eh11-1102 foa final 01.31.11.doc

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention (CDC) Healthy Homes and Lead Poisoning Prevention Program

I. AUTHORIZATION AND INTENT

Announcement Type: New – Type 1

Funding Opportunity Number: CDC-RFA-EH11-1102 Catalog of Federal Domestic Assistance Number: 93.070 (Environmental Public Health and Emergency Response) Key Dates:

Letter of Intent Deadline Date: February 28, 2011 Application Submission Date: March 16, 2011 (See full explanation in note found in Section V. Application Submission) Application Deadline Date: March 18, 2011 Authority:

Section 317(k)(2) of the Public Health Service Act (42 U.S.C. Section 247b(k)(2)), as amended and Section 317A of the Public Health Service Act, (42 U.S.C. Section 247b-1).

Background:

Housing conditions can significantly affect public health. Approximately 38 million homes in the United States have lead-based paint hazards that can result in childhood lead poisoning. In addition, injuries, respiratory diseases such as asthma, and quality of life issues have been linked to housing. According to the U.S. Department of Housing and Urban Development’s 2007 American Housing Survey, almost six million households live with moderate or severe physical housing problems. Although homes with moderate or severe physical problems place residents at increased risk for fire, electrical injuries, falls, rodent bites, and other illnesses or injuries, housing-related health hazards can affect anyone. For example, exposure to pesticide residues, indoor toxicants, tobacco smoke, and combustion gases such as CO, can affect everyone regardless of socioeconomic status. Therefore, no population group is immune to illnesses or injuries occurring in the home environment.

From 1990 to 2011, the Centers for Disease Control and Prevention (CDC) awarded funds to state and local health departments to support childhood lead poisoning prevention programs. During FY 2010 alone, CDC allocated nearly $25 million to state and city health departments. However, CDC recognizes the need to address housing related issues, including lead exposure, in a more comprehensive manner. In 2009, with Congressional acknowledgement, CDC changed the name of the Childhood Lead Poisoning and Prevention Branch to the Healthy Homes and Lead Poisoning Prevention Branch (HHLPPB). This name change reflects the new direction of the HHLPPB in implementing a healthy homes initiative that addresses multiple childhood diseases and injuries in the home.

Most public health efforts take a categorical approach to health and safety hazards in the home, focusing narrowly on one issue, even in the presence of multiple issues. The Healthy Homes Initiative builds upon CDC’s successful Childhood Lead Poisoning Prevention Programs (CLPPP) to expand efforts in addressing a variety of environmental health and safety concerns including: Interior Biological Agents (dust mites, pests, mold); Interior Chemical Agents (lead, pesticides, environmental tobacco smoke, radon); External Exposures (drinking water); and Structural Deficiencies (homes safety devices). If homes are assessed for multiple risks, then multiple interventions can be implemented simultaneously. Existing state and local programs with a home visitation component potentially can address family health, environmental, and safety issues more comprehensively and, consequently, affect more families. For example, home visits to identify lead exposure sources for children with elevated blood lead levels can be expanded to assess whether working smoke alarms and carbon monoxide detectors are present and also whether moisture-related conditions exist (such as mold and pest infestation). Some of these interventions can be implemented by state and local programs, while others may have to be referred to appropriate programs or agencies for follow-up. This holistic approach has been demonstrated to be less expensive than addressing problems individually.

In 2009, CDC worked with the Office of the Surgeon General in releasing The Call to Action to Promote Healthy Homes. The Call to Action outlines a comprehensive and coordinated approach to healthy homes. This approach seeks to reduce disparities in the availability of healthy, safe, affordable, accessible, and environmentally friendly homes. The Call to Action defines a healthy home as one that is sited, designed, built, renovated, and maintained in ways that support the health of residents. Specific features that constitute a healthy home include structural and safety aspects of the home, quality of indoor air and water, and the presence or absence of chemicals. In order to achieve a safe and healthy home environment, the Call to Action highlights integrating a variety of strategies including:

· Changing structural conditions and building practices

· Modifying resident and property owners’ behaviors

· Developing and implementing policies to enforce healthy housing practices

The Call to Action also highlights the need for research that links housing conditions with specific health outcomes. In an effort to better understand interventions ready for implementation or in need of additional research, the National Center for Healthy Housing (NCHH) and CDC convened a Healthy Homes Expert Panel Meeting to review the scientific evidence of housing interventions and its impact on improving or preventing certain diseases and conditions. The expert panel reviewed more than 170 scientific studies of housing interventions in four primary areas including: Interior Biological Agents; Interior Chemical Agents; External Exposures; and Structural Deficiencies. The interventions determined ready for broad-scale implementation include:

· Lead hazard control to prevent lead poisoning

· Integrated pest management (IPM) to reduce asthma and pesticide exposure

· Comprehensive and tailored home-based asthma interventions

· Active sub-slab depressurization to reduce lung cancer from radon gas

· Smoke alarm installations to prevent injuries and death from residential fires

· Smoke free rules at home The Healthy Homes approach is holistic and comprehensive and provides public health professionals, including environmental public health practitioners, public health nurses, and housing specialists, the requisite training and tools necessary to address the broad range of housing deficiencies and hazards associated with unhealthy and unsafe homes.

Disparities in Healthy Homes

Although homes of any age or value can contain serious environmental hazards, older properties that are poorly maintained typically present the greatest risks. The US Department of Housing and Urban Development (US HUD) defines substandard housing as homes with severe or moderate problems. Residents of poorly maintained housing are at increased risk from fire, falls, lead poisoning, asthma, and other injuries and illnesses. People living in substandard housing are disproportionately of minority race or ethnicity.

The burden of housing hazards disproportionately affects certain age groups, races, and ethnicities, and varies geographically. Anyone can suffer from housing-related illnesses or injuries; however, certain groups are more susceptible. Some risk factors that increase the susceptibility or vulnerability of certain groups for housing-related health issues include:

· Age

Children are more vulnerable to environmental exposures due to their developing organs and nervous system. Children living in older housing are more vulnerable to having elevated blood lead levels than the population of U.S. children as a whole. Elderly adults are more susceptible to certain housing-related hazards such as injuries and falls.

· Income and Ethnicity Low-income, minority populations are more likely to live in homes with structural defects and environmental hazards. Low-income households and older homes also have high concentrations of mouse and cockroach allergens.

· Geographical Location Some hazards are more common in certain geographical locations. For example, radon gas levels vary across the country.

Healthy Homes and Vulnerable Populations The Healthy Homes Initiative will promote environmental justice, the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. Within the context of healthy homes, environmental justice requires reducing disparities in the accessibility of healthy, safe, affordable, and environmentally friendly homes. It focuses on the vulnerable population to ensure that they are protected from housing-related hazards and deficiencies. As we implement the healthy homes initiative, there are compelling reasons to focus attention and resources on the needs of vulnerable populations: (1) vulnerable populations have greater health and social needs, (2) the prevalence of vulnerable groups in the population is increasing, and (3) vulnerability is a social justice issue.

A vulnerable population is defined as any population that is at an increased risk for adverse health-related outcomes due to housing patterns driven by racial, cultural, social, and economic conditions. Many vulnerable populations are disproportionately impacted by housing-related hazards such as lead hazards, pesticide residues, electrical injuries, house fires, household chemical poisoning, falls, tobacco smoke, noise, and moisture. Moreover, these populations are often left out of decision-making processes. Meaningful involvement of affected populations during initial phases of the decision-making process is an essential step to addressing health and housing inequities among disparate populations.

Purpose:

The purpose of the HHLPPP is to reduce or eliminate housing-related health hazards and to promote housing that is healthy, safe, affordable, and accessible. This program will address multiple hazards in homes and prevent diseases and/or injuries that result from housing-related hazards. Priority hazards, diseases and conditions, and high-risk populations should be determined based on programmatic data and other data sources (i.e. census, hospital admissions, or building/sanitary code violations by address). Special emphasis should be placed on populations who suffer disproportionately from housing-related disease. This announcement addresses the “Healthy People 2020” focus areas of environmental health, public health infrastructure, and education and community-based programs.

Funds will be used to do the following:

· Build a consortium of strategic partners to address unsafe and/or unhealthy housing conditions.

· Assure follow-up care is provided for high-risk populations who are identified with housing-related health issues.

· Develop a surveillance system that monitors blood lead levels, environmental test results, and healthy housing variables.

· Develop a regulatory structure and enforcement process to prevent or control housing-related environmental health hazards.

Measurable outcomes of the program will be in alignment with one (or more) of the following performance goal(s) for the CDC National Center for Environmental Health:

· Prevent or reduce illness, injury and death related to environmental risk factors.

· Build and enhance effective partnerships to improve environmental health capacity.

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address: http://www.cdc.gov/od/science/regs/hrpp/researchDefinition.htm

II. PROGRAM IMPLEMENTATION

Recipient Activities:

This funding opportunity announcement has two distinct Phases. Phase 1 focuses on conducting a comprehensive needs assessment to identify health and housing needs of the community, and evaluating program capabilities for implementation of a healthy homes program. Activities conducted during Phase 1 will result in the development of a healthy homes strategic plan by the end of Year 1. Phase 2 focuses on implementation of the strategic plan.

PROGRAM ELEMENTS - PHASE 1

The following program elements shall be included as components of the Work Plan. Awardee activities for Phase 1 are as follows:

Strategic Plan

1. Convene an advisory group of diverse stakeholders to develop a Healthy Homes Strategic Plan. At a minimum, the advisory group should meet at least quarterly. It should consist of wide representation of community health, housing, weatherization, and community members; voluntary, and professional organizations; business, community, and faith-based leaders; and at least one lay person representative of the population(s) to be served.

By the end of year one, write and submit a statewide or jurisdiction wide strategic plan for healthy homes. The applicant may submit the strategic plan prior to the end of year one and begin implementation of Phase 2 activities. At a minimum, the plan must include the following elements:

· A mission.

· A description of burden of exposures or conditions as consistent with those populations and areas identified in the Need section.

· Clear SMART (specific, measurable, achievable; realistic; and timely) goals, objectives, and activities in the proposed work plan; outline for years 2 and 3.

· A description of the person/position responsible for the specific objective/activity in the execution of the strategic plan.

· A description of partners involved.

· Guidelines for collecting and using data to evaluate and modify the plan as needed.

· A description of activities that assure engagement of the advisory group members in the process to monitor and refine the plan.

· A sustainability plan to ensure continuation of services to high-risk populations once the project funding has ended.

Further guidance on developing the strategic plan and forming the advisory workgroup or committees is located in Appendix II, "Guidance for Developing a Strategic Plan”.

Primary Prevention

1. Assess housing conditions in high-risk areas, and identify vulnerable populations at risk for health or housing issues by using programmatic data or other data sources. Compile those data into an electronic format and develop an on-going evaluation component.

2. Develop risk communication/health education activities that support housing- based primary prevention strategies, and target high-risk areas and populations identified in the Need section of the application.

3. Develop a technical assistance and training process to address the needs of staff, coalitions, and partners involved in healthy homes. Target audiences should include public health professionals; environmental health, and housing professionals; health care providers and home-visiting staff; code inspectors; non-governmental organizations; urban planners; architects; and engineers, as well as, construction maintenance; pest control; and weatherization workers.

Case Coordination/Plan of Care

1. Identify assessment tools for collection and documentation of housing-related health hazards that can alert public health practitioners of needs for follow-up, and determine methodologies (e.g. inspections, sample collection) for identifying housing issues. An assessment tool resource list is available at http://www.cdc.gov/nceh/lead/tools/assessement_tools.htm. The applicant is strongly encouraged to utilize existing assessment tools from the resource list and modify accordingly to meet their needs.

2. Develop a protocol to assure appropriate follow-up care is provided when health and housing issues are identified. The protocol should address both health and housing components, and include the following elements (at a minimum):

· Eligibility criteria for entering into case management

· Quality assurance process, for direct services and referrals, to ensure clients receive timely services and activities are properly documented.

· Plan of care for addressing medical issues (lead, asthma, etc.) directly or through a referral mechanism. See Appendix VI for case management guidelines and recommendations.

· Process for monitoring outcome of referrals and revising plan if necessary to achieve health outcome.

· Process for monitoring houses identified with hazards including documentation procedures, follow-up visits, and enforcement activities.

· Case closure criteria for ensuring remediation occurs if medical issues are resolved before the housing issue or the case moves to another location.

3. Identify barriers frequently associated with the case coordination process and develop a plan to address those barriers systematically. The plan shall be aggressive in addressing barriers by developing policies or procedures that can be instituted to change the system delivery process.

Note: Provide activities in work plan with a timeline to ensure that the plan will be developed and ready for implementation by the beginning of Year 2. A copy of the protocols shall be provided by the end of year 1.

Strategic Partnerships

1. Assess effectiveness of existing partners (i.e., Medicaid, healthcare, business, housing advocates, real estate associations, non-profit organizations, non-governmental organizations, faith and community-based organizations, academia including environmental justice academic resource centers/organizations, and federal, state, and local partners) in meeting goals and objectives of the healthy homes program.

2. Identify new partners (i.e. weatherization, injury prevention, senior programs, home visitation programs) that focus on the prevention of housing-related health issues or their associated risk factors.

Partnership development is an ongoing activity that begins during the program design stage and continues through implementation and evaluation. Partners should demonstrate a high level of commitment by their willingness to invest expertise, leadership, personnel, and other resources in the success of the project.

3. Determine resources that may be leveraged to specifically support program activities and address health or housing-related concerns in high-risk populations.

Strategies the applicant may use to leverage resources include the following:

· Coordinate activities with organizations engaged in healthy housing to optimize resources, minimize duplication of existing efforts, and ensure that activities and interventions are supportive of state plans for the prevention and control of housing-related illnesses.

· Expand the resources available through public-private ventures, foundation grants, public funding, and in-kind contributions in order to achieve and sustain healthy housing outcomes.

Surveillance

1. Identify housing-related health data variables that will be stored in the surveillance system. At a minimum, all variables from the CDC Variables List shall be collected. Cases with housing–related health conditions (Lead Poisoning and Asthma) and addresses with housing related-health hazards shall be tracked.

2. Identify required hardware and software to support the surveillance system, and develop a plan to procure the hardware and software if not already available.

3. Identify a surveillance system or modify an existing system. The system should:

· Allow person specific data collection, multiple lab tests, and addresses to be related to a single person over various years.

· Allow entry of people and addresses without a blood lead test.

· Allow multiple housing-related health hazards to be tracked to a single address over time.

· Track case management services and all housing-related health hazards until the issues are resolved.

NOTE: See Appendix III for healthy housing variables. Use of the CDC’s Healthy Homes and Lead Poisoning Surveillance System (HHLPPS) satisfies this activity requirement.

4. Develop a Data Cleaning Plan to address duplicate records and correct errors (i.e. lab results dates, reuse of patient IDs, address format problems) identified during data processing for CDC quarterly submissions. Data cleaning should be undertaken regularly and errors identified during data processing should be corrected prior to the next quarterly submission.

5. Identify sufficient staff to address each aspect of the surveillance system including: Data Collection, Data Entry, Data Management, Data Analysis, Epidemiological Support, and Information Technology Support.

6. Develop a Data Dissemination Plan to include reporting all required data elements to CDC Quarterly, as well as, surveillance activity reports to partners.

Policy

1. Assess current regulatory authorities (i.e. laws, regulations, ordinances, codes, policies) pertinent to housing, sanitation, property maintenance and health hazards in the home, and identify the appropriate agency with enforcement authority.

2. Meet with appropriate officials (i.e.. general counsel) to discuss effectively using existing authorities for addressing healthy homes issues, and identifying potential gaps within the authorities.

3. Develop a plan of approach to address gaps and inconsistencies in regulatory authorities.

PROGRAM ELEMENTS - PHASE 2

Awardee activities for Phase 2 are as follows:

Strategic Plan

1. Implement the strategic plan for healthy homes. Revise the strategic plan when necessary.

2. Assure advisory group members stay engaged in the process to monitor and refine the strategic plan.

Primary Prevention

1. Perform primary prevention activities to include conducting standardized, systematic, inspections of high-risk housing, and linking vulnerable populations to environmental interventions before a home injury/illness occurs.

2. Conduct activities that support primary prevention and reduce the risk of housing-related environmental exposures to high-risk areas and vulnerable populations.

Activities may include:

· Assuring that home assessments of nearby units and common spaces are conducted when a home health hazard is identified in multi-unit properties.

· Ensuring regular and comprehensive inspections of subsidized properties and require that these units meet basic safety and sanitary requirements.

· Developing educational material and media campaigns to support primary prevention activities.

3. Build capacity within state or high-risk areas to prevent or control housing-related environmental health hazards through implementation of a technical assistance process, leveraging of resources, training, and educational activities.

Activities may include:

· Implementing a training program for high-risk populations about housing-related environmental health and safety hazards, including the principles of healthy housing, and healthy home practices and intervention strategies.

· Expanding existing home visitation programs or childhood lead poisoning prevention programs to adopt healthy homes approaches.

· Adapting existing training programs to include healthy homes approaches and information.

· Conducting presentations to educate key stakeholders.

Care Coordination/Plan of Care

Revise, refine, and carry out the proposed methodology that will be executed by applicant or partner to address health and housing-related issues.

1. Utilize assessment tools to collect and document health or housing issues. The assessment tool should be developmentally and geographically appropriate, and designed to capture different household characteristics.

2. Implement the protocols to ensure houses with hazards are remediated and clients receive timely services.

3. Execute strategies identified to address barriers associated with the case coordination process.

Note: Chart reviews will be conducted annually to ensure houses with hazards are abated/remediated, housing/health referrals are made, and clients receive timely services. If documentation and performance issues are less than 80%, awardees will be expected to resolve those issues and demonstrate their progress. Some items that will be assessed include:

· % of time home visit is documented as performed within CDC recommended timeframes.

· % of time inspection is documented as performed within CDC recommended timeframes.

· % of time hazards identified in the home are documented.

· % of time referrals are documented for housing and health hazards identified during the assessment.

· % of time hazard remediation is documented.

· Of those properties documented with hazards, the # that were cleared or reported healthy and safe.

Strategic Partnerships

1. Establish strategic partnerships with community organizations, state and local health or housing agencies, department of education, academic institutions, and others entities involved in implementation of program activities and the Healthy Homes Strategic Plan.

Partners must include, but are not limited to, local or state health departments; local or state housing agencies; and grassroots, community-based, non-profit and/or faith-based organizations groups.

2. Implement strategies for leveraging resources which may include funds from other allowable federally funded programs, and/or state, local, charity, non-profit or for-profit entities or internal agency resources.

3. Create a capacity-building mechanism, with partners, that will provide training, education, technical support, mobilization, and consensus to improve the communities’ ability to detect health hazards in homes.

Surveillance

1. Have staff in placed trained to manage and use the surveillance system.

2. Collect housing-related and person-related data, and enter into the surveillance system database.

3. Submit required data extracts in the proper format to CDC on a quarterly basis.

Produce surveillance activity reports at least annually and disseminate reports to partners.

4. Adhere to data cleaning plan. Correct errors identified during data processing by the subsequent quarter, and submit corrected data with next CDC quarterly submission.

Policy

1. Implement a plan to enact or update regulatory authorities, and strengthen enforcement abilities when addressing healthy homes issues.

Note: Consult with Office of General Counsel’s before engaging in the legislative process concerning rules and restrictions pertinent to lobbying activities, and identify solutions to overcome barriers.

2. Enforce existing regulations within the state or jurisdiction that address housing, sanitation, property maintenance, and health issues in the home.

3. Collaborate with pertinent authorities on addressing health and housing issues. A MOU should be submitted outlining the roles and responsibilities of each party.

WORK PLAN

1. Create a work plan for Phase 1 activities in each of the program elements listed above. The work plan shall outline long-range goals for the duration of the project period, and include specific, measurable, achievable, realistic and time-phased objectives for the first budget year of the proposed project.

2. Develop a tentative work plan for Phase 2 (years two and three) of the project period. The work plan shall be updated annually to ensure consistency with the strategic plan. See Section V. Application Content for more information.

EVALUATION

1. Create a comprehensive evaluation plan for assessing overall programmatic progress by the end of year 1. The evaluation plan shall address the effectiveness of the Healthy Homes program, as well as, the overall impact of the program in reducing housing-related health hazards within the target high-risk area.

The evaluation plan must include:

· Data measures or indicator table demonstrating how to determine if each goal has been met.

· Measures that evaluate the activities and objectives of the annual work plan, including process and outcome measures.

· The name or, if person has not been hired, position (include job description) responsible for conducting the evaluation.

· Description of the data that will be used to evaluate program.

· Description of how often evaluation will occur (annually, quarterly, ongoing, etc.), and how results will be used for program improvement.

2. Submit a logic model that addresses the program as a whole, including inputs and activities of staff and strategic partners, outputs, objectives, and goals. An updated logic model consistent with the goals, objectives and activities of the strategic plan shall be submitted by the end of year 1. See Appendix IV for more information.

Note: Awardee shall participate in quarterly conference calls, trainings and projects (i.e. evaluation, program surveillance, case management, policy development, primary prevention, strategic partnerships) that will strengthen and address weaknesses/barriers of the program.

In a cooperative agreement, CDC staff is substantially involved in the program activities, above and beyond routine grant monitoring.

CDC Activities:

CDC activities for this program are as follows:

· Provide consultation and technical assistance to the awardees in the development/enhancement and implementation of their healthy homes strategic plan.

· Review the use of data and information collection methods and analysis instruments.

· Assist awardees by providing housing-related health hazard intervention “best practices” as they become known.

· Provide technical assistance in implementing activities and identifying major program issues, effective strategies, and priorities related to the cooperative agreement.

· Assist awardees in assessing program effectiveness through provision of technical assistance.

· Foster collaboration with other federal, state, and local health; environmental; and housing agencies by initiating contacts, conference calls, and on-site visits to discuss programmatic issues.

· Facilitate and assist selected projects in the development and implementation of housing-based primary prevention surveillance activities.

· Provide technical assistance for surveillance activities if necessary.

· Provide approval for key personnel.

III. AWARD INFORMATION AND REQUIREMENTS

Type of Award: Cooperative Agreement

CDC substantial involvement in this program appears in the Activities Section above.

Award Mechanism: EU1 (Studies of Environmental Hazards and Health Effects) Fiscal Year Funds: 2011 Approximate Current Fiscal Year Funding: $23,000,000

Approximate Total Project Period Funding: $69,000,000 (This amount is an estimate and is subject to availability of funds). This includes both direct and indirect costs.

Approximate Number of Awards: 40 Approximate Average Award: $500,000 (This amount is for the first 12-month budget period. This includes both direct and indirect costs).

Floor of Individual Award Range: $300,000 Ceiling of Individual Award Range: $600,000 (This ceiling is for the first 12-month budget period and includes both direct and indirect costs).

Anticipated Award Date: July 1, 2011

Budget Period Length: 12 months Project Period Length: 3 Years Throughout the project period, CDC’s commitment to continuation of awards will be conditioned on the availability of funds, evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the Federal government.

IV. ELIGIBILITY

Eligible applicants that can apply for this funding opportunity are listed below:

· Federally recognized or state-recognized American Indian/Alaska Native tribal governments

· American Indian/Alaska native tribally designated organizations

· Alaska Native health corporations

· Urban Indian health organizations

· Tribal epidemiology centers

· State and local governments or their Bona Fide Agents (this includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau)

· Political subdivisions of States (in consultation with States) (Political subdivisions of States must serve a population of 1,000,000 or more and have authority to govern, regulate, deliver, implement and enforce policies or codes related to health or housing issues in the jurisdiction identified in the Needs Section of the application. Upon submission of the application, the applicant shall include proof to verify their status).

A Bona Fide Agent is an agency/organization identified by the state as eligible to submit an application under the state eligibility in lieu of a state application. If applying as a bona fide agent of a state or local government, a letter from the state or local government as documentation of the status is required. Attach with “Other Attachment Forms” when submitting via www.grants.gov.

Limiting Competition Justification This FOA will provide financial assistance to state and local governments or their Bona Fide Agents that serve a population of 1,000,000 or more. The population threshold of 1,000,000 or more does not apply to US Territories or American Indian/Alaska Native Tribal applicants.

State and local health/housing departments are essential to bridging the gap between health and housing. The entities identified above are the only entities that are capable of establishing and further developing a public health infrastructure that will support the goals of the Healthy Homes Initiative which include the following:

· Must have authority in jurisdiction to govern, regulate, deliver, implement and enforce policies or codes (i.e. sanitation, environmental health, habitability, building) related to health or housing issues.

· Define and monitor the burden of health-related housing conditions or exposures through statewide surveillance systems.

· Must also have capability to report extensive health (i.e. name, DOB, test results) and housing (i.e. assessment variables, environmental results) data to CDC.

· Must exercise the Public Health Exemption to the Health Insurance Portability and Accountability Act (HIPAA) for reporting health-related data.

· Incorporate health or housing assessments into existing infrastructures within health or housing departments. Provide enforceable intervention services such as medical case management for children with lead poisoning or asthma, and remediation of unsafe or hazardous housing conditions.

· Gain access to data and resources to assess the efficacy of activities, interventions, and policies.

· Convene and work with a wide array of partners in both private and public sectors to holistically address unsafe and/or unhealthy housing conditions.

· Collaborate with partners to develop a statewide healthy housing plan. Work with those partners to implement the plan and sustain the impact of program efforts.

· Apply environmental public health methods and approaches to bring about policy and systems changes.

SPECIAL ELIGIBILITY CRITERIA: Licensing/Credential/Permits

Cost Sharing or Matching Cost sharing or matching funds are not required for this program.

Maintenance of Effort Maintenance of Effort is not required for this program.

Other

If a funding amount greater than the ceiling of the award range is requested, the application will be considered non-responsive and will not be entered into the review process. The applicant will be notified that the application did not meet the eligibility requirements.

Special Requirements:

If the application is incomplete or non-responsive to the special requirements listed in this section, it will not be entered into the review process. The applicant will be notified the application did not meet submission requirements.

· Applicants must address childhood lead poisoning as one of the healthy housing issues within their geographical area to assure 1) follow-up care is provided for children identified with elevated blood lead levels, and 2) elimination or control of lead hazards in housing units within the state or high-risk area(s). If lead has been eliminated or is no longer a public health problem, the applicant shall provide justification with appropriate documentation related to the lead burden within the state and/or high-risk area(s).

Documentation may include: blood lead testing data, population data, poverty status/Medicaid data, age of housing or other housing-specific condition data, and current data about non-paint sources of lead exposure in high-risk urban, suburban, and rural areas (if applicable). The applicant shall also describe populations living in those areas. This evidence should be uploaded into an Other Documents folder and named “Lead Documentation.”

· Applicants must identify data sources for determining population size including, but not limited to, U.S. Census, Tax Assessor, etc.

· Awardees must participate in quarterly conference calls or webinars to discuss special topics or share experiences, challenges, and successes with other awardees.

· Late applications will be considered non-responsive. See Section "IV.3. Submission Dates and Times" for more information on deadlines.

· Provide evidence of partnerships by including letters of support, memoranda of understanding, and/or contracts.

Note: If applicant is a health agency, evidence of partnership with the housing agency must be provided. If applicant is a housing agency, evidence of partnership with the health agency must be provided. Evidence of partnership with grassroots, community-based, non-profit and/or faith-based organizations groups must also be provided.

Letters of support or MOUs shall include meeting frequency, leveraged resources, roles, and specific responsibilities/activities for each partner, including data sharing. This evidence should be uploaded into an Other Documents folder and named “Partnerships”.

· Applicants directly providing services must be enrolled with their state Medicaid agency as a Medicaid provider. Providers entering into agreements with the applicants to provide such services must be enrolled with their state Medicaid agency as a Medicaid provider. To satisfy this program requirement, applicants must present a copy of Medicaid Provider Certification/Statement as proof that this requirement is met. Failure to include this information will result in the application being returned. This evidence should be uploaded into an Other Documents folder and named “Medicaid Provider”.

· Key personnel that require prior approval are Program Manager/Director, Principal Investigator, and Surveillance Manager/Epidemiologist. Applicant must provide commitment that key staff vacancies will be filled by end of first quarter, first budget period and within one quarter when they become vacant during the project period.

· Provide in the appendix, assurance that authorization for travel for CDC-funded personnel to attend CDC sponsored grantee meetings, conferences and trainings will be provided. This evidence should be uploaded into an Other Documents folder and named “Travel Assurance Letter”.

Note: Title 2 of the United States Code Section 1611 states that an organization described in Section 501(c)(4) of the Internal Revenue Code that engages in lobbying activities is not eligible to receive Federal funds constituting a grant, loan, or an award.

Intergovernmental Review of Applications

The application is subject to Intergovernmental Review of Federal Programs, as governed by Executive Order (EO) 12372. This order sets up a system for state and local governmental review of proposed federal assistance applications. Contact the state single point of contact (SPOC) as early as possible to alert the SPOC to prospective applications and to receive instructions on the State’s process. Visit the following Web address to get the current SPOC list: http://www.whitehouse.gov/omb/grants/spoc.html V. Application Content Unless specifically indicated, this announcement requires submission of the following information: A Table of Contents must be included in the application.

CDC Assurances and Certifications can be found on the CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm Other Requirements

Prospective applicants are requested to submit a letter of intent that includes the following information:

LOI Submission Address: Submit the LOI by express mail, delivery service, fax, or E-mail to:

Barry Brooks National Center for Environmental Health

4770 Buford Highway, MS F-60

Atlanta. GA 30341

Telephone Number: (770) 488-3641 Fax: (770) 488-3635

E-mail address: BBrooks@cdc.gov

Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows CDC Program staff to estimate and plan the review of submitted applications.

The LOI should be provided not later than by the date indicated in the Section I entitled “Authorization and Intent”.

A Project Abstract must be completed in the Grants.gov application forms. The Project Abstract must contain a summary of the proposed activity suitable for dissemination to the public. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically literate lay reader. This abstract must not include any proprietary/confidential information.

A Project Narrative must be submitted with the application forms. The project narrative must be uploaded in a PDF file format when submitting via Grants.gov. The narrative must be submitted in the following format:

· Maximum number of pages: 25 excluding budget justification and appendices. If your narrative exceeds the page limit, only the first pages which are within the page limit will be reviewed.

· Table of Contents (will not be counted towards the page limit)

· Font size: 12 point unreduced, Times New Roman

· Double spaced

· Paper size: 8.5 by 11 inches

· Page margin size: One inch

· Number all narrative pages; not to exceed the maximum number of pages.

The narrative should address activities to be conducted over the entire project period and must include the following items in the order listed:

Need

1. Describe the population in the high-risk area that supports the need for health-related housing interventions. Provide demographic information demonstrating that the high-risk area has a vulnerable population that is being adversely affected by housing-related health hazards.

2. Describe housing in the high-risk area(s) that supports the need for health-related housing interventions. Provide information on housing conditions in high-risk area(s) (e.g., pre-1950, housing in poor condition).

3. Describe the housing-related health concerns and the need for this program within the targeted high-risk area(s). Provide information on the prevalence of housing-related health concerns, and costs to the health-care system.

Program Elements

Strategic Plan

1. Describe a proposed Healthy Homes Strategic Plan Advisory Group that will develop and oversee the plan. The group shall have wide representation of community health and housing leaders, and community members.

2. Describe a process leading to the completion of a Healthy Homes Strategic Plan that will include measurable goals and objectives and roles of staff and strategic partners.

Primary Prevention

1. Describe a strategy to assess housing conditions in high-risk area(s) and link vulnerable populations to evidence-based environmental interventions or resources.

2. Describe a strategy to reduce the risk of housing-related exposures to high-risk areas and vulnerable populations.

Case Coordination/Plan of Care

1. Describe the assessment process and tools that will be used to evaluate and document housing related health hazards.

2. Describe the case management protocol that will be implemented to address medical issues, and the environmental protocol that will be followed when evaluating housing-related hazards.

Strategic Partnerships

1. Describe current or future partnerships with state and local health or housing agencies; community-based, non-profit, and/or faith-based organizations; and other entities in implementation of program activities and the Healthy Homes Strategic Plan.

2. Describe how partnerships will help to build capacity provide training, education, technical support, mobilization, and consensus to improve the community’s ability to detect housing-related health hazards.

3. Provide evidence of meaningful partnerships by including letters of support, memoranda of understanding, or contractual agreements or fiscal support in the appendix section of the application.

Surveillance

1. Describe the surveillance system (new or modified existing system) that will collect, compile, and track housing-related health hazards including blood lead data, what housing-related variables will be collected and stored in the surveillance system, what staff will operate and manage the system, and how data will be disseminated (dissemination plan).

For applicants that are not a health department, explain how data will be obtained from state and/or local health departments, Childhood Lead Poisoning Prevention Programs (CLPPP), and other health care agencies (if applicable) for reporting purposes.

2. Describe the hardware and software that will be used to support the surveillance system or discuss a plan to procure the hardware and software if not already available.

3. Include in the application as an appendix, a listing of partners involved in the development/modification, resource requirements, source of funding, and time-line for completion.

Policy Describe plans to identify and assess current laws, regulations, ordinances, codes, and policies needed to address health and safety issues in the home, enforce existing regulations, and collaborate with proper authorities to address healthy homes issues.

Work Plan

1. Submit a work plan that consists of Phase 1 activities and includes specific, measurable, achievable, realistic, and time-phased goals, objectives and activities. Work Plan must include the activities provided in the program elements: A) Strategic Plan B) Primary Prevention, C) Case Coordination/Plan of Care, D) Strategic Partnerships, E) Surveillance, and F) Policy. The objectives and activities must target populations and areas identified as high-risk in the Need section of the application.

2. Include supporting activities of 1) local programs and other organizations that are sub-grantees of funds awarded under this announcement and 2) activities of other communities that have been identified as high-risk in the Need section of this application, but are not necessarily sub-grantees of funds awarded under this announcement.

3. Include with the application as an appendix, a tentative work plan outline for Phase 2 (years two and three) of the project period that includes goals, objectives, activities, and a timetable for the remaining years of the proposed project for each element.

Evaluation

1. Provide a logic model that describes the program and will be used to develop an evaluation plan. The logic model should include inputs, activities of staff and strategic partners, outputs, objectives and goals.

2. Describe the proposed evaluation activity’s staffing, data collection and analysis strategies, and approaches to improving the program effectiveness based on findings.

Project Management Staff Describe how the project will be administered, including job descriptions and qualifications of key management officials.

Additional information may be included in the application appendices. The appendices will not be counted toward the narrative page limit. Information shall be submitted via Grants.gov, uploaded in a PDF file format, and should be named:

· Curriculum Vitae/Resume

· Letters of Support

· Work Plan

· Indirect Cost Rate Agreement

· Lead Documentation

· Medicaid Provider

· Surveillance Partners List

· Travel Assurance Letter for Annual Grantee Conference Additional requirements for additional documentation with the application are listed in Section VII. Award Administration Information subsection entitled “Administrative and National Policy Requirements.”

APPLICATION SUBMISSION

Registering your organization through www.Grants.gov, the official agency-wide E-grant website, is the first step in submitting an application online. Registration information is located on the “Get Registered” screen of www.Grants.gov. Please visit www.Grants.gov at least 30 days prior to submitting your application to familiarize yourself with the registration and submission processes. The “one-time” registration process will take three to five days to complete. However, the Grants.gov registration process also requires that you register your organization with the Central Contractor Registry (CCR) annually. The CCR registration can require an additional one to two days to complete.

Submit the application electronically by using the forms and instructions posted for this funding opportunity on www.Grants.gov. If access to the Internet is not available or if the applicant encounters difficulty in accessing the forms on-line, contact the HHS/CDC Procurement and Grant Office Technical Information Management Section (PGO TIMS) staff at (770) 488-2700 for further instruction.

Note: Application submission is not concluded until successful completion of the validation process.

After submission of your application package, applicants will receive a “submission receipt” email generated by Grants.gov. Grants.gov will then generate a second e-mail message to applicants which will either validate or reject their submitted application package. This validation process may take as long as two (2) business days. Applicants are strongly encouraged check the status of their application to ensure submission of their application package is complete and no submission errors exists. To guarantee that you comply with the application deadline published in the Funding Opportunity Announcement, applicants are also strongly encouraged to allocate additional days prior to the published deadline to file their application. Non-validated applications will not be accepted after the published application deadline date.

In the event that you do not receive a “validation” email within two (2) business days of application submission,…