CDC-RFA-DP-25-0012 Final NOFO for Publication.pdf

Division of Cancer Prevention and Control

Notice of Funding Opportunity

Application due February 20, 2025

Changing Health Systems Using Evidence-based Interventions to Increase Colorectal Cancer Screening Opportunity number: CDC-RFA-DP-25-0012

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 27

Get registered 28

Step 3: Prepare Your Application 30

Application contents and format 31

Step 4: Learn About Review and Award 38

Application review 39

Award notices 43

Step 5: Submit Your Application 44

Application submission and deadlines 45

Application checklist 47

Step 6: Learn What Happens After Award 48

Post-award requirements and administration 49

Contacts and Support 54

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 20, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information Centers for Disease Control and Prevention (CDC)

Division of Cancer Prevention and Control

Funding evidence-based interventions to increase colorectal cancer screening in people ages 45 to 75.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Changing Health Systems Using Evidence-based Interventions to Increase Colorectal Cancer Screening

Opportunity number:

CDC-RFA-DP-25-0012

Federal assistance listing: 93.800

Statutory authority number: Authorized under section 301(a) of the Public Health Service Act, [42 U.S.C.

section 241(a)], as amended

Key dates

Application deadline:

February 20, 2025

Optional letter of intent deadline: January 13, 2025

Informational call:

January 15, 2025

Expected award date:

May 30, 2025

Expected start date:

June 30, 2025

Summary This announcement funds recipients who will partner with health systems and primary care clinics with low colorectal cancer (CRC) screening prevalence. Recipients will work with their partners to use evidence-based interventions (EBIs) to increase screening in people aged 45 to 75 years old.

The focus is on populations that have low screening prevalence and experience barriers to screening.

Partner clinics must have screening prevalence below the national, regional, or local average. Programs should emphasize identifying populations that have lower screening prevalence or clinic sub-populations who may need more support to complete the screening process.

To implement the program, recipients will do the following:

• Establish partnerships with health systems and primary care clinics to implement multicomponent interventions that combine EBIs recommended in The Community Guide. Recipients should aim to implement at least 3 EBIs. These EBIs must focus on different areas of the clinical system (such as increasing demand, increasing access, and increasing delivery of screening recommendations). The EBIs of priority for this work include: patient reminders, provider reminders and feedback, reducing structural barriers, and patient navigation.

• Establish partnerships with organizations that support implementing EBIs, improving data collection, and enhancing use of electronic health records (EHRs) in primary care clinics to increase CRC screening.

• Conduct a formal readiness assessment of each partner clinic’s capacity to implement EBIs. Use this assessment to select EBIs that will support improved CRC screening.

• Make sure clinics have a CRC screening champion in the clinic.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 5 https://www.cdc.gov/nchs/hus/sources-definitions/geographic-region.htm https://www.thecommunityguide.org/findings/cancer-screening-multicomponent-interventions-colorectal-cancer.html

• Use a limited amount of funding to pay for stool-based testing in partner clinics and ensure follow-up colonoscopies occur after a positive or abnormal screening test, as a payor of last resort.

• Submit high-quality, clinic-level data, including baseline and annual CRC screening prevalence, aggregate data on stool-based tests provided to and returned by patients, and aggregate data on follow-up colonoscopies including those supported by the program.

• Make sure health systems and clinics develop the capacity to collect data and track the entire CRC screening process patients undergo.

• Submit one success story every six months.

• Plan and complete an evaluation of program activities and submit an annual evaluation report.

Funding details Type: Cooperative Agreement

Expected total program funding over the performance period:

$110,000,000

Expected total program funding per budget period: $22,000,000

Expected awards: 38

Funding range per applicant per budget period: $350,000 to $900,000

Expected average award amount per budget period: $500,000

We plan to award projects for five 12-month budget periods for a five-year period of performance.

The number of awards is subject to available funds and program priorities.

Funding strategy Funding will support no more than one applicant per state, tribe, tribal organization, or U.S. territory for up to a maximum of 38 awards. All applicants, including those who are regional or national in scope, must identify one or more populations of focus in one state, tribe, tribal organization, or territory and implement all required program activities in this selected area.

Step 1: Review the Opportunity 6

Definitions of key terms Prevalence The proportion of individuals in a population who have a specific characteristic. An example is the proportion of a population who are up to date with colorectal cancer (CRC) screening, which would be called the CRC screening prevalence.

Partner clinic Partner clinics are clinics who partner with you to measure CRC screening in their clinic populations, implement EBIs shown to increase CRC screening, and track changes in screening prevalence over time.

Supporting partner Supporting partners are partners that support you and your partner clinics and program implementation by bringing more skills and services to increase CRC screening. This may include things like helping provide technical assistance to partner clinics, helping engage clinics and expand your partnerships, helping clinic teams pull data from the EHR, or supporting patient colonoscopies.

CRC screening champion CRC screening champions are clinic or health system staff members who promote and advocate for CRC screening in the clinic. Champions within CRC programs conduct many activities including gaining buy-in and institutional support for CRC screening, motivating team members, providing expertise and facilitation, troubleshooting issues, and promoting activities needed to increase CRC screening.

High-quality, clinic-level data High-quality, clinic-level data is reliable so that public health action may be taken based on the data. It reflects what happens in the clinic in an accurate and timely way. Some activities that ensure high-quality data systems include visiting clinics, providing training, using systems with built-in data validation and error checks, providing technical support, and reviewing data before submissions.

Step 1: Review the Opportunity 7

Eligibility Who can apply

Statutory authority This program is authorized under section 301(a) of the Public Health Service Act, 42 U.S.C. section 241(a), as amended.

Eligible applicants This is an open competition award. These types of organizations may apply:

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Federally Qualified Health Centers.

• Community Health Centers.

• Native American tribal governments (federally recognized).

• Urban Indian Organizations, as defined by 25 U.S.C. 1603(29).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

Step 1: Review the Opportunity 8

Other required qualifying factors The award ceiling for the first budget period is $900,000. The floor amount is $350,000. Applications requesting an award greater than the stated ceiling will be considered non-responsive and will not receive further review.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after February 20, 2025 at 11:59 p.m.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• See the application checklist to understand which elements of your application are part of the responsiveness criteria.

• In addition to the responsiveness criteria, under this Notice of Funding Opportunity (NOFO), you may submit only one application under your organization’s UEI.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you choose to submit voluntary cost-sharing funds in your application and we fund the award, we will require you to report on use of these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background Overview Colorectal cancer (CRC) is the fourth most common cause of cancer in men and women in the United States. Screening provides a way to prevent cancer through the removal of polyps and prevent deaths by early detection of CRC, but many eligible people in the U.S. report having never been screened.

Behavioral Risk Factor Surveillance System (BRFSS) data from 2022 showed that 62.1% of eligible Americans 45 to 75 years old are up to date with colorectal cancer screening and 32.3% have never been screened. The Healthy People 2030 objective for CRC screening is 68.3%.

The Colorectal Cancer Control Program (the program) seeks to increase CRC screening among populations whose screening prevalence is currently low.

We are particularly interested in increasing screening among people served by Federally Qualified Health Centers (FQHCs) and community health centers.

Population screening use estimates are about 72% for the general population aged 50 to 75 years old, versus about 40% for people served by FQHCs.

Populations with low screening prevalence may also include people with lower incomes or those who are underinsured.

Award recipients will leverage partnerships with organizations with specific technical expertise (for example, primary care associations) to provide extensive technical assistance (TA) to support implementation of EBIs as described in The Community Guide.

This NOFO will build on the program’s successes by:

• Encouraging recipients to expand partnerships with clinics to extend the impact and number of patients reached.

• Encouraging recipients to support high-quality TA to partner clinics and engage supporting partners when needed.

• Requiring recipients to complete activities shown to be effective through evaluation.

For colorectal cancer screening to be complete, several things must happen.

Screening relies on people being counseled on screening and offered screening tests they are willing to complete, such as stool-based testing and colonoscopy. When a person completes stool-based testing and receives a

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818024 https://www.thecommunityguide.org/findings/cancer-screening-multicomponent-interventions-colorectal-cancer.html positive test result, this patient must then complete a follow-up colonoscopy to complete the screening process. Tracking people with abnormal test results can be challenging, but patient navigation can help, especially for patients who may have more difficulty navigating the healthcare system.

Finally, sustainability is a primary focus of the program. Evaluation has shown that EBIs are more sustainable when they do the following:

• Have a CRC screening champion.

• Integrate EBIs into the EHR.

• Provide free stool-based screening tests.

Related work

• CDC Colorectal Cancer Control Program

• The Community Guide: Colorectal Cancer Screening

Purpose This NOFO seeks to increase CRC screening among populations aged 45 to 75 years that have lower colorectal cancer screening prevalence, particularly those served by FQHCs or community health centers. Program recipients will partner with clinics that have patient populations with lower CRC screening prevalence. Program recipients will then work with these clinics to implement EBIs that increase CRC screening and to support clinics by providing technical assistance, implementing activities, and supporting evaluation.

Approach Overview The following logic model includes the strategies and activities required under this NOFO. It also includes the program’s expected outcomes. The asterisked outcomes are those we expect you to achieve during the five-year period of performance.

Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease. You will use these outcomes as a guide for developing performance measures.

All outcomes apply to all strategies.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.cdc.gov/cancer/crccp/index.htm https://www.thecommunityguide.org/findings/cancer-screening-multicomponent-interventions-colorectal-cancer.html

Program logic model The logic model shows the strategies and activities of the program along with the outcomes we expect over time. We will require you to report on the asterisked (*) outcomes as follows.

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1:

Establish and enhance partnerships between primary care clinics, supporting partners, and the community.

Strategy 2:

Support the implementation of evidence-based interventions (EBIs) to increase colorectal cancer (CRC) screening.

Strategy 3:

Conduct monitoring and evaluation that ensure data quality.

Strategy 4:

Support completion of stool-based tests, as well as colonoscopies for positive stool-based tests.

• Increased implementation and enhancement of EBIs in partner clinics.*

• Increased stool test kits returned and colonoscopy procedures completed among patients in partner clinics.*

• Increased CRC screening in partner clinics.*

• Increased CRCs prevented.

• Increased diagnosis of early-stage CRC.

• Decreased CRC incidence and mortality.

* Indicates outcomes you are required to report on.

Step 1: Review the Opportunity 12

Strategies and activities This section elaborates on all the required strategies and activities described in the logic model and provides details on expectations of recipients to implement the NOFO.

Strategy 1 You will establish and enhance partnerships between primary care clinics, supporting partners, and the community, and assess clinic readiness to participate in the program. To accomplish this, you are required to complete the following activities.

Activities:

• Use surveillance and other data to identify geographic areas with relatively high CRC incidence or mortality and low screening prevalence among adults who are 45 to 75 years old. You will identify clinics that may benefit from participation in the program. Sources of state and local data to consider include:

◦ Cancer Registry

◦ Behavioral Risk Factor Surveillance System

◦ HRSA Uniform Data System

◦ HRSA FQHC listing

◦ United States Cancer Statistics: Data Visualization

• Identify and engage supporting partners to provide TA and support to partner clinics. Supporting partners may have expertise in areas including clinic workflow or process mapping, quality improvement, data management, EHR use for population management, data quality improvement, and EBI implementation in clinic settings. Your partners may include groups like primary care associations, quality improvement organizations, nonprofit organizations with expertise in EBI implementation, and academic institutions.

• Collaborate with supporting partners to assist with screening needs and help partner clinics with program implementation. This may include identifying partners in the community that can provide additional support services (for example, transportation, childcare, or supporting colonoscopies for high-risk patients). The goal of this collaboration is to provide partner clinics and patients with support services from other organizations that may be closer to home, or services that are outside of the scope of the CRCCP but that enhance the patient’s ability to complete screenings. This collaboration may also help the program be sustainable

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.cdc.gov/national-program-cancer-registries/index.html https://www.cdc.gov/brfss/index.html https://data.hrsa.gov/tools/data-reporting https://data.hrsa.gov/data/reports/datagrid?gridName=FQHCs https://gis.cdc.gov/Cancer/USCS/index.html#/AtAGlance/ without funding and provide services to communities with lower screening participation.

• Engage clinic leadership and supporting partner clinics to assess their readiness to implement EBIs and participate in the program. Share your readiness assessment and implementation plan with CDC.

Strategy 2 You will support implementation of EBIs to increase colorectal cancer screening in partner clinics by completing the following required activities.

The EBIs of priority for this work include: patient reminders, provider reminders, provider assessment and feedback, reducing structural barriers, and patient navigation.

Activities:

• Use EHR systems to develop partner clinics’ capacity to monitor screening prevalence and track screening results and completion (using internal and external supports). Use these systems to identify patients due for screening and consider strategies to provide more support, such as patient navigation. Integrate EBIs into clinical workflows to enhance screening uptake. You are required to provide expertise in using EHRs to implement EBIs, calculate clinic CRC screening prevalence, track screening tests and appropriate follow-up, and collect and review data.

• Implement at least three EBIs. This may include helping partner clinics identify existing EBIs that may benefit from enhancement and new EBIs to support screening.

• Make sure that EBIs are multi-component, focusing on different areas of the clinical environment (such as clinician, patient, and process) to increase both community demand for screening and provider delivery of screening.

• Engage and support a CRC screening champion, who is a clinic- or health system-level staff member who advocates for and promotes CRC screening.

• Make sure clinics have an explicit CRC screening policy with specified age categories, methods, and intervals for screening.

• Provide resources, including technical support, to partner clinics to improve EBI implementation.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.thecommunityguide.org/findings/cancer-screening-multicomponent-interventions-colorectal-cancer.html

Strategy 3 You will conduct monitoring and evaluation activities that ensure high-quality data are being used to inform activities and assess screening prevalence. You will complete the following activities.

Activities:

• Monitor clinic-level screening prevalence at least quarterly. Submit data to CDC at baseline and annually.

• Make sure EHRs can capture high-quality data for reporting to CDC.

• Collect and report required program data to CDC.

• Develop, implement, review, and revise your program’s evaluation plan.

• Apply lessons learned from evaluation to improve program activities.

• Summarize and share evaluation findings.

• Assess and improve data quality and use data to identify gaps in implementation and patient populations who need more outreach.

Strategy 4 You will support completion of stool tests and colonoscopies, including tracking and follow-up of colonoscopies for positive stool tests. You will complete the following activities.

Activities:

• Improve partner clinics’ ability to capture data on the number of screening tests provided and completed or returned, as well as the number of people with an abnormal test who are referred to, scheduled for, and complete a colonoscopy. Implement strategies to make sure screening and follow-up are completed. Develop partnerships to help patients who are diagnosed with CRC and who do not have treatment support find resources.

• Facilitate connections to follow-up colonoscopy (for example, through community partnerships or partnerships with endoscopy sites).

• Optional: Pay for a limited number of stool-based tests and follow-up colonoscopies for those who have no other source of payment. Make sure to collect aggregate data on patients receiving tests paid for with this program’s funding (including stool tests provided and returned, results, follow-up colonoscopies completed, and follow-up results).

Step 1: Review the Opportunity 15

Outcomes This section includes outcomes you are expected to report progress on and achieve within the performance period.

We will measure your progress toward the following outcomes from the logic model:

• Increased implementation and enhancement of EBIs in partner clinics.

• Increased stool test kits returned and colonoscopy procedures completed in partner clinics.

• Increased CRC screening in partner clinics.

You will be responsible for providing the data needed to calculate these short-term outcomes. We will calculate intermediate and long-term outcomes using population data.

Population of focus The focus population includes people who live in areas with high colorectal cancer mortality and lower screening prevalence, especially people living in areas that have CRC screening below 60%. We are especially interested in funding programs that serve populations with lower screening uptake and that have difficulty accessing healthcare services. This may include people who use FQHCs and community health centers, people with lower incomes, racial or ethnic minorities who are at risk for lower screening uptake, and people who do not have full medical coverage for screening.

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate based on, race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Health disparities are often caused by social determinants that influence which populations are most disproportionately affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age. These determinants

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 16 https://www.cdc.gov/about/priorities/social-determinants-of-health-at-cdc.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html affect a wide range of health, functioning, and quality-of-life outcomes and risks.

This NOFO focuses on populations that are disproportionately impacted by colorectal cancer incidence and death.

Organizational capacity The organizational capacity section of your application tells us about your experience doing work relevant to this program and your ability to implement the required activities.

History of experience Describe established relationships with FQHCs, community health centers, and primary care clinics across your state and show your ability to form successful partnerships with partner clinics and supporting partners.

Describe your ability to leverage these partnerships to support patients in completing screening, including patient navigation and identifying support for treatment when needed.

You should describe your previous relevant work in detail, including the following information:

• When you partnered with clinics and health care systems.

• The role you played in those partnerships.

• What EBIs you implemented, including:

◦ The number of people reached.

◦ Type of intervention.

◦ Type of data collected.

◦ The outcomes of the intervention.

An example description could be: “We partnered with clinic A to implement client reminders reaching 1,000 people. We monitored screening in this clinic for six months and found there was an increase in the clinic CRC screening prevalence from 45% to 50%.”

You should also include a detailed narrative of how you partnered with supporting partners to help implement a project or program, including the roles of the partners and how the partnership supported implementation and the provision of technical assistance.

Step 1: Review the Opportunity 17

Specific capacities Describe your expertise and organizational capacity in the following areas, using specific examples where possible.

• Accessing and using data from EHRs, either independently or with your supporting partners. Discuss any methods you used to assess data reliability and validity, as well as any data quality improvement activities you implemented.

• Program evaluation. Describe project or program evaluations you have done and how you have used the results for program improvement.

Include your experience with the following:

◦ Using program data for quality improvement.

◦ Gathering population data from EHRs and assessing the validity and reliability of those data.

◦ Assessing and refining clinic processes.

• CRC screening. You should have a deep understanding of screening tests, facilitators and barriers to screening, and how they may vary by subpopulations. You should also have knowledge of CRC incidence, mortality, and screening prevalence in the focus population.

• Follow-up services. Describe your ability to track stool-based testing and follow-up colonoscopies to screening completion. Describe the relationships needed to connect patients to follow-up colonoscopy services when needed.

Staffing You must identify and maintain staff to manage the program. At a minimum, your application should describe:

• Staff to manage the program.

• Staff with expertise in conducting program evaluation.

• Staff with experience working with primary care clinics and service delivery.

• Staff with appropriate skills to collect data from EHRs and report clinic data to us. It is important that you identify current staff or supporting partners who can support EHR needs. They should have experience and capacity to do the following:

◦ Guide clinics in the integration of EBIs into the EHR (and the use of different EHRs when possible).

◦ Modify data collected from the EHR (tracking screening prevalence).

Step 1: Review the Opportunity 18

◦ Use these data to improve processes (tracking screening tests and appropriate follow-up, data validation, and quality improvement).

Collaborations We expect you to collaborate with CDC-funded programs that are currently funded in your state, county, city, territory, tribe, or tribal organization to coordinate program activities to avoid duplication of effort. Relevant CDC-funded programs may have established partnerships with organizations that can support your proposed activities or implemented EBIs in health systems.

They may also provide data that inform program activities. Relevant CDC-funded programs include:

• National Breast and Cervical Cancer Early Detection Program

• National Comprehensive Cancer Control Program

• National Program of Cancer Registries

• WISEWOMAN program

• Health Resources and Services Administration

We also expect you to collaborate with organizations with expertise in EBI implementation in primary care clinics. These organizations may include primary care associations, quality improvement organizations, nonprofit organizations, and academic institutions.

If you plan to have supporting partners from external organizations support particular areas like evaluation or data quality improvement, clearly describe:

• The type of expertise the supporting partner will provide.

• The activities they will implement.

• The supporting partners’ organizational capacity and previous experience providing this type of expertise to primary care clinics.

Data, monitoring, and evaluation CDC strategy We will evaluate the overall Colorectal Cancer Control Program (CRCCP) using a mixed methods approach. We will collect standardized data from all recipients to conduct process and outcome evaluation. You will complete quarterly surveys focused on your program’s spending and staffing. You will also complete an annual survey focused on program management, technical assistance resources, and partnerships.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 19 https://www.cdc.gov/cancer/nbccedp/ https://www.cdc.gov/cancer/ncccp/ https://www.cdc.gov/cancer/npcr/ https://www.cdc.gov/wisewoman/index.htm https://www.hrsa.gov/

Additionally, you will report baseline and annual clinic data records for all partner clinics participating in the program. Refer to the CRCCP Clinic Data Dictionary (Abbreviated Version) for the baseline and annual clinic data variables you are required to submit to CDC. We use these clinic data to calculate the performance measures specified in the required performance measures section.

Finally, we will invite you to participate in qualitative case studies and economic studies to examine implementation practices, costs, and cost effectiveness. Participation in these studies will be voluntary.

We will disseminate results of the survey and clinic data to you through data dashboards, presentations, and other reports. Results of case studies and economic studies will be provided to participating recipients and used to develop manuscripts for publication. We will conduct analyses of standardized program data (such as surveys and clinic data) and develop manuscripts for publication.

Required performance measures Following are the draft performance measures you will need to report on after award. We may refine the required measures for this program. If so, we will work with you and finalize them before we require you to submit any data.

The draft performance measures are:

Short-term outcomes Performance measures

Increased implementation and enhancement of EBIs in partner clinics.

Percent of partner clinics implementing at least three EBIs.*

Increased stool test kits returned and colonoscopy procedures completed in partner clinics.

Stool test return prevalence.*

Colonoscopy completion prevalence.*

Increased CRC screening in partner clinics. Colorectal cancer screening prevalence.*

Intermediate outcomes

Increased CRCs prevented. Number of CRCs averted.

Increased diagnosis of early-stage CRC. Number of early-stage CRCs detected.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 http://www.cdc.gov/colorectal-cancer-control/about/dp25-0012.html http://www.cdc.gov/colorectal-cancer-control/about/dp25-0012.html

*We will use required clinic data to calculate these measures.

Evaluation and performance measurement plan You must provide an evaluation and performance measurement plan. Use the measures required under the CDC strategy.

Include the following elements:

Methods Describe the following:

• The evaluation questions to be included in your evaluation plan.

• The methods you will use to address your evaluation questions.

• How you will collect high-quality baseline and annual clinic data for reporting to CDC. CDC will use these data to calculate the performance measures.

◦ Address how you will make sure high-quality screening prevalence data are extracted from the clinics’ EHR systems.

◦ Describe how you will collect data on stool kit distribution, kit return, and colonoscopy completion.

• How you will use evaluation findings for continuous program quality improvement.

• How you will incorporate evaluation and performance measurement into planning, implementing, and reporting on project activities.

• How findings will contribute to reducing or eliminating health disparities, if relevant.

• How key partners will participate in the evaluation and performance measurement process.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

Data management For all public health data you plan to collect, describe:

• The data you plan to collect in addition to the required clinic data, if relevant, and their available data sources.

• The feasibility of collecting appropriate evaluation and performance data.

• Other relevant data information, such as performance measures you propose.

Step 1: Review the Opportunity 21

For a definition of “public health data” and other key information, see AR 25:

Data Management and Access on our website.

Evaluation activities You must take on specific evaluation activities. Describe:

• The type of evaluations, such as process, outcome, or both.

• Key evaluation questions to be answered by these evaluations.

• Other information such as measures and data sources.

An initial draft of your evaluation and performance measurement plan should be submitted with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Work plan You must provide a work plan for the first year of your project. The work plan connects your period of performance outcomes, strategies, activities, and measures. In addition, the work plan details how you plan to achieve the performance outcomes, strategies and activities, and evaluation and performance measurement. It also provides more detail on how you will measure outcomes and processes.

You should use SMARTIE (specific, measurable, attainable, relevant, time-bound, inclusive, equitable) objectives for the first year of the five-year period of performance and a project narrative for subsequent years. Plans should also detail the program-specific activities that will help you accomplish your objectives.

You are not required to use a specific work plan format. A sample format is provided below.

Table: Sample format

Activities to be implemented

Progress or process measures

(From Data, Monitoring, and Evaluation section)

Relevant period of performance outcomes

(From Outcomes section)

Responsible position or party

Completion date

Strategy 1:

1.

2.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

Activities to be implemented

Progress or process measures

(From Data, Monitoring, and Evaluation section)

Relevant period of performance outcomes

(From Outcomes section)

Responsible position or party

Completion date

3.

Strategy 2:

1.

2.

3.

If you decide to use another template, make sure your work plan includes all of these required elements:

• Strategies and activities to be implemented

◦ Refer to strategies and activities or logic model.

• Process measures

◦ Refer to evaluation and performance measurement.

• Period of performance outcomes

◦ Refer to outcomes or logic model.

• Outcome measures

◦ Refer to evaluation and performance measurement.

• Responsible position or party

◦ Refer to staffing.

• Completion date

◦ Proposed time frame to complete the activity.

As part of the project narrative, your work plan should:

• Include a detailed work plan for Year 1 and a general plan for years 2 through 5.

• Align your activities, outcomes, assessments, and performance measures with the NOFO logic model and project narrative sections.

• Align with proposed strategies and activities, outcomes, and performance measures.

Step 1: Review the Opportunity 23

• Describe how you will develop partnerships with focus populations, supporting partners, and other partner organizations.

• Address how your work will reduce health disparities and advance health equity.

• Include the required elements for each performance outcome.

◦ If an activity leads to multiple outcomes, describe it under each relevant outcome.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require you to follow the Paperwork Reduction Act (PRA).

The Paperwork Reduction Act requires review and approval by the White House Office of Management and Budget. To determine if a proposed activity requires PRA approval, contact your project officer. Collection includes items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval. For more information about CDC’s requirements under PRA, see CDC Paperwork Reduction Act Compliance.

Funding policies and limitations General guidance

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. Questions about this determination should be posed to the grants management specialist.

• You may spend a small amount of your funding to purchase stool-based screening tests to support partner clinics that may not have the ability to provide free stool-based screening to patients who don’t have insurance coverage. If funds are used for this purpose, you will also report data on these tests as part of your data sharing.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 24 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm

Unallowable costs You may not use funds for:

• Research.

• Clinical care except as allowed by law. Exceptions include stool testing and follow-up colonoscopy as covered costs, as described in the activities for strategy 4.

• Pre-award costs unless CDC gives you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• The direct and primary recipient in this cooperative agreement must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs are those for a common or joint purpose across more than one project and that cannot be easily separated by project.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Justification: Provide a summary of the rate. Enclose a copy of the current approved rate agreement in the Attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you are awaiting approval of an indirect cost proposal, you may also

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 25 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-2/section-200.414 use the de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC.

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

• Salary rate limitation: The salary rate limitation in the current appropriations act applies to this program. As of January 2024, the salary rate limitation is $221,900. We will update this limitation in future years.

National public health priorities and strategies Healthy People 2030 This funding opportunity is related to the following measurable objectives under the Healthy People 2030 initiative:

• Increase colorectal cancer screening in adults 45 to 75 years old. (C-07)

• Reduce the age-adjusted annual rate of cancer mortality. (C-01)

• Reduce colorectal cancer death. (C-06)

• Increase the proportion of cancer survivors who are living five years or longer after diagnosis. (C‑11)

• Quality of life for cancer survivors. (C‑R01)

• Informatics in public health. (PHI‑R06)

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/part-75#p-75.403(d) https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/colorectal-cancer-screening https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/reduce-overall-cancer-death-rate-c-01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/reduce-colorectal-cancer-death-rate-c-06 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-cancer-survivors-who-are-living-5-years-or-longer-after-diagnosis-c-11 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-quality-life-cancer-survivors-c-r01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure/enhance-use-and-capabilities-informatics-public-health-phi-r06

Step 2:

Get Ready to Apply

In this step

Get registered 28

Get registered While you can review the requirements and get started on developing your application before your registrations are complete, you must be registered in both SAM.gov and Grants.gov to apply.

SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier. SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number

CDC-RFA-DP-25-0012.

If you can’t use Grants.gov to download application materials or have other technical difficulties, including issues with application submission, contact Grants.gov for assistance.

To get updates on changes to this NOFO, select Subscribe from the View Grant Opportunity page for this NOFO on Grants.gov.

Need help? See Contacts and Support.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 28 https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://grants.gov/search-grants https://www.grants.gov/support https://www.grants.gov/support

Help applying For help related to the application process and tips for preparing your application see How to Apply on our website. For other questions, see Contacts and Support.

Join the informational call Join our online informational call for this NOFO:

• Date: Wednesday, January 15, 2025

• Time: 3 p.m. ET

• Join on Microsoft Teams.

• Meeting ID: 234 338 672 083

• Passcode: gR3KK6jm

You can also dial in by phone:

• +1 404-718-3800,,195250164# United States, Atlanta

• (888) 994-4478,,195250164# United States (Toll-free)

• Find a local number.

Phone conference ID: 195 250 164#

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 29 https://www.cdc.gov/grants/applying/index.html https://teams.microsoft.com/l/meetup-join/19%3ameeting_MTczMTMwMGUtNGMyMS00Y2M2LWEzMzAtNTQyZmJkYmM0NDBi%40thread.v2/0?context=%7b%22Tid%22%3a%229ce70869-60db-44fd-abe8-d2767077fc8f%22%2c%22Oid%22%3a%22d0de75de-4a9b-40c9-9840-39565a333f8e%22%7d https://dialin.teams.microsoft.com/f157e5c8-9e01-4021-b245-b3aec6e9a1bc?id=195250164

Step 3:

Prepare Your Application

Application contents and format 31

Application contents and format Applications include five main elements. This section includes guidance on each. Make sure you include each of the following:

Table: Application contents

Element Submission form

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative justification Use the Budget Narrative Attachment form.

Attachments Insert each in the Other Attachments form.

Other required forms Upload using each standard form.

See requirements for the optional letter of intent and other submissions.

Your organization’s authorized official must certify your application.

We will provide instructions on document formats in the following sections. If you don’t provide the required documents, your application is incomplete.

See responsiveness criteria and initial review to understand how this affects your application.

Required format for project abstract, project narrative, and budget narrative

Font: Calibri

Format: PDF

Size: 12-point font Footnotes and text in graphics may be 10-point.

Ink color: Black

Spacing: Single-spaced

Margins: 1-inch

Include page numbers.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 31

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Project abstract Page limit: 1

File name: Project Abstract Summary

Provide a self-contained summary of your proposed project, including the purpose and outcomes. Do not include any proprietary or confidential information. We use this information when we receive public information requests about funded projects.

Project narrative Page limit: 20

File name: Project Narrative

Your project narrative must use the exact headings, subheadings, and order as follows. See the merit review criteria to understand how reviewers will evaluate your project narrative.

Background Describe the problem you plan to address. Be specific about your focus population and geographic area including information about colorectal cancer screening prevalence, populations with lower screening uptake, incidence of colorectal cancer diagnosis, and mortality. Include the number of clinics and organizations you plan to partner with to complete the strategies and activities and achieve outcomes. See the background section of the program description.

Approach

Strategies and activities Describe how you will implement the proposed strategies and activities to achieve…