MCHB HRSA-22-066 (U1V) Catalyst for IHE_Final.pdf

U.S. Department of Health and Human Services

Maternal and Child Health Bureau

Division of Healthy Start and Perinatal Services

Catalyst for Infant Health Equity

Funding Opportunity Number: HRSA-22-066

Funding Opportunity Type(s): New

Assistance Listings (AL/CFDA) Number: 93.926

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Letter of Intent Requested by: February 18, 2022

Application Due Date: April 19, 2022 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: January 19, 2022

Lud Abigail Duchatelier-Jeudy, PhD, MPH Public Health Analyst, Maternal and Women’s Health Branch Division of Healthy Start and Perinatal Services Maternal and Child Health Bureau Telephone: (301) 443-0543 Email: infanthealthequity@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254c-8 (Title III, Part D, § 330H of the Public Health Service Act) mailto:infanthealthequity@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Catalyst for Infant Health Equity program. The purpose of this new program is to support the implementation of existing action plans that apply data-driven policy and innovative systems strategies to reduce infant mortality (IM) disparities in a specific county/jurisdiction. For the purposes of this NOFO, since “county” is not a term used for all geographic areas, the term “jurisdiction” is also used and refers to tribal areas; the District of Columbia; municipalities within Puerto Rico; and similar geographical areas found within the US-affiliated Pacific Islands and Freely Associated States. The goals of the Catalyst for Infant Health Equity program are twofold: 1) to continue reducing overall IM rates in the United States, and 2) to decrease and ultimately eliminate disparities in IM across racial/ethnic groups by achieving steeper declines for groups with the highest rates. To accelerate disparity reduction, this project seeks to move beyond direct services to implementing targeted policy and systems interventions that will focus on one or more specific social determinants of health (SDOH) domains that contribute to IM disparities in a particular county/jurisdiction.

Funding Opportunity Title: Catalyst for Infant Health Equity

Funding Opportunity Number: HRSA-22-066

Due Date for Applications: April 19, 2022

Anticipated Total Annual Available FY 2022 Funding:

Up to $2,500,000 subject to the availability of appropriated funds.

Estimated Number and Type of Award(s): Up to 5 awards subject to the availability of appropriated funds.

Estimated Annual Award Amount: Up to $500,000 per award subject to the availability of appropriated funds.

Cost Sharing/Match Required: No

Period of Performance: September 1, 2022 through August 31, 2027 (5 years)

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Eligible Applicants: Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply for these funds.

Note: Eligible applicants are not required to be Healthy Start grant recipients.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online, except where instructed in this NOFO to do otherwise.

Technical Assistance HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Monday, January 31, 2022 Time: 1 p.m. ET Join ZoomGov Meeting: https://hrsa-gov.zoomgov.com/j/1612652252?pwd=VHppWER0UEs4dHllWG43N0xYQkJnQT

Audio Conference details o Computer audio is recommended (make sure computer speakers are “on”) o Attendees should click the above and select ‘Join with Computer Audio’ o Attendees without computer access or computer audio can use the dial-in information below

Dial-in Toll-Free #: 833 568 8864 Meeting ID: 161 265 2252 Passcode: 57453797

HRSA will record the webinar and make it available at:

https://mchb.hrsa.gov/fundingopportunities/default.aspx.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1612652252?pwd=VHppWER0UEs4dHllWG43N0xYQkJnQT09 https://hrsa-gov.zoomgov.com/j/1612652252?pwd=VHppWER0UEs4dHllWG43N0xYQkJnQT09 https://hrsa-gov.zoomgov.com/j/1612652252?pwd=VHppWER0UEs4dHllWG43N0xYQkJnQT09 https://mchb.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

7. OTHER SUBMISSION REQUIREMENTS

LETTER OF INTENT TO APPLY

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: GLOSSARY

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Catalyst for Infant Health Equity program. The goals of the new Catalyst for Infant Health Equity program are twofold: 1) to continue reducing overall infant mortality (IM) rates in the United States, and 2) to decrease and ultimately eliminate disparities in IM across racial/ethnic groups by achieving steeper declines for groups with the highest rates. To accomplish these goals, award recipients are expected to address the broader social and structural determinants (or root causes) contributing to IM disparities at the county or jurisdiction1 level. For example, recipients will support implementation of existing action plans that address public policies, systemic racism and discrimination, and/or institutional practices. To maximize impact on disparities in infant mortality rates at the national level, counties/jurisdictions with larger numbers of excess infant deaths2 will be considered priority areas.

The purpose of the Catalyst awards is to support the implementation of existing action plans that apply data-driven policy and innovative systems strategies to reduce IM disparities and prevent excess infant deaths. Recipients are expected to implement action plans that address the social determinants of health (i.e., environmental, social, and economic conditions), and/or the structural determinants of health (e.g., institutions, systemic barriers, policies) that contribute to disparities in IM. The policy and systems change strategies in such action plans should be targeted and specific to reducing disparities among the racial or ethnic group(s) with the highest IM rates or excess infant deaths (i.e., priority population) in a target county/jurisdiction. The plan must be implemented in partnership with cross-sector state and/or local partners (including agencies that administer the State Title V Maternal and Child Health Block Grant Program), community members, and individuals with lived experience.

Healthy People 2030 has grouped social determinants of health (SDOH) into the five domains3 below. Successful award recipients will be expected to implement policy and systems strategies in their action plan from at least one of these domains, and focus on an objective(s) within that domain that can affect birth outcomes and contribute to reducing the IM disparity in the target county/jurisdiction.

11 For the purposes of this NOFO, “jurisdiction” refers to tribal areas; the District of Columbia;

municipalities within Puerto Rico; and similar geographical areas found within the US-affiliated Pacific Islands and Freely Associated States.

2 Excess infant deaths are those that occur due to higher mortality rates relative to non-Hispanic White infants, and can be referred to as deaths attributable to disparity or deaths that need to be prevented to achieve equity in IM rates. Excess infant deaths are calculated by multiplying excess infant mortality rates by the number of births (e.g., [Black IMR – White IMR] X Black births).

3 https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://health.gov/healthypeople/objectives-and-data/social-determinants-health

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Domain 1: Economic Stability

Domain 2: Education Access and Quality

Domain 3: Health Care Access and Quality

Domain 4: Neighborhood and Built Environment

Domain 5: Social and Community Context

Award recipients are expected to address the three areas of focus below during the period of performance in order to successfully achieve the goals and objectives of the Catalyst for Infant Health Equity program:

1) Action Plan Implementation: implement an already developed action plan containing SDOH policy and systems changes to reduce racial/ethnic disparities in IM in a selected priority population (e.g., racial/ethnic group with the highest numbers of excess infant deaths) within a target county/jurisdiction.

2) Strategic Partnerships: assure accountability and sustainability of the action plan by facilitating, supporting, and building the capacity of a network of local organizations, service providers, and consumers/community members who can advance systems and policy changes that will address contributors to IM and disparities.

3) Outcome Evaluation: continuously assess progress toward implementing the action plan and reducing both IM and disparities in IM among racial or ethnic group(s) with the highest IM rates or excess infant deaths (i.e., priority population) in the target county/jurisdiction.

For more details, see Program Requirements and Expectations.

For definitions of terms, see Appendix: Glossary.

2. Background

HRSA’s Maternal & Child Health Bureau and 2021 Strategic Plan

The Maternal and Child Health Bureau (MCHB) administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and children with special health care needs. To achieve its mission of improving the health and well-being of America’s mothers, children, and families, MCHB has established a strategic plan that includes the following four goals:

Goal 1: Assure access to high quality and equitable health services to optimize health and well-being for all MCH populations

Goal 2: Achieve health equity for MCH populations

Goal 3: Strengthen public health capacity and workforce for MCH

Goal 4: Maximize impact through leadership, partnership, and stewardship

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MCHB is committed to promoting equity in its health programs for mothers, children, and families. This program primarily addresses MCHB’s goal to achieve health equity for MCH populations by focusing on eliminating racial disparities seen in IM.

To learn more about MCHB and the bureau’s strategic plan, visit https://mchb.hrsa.gov/about.

Healthy Start The Catalyst for Infant Health Equity program is authorized by 42 U.S.C. § 254c-8 (Title III, Part D, § 330H of the Public Health Service Act). The Healthy Start (HS) program is funded under this legislation. Eligible entities are not required to be HS grant recipients to apply for this new program funding. Overarching goals of the HS program are to reduce infant mortality; improve health outcomes before, during, and after pregnancy;

and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes. Under this authority, MCHB currently funds the HS program, Healthy Start Initiative: Eliminating Disparities in Perinatal Health.

Overview of the Healthy Start Initiative: Eliminating Disparities in Perinatal Health Since its start as a demonstration project in 1991, the HS program has been providing grants to communities at high risk for infant mortality, with IM rates at least 1.5 times the United States national average and high rates of other adverse perinatal outcomes (e.g., low birthweight, preterm birth, maternal morbidity and mortality). The purpose of the HS program is to reduce the rate of infant mortality and improve perinatal outcomes by using a community-based approach to service delivery and facilitating access to a comprehensive approach to women’s health care. HS works to reduce the disparity in health status between the general population and individuals who are members of racial or ethnic minority groups. For more information on HS, see https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start

A competitive supplement was recently awarded to a cohort of existing HS award recipients to support the development of action plans to develop innovative data-driven policy and systems level strategies to address the social and structural determinants of health impacting IM disparities in HS communities. The supplement is intended to accelerate reductions in IM disparities, consistent with the purpose of the Healthy Start program, while also adding to the current HS approaches that generally focus on individual and behavioral interventions. For a list of supplement award recipients, see:

https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start/fy21-awards.

Achieving Infant Health Equity by 2030: Catalyst for Infant Health Equity program

Infant mortality (IM) rates in the United States remain high compared to other well-resourced countries. While the U.S. IM rate has historically trended downward, and has https://mchb.hrsa.gov/about https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start/fy21-awards

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declined 17% since 20054, racial/ethnic disparities in IM in the United States have persisted. The highest IM rates in the country are among non-Hispanic Black, Native Hawaiian/Other Pacific Islander, and American Indian/Alaska Native (AI/AN) infants (10.62, 8.19, and 7.91 infant deaths per 1,000 live births in 2019, respectively) with rates that are approximately twice that of non-Hispanic Whites (4.49 infant deaths per 1,000 live births in 2019)—the population with the most births and longest historical advantages.5 The stark infant mortality differences across racial and ethnic groups reflect social inequities and contribute to the high overall national IM rate.

Structural inequities in access to health-promoting resources, such as education, employment, housing, and health care, contribute to racial/ethnic disparities in perinatal health6,7. Each year, approximately 3,500 excess infant deaths occur due to higher mortality rates among non-Hispanic Black, Native Hawaiian/Other Pacific Islander, and non-Hispanic AI/AN infants, relative to non-Hispanic White infants.

Healthy People (HP) 20308 has established a target of 5.0 infant deaths per 1,000 live births for all race/ethnic groups–a target already achieved at the national level for non- Hispanic White, non-Hispanic Asian, and Hispanic infants. Achieving equity will require maintaining declines in the IM rate of these infants, and accelerating the rate of decline among non-Hispanic Black, Native Hawaiian/Other Pacific Islander, and non-Hispanic AI/AN infants.

To accelerate the reduction of IM disparities and excess infant deaths, the Catalyst for Infant Health Equity program will support policy and systems changes (i.e., structural interventions) that improve conditions, such as educational and employment opportunity, to promote equity across a range of health outcomes9.

Theoretical Framework To accelerate the reduction in disparity, this program seeks to move beyond direct services to implement targeted policy and systems changes that are focused on one or more specific SDOH domains contributing to IM disparities in a particular county/jurisdiction. The Catalyst for Infant Health Equity program utilizes the social-

4 https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf 5 https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/period-cohort-linked/19PE18CO_linkedUG.pdf 6 Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res. 2016 Jan; 79 (1-2):141-7. doi: 10.1038/pr.2015.199.

7 Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and Structural Determinants of Health Inequities in Maternal Health. J Womens Health (Larchmt). 2021 Feb;30(2):230-235. doi: 10.1089/jwh.2020.8882.

8 https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/reduce-rate-infant-deaths-mich-02 9 Brown AF, Ma GX, Miranda J, Eng E, et al. Structural interventions to reduce and eliminate health disparities. AM J Public Health. 2019: 109: S72-S78. doi:10.2105?AJPH.2018.304844 https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/period-cohort-linked/19PE18CO_linkedUG.pdf https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/period-cohort-linked/19PE18CO_linkedUG.pdf https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/reduce-rate-infant-deaths-mich-02 https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/reduce-rate-infant-deaths-mich-02

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ecological model as a framework for examining and addressing disparities in IM and excess infant deaths10,11. In this model, individual outcomes and health disparities across racial groups are shaped by broader interpersonal, institutional, community and policy factors such as personally-mediated and institutional racism, providers’ cultural competence, access to quality health care, neighborhood quality, and economic and housing policy. The levels at which these factors operate include:

a) Individual: Characteristics of the individual

b) Interpersonal: Social network and support system

c) Institutional: Social institutions, rules and regulations for operations

d) Community Factors: Relationships among organizations, institutions, and informal networks within defined boundaries

e) Public Policy: Local, state, and national laws and policies

Using the social-ecological model as a guide for assessing factors that can influence outcomes (i.e., IM disparity), this program seeks to implement existing action plans that address institutional, community and public policy levels , which can more directly influence the social and structural determinants of health such as health care, education, housing, transportation and the justice system.

10 Alia AP, Richman AR, Clayton HB et al. An ecological approach to understand disparities in perinatal mortality. Matern Child Health J. 2010;14:557-566. Doi 10.1007/s10995-009-0495-9 11 Reno R, Hyder A. The Evidence Base for Social Determinants of Health as Risk Factors for Infant Mortality: A Systematic Scoping Review. J Health Care Poor Underserved. 2018;29(4):1188-1208.

Public Policy

Community

Institutitional

Interpersonal

Individual

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II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Assuring the availability of HRSA personnel to participate in the planning and development of all phases of the project;

• Conducting ongoing reviews of the establishment and implementation of activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement;

• Participating, as appropriate, in conference calls, virtual and in-person meetings, and training/capacity-building sessions that are conducted during the period of performance;

• Ensuring integration into HRSA programmatic and data reporting efforts;

• Assisting with the establishment and facilitation of collaborative relationships with federal and state contacts, HRSA-funded awards, and other entities that may contribute to successful project outcomes;

• Reviewing and providing advisory input on written documents, including information and materials to support the activities conducted through the cooperative agreement, prior to submission for publication or public dissemination; and

• Participating with the award recipient in the dissemination of project findings, best practices, and lessons learned from the project.

The cooperative agreement recipient’s responsibilities will include:

• Completing activities proposed in response to the Program-Specific Instructions section of this notice of funding opportunity (NOFO);

• Meeting with the federal project officer within 2 weeks after award to review the current strategies and to ensure the project and goals align with HRSA priorities for this activity;

• Providing ongoing, timely communication and collaboration with the federal project officer, including holding regular check-ins with the federal project officer;

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• Providing the federal project officer with the opportunity to review and provide advisory input on written documents, including information and materials to support the activities conducted through the cooperative agreement, prior to submission for publication or public dissemination. Such review should start as part of concept development and include review of drafts and final products;

• Establishing contacts relevant to the project’s mission such as federal and non-federal partners, and other HRSA projects that may be relevant to the project’s mission;

• Collaborating with HRSA on ongoing review of activities, procedures and budget items, and interagency agreements; and

• Assuring that all recipient administrative data and performance measure reports, as designated by HRSA, will be completed and submitted on time.

2. Summary of Funding

HRSA estimates approximately $2,500,000 to be available annually to fund 5 recipients.

The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $500,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is September 1, 2022 through August 31, 2027 (5 years).

Funding beyond the first year is subject to the availability of appropriated funds for the Catalyst in Infant Health Equity program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply for these funds.

Note: Eligible applicants are not required to be Healthy Start grant recipients.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

NOTE: Multiple applications from an organization are not allowable.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date as the final and only acceptable application.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO

APPLY FOR GRANTS.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-066 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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See Section 8.5 of the HRSA SF-424 Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit shall be no more than the equivalent of 60 pages when printed by HRSA. The page limit includes the project and budget narratives, and attachments required in the Application Guide and this NOFO, except for Attachment 7-Copy of Proposed Action Plan.

Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project_Abstract Summary.” Standard OMB-approved forms included in the workspace application package do not count in the page limit. If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-066, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 60 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-066 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 8–15: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications.

Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371

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or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations

To accelerate the reduction of IM disparities and excess infant deaths the Catalyst for Infant Health Equity program seeks to go beyond individual-level direct service interventions to policy and systems changes that alter the fundamental social, physical, or economic environment shaping health behaviors and health outcomes.

Recipients are expected to meet the following program objectives by August 31, 2026:

1) Action Plan Implementation: Implement an action plan containing specific policy and systems changes to reduce racial/ethnic disparities in IM in a county/jurisdiction. The action plans being implemented must address the “upstream” factors or environmental, social, and economic conditions, and/or structural (institutions and policies) or systemic barriers that contribute to disparities in IM in a county/jurisdiction. The action plans should include targeted policy and systems change strategies, specific to the target county/jurisdiction, that will reduce disparities among the racial or ethnic group(s) with the highest IM rates and excess infant deaths (i.e., priority population). The plan must be implemented in partnership with cross-sector state and/or local partners (including agencies that administer the State Title V Maternal and Child Health Block Grant Program), community members, and individuals with lived experience.

2) Strategic Partnerships: Support, assist, and facilitate a network of cross-sector state and/or local organizations (including agencies that administer the State Title V Maternal and Child Health (MCH) Block Grant program), service providers, and consumers/community members to make policy and system changes that will address contributors to IM and disparities. Provide the network with tools, training, and capacity building to be skilled to support policy and system changes that address root causes of, and contributors to, disparities in IM. This network is intended to help the award recipients assure that action plans being implemented through this funding address the racial or ethnic group(s) with the highest IM rates and excess infant deaths in the target county/jurisdiction (i.e., priority population). In addition, award recipients must coordinate their services and activities with agencies that administer State Title V MCH Block Grant programs in order to promote cooperation, integration, and dissemination of information with statewide systems and with other community services.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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3) Outcome Evaluation: Conduct regular and ongoing measurement of plan progress and its impact on IM disparities and on the racial or ethnic group(s) with the highest IM rates or excess infant deaths in the target county/jurisdiction (i.e., priority population). Regularly report out/disseminate this information to community members, partners, and stakeholders.

Healthy People 2030 has grouped SDOH into the five domains12 below. Successful award recipients will be expected to implement policy and systems strategies in their action plan from at least one of these domains, and focus on an objective(s) within that SDOH domain that can affect birth outcomes and contribute to reducing the IM disparity seen in the target county/jurisdiction. Additional social or structural determinants that contribute to IM disparities but are not listed below may be addressed in the action plan’s policy and systems strategies, such as: racism, discrimination, and bias;

supportive economic policy (e.g., paid parental leave, living wages); housing programs and policies; culturally respectful and equitable health care13,14,15; among others.

Domain 1: Economic Stability

Examples of Relevant HP Objectives:

• Reduce the proportion of adolescents and young adults who are neither enrolled in school nor working (AH-09)

• Reduce the proportion of persons living in poverty (SDOH-01)

• Increase employment among the working-age population (SDOH-02)

• Increase the proportion of children living with at least one parent employed year round, full time (SDOH-03)

• Reduce the proportion of families that spend more than 30 percent of income on housing (SDOH-04)

• Reduce household food insecurity and in doing so reduce hunger (NWS-01)

Domain 2: Education Access and Quality

Examples of Relevant HP Objectives:

• Increase the proportion of high school students who graduate in 4 years —

AH‑08

12 https://health.gov/healthypeople/objectives-and-data/social-determinants-health 13 https://www.thecommunityguide.org/content/task-force-findings-health-equity 14 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. Apr 8 2017;389(10077):1453-1463.

15 Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and Structural Determinants of Health Inequities in Maternal Health. J Womens Health (Larchmt). Feb 2021;30(2):230-235.

https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://www.thecommunityguide.org/content/task-force-findings-health-equity

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• Increase the proportion of high school completers who were enrolled in college the October immediately after completing high school (SDOH-06)

Domain 3: Health Care Access and Quality

Examples of Relevant HP Objectives:

• Increase the proportion of adults who receive appropriate evidence-based clinical preventive services (AHS-08)

• Increase the proportion of adolescents who received a preventive health care visit in the past year (AH-01)

• Increase the number of community-based organizations providing population-based primary prevention services (ECPB-D07)

• Increase the proportion of women who get needed publicly funded birth control services and support (FP-09)

• Reduce the proportion of people who can't get medical care when they need it

(AHS-04)

• Increase the proportion of adults whose health care provider checked their understanding (HC/HIT-01)

• Decrease the proportion of adults who report poor communication with their health care provider (HC/HIT-02)

• Increase the proportion of adults whose health care providers involved them in decisions as much as they wanted (HC/HIT-03)

• Increase the proportion of adults with limited English proficiency who say their providers explain things clearly (HC/HIT-D11)

• Increase the use of telehealth to improve access to health services (AHS-R02)

• Increase the proportion of people with health insurance (AHS-01)

• Increase the proportion of pregnant women who receive early and adequate prenatal care (MICH-08)

Domain 4: Neighborhood and Built Environment

Examples of Relevant HP Objectives:

• Reduce the rate of minors and young adults committing violent crimes (AH-10)

• Increase the proportion of adults with broadband internet (HC/HIT‑05)

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• Increase the proportion of people whose water supply meets Safe Drinking Water Act16 regulations (EH-03)

• Reduce the number of days people are exposed to unhealthy air (EH-01)

• Reduce health and environmental risks from hazardous sites (EH-05)

• Reduce the amount of toxic pollutants released into the environment (EH-06)

• Increase the proportion of schools with policies and practices that promote health and safety (EH‑D01)

• Increase the proportion of adults who walk or bike to get places (PA-10)

• Increase the proportion of adolescents who walk or bike to get places (PA‑11)

• Increase the proportion of smoke-free homes (TU‑18)

• Reduce the proportion of people who don't smoke but are exposed to secondhand smoke (TU‑19)

• Increase the number of states, territories, and DC that prohibit smoking in worksites, restaurants, and bars (TU-17)

• Increase the number of states, territories, and DC that prohibit smoking in multiunit housing (TU-R01)

• Increase the proportion of worksites with policies that ban indoor smoking

(ECBP-D06)

Domain 5: Social and Community Context

Examples of Relevant HP Objectives:

• Reduce the proportion of children with a parent or guardian who has served time in jail (SDOH-05)

• Increase the proportion of adults who talk to friends or family about their health

(HC/HIT-04)

• Increase the health literacy of the population (HC/HIT-R01)

• Increase the proportion of adolescents who have an adult they can talk to about serious problems (AH‑03)

• Increase the proportion of children and adolescents who show resilience to challenges and stress (EMC‑D07)

16 https://www.ecfr.gov/current/title-40/chapter-I/subchapter-D/part-141.

https://www.ecfr.gov/current/title-40/chapter-I/subchapter-D/part-141

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Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment or it will count toward the page limitation. Please use the guidance below. It is most current and differs slightly from that in Section 4.1.ix of HRSA’s SF-424 Application Guide.

Provide a summary of the application in the Project Abstract box of the Project Abstract Summary Form using 4,000 characters or less.

Address Project Director Name Contact Phone Numbers (Voice, Fax) Email Address Website Address, if applicable List all grant program funds requested in the application, if applicable

Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed project including the needs to be addressed, the proposed services, and the population group(s) to be served. If the application is funded, your project abstract information (as submitted) will be made available to public websites and/or databases including USAspending.gov.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.usaspending.gov/

HRSA-22-066 15

Narrative Section Review Criteria

Evaluation and Technical Support Capacity

(3) Evaluative Measures

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion (1) NEED Briefly describe the purpose of your proposed project. Include which SDOH domain(s) your proposed action plan addresses, the proposed policy and systems change strategies that will be implemented from the action plan, and the priority population of focus (e.g., non-Hispanic Black pregnant women and infants). Also state the county/jurisdiction that your proposed action plan focuses on.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion (1) NEED This section will help reviewers understand the need for the project, the needs of your selected priority population, and the social and structural determinants of health that are contributing to IM disparities and excess infant deaths in your selected county/jurisdiction.

State and describe the target county or jurisdiction. Describe the social and structural determinants of health that are contributing to disparities in IM and excess infant deaths, and driving health inequity for the selected priority population(s) in your target county/jurisdiction.

Describe the selected priority population(s) in your target county/jurisdiction that will be impacted by the proposed policy and systems changes and strategies in your action plan. Explain why you chose to focus on this population(s). Be sure to include:

• their IM rate (deaths per 1,000 live births based on 10 or more deaths; use multiple years if needed),

• the absolute gap compared to non-Hispanic White infants (group IM rate – non-Hispanic White IM rate), HRSA-22-066 16

• their average annual number of births (total births / # of years used),

• excess annual deaths (absolute gap ÷ 1,000 x average annual births), and

• the data source for these calculations

County-level or jurisdiction level data should be used, given the focus of this funding on broader policy and systems-level solutions. An example calculation, using 2017–2019 linked birth/infant death data, shows the national number of excess non-Hispanic Black infant deaths is 3,421 as calculated by the absolute IM rate difference (10.78 for non-Hispanic Black infants minus 4.60 for non-Hispanic White infants = 6.18 / 1000 = 0.00618) multiplied by 553,606 average annual non- Hispanic Black births. Infant mortality statistics by race/ethnicity for counties with population sizes of 250,000 or more are available on CDC Wonder https://wonder.cdc.gov/lbd.html. If technical assistance is needed in calculating excess infant deaths for your target county/jurisdiction, please contact MCHB at infanthealthequity@hrsa.gov.

Discuss known barriers and challenges related to reducing the disparity in IM in your target county/jurisdiction that the project hopes to overcome.

Discuss the SDOH domain(s) addressed in your action plan and its connection to IM disparities and excess infant deaths. Describe the current policy context, including challenges, gaps, and opportunities for addressing the selected SDOH domain(s).

Describe currently available services and state/local/community resources intended to reduce infant mortality for the selected priority population(s).

Use and cite demographic data whenever possible to support the information provided above.

METHODOLOGY -- Corresponds to Section V’s Review Criteria (2) RESPONSE and (4) IMPACT This section will help reviewers understand your proposed methods and activities planned in order to meet each of the program requirements and expectations in this NOFO.

Describe the action plan that will be implemented through this funding. Include which Healthy People 2030 SDOH domain(s) and objective(s) it addresses, and any additional social or structural determinants outside of Healthy People 2030 that are addressed in the action plan you will implement. A copy of the action plan must be included in Attachment 7. The action plan should include (among other things) activities and/or steps under the selected domain(s) that are feasible during the period of performance and will help to achieve the goals of the Catalyst for Infant Health Equity program.

Describe the cross-sector network that will help you assure that your action plan and the policy and systems strategies support the racial or ethnic group(s) with the https://wonder.cdc.gov/lbd.html

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highest IM rates or excess infant deaths in the target county/jurisdiction. Describe how you will implement the action plan in partnership with cross-sector state and/or local partners (including agencies that administer the State Title V Maternal and Child Health Block Grant Program), community members, and individuals with lived experience. Include any letters of support in Attachments 8–15: Other Relevant Documents. Include any Letters of Agreement, Memoranda of Understanding, and/or Description(s) of Proposed/Existing Contracts (project-specific) in Attachment 4.

Describe your plans for providing the network with tools, training, and capacity building in order for them to be skilled at promoting policy and system changes that address root causes of, and contributors to, disparities in IM.

Describe plans for ongoing facilitation, support, and assistance to the network of local organizations, service providers, and consumers/community members in order for them to engage decision-makers for policy and system changes that will address contributors to IM and disparities. State whether community members and/or consumers on the network will be provided financial support/payment for their time and work.

Describe your proposed process and activities for regularly reporting out/disseminating information to community members, partners, and stakeholders on the action plan’s progress and impact.

Describe how you will conduct regular and ongoing measurement of your action plan’s implementation.

Propose a plan for project sustainability after the period of federal funding ends.

HRSA encourages recipients to sustain key elements of their projects, e.g., strategies and interventions which have been effective in improving policies/practices and those that have led to improved outcomes for the priority population. A sustainability plan will be required in the final year of the award..

WORK PLAN -- Corresponds to Section V’s Review Criteria (2) RESPONSE and (4)

IMPACT

Develop a work plan for the entire period of performance that details the activities and steps that you will use to achieve each of the three required objectives in the NOFO Purpose and include it in Attachment 1. Include a timeline with dates for completing key tasks in the work plan and identify responsible personnel/staff or other parties. The work plan should demonstrate that your organization possesses a baseline capacity to implement and carry out the proposed project successfully within the period of performance.

In this section of the Project Narrative, describe the key activities and steps that you will use to achieve each of the required objectives and major milestones of your

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proposed work plan. If you will make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds.

Logic Models

In Attachment 1, please submit a logic model for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements.

While there are many versions of logic models, for the purposes of this notice, the logic model should summarize the connections between the:

• Goals of the project (e.g., reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience.);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a timeline used during program implementation; the work plan provides the “how to” steps. You can find additional information on developing logic models at the following website:

https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review…