infrastructure strategies, the evaluation and performance measurement plan, and other program requirements. This includes:

Relevant experience in asthma activities that is national in scope Evidence of recent (within 5 years) work in all ten Department of Health and Human

Services regions A strong network of asthma partners and stakeholders Capacity to develop and implement asthma communication and education activities, including staff members with appropriate experience and sufficient, dedicated staff time Ability to map and analyze data related to activities and interventions https://www.cdc.gov/grants/additionalrequirements/ar-25.html

Programmatic activities currently focused on intended audiences Capacity for program planning, data collection and management, monitoring, and evaluation; financial reporting; budget management and administration; and personnel management including delineation of staff roles and expertise o Relevant experience in evaluation should be demonstrated by having an evaluation plan that has been updated within the last 3 years o Ability to monitor reach of communication channels used to disseminate messages, as well as monitor and/or evaluate messaging strategies, and use evaluation findings to improve programs.

o Ability to provide information on significant partnerships, and characterize the extent of collaboration, including whether they lead to interventions. Ability to characterize the level partners operate at (e.g., local, state, national), population served, and how partnerships are evaluated and how findings are used to improve programmatic efforts.

o Ability to categorize interventions by EXHALE categories and report on recipient and partner roles in the intervention, audience, location, reach, and intended population of interventions. Interventions related to a climate adaptation are to be identified. Experience in having used evaluation findings to improve interventions.

o Capacity to manage required procurement efforts, including the ability to write and award contracts in accordance with application regulations.

Applicant must provide a list of evaluated asthma education programs. Upload the list of evaluated asthma education programs to www.grants.gov and label file "Asthma Education Programs".

Applicant must provide examples of asthma public health messaging at the national level. The reference document should be saved as a pdf, labeled "Asthma Public Health Messaging" and uploaded to www.grants.gov.

Applicant must provide references of developed asthma policy initiatives. The reference letters and list should be saved as a pdf document, labeled "Asthma Policy Initiatives" and uploaded to www.grants.gov.

d. Work Plan Applicants must submit a work plan that covers the first year of the five-year project period and a high level summary of activities for Years 2-5. Proposed strategies must be in alignment with the NOFO logic model.

Required elements in a work plan include strategies and any associated performance measures (with data sources, targets, and timeframes), as well as major activities and the person responsible for each activity. Strategies and activities must be uniquely identified (e.g., 1a, 1b, 2a, 2b). A work plan template is available below. Applicants are not required to use this work plan template, but any plan submitted must include all of the elements in this template.

Optional Work Plan Template Describing Priority Activities

INFRASTRUCTURE STRATEGIES

Strategy Relevant performance measures*

Data source or tool*

Target & Timeframe*

Activity completion date

Responsible person(s)

I. Communication and Education

I.A.

Potential Partners:

Anticipated activities for Years 2-5 and anticipated completion dates

II. Strategic Relationships (as above)

III. Interventions (as above)

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

Monitoring will occur routinely through ongoing communication between CDC and recipients, site visits, and reporting mechanisms (i.e., work plans, performance measures, and financial reporting). CDC will provide tools and resources aligned with program activities and outcomes for this NOFO, analyze performance measurement data, review progress, and identify technical assistance needs for all NOFO recipients. CDC may also develop aggregate performance measure reports to be disseminated to recipients, key stakeholders, federal partners and policy makers as appropriate.

f. CDC Program Support to Recipients (THIS SECTION APPLIES ONLY TO

COOPERATIVE AGREEMENTS)

CDC staff involved with these cooperative agreements will provide substantial involvement beyond site visits and regular performance and financial monitoring during the project period.

Substantial involvement means that recipients can expect federal programmatic partnership in carrying out the effort under the award. The CDC program will work in partnership with recipients to ensure the success of the cooperative agreement by:

Supporting recipients in implementing the elements of this NOFO and advancing program activities to achieve outcomes

Providing technical assistance to revise annual work plans and budgets Reviewing materials and messages developed by recipients to ensure scientific accuracy and alignment with CDC communications, recommendations and guidelines Collaborating with recipients to develop and implement evaluation plans and use evaluation findings, as resources permit Providing technical assistance to monitor and report performance measures and implement recipients' performance measurement plans Analyzing recipient performance measurement data and evaluation findings (where available) to provide suggestions for program improvement Providing professional development and training opportunities - either in person or through virtual web-based training formats - for the purpose of sharing best practices and the latest science

Planning and convening in-person meetings (as resources permit) to provide recipients with the opportunity to exchange resources, share lessons learned, and address common issues

Coordinating communication and program linkages with CDC-funded state asthma programs, other CDC programs, federal agencies, and national organizations working to reduce the burden of asthma and promote public health- health care collaboration

Facilitating interaction between and among recipients, including facilitating attendance at CDC asthma partner meetings and other appropriate venues, if any. CDC will not provide funding over and above that included in this award for travel, registration, and attendance associated with such meetings

Conducting at least one site visit over the five-year funding cycle to award implementation sites and sharing feedback verbally and/or in writing

Providing additional technical assistance as necessary and appropriate

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism: UE1 Studies of Environmental Hazards and Health Effects

3. Fiscal Year: 2020

4. Approximate Total Fiscal Year Funding: $800,000

5. Approximate Period of Performance Funding: $4,000,000

This amount is subject to the availability of funds.

Estimated Total Funding: $4,000,000

6. Approximate Period of Performance Length: 5 year(s)

7. Expected Number of Awards: 4

8. Approximate Average Award: $200,000 Per Budget Period

9. Award Ceiling: $200,000 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor: $100,000 Per Budget Period

11. Estimated Award Date: 09/01/2020

12. Budget Period Length: 12 month(s)

Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Direct Assistance Direct Assistance (DA) is not available through this NOFO.

C. Eligibility Information

1. Eligible Applicants Eligibility Category: Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"

Additional Eligibility Category:

2. Additional Information on Eligibility Applicants are required to upload to www.grants.gov all the following items to meet responsiveness requirements of this NOFO:

1. Recent (within the past 3 years) program evaluation plan. Evaluation plans must include an engagement plan, logic model(s), description of intended use, communication section, evaluation management section. Name the file Responsiveness Eval Plan.

2. Performance Measurement Plan. Name the file Responsiveness PM Plan.

3. Provide documentation along with a signed letter from the applicant documenting program activities, trainings and/or evidence-based interventions located across the United States in all 10 HHS regions to document programs are national in scope during the last 3 years. Combine the letter and documentation into one file, name the file Responsiveness National.

4. Three signed letters from NACP funded grantees (e.g. State Health Departments) describing previous collaborative asthma work. Combine the letters into one file, name the file Responsiveness Partnerships.

The award ceiling for this NOFO is $200,000. Any application requesting an award higher than this amount will be considered as non-responsive and it will receive no further review.

3. Justification for Less than Maximum Competition

4. Cost Sharing or Matching Cost Sharing / Matching Requirement: No

5. Maintenance of Effort

D. Application and Submission Information

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System:

All applicant organizations must obtain a Data Universal Numbering System (DUNS) number.

A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/ webform/ displayHomePage.do. The DUNS number will be provided at no charge.

If funds are awarded to an applicant organization that includes sub-recipients, those sub-recipients must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as a recipient. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at https://www.sam.gov/SAM/.

c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site. Registration information is located at the "Applicant Registration" option at www.grants.gov.

All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible.

Step System Requirements Duration Follow Up 1 Data

Universal Number System

(DUNS)

1. Click on http:// fedgov.dnb.com/ webform

2. Select Begin DUNS search/request process

3. Select your country or territory and follow the instructions to obtain your DUNS 9-digit #

4. Request appropriate staff member(s) to obtain DUNS number, verify & update

1-2 Business Days

To confirm that you have been issued a new DUNS number check online at (http:// fedgov.dnb.com/ webform) or call 1-866-705-5711 https://www.grants.gov/ http://fedgov.dnb.com/webform/displayHomePage.do https://www.sam.gov/SAM/ https://grants.gov/ https://www.grants.gov/ http://www.grants.gov https://www.grants.gov/ http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform information under DUNS number

2 System for Award Management

(SAM)

formerly Central Contractor Registration

(CCR)

1. Retrieve organizations DUNS number

2. Go to https://www.sam.gov/SAM/ and designate an E-Biz POC (note CCR username will not work in SAM and you will need to have an active SAM account before you can register on grants.gov)

3-5 Business Days but up to 2 weeks and must be renewed once a year

For SAM Customer Service Contact https://fsd.gov/ fsd-gov/ home.do Calls:

866-606-8220

3 Grants.gov 1. Set up an individual account in Grants.gov using organization new DUNS number to become an authorized organization representative (AOR)

2. Once the account is set up the E-BIZ POC will be notified via email

3. Log into grants.gov using the password the E-BIZ POC received and create new password

4. This authorizes the AOR to submit applications on behalf of the organization

Same day but can take 8 weeks to be fully registered and approved in the system (note, applicants

MUST

obtain a

DUNS

number and

SAM

account before applying on grants.gov)

Register early!

Log into grants.gov and check AOR status until it shows you have been approved

2. Request Application Package Applicants may access the application package at www.grants.gov.

3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this notice of funding opportunity at www.grants.gov.

4. Submission Dates and Times If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper https://www.sam.gov/SAM/ https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://www.grants.gov application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by

OGS.

a. Letter of Intent Deadline (must be emailed or postmarked by) Due Date for Letter of Intent: 03/20/2020

b. Application Deadline Due Date for Applications: 04/30/2020 , 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume.

The LOI is requested but not required. The purpose of an LOI is to allow CDC program staff to estimate the number of and plan for the review of submitted applications. LOI must be sent

Date for Information Conference Call CDC will conduct an informational conference call regarding the NOFO on March 23, 2020 at 2:00 p.m., U.S. Eastern Standard Time. The call-in information is: (877) 954-4821 Passcode: 57457322#. Questions and responses from this conference call will be posted at https ://wwwdev.cdc.gov/asthma/test-q-a-page.htm.

5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa)) /Homepage.aspx.

Applicants may follow either of the following processes:

Complete the applicable assurances and certifications with each application submission, name the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov

Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa))/ Homepage.aspx

Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply to all applications submitted to CDC by the applicant within one year of the submission date.

Risk Assessment Questionnaire Requirement https://www.grants.gov https://wwwdev.cdc.gov/asthma/test-q-a-page.htm https://wwwdev.cdc.gov/asthma/test-q-a-page.htm http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx https://www.grants.gov http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx…