PKG00262589-instructions.pdf

DEPARTMENT OF

HEALTH AND HUMAN SERVICES

OFFICE OF THE

ASSISTANT SECRETARY FOR HEALTH

Office of Minority Health

Funding Opportunity: Reducing Cardiac Arrest Disparities Through Data

Registries Initiative

Opportunity Number: MP-CPI-20-003

Application Due Date:

Monday, August 17, 2020 6:00 PM Eastern

OVERVIEW

FEDERAL AGENCY NAME

Office of the Assistant Secretary and the Office of Minority Health

FUNDING OPPORTUNITY TITLE

Reducing Cardiac Arrest Disparities Through Data Registries Initiative

ACTION

Notice

ANNOUNCEMENT TYPE

Initial Competitive Grant

FUNDING OPPORTUNITY NUMBER

MP-CPI-20-003

CFDA NUMBER AND PROGRAM:

93.137 Community Program to Improve Minority Health

DATES

Application Deadline: Monday, August 17, 2020 by 6:00 PM Eastern.

Technical Assistance: Webinar, Wednesday, July 22, 2020 4:00 PM Eastern

EXECUTIVE SUMMARY

The Office of Minority Health (OMH) announces the availability of funds for Fiscal Year

(FY) 2020 grant awards under the authority of Section 1707 of the Public Health Service Act

(42 U.S.C. § 300u-6).

This notice solicits applications for projects under the Reducing Cardiac Arrest Disparities

Through Data Registries Initiative to demonstrate if participation in an out-of-hospital cardiac arrest (OHCA) registry using standard data collection tools and data infrastructure supports the:

(1) identification of racial/ethnic minority and/or disadvantaged populations experiencing cardiac arrest; and (2) implementation of evidence-informed interventions to improve cardiac arrest survival rates.

The 350,000 annual cases of OHCA account for 50 percent of all cardiovascular mortality in the US. On average, only 10 percent of patients survive to hospital discharge and there are large regional variations that, in part, are explained by health inequities. Blacks and Hispanics have lower age-adjusted survival from OHCA compared to Whites.1 However, survival outcomes have been shown to be increased by nearly 75 percent in as little as three years in communities that begin tracking their OHCA cases via registry participation.2 At least 42 communities and states in the U.S. have implemented an OHCA registry, which provides surveillance and reporting to help increase state accountability and promote actions to improve cardiac arrest outcomes. Initiative projects will implement state/territorial/tribal-level processes for contributing to an OHCA data registry, including data collection on emergency cardiac care by emergency medical services and outcomes through hospital discharge. Using data from the OHCA registry, projects will describe the state/territorial/tribal cardiac arrest rate of occurrence by race and ethnicity and other related factors. Projects should also enhance capacity of state, territorial and tribal health agencies to implement and sustain evidence-informed interventions that significantly improve health outcomes of individuals who experience OHCA. In addition, projects will develop a sustainability plan for maintaining the project when the grant award ends.

These grants are designed to bring together stakeholders across health systems to strengthen an existing coordinated service network. OMH expects the applicant to represent a collaborative partnership, including representation from each of the following: (1) state/territorial/tribal health agencies; (2) state/territorial/tribal emergency management service

(EMS) agencies/organizations; and (3) hospitals/health care organizations. Other partners could include, but are not limited to: institutions of higher education, EMS professional associations and non-profit public health entities.

OMH anticipates the availability of $250,000 for this funding opportunity to support three to five grants with awards ranging from $50,000 to $70,000 per year for up to two years.

HHS/OASH encourages applicants to review all program requirements, eligibility information, application format and submission information, evaluation criteria, and other information in this funding announcement to ensure that its application complies with all requirements and instructions.

FUNDING OPPORTUNITY DETAILS

A. DATES

1. Application Deadline

Your application is due Monday, August 17, 2020 by 6 p.m. Eastern Time. To receive consideration, you must submit your application electronically via Grants.gov no later than this due date and time. If you do not submit your application by the specified deadline, we will return it to you unread. You must submit electronically via Grants.gov unless you obtain a written exemption from this requirement 2 business days in advance of the deadline from the Director, HHS/Office of the Assistant Secretary for Health (OASH) Grants and Acquisition Management

(GAM) Division. To obtain an exemption, you must request one via email from the HHS/OASH

GAM, and provide details as to why you are technologically unable to submit electronically through Grants.gov. Your request should be submitted at least 4 business days prior to the application deadline to ensure your request can be considered prior to 2 business days in advance of the deadline. If you request an exemption, include the following in your e-mail request: the

HHS/OASH announcement number; your organization's DUNS number; your organization’s name, address and telephone number; the name and telephone number of your Authorizing

Official; the Grants.gov Tracking Number (for example, GRANT####) assigned to your submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to ogm.oash@hhs.gov. Note: failure to have an active

System for Account Management (SAM) registration prior to the application due date will not be grounds for receiving an exemption to the electronic submission requirement. Failure to follow

Grants.gov instructions to ensure software compatibility will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH GAM will only accept applications via alternate methods (hardcopy paper via U.S. mail or other provider or PDF via email) from applicants obtaining prior written approval.

If you receive an exemption, you must still submit your application by the deadline. Only applications submitted through the Grants.gov portal or alternate format (hardcopy paper via U.S.

mail or other service or PDF via email) with an approved written exemption will be accepted. See

Section F.8 (“Other Submission Requirements”) for information on application submission mechanisms.

Executive Order 12372 comment due date: The State Single Point of Contact (SPOC) has

60 days from the application due date to submit any comments. For more information on the SPOC see section F.6 Intergovernmental Review.

To ensure adequate time to submit your application successfully, HHS/OASH recommends that you register as early as possible in Grants.gov since the registration process can take up to one month. You must register an authorizing official for your organization. HHS/OASH does not determine your organization’s authorizing official; your organization makes that designation. For mailto:ogm.oash@hhs.gov information on registering for Grants.gov, refer to http://www.grants.gov or contact the Grants.gov

Contact Center 24 hours a day, 7 days a week (excluding Federal holidays) at 1-800-518-4726 or support@grants.gov.

Your organization is strongly encouraged to register multiple authorized organization representatives in Grants.gov to ensure someone is available to submit your application.

2. Technical Assistance

A technical assistance webinar for potential applicants will be held on Wednesday July

24, 2020. Please check the Office of Minority Health website, www.minorityhealth.hhs.gov, for more detailed information.

We recommend you review the entire announcement promptly so you can have any questions answered well in advance of the application due date. We also recommend you subscribe to this announcement in Grants.gov so you receive any amendments, question and answer documents, or other updates.

B. PROGRAM DESCRIPTION

The Office of Minority Health announces the availability of funds for Fiscal Year (FY)

2020 grant awards under the authority of Section 1707 of the Public Health Service Act (42 U.S.C.

§ 300u-6). OMH is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities and advance health equity. Through its demonstration grants, OMH supports the identification of effective approaches for improving health outcomes with the ultimate goal of promoting sustainability and dissemination of these approaches. This particular grant aligns with HHS

Strategic Goal 2: Protect the Health of Americans Where They Live, Learn, Work and Play.3 It http://www.grants.gov/ mailto:support@grants.gov http://www.minorityhealth.hhs.gov/ also supports the Office of the Assistant Secretary for Health’s vision to “transform the current

‘sick-care system’ into a ‘health-promoting system’.”

1. Background

The purpose of the Reducing Cardiac Arrest Disparities Through Data Registries Initiative is to demonstrate if state/territorial/tribal participation in an out-of-hospital cardiac arrest (OHCA) registry using standard data collection tools and data infrastructure supports the: 1) identification of racial/ethnic minority and/or disadvantaged populations experiencing cardiac arrest; and

2) implementation of evidence-informed interventions to improve cardiac arrest survival rates.

Under this initiative, states/territories/tribes will develop and/or participate in an OHCA data registry to collect cardiac arrest data from EMS and hospitals to support performance and care quality measurement, the identification of cardiac arrest disparities, and the implementation of evidence-informed interventions to improve out-of-hospital sudden cardiac arrest survival rates in areas of high need.

The primary goals of the initiative are to: (1) implement state/territorial/tribal-level processes for contributing to an OHCA data registry, to include data collection on a) emergency cardiac care by EMS and b) outcomes through hospital discharge; (2) describe the state/territorial/tribal epidemiology of cardiac arrest by race and ethnicity and other related factors using data from the OHCA registry, and; (3) implement evidence-informed interventions to improve cardiac arrest survival rates based on the epidemiology of cardiac arrest. The secondary goal of the initiative is to enhance the capacity of state, territorial and tribal health agencies to sustain implementation of the OHCA registry and evidence-informed interventions that significantly improve health outcomes of individuals who experience OHCA.

The 350,000 annual cases of OHCA account for 50 percent of all cardiovascular mortality in the United States. On average, only 10 percent of patients survive to hospital discharge and there are large regional variations that, in part, are explained by health inequities. Blacks and Hispanics have lower age-adjusted survival from OHCA compared to Whites.4 Reports have shown that death from OHCA occurs in low socioeconomic census tracts at twice the rate of high socioeconomic census tracts. Some of these differences are explained by the time it takes for first responders to get on scene and rates of bystander CPR rendered before first responder contact.5 A finding reproduced by many studies has shown that Blacks are 50 percent less likely to receive bystander CPR compared to Whites.6

In communities that begin tracking their OHCA cases via registry participation, survival outcomes have been shown to be increased by nearly 75 percent in as little as three years by implementing evidence-informed interventions such as standardization of telecommunicator CPR, increasing rates of CPR training in at risk communities, and improved automated external defibrillator (AED) accessibility.7 In some communities with an OHCA registry, improvements have occurred in the rates of long-term complications that decrease quality of life that significantly impact the public health and economic burden of OHCA. Some projections show that for every one percent increase in OCHA survival rate, there is 4.5 billion dollars in savings to the economy.8

Reducing Cardiac Arrest Disparities Through Data Registries Initiative is aligned with and supports strategies recommended in the 2015 Institute of Medicine report “Strategies to Improve

Cardiac Arrest Survival: A Time to Act.”9 Organizations working at the state, territorial, or tribal level are well-positioned to lead efforts for using OHCA registry data to identify, implement and sustain successful evidence-informed interventions using a public health approach that can be applied to the system of care for sudden cardiac arrest. Ultimately, these interventions are expected to improve and reduce disparities in out-of-hospital sudden cardiac arrest survival rates.

2. Expectations

OMH expects successful applicants to address the following in the proposed project:

a. Implement state/territorial/tribal-level processes for contributing to an OHCA data registry, to include data collection on 1) emergency cardiac care by EMS and 2) outcomes through hospital discharge

OMH expects applicants to demonstrate readiness to implement the OHCA data registry by providing evidence of existing key infrastructure and EMS data collection experience.

Successful applicants should demonstrate that all EMS providers in the state/territory/tribe will report data to the current National Emergency Medical Services Information System (NEMSIS), a national database for EMS data.

The Principal Investigator/Project Director (PI/PD) is responsible for the day-to-day oversight of the project. In addition to the (PI/PD), OMH expects successful applicants to have an experienced individual responsible for collecting and managing EMS data who for this FOA we will refer to as the Data Coordinator. The Data Coordinator is a key personnel position for the project and will be responsible for ensuring that project and partner organization staff are trained in using the OHCA registry, coordinating cardiac arrest data entry by the partners, and conducting data audits. The Data Coordinator will also be responsible for ensuring evaluation requirements are met and evaluation results are reported in a timely and accurate manner to project staff and

OMH. The applicant should provide a position description for this key personnel position and the plans to fill this role if the position is vacant. OMH recommends project staff have knowledge of and experience with cultural competence and the National Standards for Culturally and

Linguistically Appropriate Services in Health and Health Care (National CLAS Standards)

(https://www.thinkculturalhealth.hhs.gov/Content/clas.asp).

https://nemsis.org/ https://www.thinkculturalhealth.hhs.gov/Content/clas.asp

OMH expects the initiative will require a collaborative partnership, with representation from each of the following: (1) state/territorial/tribal health agencies, (2) state/territorial/tribal

EMS agencies/organizations, and (3) hospitals/health care organizations. Other partners could include, but are not limited to: institutions of higher education, EMS professional associations and non-profit public health entities. Applicants should describe in detail the specific roles, responsibilities, resources, and contributions of partner(s) with whom they have begun to formalize their working relationship. If available at the time of submission applicants may include a signed memorandum of agreement (MOA) or letter of commitment (LOC) with partners who will contribute substantially to this project. Within a month prior to the anticipated start date of awards, applicants may be asked to provide LOCs (or MOAs if available) from the partners identified in the proposal. If awarded, a signed MOA representative of the collaborative partnership is required within 60 days of the award date. The MOA(s) should be signed by all partners and include specific roles, responsibilities, resources, and contributions of partner(s) to the project.

b. Participate in OHCA registry and describe the state/territorial/tribal epidemiology of cardiac arrest by race and ethnicity and other related factors using OHCA registry data

OMH expects funded projects to participate actively in an OHCA registry using standard data collection tools and data infrastructure by the end of Year 1. Projects are allowed and are encouraged to work with existing OHCA registries across the country.

The selected OHCA registry system should have the following standard features:

• A secure web database with restricted access for authorized users

• A protocol for ensuring access for authorized users that must include EMS professionals, hospital/healthcare organization staff, state/territorial/tribal/local governmental agency staff, and 911 dispatchers

• Capability of linking to multiple data sources to create a single de-identified registry for OHCA events

• Data management system that is fully HIPAA compliant to protect confidentiality

• Standardized race and ethnicity data collection consistent with HHS implementation guidance for reporting race and ethnicity10

• Ability for all authorized users to access data for comparison against benchmarks

• Reporting capability at the state/territorial/tribal/local levels

• Longitudinal tracking of performance indicators

• Capacity for public health organizations to identify areas of elevated disease burden using data mapping in order to improve quality of care

• Platform for assessing intervention implementation based on identification of service gaps and/or disparities

OMH expects successful applicants to implement a standardized data collection infrastructure capable of receiving data from multiple sources (e.g., 911 dispatch centers, EMS providers and receiving hospitals) and including a reporting mechanism (to include annual reports); coordinate OHCA data collection and entry by the partners into an OHCA registry; and develop and implement a protocol to analyze registry data to identify areas of elevated disease burden in need of interventions to improve health outcomes. OMH expects successful applicants to examine OHCA registry data by the end of Year 2 of the project period and describe the state/territorial/tribal epidemiology of cardiac arrest by race and ethnicity, including the identification of OHCA disparities, areas of elevated disease burden, service gaps and its relation to policy development.

c. Implement evidence-informed interventions to improve cardiac arrest survival rates based on the epidemiology of cardiac arrest

By the end of Year 2 of the project period, OMH expects funded projects to implement one or more of the following evidence-informed interventions in areas of elevated disease burden, based on the epidemiology of cardiac arrest resulting from data collected through the OHCA registry. The following evidence-informed interventions have resulted in positive outcomes in states that have implemented an OHCA registry and used data analysis to inform the distribution of resources.

• Standardization of telecommunicator Cardiopulmonary Resuscitation (CPR)

• Increasing rates of CPR training in communities disproportionately impacted by

OHCA

• High performance CPR training for first responders

• Improving automated external defibrillator (AED) accessibility/utilization

d. Implement a process and outcomes evaluation and develop a plan to sustain evidence-informed interventions that significantly improve health outcomes of individuals who experience OHCA

OMH expects funded projects to implement a process/implementation and outcomes evaluation to assess the impact of project activities. OMH expects project outcomes to address:

• The extent to which the project resulted in representative OHCA data from multiple sources (e.g., 911 dispatch centers, EMS providers and receiving hospitals);

• Whether OHCA registry data identifies disparities, including racial and ethnic health disparities and areas of elevated disease burden, for which evidence-informed interventions can be designed and implemented to address; and

• The extent to which evidence-informed interventions (e.g., increased bystander-initiated CPR, increased reporting to the OHCA registry, or increased telephone CPR training rates) are implemented in the second year of the grant.

By the end of Year 1, OMH expects funded projects to develop a sustainability plan to support continued implementation of the OHCA registry and evidence-informed interventions after funding ends. Applicants may submit preliminary sustainability plans with intent to update over the period of the grant to address the requirements and goals of the Reducing Cardiac Arrest

Disparities Through Data Registries Initiative.

The sustainability plan should include:

• Key activities, milestones, responsible staff, and resources for implementing the project activities;

• Engagement of key stakeholders/partners in the development of the sustainability plan;

and

• A scalable model for using OHCA registry data to implement evidence-based interventions in at-risk communities.

C. AUTHORITY

Section 1707 of the Public Health Service Act (42 U.S.C. § 300u-6)

D. FEDERAL AWARD INFORMATION

The Office of Minority Health intends to make funds available for competing grant awards.

We will fund awards in annual increments (budget periods) and generally for a project period up to 2 years, although we may approve shorter project periods. Budget periods may also vary from the estimate indicated below due to timing of award issuance or other administrative factors.

Funding for all approved budget periods beyond the first is generally level with the initial award amount and is contingent upon the availability of funds, satisfactory progress of the project, adequate stewardship of Federal funds, and the best interests of the Government.

Award Information

Estimated Federal Funds Available: $250,000

Anticipated Number of Awards: 3 to 5

Award Ceiling (Federal Funds including indirect costs): $70,000 per budget period

Award Floor (Federal Funds including indirect costs): $50,000 per budget period

Anticipated Start Date: September 30, 2020

Estimated Period of Performance: Not to exceed 2 years

Anticipated Initial Budget Period Length: 12 months

Type of Award: Grant

Type of Application Accepted: Electronic via Grants.gov ONLY unless an exemption is granted

E. ELIGIBILITY INFORMATION

1. Eligible Applicants.

• State Governments

• County Governments

• City or township governments

• Special district governments

• Independent school districts

• Public and State controlled institutions of higher education

• Native American tribal governments (Federally recognized)

• Public Housing authorities/Indian housing authorities

• Native American tribal organizations (other than federally recognized tribal governments)

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

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

• Private non-profit institutions of higher education

• U.S. Territories

2. Cost Sharing or Matching

You are not required to provide cost sharing or matching in your proposed budget.

3. Other Eligibility Information

Official documentation that verifies established partnership with a state/territorial/tribal government agency, if the applicant is not such an entity. Examples of such documentation include a signed statement from a state/territorial/tribal level authorizing official (e.g., Governor or tribal president), memoranda of understanding or agreement describing the partnership or a current legal document that establishes a partnership.

4. Application Disqualification Criteria

If you successfully submit an application, we will screen it to ensure it meets the below requirements. If we determine your application fails to meet the criteria described below we will disqualify it, that is, we will not review it and will give it no further consideration.

a. You must submit your application electronically via www.grants.gov

(unless an exemption was granted 2 business days prior to the deadline) by the date and time indicated in the DATES section (A.1) of this announcement.

b. If you successfully submit multiple applications from the same organization for the same project, we will only review the last application received by the deadline.

c. HHS/OASH/OGM deems your application eligible according to section E.1 Eligible Applicants.

d. You must complete the required forms in the application package: SF-

424, SF-424A, SF-424B, SF-LLL, and Project Abstract Summary.

e. Your Project Narrative section of the application must be double-spaced, on the equivalent of 8 ½ ” x 11” inch page size, with 1” margins on all sides (top, bottom, left and right) and font size not less than 12 points.

f. Your Project Narrative must not exceed 50 pages. NOTE: The following items do not count toward the Project Narrative page limit:

http://www.grants.gov/ all required forms, including SF-424, SF-424A, SF-424B, SF-LLL, Project Abstract Summary, and Budget Narrative (including budget tables).

g. Your total application, including the Project Narrative plus

Appendices, must not exceed 75 pages. NOTE: items listed in “(f)” immediately above do not count toward total page limit.

h. Your Federal funds request including indirect costs must not exceed the maximum indicated in Award Ceiling.

i. Your Federal funds request including indirect costs must not be below the minimum indicated in Award Floor

F. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

You may obtain an application package electronically by accessing Grants.gov at http://www.grants.gov/. You can find it by searching on the CFDA number shown on page 2 of this funding opportunity announcement. If you have problems accessing the application or difficulty downloading, contact:

OASH Grants & Acquisitions Management

Phone: 240-453-8822

Email: OASH_Grants@hhs.gov

2. Content and Form of Application Submission

a. Application Format

Your application must be prepared using the forms and information provided in the online application package.

The Project Narrative, and total application including appendices, must adhere to the page limit indicated in Application Disqualification Criteria listed in Section E.4. The page limit does not include the Budget Narrative (including budget tables), required forms, assurances, and certifications as described in the Application Disqualification Criteria. Please do not number pages or include a table of contents. Our grants management system will generate page numbers once your application is complete. If your application exceeds the specified page limits for the Project

Narrative or Project Narrative plus Appendices when printed on 8.5” X 11” paper by

HHS/OASH/GAM, we will not review it. We recommend you print out your application before submitting electronically to ensure that it is within the page limits and is easy to read.

You must double-space the Project Narrative pages.

You should use an easily readable typeface, such as Times New Roman or Arial. You must use 12-point font. You may single-space tables or use alternate fonts but you must ensure the tables are easy to read.

b. Appendices Format

Your appendices should include any specific documents outlined in Section F.3.c, under the heading “Appendices” in the Application Content section of this funding opportunity announcement. Your documents should be easy to read. You should use the same formatting specified for the Project Narrative. However, documents such as résumés/CVs, organizational charts, tables, or letters of commitment may use formatting common to those documents, but the pages must be easy to read. All of your appendices must be uploaded as a single, consolidated file in the Attachments section of your Grants.gov application.

c. Project Abstract Summary Format

You must complete the Project Abstract Summary form provided in the application package. The abstract will be used to provide reviewers with an overview of the application and will form the basis for the application summary in grants management and program summary documents. If your project is funded, HHS may publish information from your form; therefore, do not include sensitive or proprietary information.

d. Budget Narrative Format

The Budget Narrative should use the formatting required of the Project Narrative for the explanatory text. Budget tables may be single-spaced but should be laid out in an easily-readable format and within the printable margins of the page.

3. Application Content

Successful applications will contain the following information:

a. Project Narrative Content

The Project Narrative is the most important part of the application, since it will be used as the primary basis to determine whether your project meets the minimum requirements for an award under this announcement. The Project Narrative should provide a clear and concise description of your project. HHS/OASH recommends that your project narrative include the following components: 1) Problem Statement; 2) Goals, Objectives, and Outcomes; 3) Proposed

Intervention; 4) Populations Srerved and Organizations; 5) Evaluation Plan; and 6) Organizational

Capacity.

1) Problem Statement

You should describe in this section, in both quantitative and qualitative terms, the nature and scope of the specific and particular problem or issue (including health disparities), the proposed intervention(s) it is designed to address, and the geographic area(s) of focus. You should clearly describe the need for an OHCA data registry, and demonstrate that the proposed project is not duplicating any existing efforts in the geographic area(s) of focus to implement an OHCA data registry. Describe the population(s) of focus, including demographic characteristics and prevalence of OHCA and risk factors. You should detail how the project will potentially affect the populations served, specific subgroups within those populations, and other interested stakeholders as identified.

We recommend that you focus your problem statement on the specific aspects of the history, existing literature, current status, and policy considerations bearing on the program area, and the roles of the national, state, territorial, tribal and local agencies responsible for their operation, rather than providing a broad or sweeping historical overview that is not directly related to the proposed interventions and activities.

2) Goals, Objectives and Outcomes

You should describe in this section your project’s proposed goal(s) and major objectives.

We recommend you describe objectives that are Specific, Measurable, Achievable, Relevant and

Time-Oriented (SMART). For Example: By June 30, 2021, provide training for 20 EMS providers and hospital administrators in the use of OHCA registry reporting system. You should clearly state the expected outcome(s) that will result from your project for: 1) implementing state/territorial/tribal-level processes for contributing to an OHCA data registry, to include data collection on a) emergency cardiac care by EMS and b) outcomes through hospital discharge; (2) describing the State/territorial/tribal epidemiology of cardiac arrest by race and ethnicity; (3) implementing evidence-informed interventions to improve cardiac arrest survival rates based on the epidemiology of cardiac arrest; and (4) enhancing the capacity of state, territorial and tribal health agencies to sustain the implementation of the OHCA registry and evidence-informed interventions that significantly improve health outcomes of individuals who experience OHCA.

HHS/OASH will not fund any project that does not include measurable outcomes. In addition to discussion in the narrative, you should describe how you envision the project will benefit the field at large.

A “measurable outcome” is an observable end-result that describes how a particular intervention benefits program participants. It demonstrates the “impact” of the intervention. For example, a change in a client’s financial, health, and/or functional status; mental well-being;

knowledge; skill; attitude; awareness; or behavior. It can also describe a change in the degree to which participants exercise choice over the types of services they receive, or whether they are satisfied with the way a service is delivered. Additional examples include: a change in the responsiveness or cost-effectiveness of a service delivery system; a new model of support or care that can be replicated; new knowledge; a measurable increase in community awareness; or a measurable increase in persons receiving services. A measurable outcome is not a measurable output, such as: the number of clients served; the number of training sessions held; or the number of service units provided.

3) Proposed Intervention

You should provide a clear and concise description of the OHCA data registry system that you are proposing to use to address the program goals and objectives and the problem described in the “Problem Statement.” You should explain the rationale for using a particular OHCA registry system, and describe how the proposed registry system meets the system requirements outlined in

Section 2.b

Your proposal should detail the nature of the activities to be undertaken, how they address system gaps and identified issues, and how they will assist in achieving the overall project goals and objectives. You should clarify why these specific activities were selected (i.e., has this approach been successful in other settings? Does the research suggest this direction?). Describe your approach for implementing a standardized data collection infrastructure capable of receiving data from multiple sources (e.g., 911 dispatch centers, EMS providers and receiving hospitals) and including a reporting mechanism (to include annual reports); coordinating OHCA data collection and entry by the partners into an OHCA registry; and developing and implementing a protocol to analyze registry data to identify areas of elevated disease burden in need of interventions to improve health outcomes. Describe your approach for identifying and selecting evidence-based interventions to implement, based on analysis of the OHCA registry data. Describe your approach for developing a sustainability plan, including implementation resources, engagement of key stakeholders/partners and a scalable model for using OHCA registry data to implement evidence-based interventions in at-risk communities. Provide specifics about the activities, expected outcomes and barriers for all anticipated years of the award. Also note how your project will be able to overcome those barriers.

Provide a two year project work plan which should describe, at a minimum, how you will:

a. Implement state/territorial/tribal-level processes for contributing to an

OHCA data registry, to include data collection on a) emergency cardiac care by EMS and b) outcomes through hospital discharge;

b. Participate in OHCA registry and describe the state/territorial/tribal epidemiology of cardiac arrest by race and ethnicity and other related factors using OHCA registry data from the OHCA registry;

c. Implement evidence-informed interventions to improve cardiac arrest survival rates based on the epidemiology of cardiac arrest, in particular among racial/ethnic minority and disadvantaged populations; and

d. Implement a process and outcomes evaluation and develop a plan to sustain evidence-informed interventions that significantly improve health outcomes of individuals who experience OHCA.

4) Populations Served and Organizations

You should describe how you plan to involve community-based organizations in a meaningful way in the planning and implementation of the proposed project. You should also describe how your proposed project, including evidence informed intervention(s), will serve racial/ethnic minority and disadvantaged populations. Describe how you will use the National

CLAS Standards to ensure the proposed project will be implemented in a culturally appropriate manner tailored to the population(s) of focus. Additionally, this section should outline who you consider vested stakeholders in the project, how they were/will be identified, and how they will be meaningfully incorporated into the project.

5) Evaluation Plan

You should describe the methods you will use to evaluate whether or not the proposed intervention achieves its measurable outcome(s) and assess and evaluate the impact of activities you propose. You should describe how you will measure and report on the outcomes of the project.

You should describe the quantitative and qualitative tools and techniques that you will employ to measure the outcome(s) and how you will identify and document the “lessons learned.” Describe how you will evaluate the quality of the implementation of the National CLAS Standards through process and outcome measures.

6) Organizational Capacity

You should describe your organization’s capability to successfully implement the proposed project. You should describe how your agency (or the particular division of a larger agency which will have responsibility for this project) is organized, the nature and scope of its work, and the capabilities it possesses. You should describe current data collection activities and history of collecting EMS data and capacity, including data reporting in the NEMSIS. Your description should cover capabilities of the applicant agency not included elsewhere in the program narrative, such as any current or previous relevant experience and/or the record of the project team in preparing cogent and useful reports, publications, and other products. If appropriate, include an organization chart in your Appendices showing the relationship of the project to the current organization.

You should describe who will serve as key personnel (including the Principal

Investigator/Project Director and Data Coordinator, as outlined in Section 2: Program Description) and how proposed key personnel have demonstrated experience and are qualified to serve in the role. Provide a position description for the individual responsible for collecting and managing

EMS data, and who will be responsible for collecting and coordinating OHCA data and entering it into the OHCA data registry. You should describe the expertise of each key personnel in the field of cardiac arrest data collection. If the Data Coordinator position does not currently exist or is vacant, you should provide a position description for this key personnel position and your plans to fill this role. You should describe the extent of your and any proposed partner’s knowledge of and experience with cultural competence and the National Standards for Culturally and

Linguistically Appropriate Services in Health and Health Care (National CLAS Standards)

(https://www.thinkculturalhealth.hhs.gov/Content/clas.asp). Also include information about any contractual and/or supportive staff/organization(s) that will have a secondary role(s) in implementing the project and achieving project goals.

You should describe the collaborative partnership which will support project activities.

You should describe the role and makeup of partners intended to be involved in completing specific tasks, including state/territorial/tribal and local health agencies, EMS agencies/organizations and hospitals/health care organizations. Describe partners' experience of collecting and reporting EMS data and cardiac health data from regional, state, and local systems of care and emergency management systems. Describe the anticipated level of effort and responsibilities of each partner in completing programmatic activities.

b. Budget Narrative Content

Project budget calculations must include estimation methods, quantities, unit costs, and other similar quantitative detail sufficient to verify the calculations. If matching or cost sharing is required, you must include a detailed listing of any funding sources identified in box 18 of the SF-

424 (Application for Federal Assistance).

Please be sure to carefully review section A.7 Funding Restrictions for specific information regarding allowable, unallowable, and restricted costs.

You must provide an object class category budget using Section B, box 6 of the SF 424A for the first year of the proposed project. Provide a budget justification, which includes explanatory text and line-item detail, for the first year of the proposed project. The budget narrative should https://www.thinkculturalhealth.hhs.gov/Content/clas.asp describe how the categorical costs are derived. Discuss the necessity, reasonableness, and allocation of the proposed costs.

For subsequent budget years, provide a summary narrative and line item budget. For categories or items that differ significantly from the first budget year, provide a detailed justification explaining these changes. Note, do not include costs beyond the first budget year in the object class budget in box 6 of the SF- 424A or box 18 of the SF-424; the amounts entered in these sections should only reflect the first budget year.

Your budget narrative should justify the overall cost of the project as well as the proposed cost per activity, service delivered, and/or product. For example, the budget narrative should define the amount of work you have planned and expect to perform, what it will cost, and an explanation of how the result is cost effective. For example, if you are proposing to provide services to clients, you should describe how many clients are you expecting to serve, the unit cost of serving each client, and how this is cost effective.

Use the following guidelines for preparing the detailed object class budget required by box

6 of the SF-424A. The object class budget organizes your proposed costs into a set of defined categories outlined below. Both federal and non-federal resources (when required) must be detailed and justified in the budget narrative. "Federal resources" refers only to the HHS/OASH funds for which you are applying. "Non-federal resources" are all other non-HHS/OASH federal and non-federal resources. We recommend you present budget amounts and computations in a columnar format: first column, object class categories; second column, federal funds requested;

third column, non-federal resources; and last column, total budget.

Sample Budget Table Object Class Federal Funds

Requested Non-federal Resources

Total Budget

Personnel $100,000 $25,000 $125,000

Note, subrecipient/contract and consultant detailed costs should all be included in those specific line items, not in the overall project object class line items, i.e., subrecipient travel should be included in the Contractual line item not in Travel.

Object Class Descriptions and Required Justifications

(a) Personnel Description

Costs of staff salaries and wages, excluding benefits.

(b) Personnel Justification

Clearly identify the project director or principal investigator, if known at the time of application. Provide a separate table for personnel costs detailing for each proposed staff person:

the title; full name (if known at time of application), time commitment to the project as a percentage or full-time equivalent: annual salary and/or annual wage rate; federally funded award salary; non-federal award salary, if applicable; and total salary. No salary rate may exceed the statutory limitation in effect at the time you submit your application (see D.6 Funding Restrictions, Salary Rate Limitation for details). Do not include the costs of consultants, personnel costs of delegate agencies, or of specific project(s) and/or businesses to be financed by the applicant.

Contractors and consultants should not be placed under this category.

Sample Personnel Table Position Title and Full Name

Percent Time Annual Salary Federally-funded Salary

Non-federal Salary

Total Project Salary

Project Director, John K. Doe

50% $100,000 $50,000 $0 $50,000

Data Assistant, Susan R. Smith

10% $30,000 $3,000 $3,000

(c) Fringe Benefits Description

Costs of employee fringe benefits unless treated as part of an approved indirect cost rate.

(d) Fringe Benefits Justification:

Provide a breakdown of the amounts and percentages that comprise fringe benefit costs such as health insurance, Federal Insurance Contributions Act (FICA) taxes, retirement insurance, and taxes.

(e) Travel Description

Costs of travel by staff of the applicant organization only.

(f) Travel Justification

For each trip proposed for applicant organization staff only, show the date of the proposed travel, total number of traveler(s); travel destination; duration of trip; per diem; mileage allowances, if privately owned vehicles will be used; and other transportation costs and subsistence allowances. Do not include travel costs for subrecipients or contractors.

(g) Equipment Description

Equipment means tangible personal property (including information technology systems) having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level established by the non-Federal entity for financial statement purposes, or $5,000. (Note: Acquisition cost means the cost of the asset including the cost to ready the asset for its intended use. Acquisition cost for equipment, for example, means the net invoice price of the equipment, including the cost of any modifications, attachments, accessories, or auxiliary apparatus necessary to make it usable for the purpose for which it is acquired. Acquisition costs for software includes those development costs capitalized in accordance with generally accepted accounting principles (GAAP). Ancillary charges, such as taxes, duty, protective in transit insurance, freight, and installation may be included in or excluded from the acquisition cost in accordance with the non- Federal entity’s regular accounting practices.) See 45 C.F.R. § 75.2 for additional information.

(h) Equipment Justification

For each type of equipment requested you must provide a description of the equipment; the cost per unit; the number of units; the total cost; and a plan for use of the equipment in the project;

as well as a plan for the use, and/or disposal of, the equipment after the project ends. An applicant organization that uses its own definition for equipment should provide a copy of its policy, or section of its policy, that includes the equipment definition; include this with your Budget

Narrative file. Reference the policy in this justification and include the policy copy in your Budget

Narrative file (not your appendices).

(i) Supplies Description

Costs of all tangible personal property other than those included under the Equipment category. This includes office and other consumable supplies with a per-unit cost of less than

$5,000.

(j) Supplies Justification

Specify general categories of supplies and their costs. Show computations and provide other information that supports the amount requested.

(k) Contractual Description

Costs of all contracts or subawards for services and goods except for those that belong under other categories such as equipment, supplies, construction, etc. Include third-party evaluation contracts, if applicable, and contracts or subawards with subrecipient organizations

(with budget detail), including delegate agencies and specific project(s) and/or businesses to be financed by the applicant. This line item is not for individual consultants.

(l) Contractual Justification

Demonstrate that all procurement transactions will be conducted in a manner to provide, to the maximum extent practical, open, and free competition. Recipients and subrecipients are required to use 45 C.F.R. § 75.329 procedures and must justify any anticipated procurement action that is expected to be awarded without competition and exceeds the simplified acquisition threshold fixed by 41 U.S.C. § 134 and currently set at $250,000. Recipients may be required to make pre-award review and procurement documents, such as requests for proposals or invitations for bids, independent cost estimates, etc., available to HHS/OASH.

Note: Whenever you intend to delegate part of the project to another agency, you must provide a detailed budget and budget narrative for each subrecipient/contractor, by agency title, along with the same supporting information referred to in these instructions. If you plan to select the subrecipients/contractors post-award and a detailed budget is not available at the time of application, you must provide information on the nature of the work to be delegated, the estimated costs, and the process for selecting the delegate agency.

(m) Other Description

Enter the total of all other costs. Such costs, where applicable and appropriate, may include but are not limited to: consultants; insurance; professional services (including audit charges); space and equipment rent; printing and publication; training, such as tuition and stipends; participant support costs including incentives, staff development costs; and any other costs not addressed elsewhere in the budget.

(n) Other Justification

Provide computations, a narrative description, and a justification for each cost under this category.

(o) Indirect Costs Description

Total amount of indirect costs. This category has one of two methods that you may select.

You may only select one.

• Your organization currently has an indirect cost rate approved by the Department of

Health and Human Services (HHS) or another cognizant federal agency. You should enclose a copy of the current approved rate agreement in your Budget Narrative file.

If you request a rate that is less than allowed, your authorized representative must submit a signed acknowledgement that the organization is accepting a lower rate than allowed.

• Per 45 C.F.R. § 75.414(f) Indirect (F&A) costs, “any non-Federal entity [i.e., applicant] that has never received a negotiated indirect cost rate, … may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) which may be used indefinitely.