CDC-RFA-EH20-2001.pdf

Centers for Disease Control and Prevention

National Center for Environmental Health

Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children

CDC-RFA-EH20-2001

Application Due Date: 04/30/2020

Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children

CDC-RFA-EH20-2001

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- EH20-2001. 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:

Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children 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)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-EH20-2001

E. Assistance Listings (CFDA) Number:

93.197 F. Dates:

1. Due Date for Letter of Intent (LOI): 04/01/2020

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

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

An informational conference call will occur on Tuesday, March 17, 2020 from 2:30 pm - 3:30 pm Eastern Standard Time. Updated details about the informational call will be posted at: https ://www.cdc.gov/nceh/lead/

G. Executive Summary:

1. Summary Paragraph:

The Centers for Disease Control and Prevention (CDC) announces the availability of fiscal year (FY) 2020 funds that will be awarded through cooperative agreements to support primary and secondary prevention strategies for childhood lead poisoning prevention and surveillance including: ensuring blood lead testing and reporting; enhancing blood lead surveillance;

improving linkages to recommended services and developing policies for targeted, population-based interventions with a focus on community-based approaches for lead hazard elimination.

As part of this Notice of Funding Opportunity (NOFO), recipients will be expected to demonstrate that processes are in place to identify children exposed to lead and link them to recommended services. More specifically, recipients will be expected to partner with local health departments in high-risk areas, and work closely with other agencies and healthcare providers serving children, to ensure that a comprehensive system of identification, referral, follow-up, and evaluation is in place for children exposed to lead.

a. Eligible Applicants: Limited

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 51

d. Total Period of Performance Funding: $110,000,000

e. Average One Year Award Amount: $450,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 09/30/2020

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Significant progress has been made in reducing population exposures to lead in the United States due, in large part, to successful policies aimed at the removal of lead in gasoline and control of lead in residential paint and consumer products. Nonetheless, nearly half a million U.S. children still have blood lead levels (BLLs) at or above the CDC blood lead reference value of 5 μg/dL. More effective screening and follow-up is needed and must be focused where children at highest risk are most likely to benefit. Young children are particularly vulnerable to the long-term health and developmental effects of lead exposure including intellectual and behavioral deficits. The primary source of lead exposure to children is the home environment:

some 24 million homes have significant lead-based paint hazards and at least 6-10 million homes have lead service lines that may result in exposure to lead from drinking water.

Deteriorating paint, hazardous waste sites, and industrial emissions can also create hazards to lead dust and soil in and around the home. In addition, children may be exposed through other sources (e.g., consumer products or foods decorated or made with lead, workplace hazards brought home from the job, lead-based hobbies or recreational activities). Primary prevention – the removal of lead hazards from the environment before a child is exposed – is the most effective way to ensure that children do not experience the harmful effects of lead exposure.

However, blood lead screening tests and secondary prevention strategies remain an essential safety net for children who may be exposed to lead. Low-income and minority children bear a disproportionate burden of lead exposure risk and significant disparities in BLLs exist by race/ethnicity, poverty status, and geographic location. Public health action is needed to improve health equity by supporting strategies and activities to eliminate disparities in BLLs by social, demographic, and geographic factors and, ultimately, eliminate childhood lead poisoning as a public health problem. CDC’s key programmatic strategy is to strengthen childhood lead poisoning prevention programs by improving blood lead screening test rates, identifying high-risk populations, and ensuring effective follow-up for children with elevated BLLs. State-based childhood blood lead surveillance systems need to integrate information from several sources including: childhood lead poisoning prevention programs at the state and local levels, public and private laboratories, health care providers, and other state and local health, environmental, and housing agencies. One inherent limitation of these systems is the reliance on data reported by clinical laboratories and healthcare providers which are often incomplete. Assuring accurate and complete reporting of all blood lead tests, including information on sociodemographic and geographic risk factors, is a vital component of effective surveillance to ensure health equity.

Therefore, CDC will support state government agencies with public health authority in accomplishing these strategies through a required component because substantial effort is required to coordinate statewide screening plans and implement effective blood lead surveillance systems. Additionally, optional components address: direct local support in high-risk areas and development of policy interventions to target populations at high risk.

b. Statutory Authorities Authorized by 42 U.S.C. Section 247b (k)(2); 42 U.S.C. Section 247b-3(b); and 42 U.S.C.

Section 247b-16.

c. Healthy People 2030 CDC’s National Center for Environmental Health (NCEH) is committed to achieving the HHS health promotion and disease prevention objectives of Healthy People 2020 (and 2030, proposed) found at: https://www.healthypeople.gov/. This NOFO addresses the Healthy People 2020 topics of Maternal, Infant, and Child Health and Environmental Health. This NOFO is specifically committed to addressing the Healthy People 2020 goals of reducing: (1) blood lead levels above the CDC blood lead reference value, and (2) mean blood lead levels in young children, as well as eliminating disparities in blood lead levels based on race, ethnicity, and socioeconomic status, as public health concerns.

d. Other National Public Health Priorities and Strategies This NOFO supports the Federal Action Plan to Reduce Childhood Lead Exposures and Assoc iated Health Impacts developed by the Lead Subcommittee of the President Task Force on Envir onmental Health Risks and Safety Risks to Children.

e. Relevant Work The Lead Contamination Control Act of 1988 authorized CDC to initiate program efforts to eliminate childhood lead poisoning in the United States. From 1990 to 2012, CDC supported comprehensive childhood lead poisoning prevention programs in state and local health departments. From 2014 to 2019, CDC supported strategic programmatic activities to rebuild capacity under CDC-RFA-EH14-1408; CDC-RFA-EH17-1701; and CDC-RFA-EH18-1806.

This NOFO supports state-based approaches for coordinating statewide screening plans, implementing effective blood lead surveillance systems, and developing policies and strategic partnerships to ensure a comprehensive system exists for the identification, referral, and follow-up of children exposed to lead.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-EH20-2001 Logic Model:

Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children

Strategies and Activities

Short-Term Outcomes Intermediate Outcomes

Long-Term Outcomes

Increased collaboration and coordination between appropriate stakeholders.

1. Ensure Blood Lead Testing and Reporting

· Develop and sustain a statewide Lead Advisory Committee.

· Develop or update and implement an appropriate statewide screening plan based on local data.

Increased awareness of pediatric health care providers and clinical laboratories of state blood lead testing recommendations and reporting requirements.

Improved blood lead testing and reporting rates for children less than 6 years of age at risk for lead exposure.

2. Enhance Blood Lead Surveillance

· Develop, update, or maintain a blood lead surveillance system that collects and tracks all blood lead test results and follow-up data on children with elevated blood lead levels including environmental source investigations and referrals to recommended services.

· Develop and

Increased linkages between complementary data systems (e.g., Medicaid, immunization, adult blood lead, vital statistics).

Improved use of surveillance system data to capture missing data on child demographic and follow-up information.

Decreased disparities in blood lead levels by race/ethnicity and socioeconomic status

Decrease adverse health effects of lead exposure in children

Decreased societal costs associated with childhood lead exposure (e.g., healthcare, special education, criminal justice system).

Decreased number of children living in environments at high risk of lead exposure.

implement plans for surveillance data collection, data quality, and data dissemination with a focus on data interoperability.

· Conduct analyses of surveillance data to identify lead-exposed children, high-risk populations, and geographic areas.

Increased identification of geographic areas and populations at-risk for lead exposure using enhanced data linkages.

Increased identification, tracking, and recommended services for children with elevated blood lead levels.

3. Improve Linkages of Lead-Exposed Children to Recommended Services

· Develop alerts in surveillance system to flag and track children with elevated blood lead levels requiring follow- up.

· Connect children with elevated blood lead levels to recommended medical, environmental, and social services.

Increased ability for public health agencies, health care professionals, and other stakeholders to provide linkages to services and reduce loss to follow-up.

Improved rates of children less than 6 years of age with elevated blood lead levels linked to recommended services.

4. Develop Targeted Population-Based Policy Interventions

· Develop strategic partnerships and policies to implement targeted, population-based interventions aimed at primary prevention of lead exposure with a focus on community-based approaches for lead

Improved policies for targeted community-based approaches aimed at primary prevention of lead exposure in children.

Decreased lead hazards in housing occupied by vulnerable populations (such as children).

hazard elimination.

i. Purpose This NOFO supports overarching program strategies related to:

1. secondary prevention of childhood lead poisoning through the core public health functions of assurance (ensuring blood lead testing and reporting, and improving linkages to recommended services); assessment (enhancing blood lead surveillance); and policy development (using data to inform policy) –and–

2. primary prevention of childhood lead poisoning through targeted, population-based policy interventions with a focus on community-based approaches for lead hazard elimination.

ii. Outcomes Recipients must be able to use their childhood blood lead surveillance system to collect and report data to CDC to support the following period of performance outcomes (shown in bold on the CDC-RFA-EH20-2001 Logic Model: Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children):

• Improved blood lead testing and reporting rates for children less than 6 years of age at risk for lead exposure (e.g., screening penetrance, and the incidence and prevalence of children with blood lead levels greater than or equal to the CDC blood lead reference value).

• Improved use of surveillance system data to capture missing data on child demographic and follow-up information (e.g., race/ethnicity, socioeconomic status, small geographic area [zip code or census tract], referrals to recommended services, completion of services by type).

• Improved rates of children less than 6 years of age with blood lead levels greater than or equal to the CDC blood lead reference value who are linked to recommended services (e.g., environmental inspections, medical evaluations, nutritional counseling, developmental milestones).

• Decreased disparities in blood lead levels by race/ethnicity and socioeconomic status.

iii. Strategies and Activities

CORE COMPONENT- REQUIRED

Strategy 1. Ensure Blood Lead Testing and Reporting:

• Develop and sustain a statewide lead advisory committee comprised of appropriate stakeholders (e.g., representatives from academia, healthcare, non-profit or community-based organizations, clinical laboratories, state and local housing agencies, tribes or tribal organizations).

o Evidence of a functioning and sustainable statewide advisory committee to make statewide recommendations for blood lead testing based on local data.

• Develop or update and implement an appropriate statewide screening plan based on local data in collaboration with statewide lead advisory committee.

o Evidence of a statewide screening plan based on current data that provides clear blood lead testing guidance to pediatric healthcare providers.

o Evidence of a blood lead test reporting policy to ensure that clinical laboratories and healthcare providers understand and comply with reporting requirements.

o Evidence of a sustainability plan to ensure regular review of data and updates needed to statewide screening recommendation.

Strategy 2. Enhance Blood Lead Surveillance:

• Develop, update, or maintain a blood lead surveillance system that collects and tracks all blood lead test results and follow-up data on children with elevated blood lead levels including environmental source investigations and referrals to recommended services.

o Evidence of a sustainable and integrated childhood blood lead surveillance system able to generate population-level screening rates and follow-up data on environmental source investigations and referrals to recommended services.

o Evidence of ability to collect essential information including race/ethnicity, socioeconomic status, and geographic locations at the zip code or census tract level.

• Develop and implement plans for surveillance data collection, data quality checks, and data dissemination with a focus on data interoperability.

o Evidence of strategic collaborations with relevant agencies (e.g., state Medicaid, vital records, immunization program) to generate appropriate denominators (e.g., total population of children age 6 years or younger, total number of children enrolled in Medicaid by age) and risk-factor data (see “Target Populations”).

o Evidence of surveillance system data management and analysis plans with appropriate stakeholders’ roles and responsibilities outlined.

• Conduct analyses of surveillance data to identify lead-exposed children, high-risk populations, and geographic areas.

o Evidence of surveillance system reporting and dissemination plans with appropriate stakeholders’ roles and responsibilities outlined.

Strategy 3. Improve Linkages of Lead-Exposed Children to Recommended Services:

• Identify children with elevated blood lead levels requiring follow-up.

o Evidence of alerts available in surveillance system to flag and track children with elevated blood lead levels requiring follow-up.

• Partner with programs and organizations that provide services to mitigate the effects of elevated blood lead levels.

o Evidence of data sharing, data matching, and/or memoranda of understanding/agreement with key partners.

• Connect children with elevated blood lead levels to recommended medical, environmental, and social services.

o Evidence of a mechanism for the surveillance database to capture information on referrals to recommended services.

OPTIONAL COMPONENT 1 - DIRECT LOCAL SUPPORT

Applicants with specific high-risk jurisdictions (as identified in Appendix 1) are expected to partner with local health departments in the identified high-risk area(s) to improve linkages of lead-exposed children to recommended services (Strategy 3).

More specifically, applicants will directly support local health departments in high-risk jurisdictions to ensure that a comprehensive system of identification, referral, follow-up, and evaluation is in place for children exposed to lead. Applicants are also expected to work closely with other agencies and healthcare providers serving high-risk children to:

• Identify children with elevated blood lead levels requiring follow-up.

o Evidence of alerts available in surveillance system to flag and track children with elevated blood lead levels requiring follow-up.

• Partner with programs and organizations that provide services to mitigate the effects of elevated blood lead levels.

o Evidence of data sharing, data matching, and/or memoranda of understanding/agreement with key partners.

• Connect children with elevated blood lead levels to recommended medical, environmental, and social services.

o Evidence of a mechanism for the surveillance database to capture information on referrals to recommended services.

OPTIONAL COMPONENT 2 - POLICY INTERVENTIONS

Strategy 4. Develop Targeted, Population-Based Policy Interventions:

• Develop strategic partnerships and policies to implement targeted, population-based interventions aimed at primary prevention of lead exposure with a focus on community-based approaches for lead hazard elimination.

o Evidence of a detailed policy design and implementation plan, including timeline, objectives, methods, and key stakeholders.

1. Collaborations

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

ALL APPLICANTS

Applicants should provide evidence of any collaborations with other relevant CDC programs and CDC-funded organizations. Examples of relevant CDC programs include, but are not limited, to:

• Environmental Public Health Tracking (EPHT) Program http://www.cdc.gov/nceh/track ing/

• Adult Blood Lead Epidemiology and Surveillance (ABLES) Program https://www.cdc .gov/niosh/topics/ables/

• ATSDR Partnership to Promote Local Efforts to Reduce Environmental Exposure (APPLETREE) Programs https://www.atsdr.cdc.gov/states/index.html

• Pediatric Environmental Health Specialty Units https://www.pehsu.net/

• Developmental Disabilities https://www.cdc.gov/ncbddd/developmentaldisabilities

/index.html

• Immigrant and Refugee Health https://www.cdc.gov/immigrantrefugeehealth/index.html

• National Asthma Control Program https://www.cdc.gov/asthma/nacp.htm

• Immunization Information Systems https://www.cdc.gov/vaccines/programs/iis/index

.html

• National Vital Statistics System https://www.cdc.gov/nchs/nvss/births.htm

Strategies should be implemented for leveraging resources from other allowable federally-funded programs and/or state, local, charity, nonprofit or for-profit entities, or internal agency programs. Applicants are expected to develop a sustainability plan working with partners to assure that the goals of the project and efforts to achieve desired outcomes will continue beyond the period of performance.

OPTIONAL COMPONENT 1 - DIRECT LOCAL SUPPORT

If eligible and applying for optional awards in high-risks areas (as identified in Appendix 1), then recipients must engage and partner with the local health department in the identified high-risk area.

• Applicants must provide an MOU, MOA, or letter of support to verify evidence of a collaboration with the local health department to ensure that a comprehensive system of identification, referral, follow-up, and evaluation is in place for children exposed to lead in the state. The appropriate document should be uploaded as a single PDF, combined with any other documents on optional collaborations (below), using the filename "MOUs/MOAs" at grants.gov.

b. With organizations not funded by CDC:

ALL APPLICANTS

Applicants should engage applicable state agencies in data-sharing agreements (e.g., State Medicaid agency, vital statistics).

• Applicants should provide an MOU, MOA, or letter of support to verify evidence of a collaboration with the state agency to share data on children less than 16 years of age.

The appropriate document should be uploaded as a single PDF, combined with any other documents on optional collaborations (below), using the file name "MOUs/MOAs" at grants.gov.

Applicants should also engage other relevant federal, state, and local government agencies;

tribes or tribal organizations; hospitals and health care providers; clinical laboratories; non-government organizations; non profit agencies; private foundations and businesses; and academic institutions in their jurisdictions, particularly those with a focus on child health and environmental/occupational health, and leverage resources and opportunities to reach target populations, share data/information, and achieve outcomes expected under this NOFO.

Applicants should provide MOU, MOA, or letter of support to verify evidence of the collaborations. The appropriate documents should be uploaded as a single PDF, combined with any other documents using the file name "MOUs/MOAs" at grants.gov. Examples of such organizations include, but are not limited, to:

• U.S. Department of Housing and Urban Development (HUD) Office of Lead Hazard Control and Healthy Homes (OLHCHH) https://www.hud.gov/program_offices/healt hy_homes

• Centers for Medicare and Medicaid Services (CMS) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) https://www.medicaid.gov/medicaid/benefits/epsdt /index.html

• Special Supplemental Nutrition Program for Women, Infants and Children (WIC) https ://www.fns.usda.gov/wic

• Health Resources & Services Administration (HRSA): State Title V Maternal and Child Health programs; Maternal, Infant, and Early Childhood Home Visiting Program;

Healthy Start Program https://mchb.hrsa.gov/

• U.S. Environmental Protection Agency (EPA) https://www.epa.gov/lead

• U.S. Department of Education Early Childhood Education Initiatives https://www2.ed

.gov/about/inits/ed/earlylearning/index.html

• Indian Health Service Environmental Health Support Center https://www.ihs.gov/ehsc/

• Community-based, nonprofit and/or faith-based organizations

• State and local health and housing agencies

• Private and public laboratories

• Hospitals and healthcare systems

• Academic institutions

• Accredited environmental health and housing practitioners and their organizations

Strategies should be implemented for leveraging resources from other allowable federally-funded programs and/or state, local, charity, nonprofit or for-profit entities, or internal agency programs. Applicants are expected to develop a sustainability plan working with partners to assure that the goals of the project and efforts to achieve desired outcomes will continue beyond the period of performance.

OPTIONAL COMPONENT 1 - DIRECT LOCAL SUPPORT

If eligible and applying for optional awards in high-risks areas (as identified in Appendix 1), then recipients must engage and partner with the local health department in that area.

• Applicants must provide an MOU, MOA, or letter of support to verify evidence of a collaboration with the local health department to ensure that a comprehensive system of identification, referral, follow-up, and evaluation is in place for children exposed to lead in the state. The appropriate document should be uploaded as a single PDF, combined with any other documents on optional collaborations (below), using the filename "MOUs/MOAs" at grants.gov.

2. Target Populations The target population for this program is children less than 6 years (72 months) of age with a specific focus on children less than 3 years (36 months) of age. Priority should be given to high-risk children disproportionately affected by lead exposure and lead poisoning, particularly those children living in areas that include: homes built before 1978; low-income or subsidized housing with suspected or known lead hazards; hazardous waste sites or industrial emissions containing lead; racial and ethnic minorities; and recent immigrants. Medicaid-eligible and Medicaid-enrolled children, as well as children receiving services from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), represent high-risk target populations.

a. Health Disparities Despite significant progress in lowering population BLLs overall, certain populations, including: racial and ethnic minorities, recent immigrants, and those in certain geographic areas, remain at high risk for lead exposure. Non-English-speaking populations, people with limited health literacy, tribal populations, and those living in rural areas and other geographically underserved communities may also be at high risk. A major focus of this NOFO is to improve the ability to identify, screen, refer, and monitor high-risk children with the aim of reducing disparities in BLLs and associated health outcomes and improve social determinants of health among populations at greatest risk.

iv. Funding Strategy

CORE COMPONENT - REQUIRED

Applicants are eligible for base awards of $300,000 to support statewide strategies for childhood lead poisoning prevention and surveillance. Under this Notice of Funding Opportunity (NOFO), applicants are applying for support related to: Strategy 1) ensure blood lead testing and reporting; Strategy 2) enhance blood lead surveillance; Strategy 3) improve linkages to recommended services. Applicants are expected to demonstrate that statewide processes are in place to identify children with blood lead levels greater than or equal to the CDC blood lead reference value, link these children to recommended services, and monitor the management of these children for completion of services.

OPTIONAL COMPONENT 1 - DIRECT LOCAL SUPPORT

Applicants with specific high-risk jurisdictions (as identified in Appendix 1) are eligible for additional optional awards of up to $150,000 per jurisdiction to directly support local health departments [in the specific high-risk areas listed in the appendix for up to a maximum of three awards totaling $450,000]. The purpose of these optional awards is to directly support local health departments in high-risk jurisdictions with ensuring that children with blood lead levels greater than or equal to the CDC blood lead reference value are identified, linked with recommended services, and monitored for case completion. More specifically, applicants are expected to partner with local health departments in high-risk areas (as identified in Appendix

1) and work closely with other agencies and healthcare providers serving high-risk children, to ensure that a comprehensive system of identification, referral, follow-up, and evaluation is in place for children exposed to lead in the state (Strategy 3).

OPTIONAL COMPONENT 2 - POLICY INTERVENTIONS

Additionally, applicants are also eligible for an optional award of up to $50,000. These awards are to be used to support development of targeted, population-based policy interventions with a focus on community-based primary prevention approaches for lead hazard elimination (Strategy 4).

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Process Evaluation

Within 12 months of award, recipients must provide evidence of:

• Functioning statewide advisory committee to make recommendations for blood lead testing based on local data.

• Statewide screening plan based on current data that provides clear blood lead testing guidance to pediatric health care providers.

• Blood lead test reporting policy to ensure that clinical laboratories and health care providers understand and comply with reporting requirements.

• Sustainability plan to ensure regular review of data and updates needed to statewide screening recommendations.

• Integrated childhood blood lead surveillance system able to generate population-level screening rates and follow-up data on environmental source investigations and recommended services referrals.

• Strategic collaborations with relevant agencies (e.g., state Medicaid, vital records, immunization program) to generate appropriate denominator data and essential information on risk factors such as age, race/ethnicity, and socioeconomic status.

• Surveillance system data management and analysis plans with appropriate stakeholders’ roles and responsibilities outlined.

• Surveillance system reporting and dissemination plans with appropriate stakeholders’ roles and responsibilities outlined.

• Alerts available in surveillance system to flag and track children with elevated blood lead levels requiring follow-up.

• Data sharing, data matching, and/or memoranda of understanding/agreement with key partners.

• Mechanism for surveillance database to document all referrals and recommended services initiated, received, and completed.

• Data Management Plan (DMP) in accordance with federal guidelines.

Outcome Evaluation

Recipients must be able to use their childhood blood lead surveillance system to collect and report data to CDC to support the following period of performance outcomes (shown in bold on the CDC-RFA-EH20-2001 Logic Model: Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children):

Improved blood lead testing and reporting rates for children less than 6 years of age at risk for lead exposure as indicated by the ability to report:

Screening Penetrance = Number of children <6 years of age receiving first blood lead screening test Total population of children <6 years of age at risk for lead exposure

Prevalence = Number of children <6 years of age with blood lead levels ≥5 μg/dL (at a given point in time) Total population of children <6 years of age

Incidence = Number of children <6 years of age newly identified with blood lead levels ≥5 μg/dL (in a calendar year) Total population of children <6 years of age

Improved use of surveillance system data to capture missing data as indicated by the ability to report:

Percent of tests = Number of children <6 years of age receiving blood lead test with race identified with race identified Total population of children <6 years of age tested

Percent of tests = Number of children <6 years of age receiving blood lead test with ethnicity identified with ethnicity identified Total population of children <6 years of age tested

Percent of tests = Number of children <6 years of age receiving blood lead test with SES* identified with SES* identified Total population of children <6 years of age tested

*Socioeconomic status (SES) as defined by the source of funding for blood lead test (public, private, other)

Improved rates of children less than 6 years of age with blood lead levels greater than or equal to the CDC blood lead reference value who are referred to recommended services as indicated by the ability to report:

Percent of children = Number of children <6 years of age who are referred for recommended services referred for services Total population of children <6 years of age with blood lead levels greater than or equal to the CDC blood lead reference value

Decreased disparities in blood lead levels by race, ethnicity, and socioeconomic status as indicated by the ability to report:

Difference = mean blood lead levels in white children [minus] mean blood lead levels in black children (by race)

Difference = mean blood lead levels in Hispanic [minus] mean blood lead levels in Non- Hispanic children (by ethnicity)

Difference = mean blood lead levels in children living above the median Federal poverty level [minus] mean blood lead levels in children living below the median Federal poverty level (by SES)

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.

Describe available data sources and feasibility of collecting the required process and outcome measures outlined above.

c. Organizational Capacity of Recipients to Implement the Approach Describe the applicant’s Organizational Capacity needed to implement the award:

• Applicants must demonstrate that they have relevant management, administrative, and technical experience and capacity to implement the project activities, achieve the project outcomes, report data to CDC, and implement the evaluation plan.

• Applicants must provide a staffing plan and project management structure sufficient to achieve the project outcomes and which clearly defines staff roles including, at a minimum, a Principal Investigator, a Program Manager, and at least one Epidemiologist with sufficient knowledge, skills, and abilities to meet project objectives including required data collection, analysis, and reporting requirements.

• Applicants must also demonstrate that they have such skills as: program planning, program evaluation, performance monitoring, financial reporting, budget management and administration, personnel management.

• Applicants must demonstrate that they have a financial management system that will allow proper funds management and segregation of funds by program, and meet the requirements as stated in the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards.

• Applicants must demonstrate that they have their ability to manage the required procurement efforts, including the ability to write and award contracts in accordance with applicable grants regulations.

• CVs/Resumes and Organizational Chart(s) must be provided in separate files labeled "CVs/Resumes" and "Organizational Chart(s)" and uploaded at www.grants.gov.

d. Work Plan Applicants should provide a detailed work plan for the first year of the project and a high-level work plan for subsequent years. The components in the work plan should crosswalk to the strategies and activities, outcomes, and evaluation and performance measures presented in the logic model and the narrative sections of the NOFO.

Period of Performance Outcome:

[from Outcomes section and/or logic model] Outcome Measure:

[from Evaluation and Performance Measurement section]

Strategies and Activities

Process Measure [from Evaluation and Performance Measurement section]

Responsible Position/Party

Completion Date

1.

2.

3.

4.

5.

6.

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.

CDC will use performance measures data collected to track and monitor recipient progress, provide feedback and technical assistance, and access collective progress toward achieving NOFO outcomes by aggregating and analyzing data aggregated across all recipients. Recipient surveillance data will be used to:

• Determine blood lead testing and reporting rates and trends for children less than 6 years of age at risk for lead exposure including screening penetrance, and incidence and prevalence of children with blood lead levels greater than or equal to the CDC blood lead reference value.

• Determine number, percentage, and trends of blood lead testing records with missing data on child demographic and follow-up information (e.g., race/ethnicity, socioeconomic status, small geographic area [zip code or census tract], referrals to recommended services by type)

• Determine rates and trends of children less than 6 years of age with blood lead levels greater than or equal to the CDC blood lead reference value who are linked to recommended services (e.g., environmental inspections, medical evaluations, nutritional counseling, developmental milestones).

• Determine disparities and related trends in blood lead levels by race/ethnicity and socioeconomic status.

In addition to surveillance system data, recipients must collect and report complementary data from relevant agencies (e.g., Medicaid, immunization, adult blood lead, vital statistics).

CDC will provide feedback on recipient progress via monthly calls, email, and written review of recipient’s Evaluation and Performance Measurement Plan. CDC will report annually on individual recipient performance measures progress and aggregated progress across all recipients on the Lead Poisoning Prevention Program website, and periodically through published reports (e.g. Morbidity and Mortality Weekly Report).

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

COOPERATIVE AGREEMENTS)

Beyond regular monthly calls, site visits, and performance and financial monitoring, CDC will:

i. Provide Technical Assistance:

o Provide subject matter expertise to support recipients in the development or enhancement and implementation of blood lead surveillance systems.

o Provide subject matter expertise to support recipients in the development or enhancement of evaluation and performance measurement and program effectiveness.

o Provide subject matter expertise to support recipients in the development or enhancement of work plans, program planning, and capacity building.

o Provide subject matter expertise to support recipients in the development or enhancement of success stories.

ii. Support Information Sharing between Recipients:

o Support information sharing of "best practices" and "lessons learned" through required annual recipient meetings and quarterly conference calls, and at other venues, as appropriate.

o Provide access to information-sharing portals (e.g., Share point site).

o Promote the use of "Success Stories" and other reports and publications.

iii. Provide Additional Support:

o Offer the Healthy Homes and Lead Poisoning Software System (HHLPSS) at no cost to support recipients in deployment of the system and migration of data from other systems to HHLPSS.

o Review the use of data and information collected to support development, enhancement or implementation of population-based interventions.

o Provide guidance in implementing activities, and will identify major program issues, strategies, and priorities related to the cooperative agreement.

o Promote collaboration with other federal, state, and local health; environmental;

and housing agencies by initiating contacts, conference calls, and on-site visits to discuss programmatic issues.

o Provide consultation and technical assistance regarding approaches used to link children to appropriate services.

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: UE2

3. Fiscal Year: 2020

4. Approximate Total Fiscal Year Funding: $22,000,000

5. Approximate Period of Performance Funding: $110,000,000

This amount is subject to the availability of funds.

Estimated Total Funding: $110,000,000

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

7. Expected Number of Awards: 51

8. Approximate Average Award: $450,000 Per Budget Period

9. Award Ceiling: $1,000,000 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor: $300,000 Per Budget Period

11. Estimated Award Date: 09/30/2020

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: State governments

Additional Eligibility Category:

2. Additional Information on Eligibility The statutory authority for this NOFO indicates that grants for lead poisoning related activities will be made to States to support public health activities in States and localities. This includes State government agencies with the public health authority to govern, regulate, deliver, implement, and enforce policies, codes or requirements for childhood lead poisoning prevention to ensure that a comprehensive, statewide system exists for the identification, referral, and follow-up of children exposed to lead.

3. Justification for Less than Maximum Competition N/A

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

5. Maintenance of Effort N/A

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 information under DUNS number

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

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)

Same day but can take 8 weeks to be fully registered

Register early!

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

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 and approved in the system (note, applicants

MUST

obtain a

DUNS

number and

SAM

account before applying on grants.gov) 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 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: 04/01/2020

b. Application Deadline Due Date for Applications: 04/30/2020 , 11:59 p.m. U.S.