cdc-rfa-oe15-1502 amend 1.pdf

Centers for Disease Control and Prevention

Center for Surveillance, Epidemiology and Laboratory Services

The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice

CDC-RFA-OE15-1502

Application Due Date: 04/20/2015

The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice

CDC-RFA-OE15-1502

TABLE OF CONTENTS

Part I. Overview Information

Federal Agency NameA.

Funding Opportunity TitleB.

Announcement TypeC.

Agency Funding Opportunity NumberD.

Catalog of Federal Domestic Assistance (CFDA) NumberE.

Dates F.

Executive Summary G.

Part II. Full Text

Funding Opportunity Description A.

Award Information B.

Eligibility Information C.

Required Registrations D.

Review and Selection Process E.

Award Administration Information F.

Agency Contacts G.

Other Information H.

Glossary I.

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-OE15-1502. 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) B. Funding Opportunity Title:

The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice C. Announcement Type: New - Type 1 This announcement is only for non-research domestic activities supported by CDC. If research is proposed, the application will not be considered Research for this purpose is defined at http://www.cdc.gov/od/science /integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf.

D. Agency Funding Opportunity Number:

CDC-RFA-OE15-1502

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.283 F. Dates:

1. Due Date for Letter of Intent (LOI): 03/17/2015

2. Due Date for Applications: 04/20/2015, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call: 03/03/2015 An informational teleconference call will be conducted on March 3, 2015, 3:00 PM Eastern Time to address prospective applicants' questions regarding CDC-RFA-OE 15-1502: The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice. The dial in telephone number is 1-888-455-9740, and the participant passcode is 7876347.

Note: If multiple individuals will participate from your organization, make best effort to use one telephone line to ensure CDC has available ports and telephone lines for all prospective applicants.

G. Executive Summary:

1. Summary Paragraph:

Amendment 1 (02/23/15): The purpose of this amendment is to incorporate the CDC logic model.

The mission of the National Syndromic Surveillance Program (NSSP) is to promote the use of high quality syndromic surveillance data for improved nation-wide all-hazard situational awareness for public health decision-making and enhanced responses to hazardous events, and outbreaks. The purpose of this funding opportunity is to assist state and local public health authorities to implement syndromic surveillance to enhance situation awareness and detect and characterize disease outbreaks or other hazardous events or conditions of public health concern in order to respond quickly to local threats. In addition, this program provides support to state and local health authorities to advance the Meaningful Use of syndromic surveillance data from electronic health records (EHR). Activities that will be supported to enhance syndromic surveillance capacity and practice include (1) improving the overall representativeness of syndromic surveillance data by recruiting hospital or other sources of emergency https://foa.grantsolutions.gov/announcementmodule/www.grants.gov https://foa.grantsolutions.gov/announcementmodule/www.grants.gov http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.grants.gov department/urgent care or inpatient data that are representative of the jurisdiction’s population; (2) improving the quality, timeliness, utility, and sharing of these data; and (3) increasing collaboration among state and local jurisdictions through a National Syndromic Surveillance Community of Practice.

Each applicant must sign a Data Use Agreement (DUA) with the cloud steward as part of the development of the nationwide integrated system, as set out in the cited authority, section 319D of the PHS Act. The directive in the authority is to develop a nationwide system, and the need to enter into the DUA is furtherance of achieving that directive.

a. Eligible Applicants: Limited

b. FOA Type: Cooperative Agreement

c. Approximate Number of Awards: 25

d. Total Project Period Funding: $28,000,000

e. Average One Year Award Amount: $250,000

f. Number of Years of Award: 4

g. Estimated Award Date: 09/01/2015

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview

Syndromic surveillance is public health surveillance that emphasizes the use of near ‘real-time’ pre-diagnostic data, primarily from emergency departments, and statistical tools to detect and characterize unusual activity for further public health investigation or response. For over a decade, the CDC BioSense program has been a driver of syndromic surveillance nationwide. As a result of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, BioSense was launched to provide initial recognition of a bioterrorism-related illness. BioSense was redesigned in 2010 using cloud technology and offered health departments an opportunity to enhance their surveillance capabilities through provisions of the HITECH Act.

The HITECH Act’s Meaningful Use of electronic health records (EHRs) component incentivized hospitals to submit syndromic surveillance data to their public health agency, a requirement which cannot be fulfilled if a public health agency has no capacity to receive such data.

Syndromic surveillance has now become a routine component of the larger public health surveillance umbrella and is used for disease or event detection, situation awareness for mass gatherings and public health emergencies, and ad hoc and population health trend analyses.

CDC is evolving BioSense into a National Syndromic Surveillance Program (NSSP) that will build upon lessons learned and harness syndromic surveillance expertise at all levels of the public health enterprise. The vision of NSSP is a collaboration among local, state, and national public health programs that supports timely exchange of syndromic data and information for nation-wide situational awareness and enhanced response to hazardous events and disease outbreaks.

NSSP includes a collaborative National Syndromic Surveillance Community of Practice (NSSCoP), a governance system that recognizes state, federal, and other participants’ roles and responsibilities, and a cloud-based Syndromic Surveillance Platform (SyS-P) that hosts the BioSense application and other analytic tools and services. Through the NSSCoP and access to shared analytic tools and services on the SyS-P, public health programs and practitioners will be able to analyze their data, access aggregated analyses of disease patterns, and share more detailed data in order to identify, investigate, and address public health threats that cross jurisdictions. NSSP will also help state and local health departments meet Meaningful Use (MU) requirements by increasing their capacity to support MU programs intended to expand the use of electronic health records (EHR).

The 2013 CDC BioSense Investment Review recommended CDC strategically prioritize the enrollment and onboarding of hospitals to the SYS-P to increase the representativeness of jurisdictions and emergency department visits across the nation. Thus the focus of NSSP in coming years will be on improving data access, quality, representativeness and timeliness; enhancing the capabilities and technology supporting syndromic surveillance data collection, processing, and provisioning activities; and working with the syndromic surveillance community to further the science and practice of syndromic surveillance.

The current FOA BioSense 2.0: Building State, Local, Tribal, and Territorial Surveillance Capacity to Enhance Regional and National All-Hazards Public Health Situation Awareness funds 34 jurisdictions, ranging from $118,486 - $260,173. The new FOA will fund approximately 25 awards, ranging from $100,000 to $400,000 with an average award of $250,000. The increased average funding amount is meant to increase the proportion and representativeness of emergency department visits across the nation that are included in the National Syndromic Surveillance Program.

Each applicant must sign a DUA with the cloud steward as part of the development of the nationwide integrated system, as set out in the cited authority, section 319D of the PHS Act. The directive in the authority is to develop a nationwide system, and the need to enter into the DUA is in furtherance of achieving that directive.

b. Statutory Authorities

Public Health Service Act Sections 319D [42 U.S.C. 247d-4] and 317(k)(2)[42 U.S.C. 247b(k)(2)], as amended

c. Healthy People 2020

This program addresses the “Healthy People 2020” focus area(s) of Health Communication and Health Information Technology, Healthcare-Associated Infections, Immunizations and Infectious Diseases and Public Health Infrastructure http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=17 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=35

d. Other National Public Health Priorities and Strategies http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=17 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23 http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=35

Meaningful Use http://www.cdc.gov/ehrmeaningfuluse/

National Health Security Strategy http://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx

Public Health Security and Bioterrorism Preparedness and Response Act of 2002 http://www.gpo.gov/fdsys/pkg/PLAW-107publ188/html/PLAW-107publ188.htm

Pandemic and All-Hazards Preparedness Act (PAPHA) (Sec. 202) https://www.govtrack.us/congress/bills/113/hr307/text

Public Health Preparedness Capabilities: National Standards for State and Local Planning http://www.phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdf

Core Capability 6: Information Sharing http://www.cdc.gov/phpr/capabilities/capability6.pdf

Core Capability 13: Public Health Surveillance and Epidemiology Investigation http://www.cdc.gov/phpr/capabilities/capability13.pdf

e. Relevant Work

The recipient activities identified in this FOA build on programs and activities that CDC supported through earlier FOAs (e.g. CDC-RFA-OE12-1202) to enhance regional and national syndromic surveillance.

Each applicant must sign a DUA with the cloud steward as part of the development of the nationwide integrated system, as set out in the cited authority, section 319D of the PHS Act. The directive in the authority is to develop a nationwide system, and the need to enter into the DUA is in furtherance of achieving that directive.

2. CDC Project Description

a. Approach http://www.cdc.gov/ehrmeaningfuluse/ http://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx http://www.gpo.gov/fdsys/pkg/PLAW-107publ188/html/PLAW-107publ188.htm https://www.govtrack.us/congress/bills/113/hr307/text http://www.phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdfCore http://www.cdc.gov/phpr/capabilities/capability6.pdf http://www.cdc.gov/phpr/capabilities/capability13.pdf

i. Purpose

The purpose of this funding opportunity is to assist state and local public health authorities to implement syndromic surveillance to enhance situation awareness and support public health authorities in the Meaningful Use of syndromic surveillance data from electronic health records (EHR). Activities include (1) improving the representativeness of syndromic surveillance data by recruiting hospital or other sources of emergency department/urgent care or inpatient data that are representative of the jurisdiction’s population; (2) improving the quality, timeliness, utility, and sharing of these data; and (3) increasing collaboration among state and local jurisdictions through a National Syndromic Surveillance Community of Practice.

ii. Outcomes

As reflected in the Logic Model, awardees are expected to show measurable progress made toward the short-term and mid-term outcomes for this 4-year project period.

Short-term Outcomes

Improved geographic and population-based representativeness of syndromic surveillance data.1.

Data that are representative of the local, regional and national population are an essential component of a national syndromic surveillance program.

2. Improved syndromic surveillance data quality (i.e., data are complete, valid, and reliable).

CDC and jurisdiction health departments must be confident in the quality of these data in order to use such data for a coordinated response to all-hazard threats.

3. Improved knowledge and ability of state and local health department staff in conducting syndromic surveillance. Training of staff and participation in partnership and practice activities will contribute to an improvement in the skills and capabilities of participating individuals as it relates to syndromic surveillance in general. This will help ensure high-quality surveillance data are used regularly and appropriately for improved situation awareness decision-making.

4. Enhanced use of syndromic surveillance within state and local jurisdictions.

Both the availability of representative high-quality data and engagement of users with the National Syndromic Surveillance Community of Practice (NSSCoP) will facilitate enhanced use of syndromic surveillance data within state and local jurisdictions. In particular, active participation in the NSSCoP will serve enable sharing and adoption of both routine and novel uses of syndromic surveillance data for all-hazards awareness.

Mid-Term Outcomes

1. Increased data sharing between/among jurisdictions for local, regional, national health events.

Increased data sharing outside of jurisdictional boundaries is an important outcome that will enhance the value of a national syndromic surveillance program.

2. Timely identification of syndrome patterns for anticipated or present public health threats.

Anticipated threats are those where the potential for a public health threat exists due to an impending event (such as mass gatherings or sporting events). In contrast, present threats are those where the public health threat already exists or is underway (such as natural disasters or outbreaks). Unanticipated threats are those that might unfold as the result of a terrorism event or other disaster. Staff with access to high-quality data and knowledgeable about baseline disease trends will be able to identify and respond to all-hazard public health threats in a timely manner, i.e. according to the disease or condition of concern. Data shared among jurisdictions and the CDC will allow coordinated and effective responses to regional and nation-wide public health threats.

Long-Term Outcomes

1. Improved synergy/integration of syndromic surveillance data with other surveillance systems within participating health departments.

2. Improved nation-wide all-hazard situational awareness.

iii. Strategies and Activities

1. Improve representativeness of data:

a) Identify, recruit, and onboard hospitals, Health Information Exchanges (HIEs), or aggregator services to the syndromic surveillance platform (SyS-P)

It is essential that the awardee identify and recruit hospitals, HIEs or aggregator services that are representative of the jurisdiction’s population. Other considerations to inform facility recruitment could include high volume of patients in the EDs, existence of mature electronic health record (EHR) systems, record of collaborative relationships with other facilities and/or public health agencies, etc.

b) Establish Data Use Agreements (DUAs) with (1) the cloud steward within six months of award and

(2) identified facilities according to jurisdictional law

DUAs must be compliant with relevant jurisdictional laws, i.e., state and/or local legislation that govern the sharing of data.

2. Improve data quality, timeliness and utility(i.e.; complete, valid, reliable and useful)

a) Register jurisdictional users of the SyS-P for administrative activities and/or tasks related to maintenance of jurisdictional systems and procedures.

b) Conduct quality and timeliness assessments for data submitted to the SyS-P including reporting of data quality and timeliness metrics to the CDC.

c) Use syndromic surveillance data. Routine use of syndromic surveillance data builds capacity for surveillance practice and analytics, and is essential for characterizing and establishing baseline disease trends so that anomalies can be detected.

d) Collaborate with CDC and other jurisdictions on developing methods to analyze data captured in the SyS-P that will generate aggregate results at the regional and national level. Share data with CDC and other jurisdictions, when appropriate and state/local laws allow, in response to public health events of regional or national interest e.g., outbreaks, disasters, etc.

3) Strengthen syndromic surveillance practice:

a) Maintain or establish jurisdictional working groups - this will include engagement with stakeholders (public health, health care providers, hospital systems, etc.) to improve quality and use of syndromic surveillance data within a state or local jurisdiction.

b) Participate in professional development activities that further syndromic surveillance and practice -this will include training on the SyS-P, peer-to-peer mentoring, and participation in NSSCoP sponsored activities.

c) Attend an annual NSSP grantee meeting at the CDC.

1.Collaborations

Please see required and optional collaborations for this FOA below

a. With CDC-funded programs:

With CDC funded programs: Optional. Strengthen existing collaborations with CDC/CSELS and other CDC programs and initiatives. Applicants are encouraged to explore opportunities for new collaborations with and across CDC programs. For example, awardees will work with the CDC influenza program during flu season on case definitions and analytic methods, as well as other programs at CDC that could include, but is not limited to, CDCs National Center for Injury Prevention and Control (NCIPC), or CDCs Emergency Operations Center, etc.

b. With organizations external to CDC:

With organizations external to CDC: Optional. Applicants from the same jurisdictions who meet the eligibility criteria are encouraged to collaborate on proposals. Applicants are encouraged to build and/or continue partnerships and collaborations with other jurisdictions or organizations that have a role in achieving the FOA outcomes and proposed activities. This may include participating in regional workgroups that are focused on syndromic surveillance issues important to the local region.

2. Target Populations

a. Inclusion

iv. Funding Strategy (for multi-component FOAs only)

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The purpose of evaluation and performance measurement is to help CDC and the awardee: 1) Monitor the extent to which activities planned were successfully completed (e.g., Were activities implemented correctly?);

(2) Demonstrate how activities contribute towards program outcomes (e.g., Were outcomes of interest achieved?); and (3) Inform decisions about future programming that drive continuous program improvement for more efficient and effective program performance (e.g., What and how could things be improved?).

The overall CDC Evaluation and Performance Measurement Strategy will focus on both process and outcome evaluation. Process evaluation is conducted to monitor activities during the implementation and operation of a program while an outcome evaluation examines the longer-term successes and accomplishments of a program. Potential data sources will include awardee applications and progress reports (e.g., work plans, performance measures, and success stories). Process measure data will be reviewed and discussed during quarterly reporting calls with the CDC.

Each awardee’s Performance Measurement and Evaluation plan will be finalized with the CDC within the first six months of award. Below are some examples of the main evaluation questions to be addressed by the FOA during this project period.

PROCESS MEASURES

Strategy 1: Improve representativeness of syndromic surveillance data

Activity 1.a) Identify, recruit, and onboard hospitals, Health Information Exchanges (HIEs), or aggregator services to the syndromic surveillance platform (SyS-P)

Measure:

Recruitment plan with number and identification of EDs and HIEs [qualitative and qualitative indicator]

Note: CDC will use the American Hospital Association data set as a benchmark to measure national representativeness. The American Hospital Association data set includes data from 1,600 hospitals across the nation and is nationally represented data. Therefore, helping to identify those facilities and describe the recruitment plan specific to those facilities will be a strong focus.

While emergency department data is of priority, other types of data such as urgent care and inpatient data are welcomed. Awardees should identify sources accordingly within their recruitment plan.

Proportion of all ED facilities in the jurisdiction that are sending ED data to the SyS-P [quantitative indicator] Proportion of total visits in each jurisdiction’s hospital EDs that are submitted to SyS-P [quantitative indicator]

Activity 1.b) Establish Data Use Agreements (DUAs) with the cloud steward and identified facilities according to jurisdictional law

Measure:

Number of DUAs signed with local facilities [quantitative indicator] Number of DUAs signed with facilities that also allow data sharing with other jurisdictions and CDC for public health purposes. [quantitative indicator]

Strategy 2: Improve data quality, timeliness and utility (i.e., complete, valid, reliable and useful):

Activity 2.a) Register users for the SyS-P.

Measure:

Number of state and/or local users registered to access data and/or view aggregate results on the SyS-P [quantitative indicator]

Activity 2.b) Conduct data quality and timeliness assessments for data submitted to the SyS-P.

Measure:

Quarterly data quality and timeliness reports will include at a minimum:

Proportion of records with missing fields in data feeds [quantitative indicator] Proportion of records with invalid values in data feeds [quantitative indicator] Proportion of ED visit data that meet quality criteria defined by the NSSCoP core group [quantitative indicator] Proportion of records available in the front end application of the SyS-P within less than 48 hours after patient admission to the ED [quantitative indicator]

Activity 2.c) Collaborate with CDC on syndromic surveillance for health events of national interest, e.g., outbreaks, disasters, etc.

Measure:

Syndromic surveillance use “success stories” involving CDC collaborations [qualitative measure]

Strategy 3: Strengthen syndromic surveillance practice

Activity 3.a) Maintain or establish jurisdictional working groups

Measure:

Number of syndromic surveillance stakeholders participating in grantee jurisdictional workgroups, including hospital EDs and other healthcare provider organizations. [quantitative indicator] Jurisdictional workgroup plan with annual measureable objectives that align to NSSP priorities and NSSCoP activities and projects. [qualitative indicator]

Activity 3.b) Participate in NSSCoP sponsored activities/projects and other professional development activities that further syndromic surveillance and practice

Measure:

Number of grantee staff participating in NSSCoP projects. [quantitative indicator] List syndromic surveillance trainings, grantee staff attended, including the type and content e.g.

webinar, online course, conference, etc.) [qualitative indicator] Number of grantee staff engaged in peer-to-peer mentoring. [quantitative indicator]

Activity 3.c) Attend an annual NSSP grantee meeting at the CDC.

Measure:

Participation in the annual grantee meeting at CDC [qualitative indicator]

OUTCOME MEASURES

1. Outcome: Improved syndromic surveillance expertise of state and local health department staff

Measures:

List syndromic surveillance reports or publications [qualitative measure] List syndromic surveillance presentations [qualitative measure]

2. Outcome: Increased use of syndromic surveillance in state and local jurisdictions

Measures:

Number of use cases for syndromic surveillance [quantitative indicator] Syndromic surveillance “success stories” [qualitative measure]

3. Outcome: Increased data sharing between/among jurisdictions

Measure:

Number of public health events where data were shared

4. Outcome: Timely identification of syndrome patterns for anticipated or present public health threats

Measures:

Syndromic surveillance "sucess stories" [qualitative measure] Number of hospital facilities that have achieved Meaningful Use stage 2 compliance for syndromic surveillance. [quantitative measure]

ii. Applicant Evaluation and Performance Measurement Plan

As needed and on request of the awardee, CDC program will work with awardees during the first six months of the project period to finalize an evaluation and performance measurement plan to better monitor the progress of the activities implemented and outcomes achieved. As a first step, applicants must provide an overall jurisdiction evaluation and performance measurement plan that is consistent with the CDC strategy, as stated above. This plan, at a minimum, must address the following points:

a. Identify key program partners and describe how they will participate in the implementation of the evaluation plan as described within this FOA.

b. Consider the evaluation questions outlined above in CDC Evaluation and Performance Measurement Strategy. These questions will establish the scope and focus of the evaluation.

c. Describe how evaluation findings will be used for continuous program quality improvement.

Discuss any barriers or challenges expected for implementing the plan, collecting data (i.e., responding to performance measures), and reporting on evaluation results. Describe how these potential barriers would be overcome. In addition, applicants may also describe other measures to be developed or additional data sources and data collection methods that applicants will use to answer the evaluation questions stated above.

c. Organizational Capacity of Awardees to Execute the Approach

The applicant must have a demonstrated organizational capacity to successfully implement the proposed syndromic surveillance strategies and activities listed in the FOA. The organizational capacity includes skill sets in epidemiology, surveillance, informatics, program planning and performance management, evaluation, budget management and administration, and personnel management (including developing staffing plans, developing and training the workforce and developing a sustainability plan).

The applicant must submit CVs/Resumes of principal investigators. Organizational charts may also be included. Applicant must be fully capable of managing the required procurement efforts in accordance with 45 and 74 C.F.R.

d. Work Plan

Applicants must include a work plan that allows the CDC project officer to monitor implementation of activities and progress on project period outcomes. The work plan should be detailed and should focus on the first year of the project period with only a high-level plan for subsequent years. Work plans should demonstrate alignment among the outcomes, strategies, activities, timelines, and staffing/collaborations.

Additional information on performance measures and data sources can also be included.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee 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 awardee progress in achieving the desired outcomes.

Ensuring the adequacy of awardee 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:

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

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

Working with awardees 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.

Other activities deemed necessary to monitor the award, if applicable.

These activities may include 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 grantees.

Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee 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 awardee progress in achieving the desired outcomes.

Ensuring the adequacy of awardee 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:

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

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

Working with awardees 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.

Other activities deemed necessary to monitor the award, if applicable.

These activities may include 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 grantees.

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

AGREEMENTS)

There will be substantial CDC involvement. CDC staff will collaborate or participate in project or program activities. Activities include the following:

Technical assistance in evaluation, performance measurement, work plan development, program planning, and specific syndromic surveillance subject matter expertise.

1.

Provide the SyS-P for syndromic surveillance data storage and sharing2.

Support the cloud hosting environment for SyS-P3.

Provide analytic tools in the SyS-P4.

Provide data management support for the SyS-P5.

Provide data quality assurance for the SyS-P6.

Provide technical support to SyS-P users7.

Provide analysis of regional and national level aggregate data8.

Facilitate participation in the National Syndromic Surveillance Community of Practice activities where appropriate

9.

Support the National Syndromic Surveillance Community of Practice and associated governance group10.

Collaborate with recipients on specific activities to develop a sustainable infrastructure which may include site visits, webinars, and teleconferences.

11.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the

CDC Program Support to Awardees Section.

2. Award Mechanism: U50

3. Fiscal Year: 2015 Estimated Total Funding: $28,000,000

4. Approximate Total Fiscal Year Funding: $7,000,000

5. Approximate Project Period Funding: $28,000,000

6. Total Project Period Length: 4 year(s)

7. Expected Number of Awards: 25

8. Approximate Average Award: $250,000 Per Budget Period

9. Award Ceiling: $400,000 Per Budget Period

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

11. Estimated Award Date: 09/01/2015 Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the awardee (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 project period comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

12. Budget Period Length: 12 month(s)

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

C. Eligibility Information

1. Eligible Applicants Eligibility Category: State governments

County governments City or township governments Special district governments Native American tribal governments (Federally recognized)

Government Organizations:

State (includes the District of Columbia) Local governments or their bona fide agents Territorial governments or their bona fide agents in the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Giam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

American Indian or Alaska Native tribal governments (federally recognized or state-recognized)

2. Additional Information on Eligibility

Eligibility is limited to the following:

1) A single state or local health department representing a population equal to or greater than 1 million people as estimated by the U.S. Census (2013 estimate).

2) A collaborating group of state or local health departments (e.g.; MSAs, group of states, multiple counties, etc.) representing an area with a total combined population equal to or greater than 1 million people as estimated by the U.S. Census (2013 estimate) or the District of Columbia Department of Health.

3) A singel state health department representing a population less than 1 million people as estimated by the U.S. Census (2013 estimate) and/or the District of Columbia Department of Health.

All applicants must have demonstrated capacity to conduct syndromic surveillance and must be able and willing to sign the cloud steward's, currently the Association of State and Territorial Health Officials (ASTHO), Data Use Agreement (DUA) within 6 months of award. Applicants that have current DUAs with the cloud steward, currently the Association of State and Territorial Health Officials (ASTHO), are required to submit a copy of their DUA with the request for funding. Applicants that do not have a current DUA with the cloud steward are required to submit a letter signed by the health officer committing to signing the DUA within the first six months of funding.

DUAs signed by applicants are necessary to ensure they'll be able to share data in the cloud to promote the mission of the national Syndromic Surveillance program: use of high quality syndromic surveeillance data for improved nationwide all hazard situational awareness for public health decision-making and enhanced responses to hazardous events, and outbreaks - which cross geo-political boundaries.

The award ceiling for this FOA is $400,000. CDC will consider any application requesting an award higher than this amount as non- responsive and it will receive no further review. If a pre-application is required, then specify here and include it in the special eligibility requirements section. (http:// www.hhs.gov/ asfr/ ogapa/ aboutog/ hhsgps107.pdf)

3. Justification for Less than Maximum Competition

The purpose of this funding opportunity is to assist state and local public health authorities to implement syndromic surveillance to enhance situational awareness and support public health authorities in Meaningful Use of syndromic surveillance data from electronic health records (EHR).

Activities of this funding opportunity include (1) improving the responsiveness of syndromic surveillance data by recruiting hospital or other sources of emergency department/urgent care or inpatient data that are representative of the jurisdiction's population; (2) improving the quality, timeliness, utility, and sharing of these data; and (3) increasing collaboration among state and local jurisdictions through a National Syndromic Surveillance Community of Practice (NSSCoP).

The November 2013 CDC BioSense Investment Review recommended CDC strategically prioritize the state/local emergency department enrollment and on-boarding to the Syndromic Surveillance Platform (which includes the BioSense application and other analytic tools) to increase the representativeness of jurisdictions and emergency departments, which is a data quality component essential for using syndromic surveillance systems for situation awareness and disease detection. Eligibility is limited to states and local public health departments because 1) they have the ability to target and on-board hospitals or Health Information Exchanges (HIEs) that will capture a representative population within those jurisdictions and 2) generally pursuant to applicable state laws, they have complete access and legal rights to the syndromic surveillance data. This activity builds on the Public Health Security and Bioterrorism Act of 2002, which mandated a nationwide integrated system for early detection and assessment of potential bioterrorism and http://www.hhs.gov/asfr/ogapa/aboutog/hhsgps107.pdf mandated a nationwide integrated system for early detection and assessment of potential bioterrorism and all hazards related illnesses. Additionally, the Pandemic and All-Hazards Preparedness Act (PAHPA) (Sec.

202) expanded syndromic surveillance to include situational awareness.

The recipient activities identified in this FOA build on programs and activities that CDC supported through an earlier FOA, CDC-RFA-OE12-1202, to enhance regional and national syndromic surveillance.

The characteristics of the eligible applicants that make them uniquely qualified to perform the programmatic activities are limited to the following.

(1) A single state or local health department representing a population equal to or greater than 1 million people as estimated by the U.S. Census (2013 estimate); (2) A collaborating group of state or local health departments (e.g., MSAs, group of states, multiple counties, etc.) representing an area with a total combined population equal to or greater than 1 million people as estimated by the U.S. Census (2013 estimate) with one state or local health department serving as the lead applicant; (3) A single state health department representing a population less than 1 million people as estimated by the U.S. Census (2013 estimate) or the District of Columbia Department of Health. Requiring applicants to represent a population of at least 1 million people is necessary to increase the proportion and representativeness of emergency department visits across the nation that are included in the National Syndromic Surveillance Program.

All applicants must have demonstrated capacity to conduct syndromic surveillance and must be able and willing to sign the cloud stewards', currently the Association of State and Territorial Health Officials (ASTHO) , Data Use Agreement (DUA) within six months of the award. Applicants that have current DUAs with the cloud steward (ASTHO) are required to submit a copy of their DUA with the request for funding. Applicants that do not have a current DUA with the cloud steward are required to submit a letter signed by their health officer committing to signing the DUA within the first six months of funding.

This program addresses the "Healthy People 2020" focus area(s) of Health Communication and Health Information Technology, Healthcare Associated Infections, Immunizations and Infectious Diseases and Public Health Infrastructure.

Because the goal of this system is to provide a national picture of situational awareness, disapproval of this project would render our national syndromic surveillance system less capable of capturing representative data into the system.

4. Cost Sharing or Matching Cost Sharing / Matching Requirement:

No

5. Maintenance of Effort

D. Required Registrations

Additional materials that may be helpful to applicants: http://www.cdc.gov/od/pgo/funding/docs/Financial ReferenceGuide.pdf.

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 http://www.cdc.gov/od/pgo/funding/docs/FinancialReferenceGuide.pdf http://www.cdc.gov/od/pgo/funding/docs/FinancialReferenceGuide.pdf http://fedgov.dnb.com/webform/displayHomePage.do at no charge.If funds are awarded to an applicant organization that includes sub-awardees, those sub-awardees 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 an awardee. 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 usually requires not more than five business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov.

c. Grants.gov: The first step in submitting an application online is registering your organization through www.grants.gov, the official HHS E-grant website. Registration information is located at the "Get Registered" option at www.grants.gov.

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

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 funding opportunity at www.grants.gov. If Internet access is not available, or if the online forms cannot be accessed, applicants may call the CDC PGO staff at 770-488-2700 or e-mail PGO PGOTIM@cdc.gov for assistance. Persons with hearing loss may access CDC telecommunications at TTY 1-888-232-6348.

4. Submission Dates and Times If the application is not submitted by the deadline published in the FOA, it will not be processed. PGO 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 PGO.

a. Letter of Intent Deadline (must be emailed or postmarked by) Due Date for Letter of Intent: 03/17/2015

b. Application Deadline Due Date for Applications: 04/20/2015, 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume.

Date for Informational Conference Call: 03/03/2015

An informational teleconference call will be conducted on March 3, 2015, 3:00 PM Eastern Time to address prospective applicants' questions regarding CDC-RFA-OE 15-1502: The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice. The dial in telephone number is 1-888-455-9740, and the participant passcode is 7876347.

Note: If multiple individuals will participate from your organization, make best effort to use one telephone line to ensure CDC has available ports and telephone lines for all prospective applicants.

http://fedgov.dnb.com/webform/displayHomePage.do https://www.SAM.gov http://www.Grants.gov http://www.grants.gov http://www.grants.gov http://www.grants.gov http://www.grants.gov http://www.grants.gov https://foa.grantsolutions.gov/announcementmodule/PGOTIM@cdc.gov%20 line to ensure CDC has available ports and telephone lines for all prospective applicants.

5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://www.cdc.gov/grants/interestedinapplying/applicationprocess.html.

Complete the applicable assurances and certifications on an annual basis, name the file “Assurances and Certifications” and upload it as a PDF file at www.grants.gov Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc. gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/ Homepage.aspx

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

6. Content and Form of Application Submission Applicants are required to include all of the following documents with their application package at www.grants.gov.

7. Letter of Intent http://www.cdc.gov/grants/interestedinapplying/applicationprocess.html http://www.grants.gov/ http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx

Although a letter of intent (LOI) is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows CSELS staff to estimate the potential review workload and plan the review. Submission of an LOI is optional.

Due Date for Letter of Intent (LOI): March 17, 2015

Descriptive title of proposed project: CDC-RFA-OE 15-1502, The National Syndromic Surveillance Program: Enhancing Syndromic Surveillance Capacity and Practice

LOI may be sent via email, U.S. express mail or delivery service to:

Cynthia Thompson, Grants Management Specialist

Department of Health and Human Services

CDC Procurement and Grants Office

2920 Brandywine Road, Atlanta, GA 30341

Telephone: (770) 488-2714

E-mail: CBT1@cdc.gov

LOI must be sent via U.S. express mail, delivery service, fax, or email to:

Philip M.J. Baptiste, III, Project Officer

Department of Health and Human Services

Centers for Disease Control and Prevention

1600 Clifton Road, MS E-91

Atlanta, GA 30329

Telephone: 404-498-6808

E-mail: biosense2015@cdc.gov

8. Table of Contents (No page limit and not included in Project Narrative limit): The applicant must provide, as a separate attachment, the “Table of Contents” for the entire submission package.

Provide a detailed table of contents for the entire submission package that includes all of the documents in the application and headings in the "Project Narrative" section. Name the file "Table of Contents" and upload it as a PDF file under "Other Attachment Forms" at www.grants.gov.

9. Project Abstract Summary (Maximum 1 page)

A project abstract is included on the mandatory documents list and must be submitted at www.grants.gov.

The project abstract must be a self-contained, brief summary of the proposed project including the purpose and outcomes. This summary must not include any proprietary or confidential information. Applicants must enter the summary in the "Project Abstract Summary" text box at www.grants.gov.

10. Project Narrative mailto:CBT1@cdc.gov mailto:biosense2015@cdc.gov http://www.grants.gov

10. Project Narrative (Maximum of 20 pages, single spaced, Calibri 12 point, 1-inch margins, number all pages. Content beyond 20 pages will not be considered. The 20 page limit includes the work plan. For a multi-component FOA, maximum page limit is 25.)

The Project Narrative must include all of the bolded headings shown in this section. The Project Narrative must be succinct, self-explanatory, and in the order outlined in this section. It must address outcomes and activities to be conducted over the entire project period as identified in the CDC Project Description section. Applicants must submit a Project Narrative with the application forms.