Foa_Content_of_CDC-RFA-DP-23-0018.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices

Supportive of Breastfeeding

CDC-RFA-DP-23-0018

03/23/2023

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview

Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 23-0018. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

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

Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-23-0018

E. Assistance Listings Number:

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

93.945 F. Dates:

1. Due Date for Letter of Intent (LOI):

2. Due Date for Applications:

03/23/2023 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph The purposes are to:

Increase the number of US and territorial birthing hospitals implementing evidence-based maternity care for lactating individuals and their infants.

Provide training, technical assistance, and tools to help hospitals implement and sustain evidence-based maternity care for lactating individuals and their infants.

Increase breastfeeding support in hospitals serving a high proportion of families less likely to start or continue breastfeeding.

Ensure maternity care supportive of breastfeeding is delivered consistently and equitably.

Strategies include:

Enroll birthing hospitals to take part in the quality improvement (QI) collaborative funded by this NOFO.

Provide tailored training and technical assistance to maternity staff in enrolled hospitals regarding culturally competent approaches to safely implement evidence-based breastfeeding supportive maternity care.

Provide tailored training, technical assistance, and tools to assist maternity staff at enrolled hospitals use QI approaches to safely implement evidence-based breastfeeding supportive maternity care.

The recipient is expected to increase:

Reach of the breastfeeding QI collaborative among birthing hospitals serving a high proportion of families less likely to start or continue breastfeeding

Evidence-based care to birthing families and lactating persons Training and capacity of maternity staff to use culturally competent approaches to safely provide evidence-based breastfeeding supportive maternity care.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards https://www.grants.gov/

d. Total Period of Performance Funding:

$6,000,000 The estimated total amount of funding for the entire period of performance; subject to availability of funding, including both direct and indirect costs.

e. Average One Year Award Amount:

$2,000,000 This amount is for the first 12-month budget period and includes both direct and indirect costs.

f. Total Period of Performance Length:

3 year(s)

g. Estimated Award Date:

September 27, 2023

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Although most new mothers in the United States plan to breastfeed, practices and policies in maternity care often create barriers to mothers’ ability to carry out their decision to breastfeed, and the failure to adhere to evidence-based practices contribute to premature weaning. Among women who intended to breastfeed for longer than 2 months, 30% stopped breastfeeding early if they experienced none of the Ten Steps to Successful Breastfeeding (Ten Steps) in the hospital, compared with only 3% of mothers who experienced six steps.

In the United States, breastfeeding rates vary by race/ethnic groups. Black infants have the lowest breastfeeding initiation and duration rates compared to infants of other races and ethnicities, and Black mothers disproportionately experience a number of barriers to breastfeeding, including lack of knowledge about breastfeeding and insufficient education and support in health care settings. The implementation of evidence-based maternity practices supportive of breastfeeding is lower among birthing hospitals in US neighborhoods with larger black populations. Use of evidence-based maternity care practices increase rates of breastfeeding initiation, duration, and exclusivity. Improvements in the implementation of breastfeeding supportive, evidence- based maternity practices in birthing hospitals in four southern states have shown a reduction in black-white disparities in breastfeeding initiation.

With the emergence and continued longevity of the COVID-19 pandemic, hospitals continue to balance implementing maternity practices supportive of breastfeeding with measures to prevent https://publications.aap.org/pediatrics/article/130/1/54/29935/Baby-Friendly-Hospital-Practices-and-Meeting?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000 https://www.unicef.org/documents/baby-friendly-hospital-initiative#:~:text=Ten%20steps%20to%20successful%20breastfeeding%201%20c.%20Establish,pregnant%20women%20and%20their%20families.%20More%20items...%20 https://www.cdc.gov/breastfeeding/data/nis_data/data-files/2019/rates-any-exclusive-bf-socio-dem-2019.html https://www.liebertpub.com/doi/10.1089/bfm.2014.0152 https://www.liebertpub.com/doi/10.1089/bfm.2014.0152 https://www.cdc.gov/mmwr/volumes/68/wr/mm6834a3.htm?s_cid=mm6834a3_w https://www.cdc.gov/mmwr/volumes/68/wr/mm6834a3.htm?s_cid=mm6834a3_w https://pubmed.ncbi.nlm.nih.gov/25144543/ https://pubmed.ncbi.nlm.nih.gov/30659064/ https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a3.htm?msclkid=39451c12cfa611ecb14a575b0dd3f473 and control covid infection.

Since infant feeding decisions and outcomes are largely shaped by experiences in hospitals, a quality improvement collaborative to improve maternity care practices and policies that support breastfeeding in these facilities is critical. The Baby-Friendly Hospital Initiative (BFHI) designates as “Baby-Friendly” hospitals that demonstrate they meet the criteria for providing optimal feeding care for healthy newborns. The Ten Steps to Successful Breastfeeding are a set of evidence-based hospital practices and policies that form the core of the Baby-Friendly Hospital Initiative (BFHI).

b. Statutory Authorities Awards are made under the authorization of 317(k) (2) of the Public Health Service Act (PHS Act), 42 U.S.C. 247b(k)(2) and 301(a) of the PHS Act, 42 U.S.C. 241(a). In addition, this program is authorized under section 4002 of the Patient Protection and Affordable Care Act, Public Law 111-148.

c. Healthy People 2030 This NOFO specifically supports the Healthy People 2030 goal to improve the health and safety of infants, and the following Healthy People 2030 objectives:

Increase the proportion of infants who are breastfed exclusively through age 6 months –

MICH-15

Increase the proportion of infants who are breastfed at 1 year – MICH-16

d. Other National Public Health Priorities and Strategies Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Disparities;

The Surgeon General’s Call to Action to Support Breastfeeding, 2011

e. Relevant Work This NOFO is relevant to the Centers for Disease Control and Prevention’s (CDC) Health Equity Science and Intervention Commitment (CORE), and current and past CDC initiatives including EMPower Breastfeeding and Best Fed Beginnings (BFB). Abt Associates in partnership with the Carolina Global Breastfeeding Institute (CGBI) and Population Health Improvement Partners provided leadership of the EMPower initiatives. The National Institute for Children’s Health Quality (NICHQ) provided leadership of BFB. The EMPower and BFB projects were hospital-based QI initiatives which included improving knowledge, skills, and competency in evidence-based maternity care practices supportive of optimal infant nutrition and the implementation of these practices.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

The table below is the breastfeeding logic model specific to this effort and includes strategies and activities and short, intermediate, and long-term outcomes.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age-6-months-mich-15 https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age-6-months-mich-15 https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-1-year-mich-16 https://www.minorityhealth.hhs.gov/assets/pdf/hhs/HHS_Plan_complete.pdf https://www.cdc.gov/breastfeeding/resources/calltoaction.htm https://www.cdc.gov/healthequity/core/index.html https://www.cdc.gov/healthequity/core/index.html https://www.empowerbestpractices.org/breastfeeding/ https://www.nichq.org/project/best-fed-beginnings https://www.abtassociates.com/ https://sph.unc.edu/cgbi/carolina-global-breastfeeding-institute/ https://improvepartners.org/ https://www.nichq.org/ https://www.nichq.org/

Strategies Short-term Outcomes (1-2 years)

Intermediate Outcomes (3 years)

Long-term Outcomes

Recruit, enroll and retain US and territorial birthing hospitals to take part in the quality improvement (QI) collaborative funded by this NOFO

Provide tailored training and technical assistance to maternity staff in enrolled hospitals regarding culturally competent approaches to safely implement evidence-based breastfeeding supportive maternity care

Provide tailored training, technical assistance, and tools to assist maternity staff in enrolled hospitals use quality improvement approaches to safely implement evidence-based breastfeeding supportive maternity care

Increase reach of the breastfeeding QI collaborative amo ng US and territorial birthing hospitals serving a high proportion of families less likely to start or continue breastfeeding

Increase training and capacity of maternity staff to use culturally competent approaches to safely provide evidence- based breastfeeding supportive maternity care

Increase in maternity staff use of QI approaches to implement evidence-based breastfeeding supportive maternity care

Increase evidence-based care to birthing families and lactating persons

Increase initiation of breastfeeding, particularly among families at higher risk of not breastfeeding

Increase breastfeeding of infants at higher risk of not breastfeeding

Reduce use of supplemental infant formula among breastfeeding infants within infants’ first 2 days of life (unless medically necessary)

Reduce racial/ethnic disparities in breastfeeding initiation

i. Purpose The purpose is to support CDC's Hospitals Promoting Breastfeeding building on lessons learned to:

Increase the number of hospitals implementing evidence based maternity care for lactating individuals and their infants.

Provide training, technical assistance, and tools to help hospitals implement and sustain evidence based maternity care for lactating individuals and their infants.

Increase support in birthing hospitals serving a high proportion of families less likely to start or continue breastfeeding.

Ensure maternity care supportive of breastfeeding is delivered consistently and equitably.

ii. Outcomes By the end of the performance period, the recipient is expected to achieve the following short-term outcome:

Increase reach of the breastfeeding QI collaborative among US and territorial birthing hospitals serving a high proportion of families less likely to start or continue breastfeeding.

By the end of the performance period, the recipient is expected to achieve the following intermediate outcomes:

Increase evidence-based care to birthing families and lactating persons.

Increase training and capacity of direct maternity staff to use culturally competent approaches to safely provide evidence-based breastfeeding supportive maternity care.

iii. Strategies and Activities The applicant should define an overall approach, strategies and activities consistent with the intent of the NOFO, the CDC project description and logic model that leads to the achievement of performance outcomes within the three-year period of performance.

Strategy: Recruit, enroll and retain US and territorial birthing hospitals to take part in the quality improvement (QI) collaborative funded by this NOFO. Activities in support of this strategy include:

Recruit a minimum of 100 US and territorial birthing hospitals to take part in the QI collaborative funded by this NOFO.

Use county, state, and/or national data to identify and recruit hospitals serving populations disproportionately at risk of not breastfeeding.

Enroll a minimum of 95 US and territorial birthing hospitals, serving a high proportion of families less likely to start or continue breastfeeding, to take part in this QI collaborative funded by this NOFO.

Strategy: Provide tailored training and technical assistance to maternity staff in enrolled hospitals regarding culturally competent approaches to safely implement evidence-based breastfeeding supportive maternity care. Activities in suppport of this strategy include:

Provide tailored training and technical assistance to enrolled hospitals regarding culturally competent approaches to improve capacity in the 16 competencies neccessary to safely implement the Ten Steps to Successful Breastfeeding (Ten Steps).

Coordinate hospital training and technical assistance activities for enrolled hospitals to reflect current recommendations from national authorities, public health organizations, health care provider societies and associations, hospital associations, and/or organizations focused on maternal infant health.

Strategy: Provide tailored training, technical assistance, and tools to increase in maternity staff at enrolled hospitals use of quality improvement approaches to safely implement evidence-based breastfeeding supportive maternity care. Activities in support of this strategy include:

Provide tailored training, technical assistance, and tools to increase to 80% or more of the maternity staff at enrolled hospitals use of QI approaches to safely implement evidence-based breastfeeding supportive maternity care.

Provide resources and support (financial, shared learning platforms, and tools) for maternity staff at enrolled hospitals to safely implement evidence-based maternity care supportive of breastfeeding, the Ten Steps.

1. Collaborations

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

The recipient is expected to collaborate and coordinate with existing and future CDC-funded programs and organizations, during the 3-year period of performance, that are implementing efforts to increase hospital support for breastfeeding.

b. With organizations not funded by CDC:

The recipient is expected to build and sustain strategic partnerships and collaborations with organizations that have prior experience with the priority populations, and organizations that have a role in implementing this program’s strategies and activities to achieve expected outcomes. Collaborations with a variety of public and private partners may be needed to achieve the expected outcomes and may include public health and/or QI organizations, non-profit accrediting bodies and national authorities, and professional health care provider societies and organizations. Applicants should explain how each collaboration would assist recipient in implementing activities and achieving the NOFO period of performance outcomes.

2. Target Populations The recipient should prioritize enrolling hospitals that serve racially/ethnically diverse populations with the lowest breastfeeding rates and/or populations at risk of not breastfeeding. A specific priority is to increase breastfeeding initiation among African American families. The use of county, state, and national data are recommended to recruit and enroll hospitals serving these populations.

a. Health Disparities This program will strengthen national infrastructure to provide increased availability and access to hospital breastfeeding support that prioritizes, in general, hospitals that serve racially/ethnically diverse populations with low breastfeeding rates and/or are at risk of not breastfeeding. This program will strengthen efforts to ensure that maternity care practices and policies that support breastfeeding are implemented safely, as intended, for all birthing parents and their infants.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy https://www.cdc.gov/breastfeeding/data/county/breastfeeding-initiation-rates.html https://www.cdc.gov/breastfeeding/data/nis_data/results.html

Since this NOFO does not involve the generation or collection of public health data, a Data Management Plan is not required for this NOFO.

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

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

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

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

Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

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

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

Describe key evaluation questions to be addressed by these evaluations.

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

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

CDC will provide technical assistance as requested by the recipient so that the recipient can collect relevant information on measures and conduct evaluations that determine the impact of CDC funding on increasing the number of enrolled hospitals that are safely implementing evidence based maternity care supportive of breastfeeding. CDC will provide technical assistance as requested by the recipient to develop a framework to guide evaluation for the funded project. This will include monitoring activities and strategy implementation, conducting evaluations on the effectiveness of the activities at achieving expected outcomes, and describing contextual factors that may influence outcomes.

https://www.cdc.gov/grants/additional-requirements/ar-25.html

c. Organizational Capacity of Recipients to Implement the Approach The applicant organization should have the capacity to serve as the coordinating center bringing together enrolled hospitals with experts to facilitate the implementation of evidence-based maternity care practices supportive of breastfeeding. As the coordinating center, the applicant organization will plan and conduct a hospital-based quality improvement collaborative and will measure and evaluate progress toward outcomes. The applicant must be able to describe significant expertise, project management, and staffing experience, and capacity to engage hospitals in other projects that serve the priority populations that are a focus of this project. The applicant should also be able to describe their ability to successfully plan, implement, and evaluate the approach, and obtain the desired outcomes within the period of performance.

The applicant should describe the existing and available subject matter and content experts needed to implement the proposed approach and document their qualifications and expertise in breastfeeding supportive maternity care policies and practices, breastfeeding support and lactation science, quality improvement science, diversity and health equity, and adult learning.

The applicant should describe the staff involved in this project, their qualifications and expertise, experience implementing QI collaboratives and the percent effort committed to the project.

The applicant should provide documentation of qualifications, expertise, and experience of the key personnel involved in the project including position descriptions and resumes. Applicants must name these files “Position Descriptions [name of applicant]” and "Resumes/CVs [name of applicant] upload then as PDF files on www.grants.gov. The applicant should provide an organizational chart that defines roles and responsibilities of key personnel and staff including lines of communication, reporting hierarchy, and the interface with the CDC Project Officer.

Applicant must name this file “Organizational Charts [name of applicant]” and upload it as a PDF file on www.grants.gov.

Strong applicants should describe previous experience recruiting and enrolling US and territorial birthing hospitals serving diverse populations at risk of not breastfeeding and retaining these hospitals in a multi-year project. The applicant organization should demonstrate partnerships to assist in implementing the workplan. Acceptable forms of evidence include letters of support from partner organizations that express their commitment to assist in implementing the workplan. Applicant must name this file “Letters of Support [name of applicant]” and upload it as a PDF file on www.grants.gov.

Strong applicants will have experience implementing QI collaboratives with hospitals across multiple states or nationwide to improve policies, practices, and delivery of maternal infant care and address disparities in maternal-infant health. The applicant should describe experience implementing QI collaboratives that have resulted in measurable improvements in health care quality, reduced health disparities, and advanced health equity. The applicant should describe experience in designing and implementing virtual and face-to-face training to improve hospital staff knowledge, skills, and competencies in evidence-based maternal infant care including culturally and linguistically appropriate care that respects and responds to a family’s experiences, values, and beliefs. The applicant should describe previous success in implementing tailored approaches for sustainable policy and practice changes within hospitals that optimally support maternal infant health. The applicant should describe their programs or initiatives of similar https://www.grants.gov/ complexity, scope, and size that demonstrate their ability to implement this QI collaborative.

The applicant must have the organizational capacity to be able to readily execute and implement strategies and activities associated with this project upon receipt of award and to accelerate progress necessary to successfully achieve short and intermediate outcomes within the period of performance. The applicant must demonstrate their organizational capacity with a staffing plan that reflects adequate time and necessary skills to implement the QI collaborative and ensure effective leadership. Applicant must name this file “Staffing Plan [name of applicant]” and upload it as a PDF file on www.grants.gov. The applicant must describe their organizational capacity to collect information on the process and outcome performance measures presented in their approach.

d. Work Plan At a minimum, the work plan must include:

Period of performance outcomes Outcome measure(s) Strategies and activities to support achievement of outcomes that align with the NOFO logic model Milestones for completion of activities related to each outcome Responsible Position/Party such as staff, partners, contractors, consultants, and administrative roles and functions to support implementation of the award Completion date

The applicant must submit a detailed work plan for Year 1 of the award and provide a general summary of the work plan activities for Years 2-3 in narrative form. The work plan should describe how the applicant plans to implement all the strategies and activities to achieve NOFO outcomes, and the period of performance outcomes and outcome measures should align with the performance measures listed in the evaluation and performance measurement section. For Year 1, applicants are required to include period of performance outcomes, outcome measure(s), strategies and activities, milestone(s) for completion of activity related to each outcome, responsible position/party, and completion date within the sample work plan template, provided below. The applicant should provide an overview of the workplan for the 3-year period of performance that appears reasonable and achievable, and period of performance milestones that are appropriate to achieve the desired outcomes by the end of the 3-year period of performance.

CDC will provide feedback and technical assistance to recipients to finalize the work plan activities after award. Applicants must name this file “Work_Plan [name of applicant]” and upload it as a PDF file on www.grants.gov.

In this format, complete the table for each period of performance outcome. If a particular activity leads to multiple outcomes, it should be described under each outcome measure.

Period of Performance Outcome: Outcome Measure:

Strategies and Activities

Milestone(s) for Completion of Activity

Responsible Position/Party

Completion Date

1.

2.

http://www.grants.gov

3.

4.

5.

6.

Applicants are not required to use the table but are required to include all the elements listed:

Period of Performance Outcome, Outcome Measure(s), Strategies and Activities, Milestone(s) for Completion of Activities, Responsible Position/Party, and Completion Date.

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

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

Tracking recipient progress in achieving the desired outcomes.

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

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

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

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

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

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

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

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

Recipients will participate in monthly conference calls to discuss progress, barriers, unexpected events, activities, successes, and other relevant information that describe implementation of the strategies and accomplishment of outcomes.

f. CDC Program Support to Recipients

CDC will have substantial involvement beyond regular performance and financial monitoring during the period of performance. CDC activities are intended to ensure the success of the project and will include the following:

Provide post-award technical assistance, as requested.

Provide guidance to the recipient on identifying and implementing strategies and activities.

Facilitate collaborative opportunities with other CDC funded NOFO recipients and partners.

Collaborate with the recipient to explore appropriate flexibilities needed to meet the outcomes. Flexibility in cooperative agreements includes the recipient’s ability to propose alternative methods to achieve the outcomes of the cooperative agreement that align with recipient’s opportunities for success, infrastructure, partner buy-in, demographics, and burden.

B. Award Information

1. Funding Instrument Type:

CA (Cooperative Agreement) CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism:

U58

3. Fiscal Year:

4. Approximate Total Fiscal Year Funding:

$2,000,000

5. Total Period of Performance Funding:

$6,000,000 This amount is subject to the availability of funds.

The estimated total amount of funding for the entire period of performance; subject to availability of funding, including both direct and indirect costs.

Estimated Total Funding:

$6,000,000

6. Total Period of Performance Length:

3 year(s) year(s)

7. Expected Number of Awards:

8. Approximate Average Award:

$2,000,000 Per Budget Period

This amount is for the first 12-month budget period and includes both direct and indirect costs.

9. Award Ceiling:

$2,000,000 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor:

$1,800,000 Per Budget Period

11. Estimated Award Date:

September 27, 2023

12. Budget Period Length:

12 month(s)

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

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

If you are successful and receive a Notice of Award, in accepting the award, you agree that the award and any activities thereunder are subject to all provisions of 45 CFR part 75, currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions.

C. Eligibility Information

1. Eligible Applicants

Eligibility Category:

00 (State governments)

01 (County governments)

02 (City or township governments)

04 (Special district governments)

05 (Independent school districts)

06 (Public and State controlled institutions of higher education)

07 (Native American tribal governments (Federally recognized))

08 (Public housing authorities/Indian housing authorities)

11 (Native American tribal organizations (other than Federally recognized tribal governments))

12 (Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education)

13 (Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education)

20 (Private institutions of higher education)

22 (For profit organizations other than small businesses)

23 (Small businesses)

25 (Others (see text field entitled "Additional Information on Eligibility" for clarification))

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

Additional Eligibility Category:

Government Organizations:

State governments or their bona fide agents (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, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau

State controlled institutions of higher education

Non-government Organizations

American Indian or Alaska native tribally designated organizations

2. Additional Information on Eligibility

N/A

3. Justification for Less than Maximum Competition

N/A

4. Cost Sharing or Matching

Cost Sharing / Matching Requirement:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

5. Maintenance of Effort

Maintenance of effort is not required for this program.

D. Application and Submission Information

1. Required Registrations

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

PLEASE NOTE: Effective April 4, 2022, applicants must have a Unique Entity Identifier (UEI) at the time of application submission (SF-424, field 8c). The UEI is generated as part of SAM.gov registration. Current SAM.gov registrants have already been assigned their UEI and can view it in SAM.gov and Grants.gov. Additional information is available on the GSA website, SAM.gov, and Grants.gov- Finding the UEI.

a. Unique Entity Identifier (UEI):

All applicant organizations must obtain a Unique Entity Identifier (UEI) number by registering in SAM.gov prior to submitting an application. A UEI number is a unique twelve-digit identification number assigned to the registering organization.

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

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as a recipient. All applicant organizations must register with SAM, and will be assigned a SAM number and a Unique Entity Identifier (UEI). All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC.

If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at SAM.gov and the SAM.gov Knowledge Base.

c. Grants.gov:

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

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

https://www.grants.gov/ https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-systems-information-kit/unique-entity-identifier-update https://sam.gov/content/home https://grantsgovprod.wordpress.com/2021/09/14/how-to-find-an-applicants-uei-within-grants-gov/ https://grantsgovprod.wordpress.com/2021/09/14/how-to-find-an-applicants-uei-within-grants-gov/ https://sam.gov/content/home https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fsd.gov%2Fgsafsd_sp%3Fid%3Dgsa_kb_view2%26kb_id%3Df66d8e6cdb76d4100d73f81d0f9619c6&data=04%7C01%7Ccshifflett%40dminc.com%7C8eee7a2adab549a3b3c008d925e9a364%7Cdb7ac9ef779d46e59bca00509580ad6b%7C0%7C0%7C637582507851821018%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=UrR%2B%2FM2wWF2fZG05Z8O6JS2C3FXXSl%2F7B3%2FB45XHRrg%3D&reserved=0 https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fsd.gov%2Fgsafsd_sp%3Fid%3Dgsa_kb_view2%26kb_id%3Df66d8e6cdb76d4100d73f81d0f9619c6&data=04%7C01%7Ccshifflett%40dminc.com%7C8eee7a2adab549a3b3c008d925e9a364%7Cdb7ac9ef779d46e59bca00509580ad6b%7C0%7C0%7C637582507851821018%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=UrR%2B%2FM2wWF2fZG05Z8O6JS2C3FXXSl%2F7B3%2FB45XHRrg%3D&reserved=0 https://grants.gov/ https://www.grants.gov/ http://www.grants.gov/

Step System Requirements Duration Follow Up

System for Award Management

(SAM)

1. Go to SAM.gov and designate an E-Biz POC (You will need to have an active SAM account before you can register on grants.gov). The UEI is generated as part of your registration.

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

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

866-606-8220

2 Grants.gov

1. Set up an individual account in Grants.gov using organization's new UEI number to become an Authorized Organization Representative

(AOR)

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

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

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

It takes one day (after you enter the EBiz POC name and EBiz POC email in SAM) to receive a UEI (SAM) which will allow you to register with Grants.gov and apply for federal funding.

Register early!

Applicants can register within minutes.

2. Request Application Package

Applicants may access the application package at www.grants.gov.

3. Application Package

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

4. Submission Dates and Times

If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by OGS.

a. Letter of Intent Deadline (must be emailed)

b. Application Deadline

Due Date for Applications 03/23/2023

03/23/2023 https://sam.gov/content/home https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do

11:59 pm U.S. Eastern 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.

Due Date for Information Conference Call N/A

5. Pre-Award Assessments

Risk Assessment Questionnaire Requirement

CDC is required to conduct pre-award risk assessments to determine the risk an applicant poses to meeting federal programmatic and administrative requirements by taking into account issues such as financial instability, insufficient management systems, non-compliance with award conditions, the charging of unallowable costs, and inexperience. The risk assessment will include an evaluation of the applicant’s CDC Risk Questionnaire, located at https://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionnaire.pdf, as well as a review of the applicant’s history in all available systems; including OMB-designated repositories of government-wide eligibility and financial integrity systems (see 45 CFR 75.205(a)), and other sources of historical information. These systems include, but are not limited to: FAPIIS (https://www.fapiis.gov/), including past performance on federal contracts as per Duncan Hunter National Defense Authorization Act of 2009; Do Not Pay list; and System for Award Management (SAM) exclusions.

CDC requires all applicants to complete the Risk Questionnaire, OMB Control Number 0920- 1132 annually. This questionnaire, which is located at https://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionnaire.pdf, along with supporting documentation must be submitted with your application by the closing date of the Notice of Funding Opportunity Announcement. If your organization has completed CDC’s Risk Questionnaire within the past 12 months of the closing date of this NOFO, then you must submit a copy of that questionnaire, or submit a letter signed by the authorized organization representative to include the original submission date, organization’s EIN and UEI.

When uploading supporting documentation for the Risk Questionnaire into this application package, clearly label the documents for easy identification of the type of documentation. For example, a copy of Procurement policy submitted in response to the questionnaire may be labeled using the following format: Risk Questionnaire Supporting Documents _ Procurement Policy.

Duplication of Efforts

Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (i.e. grant, cooperative agreement, or contract) submitted to another funding source in the same fiscal year. Programmatic overlap occurs when (1) substantially the same project is proposed in more than one application or is submitted to two or more funding sources for review and funding consideration or (2) a specific objective and the project design for accomplishing the objective are the same or closely related in two or more applications or awards, regardless of the funding source. Budgetary overlap occurs when duplicate or equivalent budgetary items (e.g., https://www.grants.gov/ https://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionnaire.pdf https://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionnaire.pdf equipment, salaries) are requested in an application but already are provided by another source. Commitment overlap occurs when an individual’s time commitment exceeds 100 percent, whether or not salary support is requested in the application. Overlap, whether programmatic, budgetary, or commitment of an individual’s effort greater than 100 percent, is not permitted. Any overlap will be resolved by the CDC with the applicant and the PD/PI prior to award.

Report Submission: The applicant must upload the report in Grants.gov under “Other Attachment Forms.” The document should be labeled: "Report on Programmatic, Budgetary, and Commitment Overlap.”

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

LOI is not requested or required as part of the application for this NOFO.

8. Table of Contents

(There is no page limit. The table of contents is not included in the project narrative page 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

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

(Unless specified in the "H. Other Information" section, maximum of 20 pages, single spaced, 12 point font, 1-inch margins, number all pages. This includes the work plan. Content beyond the specified page number will not be reviewed.)

Applicants must submit a Project Narrative with the application forms. Applicants must name this file “Project Narrative” and upload it at www.grants.gov. The Project Narrative must include all of the following headings (including subheadings): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of https://www.grants.gov/ https://www.grants.gov/ https://www.grants.gov/

Applicants to Implement the Approach, and Work Plan. 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 period of performance as identified in the CDC Project Description section. Applicants should use the federal plain language guidelines and Clear Communication Index to respond to this Notice of Funding Opportunity. Note that recipients should also use these tools when creating public communication materials supported by this NOFO. Failure to follow the guidance and format may negatively impact scoring of the application.

a. Background

Applicants must provide a description of relevant background information that includes the context of the problem (See CDC Background).

b. Approach

i. Purpose

Applicants must describe in 2-3 sentences specifically how their application will address the public health problem as described in the CDC Background section.

ii. Outcomes

Applicants must clearly identify the outcomes they expect to achieve by the end of the project period, as identified in the logic model in the Approach section of the CDC Project Description.

Outcomes are the results that the program intends to achieve and usually indicate the intended direction of change (e.g., increase, decrease).

iii. Strategies and Activities

Applicants must provide a clear and concise description of the strategies and activities they will use to achieve the period of performance outcomes. Applicants must select existing evidence-based strategies that meet their needs, or describe in the Applicant Evaluation and Performance Measurement Plan how these strategies will be evaluated over the course of the project period.

See the Strategies and Activities section of the CDC Project Description.

1. Collaborations

Applicants must describe how they will collaborate with programs and organizations either internal or external to CDC. Applicants must address the Collaboration requirements as described in the CDC Project Description.

2. Target Populations and Health Disparities Applicants must describe the specific target population(s) in their jurisdiction and explain how such a target will achieve the goals of the award and/or alleviate health disparities. The applicants must also address how they will include specific populations that can benefit from the program that is described in the Approach section. Applicants must address the Target Populations and Health Disparities requirements as described in the CDC Project Description.

c. Applicant Evaluation and Performance Measurement Plan

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

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