Office of Urban Indian Health Programs; Announcement Type: Limited Competition, Continuation; Funding Announcement Number: HHS-2011-IHS-UIHP-0001, 9789-9805 [2011-3856]
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Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2009–P–0257]
Determination That Theophylline Oral
Solution, 80 Milligrams/15 Milliliters,
Was Not Withdrawn From Sale for
Reasons of Safety or Effectiveness
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
The Food and Drug
Administration (FDA) has determined
that theophylline oral solution, 80
milligrams (mg)/15 milliliters (mL), was
not withdrawn from sale for reasons of
safety or effectiveness. This
determination will allow FDA to
approve abbreviated new drug
applications (ANDAs) for theophylline
oral solution, 80 mg/15 mL, if all other
legal and regulatory requirements are
met.
SUMMARY:
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FOR FURTHER INFORMATION CONTACT:
Nancy Hayes, Center for Drug
Evaluation and Research, Food and
Drug Administration, 10903 New
Hampshire Ave., Bldg. 51, rm. 6244,
Silver Spring, MD 20993–0002, 301–
796–3601.
SUPPLEMENTARY INFORMATION: In 1984,
Congress enacted the Drug Price
Competition and Patent Term
Restoration Act of 1984 (Pub. L. 98–417)
(the 1984 amendments), which
authorized the approval of duplicate
versions of drug products approved
under an ANDA procedure. ANDA
applicants must, with certain
exceptions, show that the drug for
which they are seeking approval
contains the same active ingredient in
the same strength and dosage form as
the ‘‘listed drug,’’ which is a version of
the drug that was previously approved.
ANDA applicants do not have to repeat
the extensive clinical testing otherwise
necessary to gain approval of a new
drug application (NDA). The only
clinical data required in an ANDA are
data to show that the drug that is the
subject of the ANDA is bioequivalent to
the listed drug.
The 1984 amendments include what
is now section 505(j)(7) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C.
355(j)(7)), which requires FDA to
publish a list of all approved drugs.
FDA publishes this list as part of the
‘‘Approved Drug Products With
Therapeutic Equivalence Evaluations,’’
which is generally known as the
‘‘Orange Book.’’ Under FDA regulations,
drugs are removed from the list if the
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Agency withdraws or suspends
approval of the drug’s NDA or ANDA
for reasons of safety or effectiveness or
if FDA determines that the listed drug
was withdrawn from sale for reasons of
safety or effectiveness (21 CFR 314.162).
Under § 314.161(a)(1) (21 CFR
314.161(a)(1)), the Agency must
determine whether a listed drug was
withdrawn from sale for reasons of
safety or effectiveness before an ANDA
that refers to that listed drug may be
approved. FDA may not approve an
ANDA that does not refer to a listed
drug.
Theophylline oral solution, 80 mg/15
mL, is the subject of ANDA 087449,
held by Roxane Laboratories, Inc.
(Roxane), and initially approved on
September 15, 1983. ANDA 087449 was
identified in the Orange Book as the
listed drug for theophylline oral
solution, 80 mg/15 mL.
According to the latest version of the
approved labeling for theophylline oral
solution, 80 mg/15 mL, theophylline is
indicated for the treatment of the
symptoms and reversible airflow
obstruction associated with chronic
asthma and other chronic lung diseases,
such as emphysema and chronic
bronchitis. Roxane notified FDA by
letter dated August 4, 2008, that it was
no longer marketing theophylline oral
solution, 80 mg/15 mL and requested
that ANDA 087449 be withdrawn.
Theophylline oral solution, 80 mg/15
mL was moved to the ‘‘Discontinued
Drug Product List’’ section of the Orange
Book.
Silarx Pharmaceuticals, Inc. (Silarx or
petitioner), submitted a citizen petition
to FDA dated May 29, 2009 (Docket No.
FDA–2009–P–0257), under 21 CFR
10.30, requesting that the Agency accept
an ANDA submitted by Silarx for
theophylline oral solution 80 mg/15 mL,
referencing ANDA 087449 as the listed
drug. FDA cannot approve the
petitioner’s ANDA or any ANDA unless
it first determines whether ANDA
087449 was withdrawn from sale for
reasons of safety or effectiveness.
After considering the citizen petition
and reviewing Agency records, FDA has
determined, under § 314.161, that
theophylline oral solution, 80 mg/15
mL, ANDA 087449, was not withdrawn
from sale for reasons of safety or
effectiveness. The petitioner identified
no data or other information suggesting
that theophylline oral solution, 80 mg/
15 mL, was withdrawn from sale for
reasons of safety or effectiveness. We
have carefully reviewed our files for
records concerning the withdrawal of
theophylline oral solution, 80 mg/15
mL, from sale. We have also
independently evaluated relevant
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9789
literature and data for possible
postmarketing adverse events and have
found no information that would
indicate that this product was
withdrawn from sale for reasons of
safety or effectiveness.
Accordingly, the Agency will
continue to list theophylline oral
solution, 80 mg/15 mL, in the
‘‘Discontinued Drug Product List’’
section of the Orange Book. The
‘‘Discontinued Drug Product List’’
delineates, among other items, drug
products that have been discontinued
from marketing for reasons other than
safety or effectiveness. ANDAs that refer
to theophylline oral solution, 80 mg/15
mL, may be approved by the Agency if
they meet all other legal and regulatory
requirements for the approval of
ANDAs. If FDA determines that labeling
for this drug product should be revised
to meet current standards, the Agency
will advise ANDA applicants to submit
such labeling.
Dated: February 15, 2011.
Leslie Kux,
Acting Assistant Commissioner for Policy.
[FR Doc. 2011–3784 Filed 2–18–11; 8:45 am]
BILLING CODE 4160–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Indian Health Service
Office of Urban Indian Health
Programs; Announcement Type:
Limited Competition, Continuation;
Funding Announcement Number:
HHS–2011–IHS–UIHP–0001
Catalogue of Federal Domestic Assistance
Number: 93.193
Key Dates: Application Deadline Date:
March 23, 2011.
Review Period: April 25–27, 2011.
Earliest Anticipated Start Date: May
16, 2011.
I. Funding Opportunity Description
Statutory Authority
The Indian Health Service (IHS),
Office of Urban Indian Health Programs
(OUIHP), announces the FY 2011
limited competition, continuation grants
for continued operation support for the
4-in-1 Title V grants to make health care
services more accessible for American
Indians and Alaska Natives (AI/AN)
residing in urban areas. This program is
authorized under the authority of the
Snyder Act, 25 U.S.C. 1652, 1653, 1660a
of Title V of the Indian Health Care
Improvement Act (IHCIA), Public Law
94–437, as amended.
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This program is described at 93.193 in the
Catalog of Federal Domestic Assistance
(CFDA).
Background
Prior to the 1950s, most AI/ANs
resided on reservations, in nearby rural
towns, or in Tribal jurisdictional areas
such as Oklahoma. In the era of the
1950s and 1960s, the Federal
Government passed legislation to
terminate its legal obligations to the
Indian Tribes, resulting in policies and
programs to assimilate Indian people
into the mainstream of American
society. This philosophy produced the
Bureau of Indian Affairs (BIA)
Relocation/Employment Assistance
Programs (BIA Relocation) which
enticed Indian families living on
impoverished Indian Reservations to
‘‘relocate’’ to various cities across the
country, i.e., San Francisco, Los
Angeles, Chicago, Salt Lake City,
Phoenix, etc. BIA Relocation offered job
training and placement, and was viewed
by Indians as a way to escape poverty
on the reservation. Health care was
usually provided for six months through
the private sector, unless the family was
relocated to a city near a reservation
with an IHS facility service area, such
as Rapid City, Phoenix, and
Albuquerque. Eligibility for IHS was not
forfeited due to Federal Government
relocation.
The American Indian and Policy
Review Commission found that in the
1950s and 1960s, the BIA relocated over
160,000 AI/ANs to selected urban
centers across the country. Today, over
61 percent of all AI/ANs identified in
the 2010 census reside off-reservation.
In the late 1960s, urban Indian
community leaders began advocating at
the local, State and Federal levels for
culturally appropriate health programs
addressing the unique social, cultural
and health needs of AI/ANs residing in
urban settings. These community-based
grassroots efforts resulted in programs
targeting health and outreach services to
the urban Indian community. Programs
that were developed at that time were in
many cases staffed by volunteers,
offering outreach and referral-type
services, and maintaining programs in
storefront settings with limited budgets
and primary care services.
In response to efforts of the urban
Indian community leaders in the 1960s,
Congress appropriated funds in 1966,
through the IHS, for a pilot urban clinic
in Rapid City. In 1973, Congress
appropriated funds to study the unmet
urban Indian health needs in
Minneapolis. The findings of this study
documented cultural, economic, and
access barriers to health care and
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resulted in Congressional
appropriations under the Snyder Act to
support emerging Urban Indian clinics
in several BIA relocation cities, i.e.,
Seattle, San Francisco, Tulsa, and
Dallas.
The awareness of poor health status of
all Indian people continued to grow,
and in 1976, Congress passed the Indian
Health Care Improvement Act (IHCIA),
Public Law 94–437, establishing the
Urban Indian Health Program under
Title V. Congress reauthorized the
IHCIA in 2010 under Public Law 111–
148 (2010). This law is considered
health care reform legislation to
improve the health and well-being of all
AI/ANs, including urban Indians. Title
V specific funding is authorized for the
development of programs for AI/ANs
residing in urban areas. Since passage of
this legislation, amendments to Title V
provided resources to and expanded
Urban Indian Health Programs in the
areas of direct medical services, alcohol
services, mental health services, human
immunodeficiency virus (HIV) services,
and health promotion—disease
prevention services.
Purpose
Under this grant opportunity, the IHS
proposes to award grants to 34 Urban
Indian Health Programs (UIHP), which
are Urban Indian organizations that
have existing IHS contracts, in
accordance with 25 U.S.C. 1653(c)–(e),
1660a. This grant announcement seeks
to ensure the highest possible health
status for AI/ANs. Funding will be used
to continue the 34 urban Indian
organizations’ successful
implementation of the priorities of the
Department of Health and Human
Services (HHS), Strategic Plan Fiscal
Years 2007–2012, Healthy People 2020,
and the IHS Strategic Plan 2006–2011.
Additionally, funding will be utilized to
meet objectives for Government
Performance Rating Act (GPRA)
reporting, collaborative activities with
the Veterans Health Administration
(VA), and four health programs that
make health services more accessible to
AI/ANs living in urban areas. The four
health services programs are: (1) Health
Promotion/Disease Prevention (HP/DP)
services, (2) Immunizations, and
Behavioral Health Services consisting of
(3) Alcohol/Substance Abuse services,
and (4) Mental Health Prevention and
Treatment services. These programs are
integral components of the IHS
improvement in patient care initiative
and the strategic objectives focused on
improving safety, quality, affordability,
and accessibility of health care.
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II. Award Information
Type of Awards—Limited
Competition, Continuation Grants
Estimated Funds Available—The total
amount of funding identified for the
current fiscal year (FY) 2011 is
approximately $8 million. Competing
and continuation awards issued under
this announcement are subject to the
availability of funds. In the absence of
funding, the Agency is under no
obligation to make awards funded under
this announcement.
Anticipated Number of Awards—
Approximately 34 grants will be issued
under this program announcement.
Project Period—Five year award.
April 1, 2011—March 31, 2016.
Award Amount—$135,289 to
$612,893, subject to the availability of
congressional appropriations.
III. Eligibility Information
1. Eligibility
Competition is limited to those urban
Indian organizations currently
contracted under Title V of the IHCIA.
It is legislatively mandated that the
urban Indian organization must have a
Title V contract in place to be eligible
to apply for a Title V grant. 25 U.S.C.
1653(c)–(e), 1660a. Urban Indian
organizations are defined by 25 U.S.C.
1603(29) as a non-profit corporate body
situated in an urban center, governed by
an urban Indian controlled board of
directors, and providing for the
maximum participation of all interested
Indian groups and individuals, which
body is capable of legally cooperating
with other public and private entities
for the purpose of performing the
activities described in 25 U.S.C. 1653(a).
25 U.S.C. 1603(29). Each organization
must provide proof of non-profit status
with the application, including a copy
of the 501 (c)(3) Certificate.
2. Cost Sharing or Matching
This program does not require
matching funds or cost sharing.
3. Other Requirements
If the application budget exceeds the
stated dollar amount that is outlined
within this announcement, it will not be
considered for funding.
IV. Application and Submission
Information
1. Obtaining Application Materials
The Applicant package and
instructions may be located at
Grants.gov (https://www.grants.gov) or at:
https://www.ihs.gov/
NonMedicalPrograms/gogp/
gogp_funding.asp.
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Information regarding the electronic
application process may be directed to
Paul Gettys at (301) 443–2114.
2. Content and Form of Application
Submission
The application must include the
project narrative as an attachment to the
application package.
Mandatory documents for all
applications include:
• Application forms:
Æ SF–424.
Æ SF–424A.
Æ SF–424B.
• Budget Narrative (must be single
spaced).
• Project Narrative (must not exceed
twenty-five pages).
• 501(c)(3) Certificate.
• Biographical sketches of all Key
Personnel.
• Disclosure of Lobbying Activities
(SF–LLL) (if applicable), https://www.
whitehouse.gov/sites/default/
files/omb/grants/sflllin.pdf.
• Documentation of current OMB
A–133 required Financial Audits.
Acceptable forms of documentation
include:
Æ E-mail confirmation from the
Federal Audit Clearinghouse (FAC) that
audits were submitted; or
Æ Face sheets from audit reports.
These can be found on the FAC Web
site: https://harvester.census.gov/fac/
dissem/accessoptions.html?submit
=Retrieve+Records
Public Policy Requirements
All Federal wide public policies
apply to IHS grants with exception of
the Discrimination policy.
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Requirements for Project and Budget
Narratives
A. Project Narrative: This narrative
should be a separate Word document
that is no longer than 25 pages with
consecutively numbered pages. Be sure
to place all responses and required
information in the correct section or
they will not be considered or scored. If
the narrative exceeds the page limit,
only the first 25 pages will be reviewed.
The narrative consists of three parts:
Part A—Program Information; Part B—
Program Planning and Evaluation; and
Part C—Program Report. See below for
additional details about what must be
included in the narrative.
Part A: Program Information
Section 1: Needs
Part B: Program Planning and
Evaluation
Section 1: Program Plans
Section 2: Program Evaluation
Part C: Program Report
Section 1: Describe Major
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Accomplishments for the Last 9
Months, From April 1, 2010–
December 31, 2010
Section 2: Describe Major Activities
Planned for the Next 12 Months,
Beginning April 1, 2011
B. Budget Narrative: This narrative
must describe the budget requested and
match the scope of work described in
the project narrative. The page
limitation should not exceed three
pages.
3. Submission Dates and Times
Applications must be submitted
electronically through Grants.gov by
March 23, 2011 at 12 midnight Eastern
Standard Time (EST). Any application
received after the application deadline
will not be accepted for processing, and
it will be returned to the applicant(s)
without further consideration for
funding.
If technical challenges arise and the
Urban Indian Health Organization
(UIHP) is unable to successfully
complete the electronic application
process, contact Grants.gov Customer
Service Support via e-mail to
support@Grants.gov or phone at (800)
518–4726. Customer Support is
available to address questions 24 hours
a day, 7 days a week (except Federal
holidays). If problems persist, contact
Paul Gettys, Division of Grants
Management (DGM),
Paul.gettys@ihs.gov at (301) 443–5204.
Please be sure to contact Mr. Gettys at
least ten days prior to the application
deadline. Please do not contact the DGM
until you have received a Grants.gov
tracking number. In the event you are
not able to obtain a tracking number,
call the DGM as soon as possible.
If an applicant needs to submit a
paper application instead of submitting
electronically via Grants.gov, prior
approval must be requested and
obtained (see page 11 for additional
information). The waiver must be
documented in writing (e-mails are
acceptable), before submitting a paper
application. A copy of the written
approval must be submitted along with
the hardcopy that is mailed to the DGM
(Refer to Section IV to obtain mailing
address). Paper applications that are
submitted without a waiver will be
returned to the applicant without
review or further consideration. The
application must be postmarked by
March 23, 2011. Applications received
after this date will not be accepted for
processing, will be returned to the
applicant, and will not be considered
for funding.
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4. Intergovernmental Review
Executive Order 12372 requiring
intergovernmental review is not
applicable to this program.
5. Funding Restrictions
• Pre-award costs are allowable
pending prior approval from the
awarding agency. However, in
accordance with 45 CFR Part 74, all preaward costs are incurred at the
recipient’s risk. The awarding office is
under no obligation to reimburse such
costs if for any reason the UIHOs do not
receive an award or if the award to the
recipient is less than anticipated;
• The available funds are inclusive of
direct and appropriate indirect costs;
• Only one grant/cooperative
agreement will be awarded per
applicant; and
• IHS will not acknowledge receipt of
applications.
6. Electronic Submission Requirements
Use the https://www.Grants.gov Web
site to submit an application
electronically and select the ‘‘Find Grant
Opportunities’’ link on the homepage.
Download a copy of the application
package, complete it offline, and then
upload and submit the application via
the Grants.gov Web site. Electronic
copies of the application may not be
submitted as attachments to e-mail
messages addressed to IHS employees or
offices.
Applicants that receive a waiver to
submit paper application documents
must follow the rules and timelines that
are noted below. The applicant must
seek assistance at least ten days prior to
the application deadline.
Applicants that do not adhere to the
timelines for Central Contractor Registry
(CCR) and/or Grants.gov registration
and/or request timely assistance with
technical issues will not be considered
for a waiver to submit a paper
application.
Please be aware of the following:
• Please search for the application
package in Grants.gov by entering the
CFDA number or the Funding
Opportunity Number. Both numbers are
located in the header of this
announcement.
• Paper applications are not the
preferred method for submitting
applications. However, if you
experience technical challenges while
submitting your application
electronically, please contact Grants.gov
Support directly at: https://
www.Grants.gov/CustomerSupport or
(800) 518–4726. Customer Support is
available to address questions 24 hours
a day, 7 days a week (except on Federal
holidays).
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• Upon contacting Grants.gov, obtain
a tracking number as proof of contact.
The tracking number is helpful if there
are technical issues that cannot be
resolved and waiver from the agency
must be obtained.
• If it is determined that a waiver is
needed, you must submit a request in
writing (e-mails are acceptable) to
GrantsPolicy@ihs.gov with a copy to
Tammy.Bagley@ihs.gov. Please include
a clear justification for the need to
deviate from our standard electronic
submission process.
• If the waiver is approved, the
application should be sent directly to
the DGM with a postmark of no later
than March 23, 2011.
Division of Grants Management,
Indian Health Service, 801 Thompson
Avenue, TMP 360, Rockville, MD
20852.
• Applicants are strongly encouraged
not to wait until the deadline date to
begin the application process through
Grants.gov as the registration process for
CCR and Grants.gov could take up to
fifteen working days.
• Please use the optional attachment
feature in Grants.gov to attach
additional documentation that may be
requested by the DGM.
• All applicants must comply with
any page limitation requirements
described in this Funding
Announcement.
• After you electronically submit
your application, you will receive an
automatic acknowledgment from
Grants.gov that contains a Grants.gov
tracking number. The DGM will
download your application from
Grants.gov and provide necessary copies
to the appropriate agency officials.
Neither the DGM nor the OUIHP will
notify applicants that the application
has been received.
E-mail applications will not be
accepted under this announcement.
Dun and Bradstreet (D&B) Data
Universal Numbering Systems (DUNS)
All IHS applicants and grantee
organizations are required to obtain a
DUNS number and maintain an active
registration in the CCR database.
Additionally, all IHS grantees must
notify potential first-tier sub-recipients
that no entity may receive a first-tier
sub-award unless the entity has
provided its DUNS number to the prime
grantee organization. These
requirements will ensure use of a
universal identifier to enhance the
quality of information available to the
public when recipients begin on
October 1, 2010 to report information on
sub-awards, as required by the Federal
Funding Accountability and
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Transparency Act (FFATA) of 2006, as
amended (‘‘the Transparency Act’’). The
DUNS number is a unique nine digit
identification number provided by D&B,
which uniquely identifies your entity.
The DUNS number is site specific;
therefore each distinct performance site
may be assigned a DUNS number.
Obtaining a DUNS number is easy and
there is no charge. To obtain a DUNS
number, you may access it through the
following Web site https://
fedgov.dnb.com/webform or to expedite
the process call (866) 705–5711.
Central Contractor Registry (CCR)
Organizations that have not registered
with CCR will need to obtain a DUNS
number first and then access the CCR
online registration through the CCR
home page at https://www.bpn.gov/ccr/
default.aspx (U.S. organizations will
also need to provide an Employer
Identification Number from the Internal
Revenue Service that may take an
additional 2–5 weeks to become active).
Completing and submitting the
registration takes approximately one
hour to finish and your CCR registration
will take 3–5 business days to process.
Registration with the CCR is free of
charge. Applicants may register online
at https://www.ccr.gov.
Additional information on
implementing FFATA, including the
specific requirements for—DUNS, CCR,
can be found on the IHS Grants Policy
Web site: https://www.ihs.gov/
NonMedicalPrograms/gogp/
index.cfm?module=gogp_policy_topics
• CATEGORICAL BUDGET AND
BUDGET JUSTIFICATION (5 Points)
A. PROJECT NARRATIVE:
UNDERSTANDING OF THE NEED AND
NECESSARY CAPACITY (30 points)
1. Facility Capability
Urban Indian programs provide health
care services within the context of the
HHS Strategic Plan, Fiscal Years 2007–
2012; the IHS Strategic Plan 2006–2011,
and four IHS priorities.
Describe the UIHP: (1) Current budget
period performance April 1, 2010–
December 31, 2010 accomplishments
and (2) define activities planned for the
2011 continuation budget period April
1, 2011–March 31, 2012 budget period
in each of the following areas:
a. IHS Priorities for American Indian/
Alaska Native Health Care
Current governmental trends and
environmental issues impact AI/ANs
residing in urban locations and require
clear and consistent support by the Title
V funded UIHP. The IHS Web site is
https://www.ihs.gov.
(1) Renew and Strengthen
Partnerships with Tribes and the UIHPs:
The UIHPs have a hybrid relationship
with the IHS. With the passage of Public
Law 111–148, the Indian Health Care
Improvement Act was made permanent.
• Identify what the UIHP is doing to
strengthen its partnerships with Tribes
and other UIHPs.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned, including
V. Application Review Information
information on how results are shared
with the community.
1. Evaluation Criteria
c. List the top ten Tribes who
The instructions for preparing the
members are seen by the program.
application narrative also constitute the
(2) Bring Health Care Reform to the
evaluation criteria for reviewing the
UIHPs: In order to support health care
application.
reform, it must be demonstrated there is
The narrative should address program a willingness to change and improve,
progress for the 12 months continuation i.e., in human resources and business
budget period activities, April 1, 2011
practices.
through March 31, 2012.
• Describe activities the UIHP is
The narrative should be written in a
taking to ensure health care reform is
manner that is clear to outside reviewers being applied.
unfamiliar with prior related activities
a. April 1, 2010–December 31, 2010
of the UIHP. It should be well
accomplishments.
organized, succinct, and contain all
b. April 1, 2011–March 31, 2012
information necessary for reviewers to
activities planned.
fully understand the project.
(3) Improve the Quality of and Access
Points assigned for the criteria are as
to Care: Customer service is the key to
follows:
quality care. Treating patients well is
• UNDERSTANDING OF THE NEED
the first step to improving quality and
AND NECESSARY CAPACITY (30
access. This area also incorporates Best
Points)
Practices in customer service.
• WORK PLANS (40 Points)
• Identify activities that demonstrate
• PROJECT EVALUATION (15 Points) the UIHP improving quality of and
• ORGANIZATIONAL
access to care.
a. April 1, 2010–December 31, 2010
CAPABILITIES AND QUALIFICATIONS
accomplishments.
(10 Points)
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b. April 1, 2011–March 31, 2012
activities planned.
(4) Ensure all UIHP work is
Transparent, Accountable, Fair, and
Inclusive: Quality health care needs to
be transparent, with all parties held
accountable for that care. Accountability
for services is emphasized.
• Describe activities that demonstrate
how this is implemented in the UIHP
program.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned.
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b. HHS Priorities for Health Care
Current governmental trends and
environmental issues impact AI/ANs
residing in urban locations and require
clear and consistent support by the Title
V funded UIHP.
1. Health Care Value Incentives: The
growth of health care costs is restrained
because consumers know the
comparative costs and quality of their
health care—and they have a financial
incentive to care.
• Identify what the UIHP is doing to
help its consumers gain control of their
health care and have the knowledge to
make informed health care decisions.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned, including
information on how clinical quality data
is shared with consumers and the
community.
2. Health Information Technology:
The medical clipboard is becoming a
thing of the past. Secure interoperable
electronic records are available to
patients and their doctors anytime,
anywhere.
• Describe activities the UIHP is
taking to ensure immediate access to
accurate information to reduce
dangerous medical errors and help
control health care costs.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned.
3. Medicare Rx: Every senior has
access to affordable prescription drugs.
Consumers will inspire plans to provide
better benefits at lower costs. Medicare
Part D is streamlined and improved to
better connect people with their
benefits. Pay for Performance
methodologies act to increase health
care quality.
• Identify activities the UIHP is
taking to implement Medicare Rx.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned.
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4. Personalized Health Care: Health
care is tailored to the individual.
Prevention is emphasized. Propensities
for disease are identified and addressed
through preemptive intervention.
• Describe activities that demonstrate
how this is implemented in the UIHP
program.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–March 31, 2012
activities planned.
5. Obesity Prevention: The risk of
many diseases and health conditions are
reduced through actions that prevent
obesity. A culture of wellness deters or
diminishes debilitating and costly
health events. Individual health care is
built on a foundation of responsibility
for personal wellness.
• Describe activities that demonstrate
how the UIHP program is implementing
this priority.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–December 31, 2012
activities planned.
6. Tobacco Cessation: The only
proven strategies to reduce the risks of
tobacco-caused disease are preventing
initiation, facilitating cessation, and
eliminating exposure to secondhand
smoke.
• Describe activities that demonstrate
how the UIHP is implementing this
priority.
a. April 1, 2010–December 31, 2010
accomplishments.
b. April 1, 2011–December 31, 2012
activities planned.
7. Pandemic Preparedness: The
United States is better prepared for an
influenza pandemic. Rapid vaccine
production capacity is increased,
national stockpiles and distribution
systems are in place, disease monitoring
and communication systems are
expanded and local preparedness
encompasses all levels of government
and society.
• Describe activities that demonstrate
how the UIHP is prepared and identify
changes, if any, made to the UIHP
pandemic preparedness plan.
8. Emergency Response: We have
learned from the past and are better
prepared for the future. There is an ethic
of preparedness at the urban program
and throughout the Nation.
• Describe activities that demonstrate
how the UIHP is prepared and identify
changes, if any, made to the UIHP
emergency preparedness plan.
9. Hours of Operation Ensure Access
to Care
• Identify the urban program hours of
operation and provide assurance that
services are available and accessible at
times that meet the needs of the urban
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9793
Indian population, including
arrangements that assure access to care
when the UIHP is closed.
c. UIHP Collaboration With the
Veteran’s Health Administration (VA)
In 2007, the UIHPs contacted their
local VA Veterans Integrated Services
Network and established agreements to
collaborate at the local level to expand
opportunities to enhance access to
health services and improve the quality
of health care of AI/AN veterans.
1. Report April 1, 2010–December 31,
2010 results/outcomes of the
collaborative activities implemented or
explored between your UIHP and your
local area VA. Include number of
patients who used VA services, number
of visits made, and types of healthcare
services provided.
2. Identify areas of collaboration and
activities that will be conducted
between your UIHP and your local area
VA for continuation budget period April
1, 2011–March 31, 2012.
d. GPRA Reporting
All UIHPs report on IHS GPRA
clinical performance measures. This is
required of both urban facilities using
the Resource and Patient Management
System (RPMS) and facilities not using
RPMS. RPMS users must use the
Clinical Reporting System (CRS) for
reporting, and non-RPMS users must
develop a bridge to transfer data from
their current data system to RPMS for
CRS reporting. Questions related to
GPRA reporting may be directed to the
IHS Area Office GPRA Coordinator, or
Danielle Steward, Health Systems
Specialist, OUIHP,
danielle.steward@ihs.gov
The 2012 GPRA Report Period is July
1, 2011 through June 30, 2012. The
GPRA measures to report for 2012 will
include the 20 GPRA measures reported
for 2010.
Note that the target rates for FY 2011
GPRA are not currently available. They
will be provided in calendar year 2011.
1. During the continuation budget
period, April 1, 2011–March 31, 2012,
the following GPRA measures are
priority focus areas for target
achievement: (#1) Diabetes: Ideal
Glycemic Control: Proportion of patients
with diagnosed diabetes with ideal
glycemic control (A1c < 7.0) achieve
2011 and 2012 target rates. (#4)
Diabetes: Blood Pressure Control:
Proportion of patients with diagnosed
diabetes that have achieved blood
pressure control (< 130/80) achieve 2011
and 2012 target rates. (#9) Cancer
Screening: Colorectal Rates: Proportion
of eligible patients who have had
appropriate colorectal cancer screening.
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Briefly describe the steps/activities you
will take to ensure your program meets
the 2011 target rates for these measures.
2. Significant increases to the
measurement targets of (#16) Domestic
Violence/Intimate Partner Violence
Screening, (#17) Depression Screening,
and (#12) Mammography Screening will
occur in the 2011 GPRA year. Describe
at least two actions you will complete
to meet the 2011 desired performance
outcomes/results. For programs using
RPMS, a Performance Improvement
Toolbox is available on the CRS Web
site at https://www.ihs.gov/cio/crs_
performance_improvementtoolbox.asp
3. GPRA Behavioral Health
performance measures include alcohol
screening, Fetal Alcohol Syndrome
(FAS) prevention, domestic (intimate
partner) violence screening, depression
screening, HIV/AIDS screening and
suicide surveillance. Describe actions
you will take to improve 2011–2012
desired behavioral health performance
outcomes/results.
4. Document your ability to collect
and report on the required performance
measures to meet GPRA requirements.
Include information about your health
information technology system.
FY 2011 GPRA Measures
1. Diabetes DX Ever (not a GPRA
measure, used for context only).
2. Documented A1c (not a GPRA
measure, used for context only).
3. Poor Glycemic Control.
4. Ideal Glycemic Control.
5. Controlled Blood Pressure.
6. Dyslipidemia (LDL) Assessment.
7. Nephropathy Assessment.
8. Influenza 65 years old +.
9. Pneumovax 65 years old +.
10. Childhood Immunizations.
11. Pap Smear Rates.
12. Mammography Rates.
13. Colorectal Cancer Rates.
14. Tobacco Cessation.
15. Alcohol Screening (FAS
Prevention).
16. Domestic Violence/Intimate
Partner Violence Screening.
17. Depression Screening.
18. Prenatal HIV Screening.
19. Childhood Weight Control.
20. Suicide Surveillance.
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e. Schedule of Charges and
Maximization of Third Party Payments
1. Describe the UIHP established
schedule of charges and consistency
with local prevailing rates.
• If the UIHP is not currently billing
for billable services, describe the
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process the UIHP will take to begin
third party billing to maximize
collections.
2. Describe how reimbursement is
maximized from Medicare, Medicaid,
State Children’s Health Insurance
Program, private insurance, etc.
3. Describe how the UIHP achieves
cost effectiveness in its billing
operations with a brief description of
the following:
a. Establishes appropriate eligibility
determination.
b. Reviews/updates and implements
up-to-date billing and collection
practices.
c. Updates insurance at every visit.
d. Maintains procedures to evaluate
necessity of services.
e. Identifies and describes financial
information systems used to track,
analyze and report on the program’s
financial status by revenue generation,
by source, aged accounts receivable,
provider productivity, and encounters
by payor category.
f. Indicates the date the UIHP last
reviewed and updated its Billing
Policies and Procedures.
B. Program Planning: Work Plans (40
Points)
A program narrative and a program
specific work plan are required for each
health services program: (1) Health
Promotion/Disease Prevention, (2)
Immunizations, (3) Alcohol/Substance
Abuse, and (4) Mental Health. Title V of
the IHCIA, Public Law 94–437, as
amended, identifies eligibility for health
services as follows.
Each grantee shall provide health care
services to eligible Urban Indians living
within the urban service area. An
‘‘Urban Indian’’ eligible for services, as
codified at 25 U.S.C. 1603(13), (27), (28),
includes any individual who:
(1) Resides in an urban center, which
is any community that has a sufficient
urban Indian population with unmet
health needs to warrant assistance
under Title V, as determined by the
Secretary, HHS; and who
(2) Meets one or more of the following
criteria:
(A) Irrespective of whether he or she
lives on or near a reservation, is a
member of a Tribe, band, or other
organized group of Indians, including:
(i) Those Tribes, bands, or groups
terminated since 1940, and (ii) those
recognized now or in the future by the
State in which they reside; or
(B) Is a descendant, in the first or
second degree, of any such member
described in (A); or
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(C) Is an Eskimo or Aleut or other
Alaska Native; or
(D) Is the descendant of an Indian
who was residing in the State of
California on June 1, 1852, so long as
the descendant is now living in said
State; or 1
(E) Is considered by the Secretary of
the Department of the Interior to be an
Indian for any purpose; or
(F) Is determined to be an Indian
under regulations pertaining to the
Urban Indian Health Program that are
promulgated by the Secretary, HHS.
1 Eligibility of California Indians may
be demonstrated by documentation that
the individual:
(1) Holds trust interests in public
domain, national forest, or Indian
reservation allotments; or
(2) Is listed on the plans for
distribution of assets of California
Rancherias and reservations under the
Act of August 18, 1958 (72 Stat. 619), or
is the descendant of such an individual.
Each grantee is responsible for taking
reasonable steps to confirm that the
individual is eligible for IHS services as
an urban Indian.
Program Narratives and Workplans
(1) HP/DP
Program Narrative and Work Plan
Contact your IHS Area Office HP/DP
Coordinator to discuss and identify
effective and innovative strategies to
promote health and enhance prevention
efforts to address chronic diseases and
conditions. Identify one or more of the
strategies you will conduct during
budget period April 1, 2011—March 31,
2012.
1. Applicants are encouraged to use
evidence-based and promising strategies
which can be found at the IHS best
practice database at https://www.ihs.gov/
hpdp/and the National Registry for
Effective Programs at https://
modelprograms.samhsa.gov/
2. Program Narrative. Provide a brief
description of the collaboration
activities that: (1) Were accomplished
April 1, 2010–December 31, 2010, and
(2) are planned and will be conducted
between your UIHP and the IHS Area
Office HP/DP Coordinator during the
budget period April 1, 2011 through
March 31, 2012.
3. An example of an HP/DP work plan
is provided on the following pages.
Develop and attach a copy of the UIHP
HP/DP Work Plan for April 1, 2011
through March 31, 2012.
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SAMPLE 2011 HP/DP WORK PLAN
Objectives
Activities/time line
Person responsible
Evaluation
Goal: To address physical inactivity and consumption of unhealthy food among youth who are in the 4th to 6th grade in the Watson, Kennedy,
Blackwood, and Rocky Hill Elementary schools.
1. Develop school policies to address
physical inactivity and consumption
of unhealthy foods in the first year
of the funding year.
2. Implement a classroom nutrition
curriculum to increase awareness
about the importance of healthier
foods.
3. Implement physical activity in at
least four schools for grades 4th to
6th in first year of the funding.
1. Schedule a meeting with the
school health board in the first
quarter of the project.
2. Establish a parent advisory committee to assist with the development of the policy in 2nd quarter.
1. Design pre/post test survey and
pilot test with group of students
by 2nd quarter.
Program Coordinator .........
School Administrator .........
Progress report on status of policy
and documentation of number of
participants in parent advisory
committee, and number of meetings held.
Program Coordinator .........
IHS Nutritionist ..................
Pre/post knowledge, attitude, and
behavior survey.
2. Schedule a meeting with the
School Principal to discuss dates
of program implementation by 3rd
quarter.
3. Implement the ‘‘Healthy Eating’’
curriculum, a 6-week program in
the 2nd quarter.
4. Collect pre/post survey at beginning and end of the program to
assess changes.
1. Contract with SPARK PE to train
classroom teachers to implement
SPARK PE in the school by 3rd
Quarter.
2. Train volunteers to administer
FITNESSGRAM to collect baseline data and post data to assess
changes.
............................................
............................................
............................................
Program Coordinator .........
School Counselor and PE
teacher.
1. Training evaluation and number
of participants.
............................................
2. Pre/post FITNESSGRAM Data.
Tobacco Coordinator .........
Documentation of the number of
participants.
Tobacco Coordinator .........
Health Educator ................
Documentation of the number of
participants.
............................................
Documentation of whether the policy was established.
Tobacco Coordinator .........
Health Educator ................
Pharmacist ........................
Progress toward timeline.
Tobacco Coordinator .........
Health Educator ................
Progress report indicating timeline
is being met.
Tobacco Coordinator .........
Number of brochures distributed.
Goal: To reduce tobacco use among residents of community X and Y.
1. Establish a tobacco-free policy in
the schools and Tribal buildings by
year 1.
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2. Coordinate and establish tobacco
cessation programs with the local
hospitals and clinics.
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1. Schedule a meeting with the
Tribal Council and school board
to increase awareness of the
health effects of tobacco by June
2010.
2. Schedule and conduct tobacco
awareness education in the community, schools, and worksites by
July 2010 through September
2010.
3. Draft a policy and present to the
Tribal Council for approval by
January 2011.
1. Partner with the American Cancer Association and the Tribal
Health Education Coordinators to
establish 8-week tobacco cessation programs by July 2010.
2. Meet with the hospital/clinic administrators and pharmacist to
discuss and develop a behaviorbased tobacco cessation program.
3. Design and disseminate brochures and flyers of the tobacco
cessation programs that are available in the community and clinic.
4. Meet with nursing and medical
provider staff to increase patient
referral to tobacco cessation program.
5. Implement the 8-week tobacco
cessation program at the community X and Y clinic.
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Health Educator
Tobacco Coordinator .........
Tobacco Coordinator
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RPMS data—baseline # of referrals,
# of participants who completed
program, # who quit tobacco.
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(2) Immunization Services
Program Narrative and Work Plan
1. Program Management Required
Activities.
A. Provide assurance that your facility
is participating in the Vaccines for
Children program.
B. Provide assurance that your facility
has look up capability with State/
regional immunization registry (where
applicable). Please contact Amy Groom,
Immunization Program Manager at
amy.groom@ihs.gov or (505) 248–4374
for more information.
2. Service Delivery Required
Activities—For Sites using RPMS.
A. Provide trainings to providers and
data entry clerks on the RPMS
Immunization package.
B. Establish process for immunization
data entry into RPMS (e.g., point of
service or through regular data entry).
C. Utilize RPMS Immunization
package to identify 3–27 month old
children who are not up to date and
generate reminder/recall letters.
3. Immunization Coverage
Assessment Required Activities.
A. Submit quarterly immunization
reports to Area Immunization
Coordinator for the 3–27 month old,
Two year old and Adolescent and
influenza reports. Sites not using the
RPMS Immunization package should
submit a Two Year old immunization
coverage report—an Excel spreadsheet
with the required data elements that can
be found under the ‘‘Report Forms for
non-RPMS sites’’ section at: https://
www.ihs.gov/Epi/
index.cfm?module=epi_vaccine_reports.
4. Program Evaluation Required
Activities.
A. Establish baseline for coverage
with the 431331* and 4313314**
vaccine series for children 19–35
months old.
B. Establish baseline for coverage with
influenza vaccine for adults 65 years
and older.
C. Establish baseline for coverage with
at least one dose of pneumococcal
vaccine for adults 65 years and older.
D. Establish baseline coverage for
patients (all ages) who received at least
one dose of seasonal flu vaccine during
flu season.
* The 4:3:1:3:3:1 vaccine series is
defined as: = 4 doses diphtheria and
tetanus toxoids and pertussis vaccine,
diphtheria and tetanus toxoids, or
diphtheria and tetanus toxoids and any
pertussis vaccine, = 3 doses of oral or
inactivated polio vaccine, = 1 dose of
measles, mumps, and rubella vaccine,
= 3 doses of Haemophilus influenzae
type b vaccine, = 3 doses of hepatitis B
vaccine, and, = 1 of varicella vaccine.
** The 4:3:1:3:3:1:4 vaccine series
includes the 4:3:1:3:3:1 series outlined
above, +4 or more doses of
pneumococcal conjugate vaccine (PCV).
SAMPLE URBAN GRANT FY 2012 WORK PLAN IMMUNIZATION
Primary prevention objective
Protect children and communities from vaccine
preventable diseases.
Service or program
Immunization
program.
Target population
Process measure
Children <3
years.
Outcome measures
On a quarterly basis:
# of children 3–27 months old.
As of June 30th 2012:
# of children 3–27 months old who are
children up to date with age appropriate vaccinations.
% of 3–27 month old children up to date
with age appropriate vaccinations.
Protect adolescents and
communities from vaccine preventable diseases.
Immunization
program.
Adolescents 13–
17 years.
# of children 19–35 months old.
# of children 19–35 months old who received the 431331 and 4313314 vaccine series.
# of children 19–35 months old who received the 431331 and 4313314 vaccine series.
On a quarterly basis:
# of adolescents 13–17 years old.
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# of adolescents 13–17 years old who
are up to date with Tdap, Tdap/Td,
Meningococcal, and 1, 2 and 3 dose of
HPV (females only).
% of adolescents 13–17 years old who
are up to date with Tdap, Tdap/Td,
Meningococcal, and 1, 2 and 3 dose of
HPV (females only).
Protect adults and communities from influenza.
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All ages ............
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On a quarterly basis during flu season
(e.g., Sept–June)
# of patients (all ages).
# of patients who received a seasonal flu
shot during the flu season.
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% of 19–35 month olds up to
date with the 431331 and
4313314 vaccine series.
As of June 30th 2012:
% of adolescents 13–17 years
old who are up to date with
Tdap.
% of adolescents 13–17 years
old who are up to date with
Tdap, females only.
# of adolescents 13–17 years old
who are up to date with
Meningococcal vaccine.
# of adolescents 13–17 years old
who are up to date with 1, 2
and 3 dose of HPV (females
only).
As of June 30th, 2012:
# of patients who received a seasonal flu shot during the flu
season.
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9797
SAMPLE URBAN GRANT FY 2012 WORK PLAN IMMUNIZATION—Continued
Primary prevention objective
Service or program
Target population
Immunization
program.
Adults >65
years.
Outcome measures
% of patients who received a seasonal flu
shot during flu season.
Protect adults and communities from influenza
& Pneumovax.
Process measure
% of patients who received a
seasonal flu shot during the flu
season.
As of June 30th, 2012:
On a quarterly basis:
# of adults 65+ years.
# of adults 65+ years who received an influenza shot during flu season.
# of adults 65+ years who received a
pneumovax shot.
% of adults 65+ years who received an
influenza shot during flu season.
% of adults 65+ years who received a
pneumovax shot..
(3) Alcohol/Substance Abuse
Program Narrative and Work Plan
1. Program Progress Report or Results/
Outcomes for April 1, 2010–December
31, 2010.
A. Briefly address the extent to which
the program was able to achieve its
objectives and demonstrate effective use
of funding for April 1, 2010–December
31, 2010.
B. Include quantifiable and qualitative
information and describe the
relationship to the UDS data submitted
for calendar year 2009.
C. Identify Specific Program Services
Outcomes/Results:
• State the number of patient
encounters (or specific service) per
provider staff for this program service,
• List populations and age groups
that were targeted (homeless, women,
youth, elders, men, etc.), and
• Identify specific outcomes/results
that were measured in addition to the
number of patient encounters/staff (and
not included in the UDS).
2. Narrative Description of Program
Services for April 1, 2011–March 31,
2012 Continuation Budget Period.
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A. Program Objectives
1. Clearly state the outcomes of the
health service.
2. Define needs related outcomes of
the program health care service.
3. Define who is going to do what,
when, how much, and how you will
measure it.
4. Define the population to be served
and provide specific numbers regarding
the number of eligible clients for whom
services will be provided.
5. State the time by which the
objectives will be met.
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6. Describe objectives in numerical
terms—specify the number of clients
that will receive services.
7. Describe how achievement of the
goals will produce meaningful and
relevant results (e.g., increase access,
availability, prevention, outreach, preservices, treatment, and/or
intervention).
8. Provide a one-year work plan that
will include the primary objectives,
services or program, target population,
process measures, outcome measures,
and data source for measures (see work
plan sample in Appendix 2).
a. Identify Services Provided: Primary
Residential; Detox; Halfway House;
Counseling; Outreach and Referral; and
Other (Specify).
b. Number of beds: Residential l ,
Detoxl ; or Halfway House l.
c. Average monthly utilization for the
past year.
d. Identify Program Type: Integrated
Behavioral Health; Alcohol and
Substance Abuse only; Stand Alone; or
part of a health center or medical
establishment.
9. Address methamphetamine-related
contacts:
a. Identify the documented number of
patient contacts during the April 1,
2010–December 31, 2010 budget period,
and estimate the number patient
contacts during the continuation budget
period, April 1, 2011–March 31, 2012.
b. Describe your formal
methamphetamine prevention and
education program efforts to reduce the
prevalence of methamphetamine abuse
related problems through increased
outreach, education, prevention and
treatment of methamphetamine-related
issues.
c. Describe collaborative programming
with other agencies to coordinate
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% of adults 65+ years who received an influenza shot Sept.
1, 2010–June 30, 2011.
% of adults 65+ years who received a pneumovax shot ever
medical, social, educational, and legal
efforts.
B. Program Activities
1. Clearly describe the program
activities or steps that will be taken to
achieve the desired outcomes/results.
Describe who will provide (program,
staff) what services (modality, type,
intensity, duration), to whom
(individual characteristics), and in what
context (system, community).
2. State reasons for selection of
activities.
3. Describe sequence of activities.
4. Describe program staffing in
relation to number of clients to be
served.
5. Identify number of Full Time
Equivalents (FTEs) proposed and
adequacy of this number:
• Percentage of FTEs funded by IHS
grant funding; and
• Describe clients and client
selection.
6. Address the comprehensive nature
of services offered in this program
service area.
7. Describe and support any unusual
features of the program services, or
extraordinary social and community
involvement.
8. Present a reasonable scope of
activities that can be accomplished
within the time allotted for program and
program resources.
C. Accreditation and Practice Model
• Name of Program Accreditation
• Type of evidence-based practice
• Type of practice-based model
D. Attach the Alcohol/Substance Abuse
Work Plan.
IHS Urban Grant FY 2011 Work Plan
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ALCOHOL/SUBSTANCE ABUSE PROGRAM SAMPLE WORK PLAN
Objectives
What are you trying to
accomplish?
Service or program
Target population
What type of program
do you propose?
Process measure
Outcome measures
Data source for measures
Who do you hope to
serve in your program?
What information will you
collect about the program
activities?
What information will
you collect to find out
the results of your program?
Where will you find the information you collect?
# of youth completing
the curriculum, # of
sessions conducted, # of staff
trained.
# of youth completing
community-based
sessions, # of parents completing
community- based
sessions, # of community-based sessions.
# of clients completing
program, # of relapse prevention
sessions, # of family and group therapies, # of drug education sessions, #
of self-help groups,
# of urine tests.
Incidence/prevalence Medical records, RPMS
of substance
behavioral health
abuse/dependence.
package, National
Youth Survey.
To prevent substance
abuse among
urban American Indian youth.
Community-based
substance abuse
prevention curriculum.
American Indian
youth ages 5–18
years old.
To prevent substance
abuse and related
problems.
Afterschool, summer,
and weekend activities (e.g. outdoor experiential
activities, camps,
classroom based
problem solving
activities).
Matrix model for outpatient treatment.
American Indian
youth ages 5–14
years old.
Reduce drug use and
increase treatment
retention.
(4) MENTAL HEALTH SERVICES
Program Narrative and Work Plan
American Indian
adult methamphetamine clients.
Use the alcohol/substance abuse
program narrative description template
to develop the Mental Health Services
Incidence of substance abuse, incidence of negative
and positive attitudes and behaviors, incidence of
peer drug use.
Charts, RPMS behavioral health package,
National Youth Survey.
Incidence of drug
use, increase or
decrease in treatment retention,
positive or negative urine samples.
Medical records, RPMS
behavioral health
package, Addiction
Severity Index, results
of urine tests.
program narrative. Attach the UIHP
Mental Health Services Work Plan.
IHS Urban Grant FY 2011 Work Plan
MENTAL HEALTH PROGRAM SAMPLE WORK PLAN
Objectives
Service or program
Target population
Process measure
Outcome measures
Data source for measures
Where will you find the information you collect?
What type of program
do you propose?
Who do you hope to
serve in your program?
What information will you
collect about the program
activities?
What information will
you collect to find out
the results of your program?
To promote mental
health.
American Indian Life
Skills Development
curriculum.
American Indian
youth ages 13–17
years old.
Feelings of hopelessness, problem
solving skills.
Medical records, RPMS
behavioral health
package, Beck Hopelessness Scale, problem solving skills.
Improve the mental
health of American
Indian children and
their families.
Home-based, community-based, and
office-based mental health counseling.
American Indian children and their families needing services from our community-based program.
# of youth completing
the curriculum, # of
sessions conducted, # of teachers trained, number
of community resource leaders
trained.
# of individual, couples, group, and
family counseling
sessions, # of
home, community,
and office-based
visits.
Medical records, RPMS
behavioral health
package coping skill
measure, report
cards, attendance
records.
Reduce symptoms related to trauma.
Mental health counAmerican Indian
seling with cogadults.
nitive behavioral
therapy intervention and historical
trauma intervention.
Reduced child involvement in juvenile justice and
child welfare, improved coping
skills, improved
school attendance
and grades.
Incidence of PostTraumatic Stress
Disorder (PTSD)
symptoms, incidence of depression, increased
coping skills, increased peer and
family support.
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What are you trying to
accomplish?
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# of individual, couples, group, and
family counseling
sessions, # of historical trauma
groups, # of adults
counseled.
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Self-report PTSD, Beck
Depression Inventory,
coping skills measure,
peer and family support measure, medical
records, RPMS behavioral health package.
Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
RPMS Suicide Reporting Form
Instructions for Completing
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This form is intended as a data collection
tool only. It does not replace documentation
of clinical care in the medical record and it
is not a referral form. The provider should
complete a corresponding RPMS Patient Care
Components (PCC) or MH/SS encounter form
and update the PCC and/or BH problem lists
accordingly. Health Record Number, Date of
Act and Provider Name are required fields.
If the information requested is not known or
not listed as an option, choose ‘‘Unknown’’ or
‘‘Other’’ (with specification) as appropriate.
LOCAL CASE NUMBER:
Indicate internal tracking number if used, not
required.
DATE FORM COMPLETED:
Indicate the date the Suicide Reporting Form
was completed.
PROVIDER NAME:
Record the name of Provider completing the
form.
DATE OF ACT:
Record Date of Act as mm/dd/yy. If exact day
is unknown, use the month, 1st day of the
month (or another default day), year. If exact
date of act is unknown, all providers should
use the same default day of the month.
HEALTH RECORD NUMBER:
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Record the patient’s health record number.
DOB/AGE:
Record Date of Birth as mm/dd/yy and
patient’s age.
SEX:
Indicate Male or Female.
COMMUNITY WHERE ACT OCCURRED:
Record the community code or the name,
county and state of the community where the
act occurred.
EMPLOYMENT STATUS:
Indicate patient’s employment status, choose
one.
RELATIONSHIP STATUS:
Indicate patient’s relationship status, choose
one.
EDUCATION:
Select the highest level of education attained
and if less than a High School graduate,
record the highest grade completed. Choose
one.
SUICIDAL BEHAVIOR:
Identify the self destructive act, choose one.
Generally, the threshold for reporting should
be ideation with intent and plan, or other
acts with higher severity, either attempted or
completed.
LOCATION OF ACT:
Indicate location of act, choose one.
PREVIOUS ATTEMPTS:
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Indicate number of previous suicide
attempts, choose one.
METHOD:
Indicate method used. Multiple entries are
allowed, check all that apply. Describe
methods not listed.
SUBSTANCE USE INVOLVED:
If known, indicate which substances the
patient was under the influence of at the time
of the act. Multiple entries allowed, check all
that apply. List drugs not shown.
CONTRIBUTING FACTORS:
Multiple entries allowed, check all that
apply. List contributing factors not shown.
LETHALITY:
Indicate the level of risk (based on type and
location of act, previous number of attempts,
method, substance use involved, contributing
factors and other clinically relevant
information), choose one.
DISPOSITION:
Indicate the type of follow-up planned, if
known.
NARRATIVE:
Record any other relevant clinical
information not included above.
Note: This document should be shredded
after electronic entry into RPMS. updated:
07/16/07
BILLING CODE 4165–16–P
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BILLING CODE 4165–16–C
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Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
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C. PROJECT EVALUATION (15 Points)
1. Describe your evaluation plan. Provide
a plan to determine the degree to which
objectives are met and methods are followed.
2. Describe how you will link program
performance/services to budget expenditures.
Include a discussion of UDS and GPRA
Report Measures here.
3. Include the following program specific
information:
a. Describe the expected feasibility and
reasonable outcomes (e.g., decreased drug
use in those patients receiving services) and
the means by which you determined these
targets or results.
b. Identify dates of reviews by the internal
staff to assess efficacy:
I. Assessment of staff adequacy.
II. Assessment of current position
descriptions.
III. Assessment of impact on local
community.
IV. Involvement of local community.
V. Adequacy of community/governance
board.
VI. Ability to leverage IHS funding to obtain
additional funding.
VII. Additional IHS grants obtained.
VIII. New initiatives planned for funding
year.
IX. Customer satisfaction evaluations.
4. Quality Improvement Committee (QIC).
The UIHP QIC, a planned, organizationwide, interdisciplinary team, systematically
improves program performance as a result of
its findings regarding clinical, administrative
and cost-of-care performance issues, and
actual patient care outcomes including the
GPRA and UDS reports (results of care
including safety of patients).
a. Identify the QIC membership, roles,
functions, and frequency of meetings.
Frequency of meeting shall be at least
quarterly.
b. Describe how the results of the QIC
reviews provide regular feedback to the
program and community/governance board
to improve services.
1. April 1, 2010–December 31, 2010
accomplishments.
2. April 1, 2011–March 31, 2012 activities
planned.
c. Describe how your facility is integrating
the care model into your health delivery
structure:
1. Identify specific measures you are
tracking as part of the Improvements in
Patient Care (IPC) work.
2. Identify community members that are
part of your IPC team.
3. Describe progress meeting your
program’s goals for the use of the IPC model
within your healthcare delivery model.
D. Progress Report: Organizational
Capabilities and Qualifications (10 Points)
This section outlines the broader capacity
of the organization to complete the project
outlined in the continuation application and
program specific work plans. This section
includes the identification of personnel
responsible for completing tasks and the
chain of responsibility for successful
completion of the project outlined in the
work plans.
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1. Describe the organizational structure
with a current approved one page
organizational chart that shows the board of
directors, key personnel, and staffing. Key
positions include the Chief Executive Officer
or Executive Director, Chief Financial
Officer, Medical Director, and Information
Officer.
2. Describe the board of directors that is
fully and legally responsible for operation
and performance of the 501(c)(3) non-profit
urban Indian organization:
a. List all current board members by name,
sex, and Tribe or race/ethnicity.
b. Indicate their board office held.
c. Indicate their occupation or area of
expertise.
d. Indicate if the board member uses the
UIHP services.
e. Indicate if the board member lives in the
health service area.
f. Indicate the number of years of
continuous service.
g. Indicate number of hours of Board of
Directors training provided, training dates
and attach a copy of the Board of Directors
training curriculum.
3. List key personnel who will work on the
project.
a. Identify existing key personnel and new
program staff to be hired.
b. For all new key personnel only include
position descriptions and resumes in the
appendix. Position descriptions should
clearly describe each position and duties
indicating desired qualifications, experience,
and requirements related to the proposed
project and how they will be supervised.
Resumes must indicate that the proposed
staff member is qualified to carry out the
proposed project activities and who will
determine if the work of a contractor is
acceptable.
c. Identify who will be writing the progress
reports.
d. Indicate the percentage of time to be
allocated to this project and identify the
resources used to fund the remainder of the
individual’s salary if personnel are to be only
partially funded by this grant.
E. Categorical Budget and Budget
Justification (5 Points)
This section should provide a clear
estimate of the project program costs and
justification for expenses for the continuation
budget period April 1, 2011–March 31, 2012.
The budget and budget justification should
be consistent with the tasks identified in the
work plan.
1. Categorical Budget (Form SF 424A,
Budget Information Non-Construction
Programs) complete each of the budget
periods requested.
a. Provide a narrative justification for all
costs, explaining why each line item is
necessary or relevant to the proposed project.
Include sufficient details to facilitate the
determination of cost allowability.
b. If indirect costs are claimed, indicate
and apply the current negotiated rate to the
budget. Include a copy of the current rate
agreement in the appendix.
2. Review and Selection
Each application will be prescreened by
the DGM staff for eligibility and
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completeness as outlined in the funding
announcement. Incomplete applications and
applications that are non-responsive to the
eligibility criteria will not be referred to the
Objective Review Committee. Applicants will
be notified by DGM, via letter, to outline the
missing components of the application.
To obtain a minimum score for funding by
the Objective Review Committee, applicants
must address all program requirements and
provide all required documentation.
Applicants that receive less than a minimum
score will be considered to be ‘‘Disapproved’’
and will be informed via e-mail or regular
mail by the IHS Program Office of their
application’s deficiencies. A summary
statement outlining the strengths and
weaknesses of the application will be
provided to each disapproved applicant. The
summary statement will be sent to the
Authorized Organizational Representative
(AOR) that is identified on the face page of
the application within 60 days of the
completion of the Objective Review.
VI. Award Administration Information
1. Award Notices
The Notice of Award (NoA) will be
initiated by DGM and will be mailed via
postal mail to each entity that is approved for
funding under this announcement. The NoA
will be signed by the Grants Management
Officer and this is the authorizing document
for which funds are dispersed to the
approved entities. The NoA will serve as the
official notification of the grant award and
will reflect the amount of Federal funds
awarded, the purpose of the grant, the terms
and conditions of the award, the effective
date of the award, and the budget/project
period. The NoA is the legally binding
document and is signed by an authorized
grants official within the IHS.
2. Administrative Requirements
Grants are administered in accordance
with the following regulations, policies, and
OMB cost principles:
A. The criteria as outlined in this Program
Announcement.
B. Administrative Regulations for Grants:
• 45 CFR Part 92, Uniform Administrative
Requirements for Grants and Cooperative
Agreements to State, Local and Tribal
Governments.
• 45 CFR Part 74, Uniform Administrative
Requirements for Grants and Agreements
with Institutions of Higher Education,
Hospitals, and other Non-profit
Organizations.
C. Grants Policy:
• HHS Grants Policy Statement, Revised
01/07.
D. Cost Principles:
• Title 2: Grant and Agreements, Part
225—Cost Principles for State, Local, and
Indian Tribal Governments (OMB A–87).
• Title 2: Grant and Agreements, Part
230—Cost Principles for Non-Profit
Organizations (OMB Circular A–122).
E. Audit Requirements:
• OMB Circular A–133, Audits of States,
Local Governments, and Non-profit
Organizations.
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Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
3. Indirect Costs
This section applies to all grant recipients
that request reimbursement of indirect costs
in their grant application. In accordance with
HHS Grants Policy Statement, Part II–27, IHS
requires applicants to obtain a current
indirect cost rate agreement prior to award.
The rate agreement must be prepared in
accordance with the applicable cost
principles and guidance as provided by the
cognizant agency or office. A current rate
covers the applicable grant activities under
the current award’s budget period. If the
current rate is not on file with the DGM at
the time of award, the indirect cost portion
of the budget will be restricted. The
restrictions remain in place until the current
rate is provided to the DGM. Generally,
indirect costs rates for IHS grantees are
negotiated with the Division of Cost
Allocation https://rates.psc.gov/ and the
Department of Interior (National Business
Center) https://www.aqd.nbc.gov/services/
ICS.aspx. If your organization has questions
regarding the indirect cost policy, please call
(301) 443–5204 to request assistance.
4. Reporting Requirements
Failure to submit required reports within
the time allowed may result in suspension or
termination of an active agreement,
withholding of additional awards for the
project, or other enforcement actions such as
withholding of payments or converting to the
reimbursement method of payment.
Continued failure to submit required reports
may result in one or both of the following:
(1) The imposition of special award
provisions; and (2) the non-funding or nonaward of other eligible projects or activities.
This applies whether the delinquency is
attributable to the failure of the organization
or the individual responsible for preparation
of the reports.
The reporting requirements for this
program are noted below:
A. Program Progress Report
Program progress reports are required
quarterly. These reports will include a brief
comparison of actual program
accomplishments to the goals established for
the period, reasons for slippage (if
applicable), and other pertinent information
as required. A final program report must be
submitted within 90 days of expiration of the
budget/project period.
B. Financial Status Report
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A quarterly financial status report must be
submitted within 30 days of the end of the
half year. A final financial status report is
due within 90 days of expiration of the
budget period. Standard Form 269 (long
form) will be used for financial reporting.
C. Annual Audit Report
The reports and records of the urban
Indian organization with respect to a contract
or grant under Subchapter IV, 25 U.S.C. 1657
shall be subject to audit by the Secretary and
the Comptroller General of the United States.
The Secretary shall allow as a cost to any
contract or grant entered into under section
1653 of this title the cost of an annual private
audit conducted by a certified public
accountant.
D. GPRA Report
GPRA reports are required quarterly. These
reports are submitted to the IHS Area GPRA
Coordinator. RPMS users must use CRS for
reporting. Non-RPMS users must use the
interface system to transfer data from their
current data system to RPMS for CRS
reporting.
E. Quarterly Immunization Report
Immunization reports are required
quarterly. These reports are submitted to the
IHS Area Immunization Coordinator.
F. Federal Cash Transaction Reports
Federal Cash Transaction Reports are due
every calendar quarter to the Division of
Payment Management, Payment Management
Branch, HHS at: https://www.dpm.gov. Failure
to submit timely reports may cause a
disruption in timely payments to your
organization.
Grantees are responsible and accountable
for accurate reporting of the Progress Reports
and Financial Status Reports which are
generally due annually. Financial Status
Reports (SF–269) are due 90 days after each
budget period and the final SF–269 must be
verified from the grantee records on how the
value was derived.
F. Federal Subaward Reporting System
(FSRS)
This award may be subject to the
Transparency Act subaward and executive
compensation reporting requirements of 2
CFR Part 170. The FFATA ‘‘Transparency
Act’’, requires the OMB to establish a single
searchable database, accessible to the public,
with information on financial assistance
awards made by Federal agencies. The
Transparency Act also includes a
requirement for recipients of Federal grants
to report information about first-tier
subawards and executive compensation
under Federal assistance awards.
Effective as of October 1, 2010, IHS
implemented a Term of Award into all Notice
of Awards issued on/after the date of this
announcement by incorporating it on all IHS
Standard Terms and Conditions. For the full
IHS award term implementing this
requirement and additional award
applicability information see the Grants
Policy Web site at: https://www.ihs.gov/
NonMedicalPrograms/gogp/
index.cfm?module=gogp_policy_topics
Aberdeen Area IHS Office
Janelle Trottier, MSW, LCSW, Aberdeen Area Health Systems Specialist, 115 Fourth Avenue, SE, Rm 309, Aberdeen, SD 57401,
Phone:
(605)
226–7474,
Fax:
(605)
226–7670,
Email:
janelle.trottier@ihs.gov..
Albuquerque Area IHS Office
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Although referenced on all Notices of
Award, the following IHS Term of Award is
applicable to all New (Type 1) IHS grant and
cooperative agreement awards issued on or
after October 1, 2010. Additionally, all IHS
Renewal (Type 2) grant and cooperative
agreement awards and Competing Revision
awards (Competing T–3s) issued on or after
October 1, 2010 may also be subject to the
following award term. Further guidance on
Renewal and Competing Revision awards is
expected to be provided as it becomes
available. Telecommunication for the hearing
impaired is available at: TTY (301) 443–6394.
G. Unmet Needs Report
An unmet needs report is required
quarterly. These reports will include
information gathered to: (1) Identify gaps
between unmet health needs of urban Indians
and the resources available to meet such
needs; and (2) make recommendations to the
Secretary and Federal, State, local, and other
resource agencies on methods of improving
health service programs to meet the needs of
urban Indians.
VII. Agency Contacts
For program-related information:
Phyllis S. Wolfe, Director, Office of Urban
Indian Health Programs, 801 Thompson
Avenue, Suite 200, Rockville, Maryland
20852. (301) 443–4680 or
phyllis.wolfe@ihs.gov.
For general information regarding this
announcement:
Danielle Steward, Health Systems Specialist,
Office of Urban Indian Health Programs,
801 Thompson Avenue, Room 200,
Rockville, MD 20852. (301) 443–4680 or
danielle.steward@ihs.gov.
For specific grant-related and business
management information:
Pallop Chareonvootitam, Grants Management
Specialist, 801 Thompson Avenue, TMP
360, Rockville, MD 20852. (301) 443–5204
or pallop.chareonvootitam@ihs.gov.
Dated: February 7, 2011.
Yvette Roubideaux,
Director, Indian Health Service.
Appendix—Title V Urban Indian Health 4in-1 Grants
1. Indian Health Service Area HP/DP
Coordinators
2. Indian Health Service Behavioral Health
Area Consultants
3. Indian Health Service Area GPRA
Coordinators
4. Indian Health Service/Veterans Health
Administration Area Points of Contact
Indian Health Service Area HP/DP
Coordinators
Alaska Area IHS Office
Margaret David, BS, Alaska Native Tribal Health Consortium, Community Health Services, Office of Alaska Native Health Research, 4000
Ambassador Drive—Floor 4, Anchorage, AK 99508, Phone: (907)
729–3634, Fax: (907) 729–3652, Email: mohdavid@anthc.org.
Bemidji Area IHS Office
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Theresa Clay, MS, 5300 Homestead Road, NE, Division of Clinical
Quality/HPDP, Albuquerque, NM 87110, Phone: (505) 248–4772,
Fax: (505) 248–4257, Email: theresa.clay@ihs.gov..
Billings Area IHS Office
VACANT, 2900 4th Ave. N., P.O. Box 36600, Billings, MT 59107,
Phone: (406) 247–7118, Fax: (406) 247–7231, Email:.
Nashville Area IHS Office
VACANT, 711 Stewarts Ferry Pike, Nashville, TN 37214–2634, Phone:
(615) 467–1628, Fax: (615) 467–1665, Email:.
Oklahoma Area IHS Office
Freda Carpitcher, MPH, Five Corporate Plaza, 3625 NW 56th Street,
Oklahoma City, OK 73112, Phone: (405) 951–3717, Fax: (405) 951–
3916 , Email: freda.carpitcher@ihs.gov..
Portland Area IHS Office
Joe W. Law, BS, 1414 NW Northrup St., Ste. 800, Portland, OR 97209,
Phone:
(503)
414–5597,
Fax:
(503)
414–7795,
Email:
joe.law@ihs.gov.
IHS National Programs Albuquerque
Alberta Becenti, MPH, 5300 Homestead Rd., NE, Albuquerque, NM
87110, Phone: (505) 248–4238, Email: alberta.becenti@ihs.gov.
9803
Michelle Archuleta, MS, 522 Minnesota Ave., NW, Bemidji, MN 56601,
Phone: (218) 444–0492, Fax: (218) 444–0513, Email:
michelle.archuleta@ihs.gov.
California Area IHS Office
Beverly Calderon, RD, MS, CDE, 1320 W. Valley Parkway, Suite 309,
Escondido, CA 92029, Phone: (760) 735–6884, Fax: (760) 735–
6893, Email: beverly.calderon@ihs.gov.
Navajo Area IHS Office
Marie Nelson, BS, Navajo Area Indian Health Service, P.O. Box 9020
(NAIHS Complex), Window Rock, AZ 86515–9020, Phone: (928)
871–1338, Fax: (928) 871–5872, Email: marie.nelson@na.ihs.gov.
Phoenix Area IHS Office
Shannon Beyale, MPH, Phoenix Area Indian Health Service, Two Renaissance Square, 40 North Central Ave., Phoenix AZ 85004, Phone:
(602) 364–5155, Fax: (602) 364–5025, Email: Shannon.beyale@ihs.
gov.
Tucson Area IHS Office
Shawnell Damon, MPH, 7900 South ‘‘J’’ Stock Road, Tucson, AZ
85746–7012, Phone: (520) 295–2492, Fax: (520) 295–2602, Email:
shawnell.damon@ihs.gov.
DIVISION OF BEHAVIORAL HEALTH
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Behavioral Health Area Consultants Point of
Contacts
ABERDEEN:
Vicki Claymore-Lahammer, PhD, (605) 226–7341, vicki.claymorelahammer@ihs.gov.
ALBUQUERQUE:
Christopher Fore, PhD, (505) 248–4444, christopher.fore@ihs.gov
ALASKA:
Kathleen Graves, PhD, (907) 729–4594, kgraves@anmc.org .........
BEMIDJI:
Dawn L. Wylie, MD, MPH, (218) 444–0491, dawn.wylie@ihs.gov ...
BILLINGS:
Susan
Fredericks,
RPH,
MA,
(406)
247–7104,
susan.fredericks@ihs.gov.
Margene
Tower,
R.N.,
M.S.,
(406)
247–7116,
margene.tower@ihs.gov.
CALIFORNIA:
David
Sprenger,
MD,
(916)
930–3981,
Ext.
321,
david.sprenger@ihs.gov.
Dawn M. Phillips, R.N., M.P.A., (916) 930–3981, Ext. 331,
dawn.phillips@ihs.gov.
NASHVILLE:
Palmeda Taylor, PhD, (615) 467–1534, palmeda.taylor@ihs.gov ...
NAVAJO:
Jayne Talk-Sanchez, (505) 368–7420, jayne.talk-sanchez@ihs.gov
OKLAHOMA:
Don Carter, (405) 951–3817, don.carter@ihs.gov ............................
PHOENIX:
David Atkins, LISW, ACSW, (602) 364–5159, david.atkins@ihs.gov
David McIntyre, (602) 364–5183, david.mcintyre@ihs.gov, Mental
Health Consultant.
Linda Westover, LCSW, (602) 364–5157, linda.westover@ihs.gov,
Social Work Consultant.
PORTLAND:
Ann Arnett, (503) 326–2005, Ann.arnett@ihs.gov ............................
TUCSON:
Patricia Nye, MD, LISAC, (520) 295–2469, patricia.nye@ihs.gov ...
HQ STAFF:
Shelly Carter, (301) 443–0226, shelly.carter@ihs.gov .....................
Michele Muir, (301) 443–2040, michele.muir@ihs.gov .....................
Rose Weahkee, PhD, (301) 443–1539, rose.weahkee@ihs.gov .....
Amina Bashir, (301) 443–6581, amina.bashir@ihs.gov ...................
Debbie Black, (301) 443–8028, debbie.black@ihs.gov ....................
Jon Perez, PhD, (301) 281–1777, jon.perez@ihs.gov .....................
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Federal Building, 115 Fourth Avenue, SE., Aberdeen, SD 57401.
5300 Homestead Road, NE., Albuquerque, NM 87110.
4000 Ambassador Drive, Room 443, Anchorage, AK 99508.
522 Minnesota Avenue, Bemidji, MN 56601.
2900 4th Avenue North, Billings, MT 59101.
Do.
650 Capitol Mall, Suite 7–100, Sacramento, CA 95814.
Do.
711 Stewarts Ferry Pike, Nashville, TN 37214.
N. HWY 666, P.O. Box 160, Shiprock, NM 87420.
5 Corporate Plaza, 3625 NW. 56th Street, Oklahoma City, OK 73112.
40 North Central Avenue, Suite 606, Phoenix, AZ 85004.
Do.
Do.
1220 SW. Third Avenue, Room 476, Portland, OR 97204.
7900 South J Stock Road, Tucson, AZ 85746.
801 Thompson Ave., Suite 300, Rockville, MD 20852.
Do.
Do.
Do.
Do.
Phoenix, AZ.
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9804
Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
AREA GPRA COORDINATORS AS OF AUGUST 2009
Area
GPRA coordinator(s)
Contact information
Aberdeen .................................................
Alaska .....................................................
Albuquerque ............................................
Bemidji ....................................................
Billings .....................................................
California .................................................
Nashville ..................................................
Navajo .....................................................
Oklahoma ................................................
Phoenix ...................................................
Portland ...................................................
Tucson ....................................................
Janelle Trottier .......................................
Bonnie Boedeker ...................................
Steve Petrakis .......................................
Jason Douglas .......................................
Carol Strashiem .....................................
Elaine Brinn ...........................................
Kristina Rogers ......................................
Jenny Notah ..........................................
Marjorie Rogers .....................................
Jody Sekerak .........................................
Mary Brickell ..........................................
Scott Hamstra, M.D ...............................
janelle.trottier@ihs.gov, (605) 226–7474
Bonnie.Boedeker@ihs.gov, (907) 729–3665.
steve.petrakis@ihs.gov, (505) 248–1361.
Jason.Douglas@ihs.gov, (218) 444–0550.
carol.strasheim@ihs.gov, (406) 247–7111.
Elaine.Brinn@ihs.gov, (916) 930–3927 ext. 320.
Kristina.Rogers@ihs.gov, (615) 467–2926.
Genevieve.Notah@ihs.gov, (928) 871–5836.
Marjorie.Rogers@mail.ihs.gov, (405) 951–6020.
Jody.Sekerak@ihs.gov, (602) 364–5274.
Mary.Brickell@ihs.gov, (503) 326–5592.
Scott.hamstra@ihs.gov, (520) 295–2406.
IHS/VA AREA POINTS OF CONTACT
IHS
VA
Aberdeen Area—North Dr. George
Dakota, South DaCeremuga (Acting).
kota, Iowa, Nebraska.
george.ceremuga@ihs.gov,
(605)-964–7724.
Alaska Area—Alaska ...
Dr. Kenneth Glifort ....
Kenneth.Glifort@ihs.gov, (907)
729–3686.
Albuquerque Area—
Colorado, New Mexico, Texas.
Dr. Leonard Thomas
Lenonard.Thomas@ihs.gov,
(505) 248–4115.
Dr. Dawn Wyllie ........
Dawn.Wyllie@ihs.gov,
444–0491.
(218)
Billings—Montana, Wyoming.
Dr. Doug Moore ........
doug.moore@ihs.gov,
247–7129.
California—California,
Hawaii.
Dr. David Sprenger ...
david.sprenger@ihs.gov, (916)
930–3981.
Headquarters—Washington D.C./Rockville
MD.
Dr. Susan Karol ........
Mr. Leo Nolan ...........
Nashville—TX, LA, AR,
MS, AL, MO, IL, IN,
TN, KY, OH, GA, FL,
SC, NC, VA, WV,
PA, MD, DC, DE,
NY, CT, MA, VT, NH,
RI, ME, NJ.
Ms. Elizabeth Neptune.
(406)
susan.karol@ihs.gov,
(301)
443–1083.
leo.nolan@ihs.gov, (301)-443–
7261.
Elizabeth.Neptune@ihs.gov,
(207) 214–6524..
Ms. Carla Belle Alexander.
carlabelle.alexander@va.gov,
(605) 720–7337.
Mr. Alexander
Spector.
alexander.spector@va.gov,
(907) 257–5460.
VISN 18—Ms. Deborah Thompson.
deborah.thompson7ec@
va.gov, (928) 776–6001.
VISN 19—Colorado,
Utah, Montana.
VISN 11—Michigan,
Illinois, Indiana.
VISN 12—Illinois,
Wisconsin, Michigan.
VISN 23—Minnesota,
SD, ND, IA, NE.
VISN 19—Wyoming,
Colorado, Montana,
Utah.
VISN 21—Northern
California, Hawaii,
Nevada.
VISN 22—So. California, Nevada.
VA Central Office ......
VISN 19—Mr. James
Floyd.
VISN 11—Mr. Gabriel
Perez.
VISN 12—Dr. Ed
Zarling.
james.floyd@va.gov, (801)
582–1565 x1500.
g.perez@va.gov, (734) 761–
5488.
edwin.zarling@va.gov, (708)
202–8413.
VISN 23—Ms. Carla
Belle Alexander.
Mr. James Floyd .......
carlabelle.alexander@va.gov,
(605) 720–7337.
james.floyd@va.gov, (801)
582–1565 x1500.
VISN 21—Ms. Martha
Akrop.
martha.akrop@va.gov, (775)
328–1428.
VISN 22—Ms. Barbara Fallen.
Ms. Louise Van
Diepen.
barbara.fallen@va.gov, (562)
826–5963.
Louise.VanDiepen@va.gov,
(202) 273–5878.
VISN 1—MA, NH,
CT, RI, ME, VT.
VISN 1—Dr. Gail
Goza-MacMullan.
gail.gozamacmullan@med.va.gov,
(781) 687–3412.
VISN 2—New York
State.
Bemidji—Minnesota,
Wisconsin, Michigan.
VISN 23—South Dakota, North Dakota,
Nebraska, Iowa,
Minnesota.
VISN 20—Alaska,
Idaho, Oregon,
Washington.
VISN 18—New Mexico, Texas, Arizona.
VISN 2—Dr. Scott
Murray VISN 2
(alt)—Dr. Bruce
Nelson.
VISN 3—Dr. James
Smith.
VISN 6—Mr. Mark
Hall.
VISN 7—Mr. Brian
Heckert.
VISN 8—TBD ............
VISN 12—Dr. Ed
Zarling.
VISN 15—Dr. James
Sanders.
VISN 16—Mr. Adam
Walmus.
VISN 17—Mr. Jack
Dufon.
VISN 18—Ms. Deborah Thompson.
VISN 18—Ms. Deborah Thompson.
VISN 19—Mr. James
Floyd.
scott.murray@va.gov, (518)
626–7310
bruce.nelson@va.gov, (518)
626–5320.
james.smith@med.va.gov,
(718) 741–4135.
mark.hall@med.va.gov, (919)
956–5541.
brian.heckert@va.gov, (803)
695–7980.
TBD.
edwin.zarling@va.gov,
(708) 202–8413
james.sanders@med.va.gov,
(816) 701–3000.
adam.walmus2@va.gov, (918)
680–3644.
jack.dufon2@med.va.gov, (817)
385–3786.
deborah.thompson7ec@va.gov,
(928) 776–6001.
deborah.thompson7ec@va.gov,
(928) 776–6001.
james.floyd@va.gov, (801)
582–1565 x1500.
VISN 15—Dr. James
Sanders.
VISN 16—Mr. Adam
Walmus.
james.sanders@med.va.gov,
(816) 701–3000.
adam.walmus2@va.gov, (918)
680–3644.
VISN 3—NYC, NJ .....
VISN 6—NC, WV, VA
VISN 7—GA, AL, SC
VISN 8—FL, PR ........
VISN 12—IL, MI, WI
mstockstill on DSKH9S0YB1PROD with NOTICES
VISN 16—OK, LA,
MS, AR, TX,.
VISN 17—TX ............
Navajo—Arizona, Utah,
New Mexico.
Ms. Patricia Olson .....
Dr. Douglas Peter
(alt.).
Oklahoma—Oklahoma,
Kansas, Texas.
VerDate Mar<15>2010
Dr. John Farris ..........
16:51 Feb 18, 2011
Jkt 223001
Patricia.Olson@ihs.gov,
871–5811.
Douglas.Peter@ihs.gov,
871–5813.
(928)
John.Farris@ihs.gov,
951–3776.
(405)
PO 00000
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VISN 18—NM, TX,
AZ.
VISN 18—New Mexico, TX, Arizona.
VISN 19—Wyoming,
Colorado, Montana,
Utah.
VISN 15—Kansas,
Missouri.
VISN 16—Oklahoma,
Louisiana, Mississippi, Arkansas,
Texas.
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Federal Register / Vol. 76, No. 35 / Tuesday, February 22, 2011 / Notices
9805
IHS/VA AREA POINTS OF CONTACT—Continued
IHS
Phoenix—Nevada,
Utah, Arizona.
Dr. Charles (Ty)
Reidhead.
Dr. Augusta Hays
(alt.).
VA
charles.reidhead@ihs.gov,
(602) 364–5039.
Augusta.Hays@ihs.gov, (602)
364–5039.
Portland—Washington,
Oregon, Idaho.
Mr. Terry Dean ..........
Terry.Dean@ihs.gov,
326–7270.
(503)
Tucson—Arizona .........
Dr. John R. Kittredge
John.Kittredge@ihs.gov,
295–2406.
(520)
Note: The address listed in this notice
should only be used to submit comments
concerning the revision of this information
collection. Please do not submit requests for
individual case status inquiries to this
address. If you are seeking information about
the status of your individual case, please
check ‘‘My Case Status’’ online at: https://
egov.uscis.gov/cris/Dashboard.do, or call the
USCIS National Customer Service Center at
1–800–375–5283 (TTY 1–800–767–1833).
[FR Doc. 2011–3856 Filed 2–18–11; 8:45 am]
BILLING CODE 4165–16–P
DEPARTMENT OF HOMELAND
SECURITY
U.S. Citizenship and Immigration
Services
Agency Information Collection
Activities: Form G–845 and
Supplement; Revision of a Currently
Approved Information Collection;
Comment Request
60-Day Notice of Information
Collection Under Review: Form G–845
and Supplement; Document Verification
Request, and Document Verification
Request Supplement; OMB Control No.
1615–0101.
mstockstill on DSKH9S0YB1PROD with NOTICES
ACTION:
The Department of Homeland
Security, U.S. Citizenship and
Immigration Services (USCIS) will be
submitting the following information
collection request for review and
clearance in accordance with the
Paperwork Reduction Act of 1995. The
information collection is published to
obtain comments from the public and
affected agencies. Comments are
encouraged and will be accepted for
sixty days until April 25, 2011.
Written comments and/or suggestions
regarding the item(s) contained in this
notice, especially regarding the
estimated public burden and associated
response time, should be directed to the
Department of Homeland Security
(DHS), USCIS, Chief, Regulatory
Products Division, Office of the
Executive Secretariat, 20 Massachusetts
Avenue, NW., Washington, DC 20529–
2020. Comments may also be submitted
to DHS via facsimile to 202–272–0997
or via e-mail at rfs.regs@dhs.gov. When
submitting comments by e-mail, please
make sure to add OMB Control No.
1615–0101 in the subject box.
VerDate Mar<15>2010
16:51 Feb 18, 2011
Jkt 223001
VISN 18—New Mexico, Texas, Arizona.
VISN 18—New Mexico, Texas, Arizona.
VISN 19—Wyoming,
Colorado, Montana,
Utah.
VISN 21—Northern
California, Hawaii,
Nevada.
VISN 22—So. California, Nevada.
VISN 20—Alaska,
Idaho, Oregon,
Washington.
VISN 18—New Mexico, Texas, Arizona.
Written comments and suggestions
from the public and affected agencies
concerning the collection of information
should address one or more of the
following four points:
(1) Evaluate whether the collection of
information is necessary for the proper
performance of the functions of the
agency, including whether the
information will have practical utility;
(2) Evaluate the accuracy of the
agency’s estimate of the burden of the
collection of information, including the
validity of the methodology and
assumptions used;
(3) Enhance the quality, utility, and
clarity of the information to be
collected; and
(4) Minimize the burden of the
collection of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses.
Overview of this information
collection:
(1) Type of Information Collection:
Revision of a currently approved
information collection.
(2) Title of the Form/Collection:
Document Verification Request and
Document Verification Request
Supplement.
(3) Agency form number, if any, and
the applicable component of the
Department of Homeland Security
sponsoring the collection: Form G–845
PO 00000
Frm 00066
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Sfmt 9990
VISN 18—Ms. Deborah Thompson.
VISN 18—Ms. Deborah Thompson.
VISN 19—Mr. James
Floyd.
deborah.thompson7ec@va.gov,
(928) 776–6001.
deborah.thompson7ec@va.gov,
(928) 776–6001.
james.floyd@va.gov, (801)
582–1565 x1500.
VISN 21—Ms. Martha
Akrop.
Martha.Akrop@va.gov, (775)
328–1428.
VISN 22—Ms. Barbara Fallen.
Mr. Alexander
Spector.
barbara.fallen@va.gov, (562)
826–5963.
alexander.spector@va.gov,
(907) 257–5460.
Ms. Deborah Thompson.
deborah.thompson7ec@va.gov,
(928) 776–6001.
and Supplement. U.S. Citizenship and
Immigration Services.
(4) Affected public who will be asked
or required to respond, as well as a brief
abstract: Primary: Individuals and
households. The information collections
allow for the verification of immigration
status of certain persons applying for
benefits under certain entitlement
programs.
(5) An estimate of the total number of
respondents and the amount of time
estimated for an average respondent to
respond: Form G–845—248,206
responses at 5 minutes (.083) per
response; Supplement—11,247
responses at 5 minutes (.083) per
response; Automated Queries
11,839,892 responses at 5 minutes (.083)
per response.
(6) An estimate of the total public
burden (in hours) associated with the
collection: 1,004,246 annual burden
hours.
If you need a copy of this information
collection instrument, please visit the
Web site at: https://www.regulations.
gov/.
We may also be contacted at: USCIS,
Regulatory Products Division, Office of
the Executive Secretariat, 20
Massachusetts Avenue, NW.,
Washington, DC 20529–2020,
Telephone number 202–272–8377.
Dated: February 15, 2011.
Sunday Aigbe,
Chief, Regulatory Products Division, Office
of the Executive Secretariat, U.S. Citizenship
and Immigration Services, Department of
Homeland Security.
[FR Doc. 2011–3786 Filed 2–18–11; 8:45 am]
BILLING CODE 9111–97–P
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]]>Agencies
[Federal Register Volume 76, Number 35 (Tuesday, February 22, 2011)]
[Notices]
[Pages 9789-9805]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-3856]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Office of Urban Indian Health Programs; Announcement Type:
Limited Competition, Continuation; Funding Announcement Number: HHS-
2011-IHS-UIHP-0001
Catalogue of Federal Domestic Assistance Number: 93.193
Key Dates: Application Deadline Date: March 23, 2011.
Review Period: April 25-27, 2011.
Earliest Anticipated Start Date: May 16, 2011.
I. Funding Opportunity Description
Statutory Authority
The Indian Health Service (IHS), Office of Urban Indian Health
Programs (OUIHP), announces the FY 2011 limited competition,
continuation grants for continued operation support for the 4-in-1
Title V grants to make health care services more accessible for
American Indians and Alaska Natives (AI/AN) residing in urban areas.
This program is authorized under the authority of the Snyder Act, 25
U.S.C. 1652, 1653, 1660a of Title V of the Indian Health Care
Improvement Act (IHCIA), Public Law 94-437, as amended.
[[Page 9790]]
This program is described at 93.193 in the Catalog of Federal
Domestic Assistance (CFDA).
Background
Prior to the 1950s, most AI/ANs resided on reservations, in nearby
rural towns, or in Tribal jurisdictional areas such as Oklahoma. In the
era of the 1950s and 1960s, the Federal Government passed legislation
to terminate its legal obligations to the Indian Tribes, resulting in
policies and programs to assimilate Indian people into the mainstream
of American society. This philosophy produced the Bureau of Indian
Affairs (BIA) Relocation/Employment Assistance Programs (BIA
Relocation) which enticed Indian families living on impoverished Indian
Reservations to ``relocate'' to various cities across the country,
i.e., San Francisco, Los Angeles, Chicago, Salt Lake City, Phoenix,
etc. BIA Relocation offered job training and placement, and was viewed
by Indians as a way to escape poverty on the reservation. Health care
was usually provided for six months through the private sector, unless
the family was relocated to a city near a reservation with an IHS
facility service area, such as Rapid City, Phoenix, and Albuquerque.
Eligibility for IHS was not forfeited due to Federal Government
relocation.
The American Indian and Policy Review Commission found that in the
1950s and 1960s, the BIA relocated over 160,000 AI/ANs to selected
urban centers across the country. Today, over 61 percent of all AI/ANs
identified in the 2010 census reside off-reservation.
In the late 1960s, urban Indian community leaders began advocating
at the local, State and Federal levels for culturally appropriate
health programs addressing the unique social, cultural and health needs
of AI/ANs residing in urban settings. These community-based grassroots
efforts resulted in programs targeting health and outreach services to
the urban Indian community. Programs that were developed at that time
were in many cases staffed by volunteers, offering outreach and
referral-type services, and maintaining programs in storefront settings
with limited budgets and primary care services.
In response to efforts of the urban Indian community leaders in the
1960s, Congress appropriated funds in 1966, through the IHS, for a
pilot urban clinic in Rapid City. In 1973, Congress appropriated funds
to study the unmet urban Indian health needs in Minneapolis. The
findings of this study documented cultural, economic, and access
barriers to health care and resulted in Congressional appropriations
under the Snyder Act to support emerging Urban Indian clinics in
several BIA relocation cities, i.e., Seattle, San Francisco, Tulsa, and
Dallas.
The awareness of poor health status of all Indian people continued
to grow, and in 1976, Congress passed the Indian Health Care
Improvement Act (IHCIA), Public Law 94-437, establishing the Urban
Indian Health Program under Title V. Congress reauthorized the IHCIA in
2010 under Public Law 111-148 (2010). This law is considered health
care reform legislation to improve the health and well-being of all AI/
ANs, including urban Indians. Title V specific funding is authorized
for the development of programs for AI/ANs residing in urban areas.
Since passage of this legislation, amendments to Title V provided
resources to and expanded Urban Indian Health Programs in the areas of
direct medical services, alcohol services, mental health services,
human immunodeficiency virus (HIV) services, and health promotion--
disease prevention services.
Purpose
Under this grant opportunity, the IHS proposes to award grants to
34 Urban Indian Health Programs (UIHP), which are Urban Indian
organizations that have existing IHS contracts, in accordance with 25
U.S.C. 1653(c)-(e), 1660a. This grant announcement seeks to ensure the
highest possible health status for AI/ANs. Funding will be used to
continue the 34 urban Indian organizations' successful implementation
of the priorities of the Department of Health and Human Services (HHS),
Strategic Plan Fiscal Years 2007-2012, Healthy People 2020, and the IHS
Strategic Plan 2006-2011. Additionally, funding will be utilized to
meet objectives for Government Performance Rating Act (GPRA) reporting,
collaborative activities with the Veterans Health Administration (VA),
and four health programs that make health services more accessible to
AI/ANs living in urban areas. The four health services programs are:
(1) Health Promotion/Disease Prevention (HP/DP) services, (2)
Immunizations, and Behavioral Health Services consisting of (3)
Alcohol/Substance Abuse services, and (4) Mental Health Prevention and
Treatment services. These programs are integral components of the IHS
improvement in patient care initiative and the strategic objectives
focused on improving safety, quality, affordability, and accessibility
of health care.
II. Award Information
Type of Awards--Limited Competition, Continuation Grants
Estimated Funds Available--The total amount of funding identified
for the current fiscal year (FY) 2011 is approximately $8 million.
Competing and continuation awards issued under this announcement are
subject to the availability of funds. In the absence of funding, the
Agency is under no obligation to make awards funded under this
announcement.
Anticipated Number of Awards--Approximately 34 grants will be
issued under this program announcement.
Project Period--Five year award. April 1, 2011--March 31, 2016.
Award Amount--$135,289 to $612,893, subject to the availability of
congressional appropriations.
III. Eligibility Information
1. Eligibility
Competition is limited to those urban Indian organizations
currently contracted under Title V of the IHCIA. It is legislatively
mandated that the urban Indian organization must have a Title V
contract in place to be eligible to apply for a Title V grant. 25
U.S.C. 1653(c)-(e), 1660a. Urban Indian organizations are defined by 25
U.S.C. 1603(29) as a non-profit corporate body situated in an urban
center, governed by an urban Indian controlled board of directors, and
providing for the maximum participation of all interested Indian groups
and individuals, which body is capable of legally cooperating with
other public and private entities for the purpose of performing the
activities described in 25 U.S.C. 1653(a). 25 U.S.C. 1603(29). Each
organization must provide proof of non-profit status with the
application, including a copy of the 501 (c)(3) Certificate.
2. Cost Sharing or Matching
This program does not require matching funds or cost sharing.
3. Other Requirements
If the application budget exceeds the stated dollar amount that is
outlined within this announcement, it will not be considered for
funding.
IV. Application and Submission Information
1. Obtaining Application Materials
The Applicant package and instructions may be located at Grants.gov
(https://www.grants.gov) or at: https://www.ihs.gov/NonMedicalPrograms/gogp/gogp_funding.asp.
[[Page 9791]]
Information regarding the electronic application process may be
directed to Paul Gettys at (301) 443-2114.
2. Content and Form of Application Submission
The application must include the project narrative as an attachment
to the application package.
Mandatory documents for all applications include:
Application forms:
[cir] SF-424.
[cir] SF-424A.
[cir] SF-424B.
Budget Narrative (must be single spaced).
Project Narrative (must not exceed twenty-five pages).
501(c)(3) Certificate.
Biographical sketches of all Key Personnel.
Disclosure of Lobbying Activities (SF-LLL) (if
applicable), https://www. whitehouse.gov/sites/default/ files/omb/
grants/sflllin.pdf.
Documentation of current OMB A-133 required Financial
Audits. Acceptable forms of documentation include:
[cir] E-mail confirmation from the Federal Audit Clearinghouse
(FAC) that audits were submitted; or
[cir] Face sheets from audit reports. These can be found on the
FAC Web site: https://harvester.census.gov/fac/dissem/
accessoptions.html?submit=Retrieve+Records
Public Policy Requirements
All Federal wide public policies apply to IHS grants with exception
of the Discrimination policy.
Requirements for Project and Budget Narratives
A. Project Narrative: This narrative should be a separate Word
document that is no longer than 25 pages with consecutively numbered
pages. Be sure to place all responses and required information in the
correct section or they will not be considered or scored. If the
narrative exceeds the page limit, only the first 25 pages will be
reviewed. The narrative consists of three parts: Part A--Program
Information; Part B--Program Planning and Evaluation; and Part C--
Program Report. See below for additional details about what must be
included in the narrative.
Part A: Program Information
Section 1: Needs
Part B: Program Planning and Evaluation
Section 1: Program Plans
Section 2: Program Evaluation
Part C: Program Report
Section 1: Describe Major Accomplishments for the Last 9 Months,
From April 1, 2010-December 31, 2010
Section 2: Describe Major Activities Planned for the Next 12
Months, Beginning April 1, 2011
B. Budget Narrative: This narrative must describe the budget
requested and match the scope of work described in the project
narrative. The page limitation should not exceed three pages.
3. Submission Dates and Times
Applications must be submitted electronically through Grants.gov by
March 23, 2011 at 12 midnight Eastern Standard Time (EST). Any
application received after the application deadline will not be
accepted for processing, and it will be returned to the applicant(s)
without further consideration for funding.
If technical challenges arise and the Urban Indian Health
Organization (UIHP) is unable to successfully complete the electronic
application process, contact Grants.gov Customer Service Support via e-
mail to Grants.gov">support@Grants.gov or phone at (800) 518-4726. Customer Support
is available to address questions 24 hours a day, 7 days a week (except
Federal holidays). If problems persist, contact Paul Gettys, Division
of Grants Management (DGM), Paul.gettys@ihs.gov at (301) 443-5204.
Please be sure to contact Mr. Gettys at least ten days prior to the
application deadline. Please do not contact the DGM until you have
received a Grants.gov tracking number. In the event you are not able to
obtain a tracking number, call the DGM as soon as possible.
If an applicant needs to submit a paper application instead of
submitting electronically via Grants.gov, prior approval must be
requested and obtained (see page 11 for additional information). The
waiver must be documented in writing (e-mails are acceptable), before
submitting a paper application. A copy of the written approval must be
submitted along with the hardcopy that is mailed to the DGM (Refer to
Section IV to obtain mailing address). Paper applications that are
submitted without a waiver will be returned to the applicant without
review or further consideration. The application must be postmarked by
March 23, 2011. Applications received after this date will not be
accepted for processing, will be returned to the applicant, and will
not be considered for funding.
4. Intergovernmental Review
Executive Order 12372 requiring intergovernmental review is not
applicable to this program.
5. Funding Restrictions
Pre-award costs are allowable pending prior approval from
the awarding agency. However, in accordance with 45 CFR Part 74, all
pre-award costs are incurred at the recipient's risk. The awarding
office is under no obligation to reimburse such costs if for any reason
the UIHOs do not receive an award or if the award to the recipient is
less than anticipated;
The available funds are inclusive of direct and
appropriate indirect costs;
Only one grant/cooperative agreement will be awarded per
applicant; and
IHS will not acknowledge receipt of applications.
6. Electronic Submission Requirements
Use the https://www.Grants.gov Web site to submit an application
electronically and select the ``Find Grant Opportunities'' link on the
homepage. Download a copy of the application package, complete it
offline, and then upload and submit the application via the Grants.gov
Web site. Electronic copies of the application may not be submitted as
attachments to e-mail messages addressed to IHS employees or offices.
Applicants that receive a waiver to submit paper application
documents must follow the rules and timelines that are noted below. The
applicant must seek assistance at least ten days prior to the
application deadline.
Applicants that do not adhere to the timelines for Central
Contractor Registry (CCR) and/or Grants.gov registration and/or request
timely assistance with technical issues will not be considered for a
waiver to submit a paper application.
Please be aware of the following:
Please search for the application package in Grants.gov by
entering the CFDA number or the Funding Opportunity Number. Both
numbers are located in the header of this announcement.
Paper applications are not the preferred method for
submitting applications. However, if you experience technical
challenges while submitting your application electronically, please
contact Grants.gov Support directly at: https://www.Grants.gov/CustomerSupport or (800) 518-4726. Customer Support is available to
address questions 24 hours a day, 7 days a week (except on Federal
holidays).
[[Page 9792]]
Upon contacting Grants.gov, obtain a tracking number as
proof of contact. The tracking number is helpful if there are technical
issues that cannot be resolved and waiver from the agency must be
obtained.
If it is determined that a waiver is needed, you must
submit a request in writing (e-mails are acceptable) to
GrantsPolicy@ihs.gov with a copy to Tammy.Bagley@ihs.gov. Please
include a clear justification for the need to deviate from our standard
electronic submission process.
If the waiver is approved, the application should be sent
directly to the DGM with a postmark of no later than March 23, 2011.
Division of Grants Management, Indian Health Service, 801 Thompson
Avenue, TMP 360, Rockville, MD 20852.
Applicants are strongly encouraged not to wait until the
deadline date to begin the application process through Grants.gov as
the registration process for CCR and Grants.gov could take up to
fifteen working days.
Please use the optional attachment feature in Grants.gov
to attach additional documentation that may be requested by the DGM.
All applicants must comply with any page limitation
requirements described in this Funding Announcement.
After you electronically submit your application, you will
receive an automatic acknowledgment from Grants.gov that contains a
Grants.gov tracking number. The DGM will download your application from
Grants.gov and provide necessary copies to the appropriate agency
officials. Neither the DGM nor the OUIHP will notify applicants that
the application has been received.
E-mail applications will not be accepted under this announcement.
Dun and Bradstreet (D&B) Data Universal Numbering Systems (DUNS)
All IHS applicants and grantee organizations are required to obtain
a DUNS number and maintain an active registration in the CCR database.
Additionally, all IHS grantees must notify potential first-tier sub-
recipients that no entity may receive a first-tier sub-award unless the
entity has provided its DUNS number to the prime grantee organization.
These requirements will ensure use of a universal identifier to enhance
the quality of information available to the public when recipients
begin on October 1, 2010 to report information on sub-awards, as
required by the Federal Funding Accountability and Transparency Act
(FFATA) of 2006, as amended (``the Transparency Act''). The DUNS number
is a unique nine digit identification number provided by D&B, which
uniquely identifies your entity. The DUNS number is site specific;
therefore each distinct performance site may be assigned a DUNS number.
Obtaining a DUNS number is easy and there is no charge. To obtain a
DUNS number, you may access it through the following Web site https://fedgov.dnb.com/webform or to expedite the process call (866) 705-5711.
Central Contractor Registry (CCR)
Organizations that have not registered with CCR will need to obtain
a DUNS number first and then access the CCR online registration through
the CCR home page at https://www.bpn.gov/ccr/default.aspx (U.S.
organizations will also need to provide an Employer Identification
Number from the Internal Revenue Service that may take an additional 2-
5 weeks to become active). Completing and submitting the registration
takes approximately one hour to finish and your CCR registration will
take 3-5 business days to process. Registration with the CCR is free of
charge. Applicants may register online at https://www.ccr.gov.
Additional information on implementing FFATA, including the
specific requirements for--DUNS, CCR, can be found on the IHS Grants
Policy Web site: https://www.ihs.gov/NonMedicalPrograms/gogp/index.cfm?module=gogp_policy_topics
V. Application Review Information
1. Evaluation Criteria
The instructions for preparing the application narrative also
constitute the evaluation criteria for reviewing the application.
The narrative should address program progress for the 12 months
continuation budget period activities, April 1, 2011 through March 31,
2012.
The narrative should be written in a manner that is clear to
outside reviewers unfamiliar with prior related activities of the UIHP.
It should be well organized, succinct, and contain all information
necessary for reviewers to fully understand the project.
Points assigned for the criteria are as follows:
UNDERSTANDING OF THE NEED AND NECESSARY CAPACITY (30
Points)
WORK PLANS (40 Points)
PROJECT EVALUATION (15 Points)
ORGANIZATIONAL CAPABILITIES AND QUALIFICATIONS (10 Points)
CATEGORICAL BUDGET AND BUDGET JUSTIFICATION (5 Points)
A. PROJECT NARRATIVE: UNDERSTANDING OF THE NEED AND NECESSARY CAPACITY
(30 points)
1. Facility Capability
Urban Indian programs provide health care services within the
context of the HHS Strategic Plan, Fiscal Years 2007-2012; the IHS
Strategic Plan 2006-2011, and four IHS priorities.
Describe the UIHP: (1) Current budget period performance April 1,
2010-December 31, 2010 accomplishments and (2) define activities
planned for the 2011 continuation budget period April 1, 2011-March 31,
2012 budget period in each of the following areas:
a. IHS Priorities for American Indian/Alaska Native Health Care
Current governmental trends and environmental issues impact AI/ANs
residing in urban locations and require clear and consistent support by
the Title V funded UIHP. The IHS Web site is https://www.ihs.gov.
(1) Renew and Strengthen Partnerships with Tribes and the UIHPs:
The UIHPs have a hybrid relationship with the IHS. With the passage of
Public Law 111-148, the Indian Health Care Improvement Act was made
permanent.
Identify what the UIHP is doing to strengthen its
partnerships with Tribes and other UIHPs.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned, including
information on how results are shared with the community.
c. List the top ten Tribes who members are seen by the program.
(2) Bring Health Care Reform to the UIHPs: In order to support
health care reform, it must be demonstrated there is a willingness to
change and improve, i.e., in human resources and business practices.
Describe activities the UIHP is taking to ensure health
care reform is being applied.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned.
(3) Improve the Quality of and Access to Care: Customer service is
the key to quality care. Treating patients well is the first step to
improving quality and access. This area also incorporates Best
Practices in customer service.
Identify activities that demonstrate the UIHP improving
quality of and access to care.
a. April 1, 2010-December 31, 2010 accomplishments.
[[Page 9793]]
b. April 1, 2011-March 31, 2012 activities planned.
(4) Ensure all UIHP work is Transparent, Accountable, Fair, and
Inclusive: Quality health care needs to be transparent, with all
parties held accountable for that care. Accountability for services is
emphasized.
Describe activities that demonstrate how this is
implemented in the UIHP program.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned.
b. HHS Priorities for Health Care
Current governmental trends and environmental issues impact AI/ANs
residing in urban locations and require clear and consistent support by
the Title V funded UIHP.
1. Health Care Value Incentives: The growth of health care costs is
restrained because consumers know the comparative costs and quality of
their health care--and they have a financial incentive to care.
Identify what the UIHP is doing to help its consumers gain
control of their health care and have the knowledge to make informed
health care decisions.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned, including
information on how clinical quality data is shared with consumers and
the community.
2. Health Information Technology: The medical clipboard is becoming
a thing of the past. Secure interoperable electronic records are
available to patients and their doctors anytime, anywhere.
Describe activities the UIHP is taking to ensure immediate
access to accurate information to reduce dangerous medical errors and
help control health care costs.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned.
3. Medicare Rx: Every senior has access to affordable prescription
drugs. Consumers will inspire plans to provide better benefits at lower
costs. Medicare Part D is streamlined and improved to better connect
people with their benefits. Pay for Performance methodologies act to
increase health care quality.
Identify activities the UIHP is taking to implement
Medicare Rx.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned.
4. Personalized Health Care: Health care is tailored to the
individual. Prevention is emphasized. Propensities for disease are
identified and addressed through preemptive intervention.
Describe activities that demonstrate how this is
implemented in the UIHP program.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-March 31, 2012 activities planned.
5. Obesity Prevention: The risk of many diseases and health
conditions are reduced through actions that prevent obesity. A culture
of wellness deters or diminishes debilitating and costly health events.
Individual health care is built on a foundation of responsibility for
personal wellness.
Describe activities that demonstrate how the UIHP program
is implementing this priority.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-December 31, 2012 activities planned.
6. Tobacco Cessation: The only proven strategies to reduce the
risks of tobacco-caused disease are preventing initiation, facilitating
cessation, and eliminating exposure to secondhand smoke.
Describe activities that demonstrate how the UIHP is
implementing this priority.
a. April 1, 2010-December 31, 2010 accomplishments.
b. April 1, 2011-December 31, 2012 activities planned.
7. Pandemic Preparedness: The United States is better prepared for
an influenza pandemic. Rapid vaccine production capacity is increased,
national stockpiles and distribution systems are in place, disease
monitoring and communication systems are expanded and local
preparedness encompasses all levels of government and society.
Describe activities that demonstrate how the UIHP is
prepared and identify changes, if any, made to the UIHP pandemic
preparedness plan.
8. Emergency Response: We have learned from the past and are better
prepared for the future. There is an ethic of preparedness at the urban
program and throughout the Nation.
Describe activities that demonstrate how the UIHP is
prepared and identify changes, if any, made to the UIHP emergency
preparedness plan.
9. Hours of Operation Ensure Access to Care
Identify the urban program hours of operation and provide
assurance that services are available and accessible at times that meet
the needs of the urban Indian population, including arrangements that
assure access to care when the UIHP is closed.
c. UIHP Collaboration With the Veteran's Health Administration (VA)
In 2007, the UIHPs contacted their local VA Veterans Integrated
Services Network and established agreements to collaborate at the local
level to expand opportunities to enhance access to health services and
improve the quality of health care of AI/AN veterans.
1. Report April 1, 2010-December 31, 2010 results/outcomes of the
collaborative activities implemented or explored between your UIHP and
your local area VA. Include number of patients who used VA services,
number of visits made, and types of healthcare services provided.
2. Identify areas of collaboration and activities that will be
conducted between your UIHP and your local area VA for continuation
budget period April 1, 2011-March 31, 2012.
d. GPRA Reporting
All UIHPs report on IHS GPRA clinical performance measures. This is
required of both urban facilities using the Resource and Patient
Management System (RPMS) and facilities not using RPMS. RPMS users must
use the Clinical Reporting System (CRS) for reporting, and non-RPMS
users must develop a bridge to transfer data from their current data
system to RPMS for CRS reporting. Questions related to GPRA reporting
may be directed to the IHS Area Office GPRA Coordinator, or Danielle
Steward, Health Systems Specialist, OUIHP, danielle.steward@ihs.gov
The 2012 GPRA Report Period is July 1, 2011 through June 30, 2012.
The GPRA measures to report for 2012 will include the 20 GPRA measures
reported for 2010.
Note that the target rates for FY 2011 GPRA are not currently
available. They will be provided in calendar year 2011.
1. During the continuation budget period, April 1, 2011-March 31,
2012, the following GPRA measures are priority focus areas for target
achievement: (1) Diabetes: Ideal Glycemic Control: Proportion
of patients with diagnosed diabetes with ideal glycemic control (A1c <
7.0) achieve 2011 and 2012 target rates. (4) Diabetes: Blood
Pressure Control: Proportion of patients with diagnosed diabetes that
have achieved blood pressure control (< 130/80) achieve 2011 and 2012
target rates. (9) Cancer Screening: Colorectal Rates:
Proportion of eligible patients who have had appropriate colorectal
cancer screening.
[[Page 9794]]
Briefly describe the steps/activities you will take to ensure your
program meets the 2011 target rates for these measures.
2. Significant increases to the measurement targets of
(16) Domestic Violence/Intimate Partner Violence Screening,
(17) Depression Screening, and (12) Mammography
Screening will occur in the 2011 GPRA year. Describe at least two
actions you will complete to meet the 2011 desired performance
outcomes/results. For programs using RPMS, a Performance Improvement
Toolbox is available on the CRS Web site at https://www.ihs.gov/cio/crs_performance_improvementtoolbox.asp
3. GPRA Behavioral Health performance measures include alcohol
screening, Fetal Alcohol Syndrome (FAS) prevention, domestic (intimate
partner) violence screening, depression screening, HIV/AIDS screening
and suicide surveillance. Describe actions you will take to improve
2011-2012 desired behavioral health performance outcomes/results.
4. Document your ability to collect and report on the required
performance measures to meet GPRA requirements. Include information
about your health information technology system.
FY 2011 GPRA Measures
1. Diabetes DX Ever (not a GPRA measure, used for context only).
2. Documented A1c (not a GPRA measure, used for context only).
3. Poor Glycemic Control.
4. Ideal Glycemic Control.
5. Controlled Blood Pressure.
6. Dyslipidemia (LDL) Assessment.
7. Nephropathy Assessment.
8. Influenza 65 years old +.
9. Pneumovax 65 years old +.
10. Childhood Immunizations.
11. Pap Smear Rates.
12. Mammography Rates.
13. Colorectal Cancer Rates.
14. Tobacco Cessation.
15. Alcohol Screening (FAS Prevention).
16. Domestic Violence/Intimate Partner Violence Screening.
17. Depression Screening.
18. Prenatal HIV Screening.
19. Childhood Weight Control.
20. Suicide Surveillance.
e. Schedule of Charges and Maximization of Third Party Payments
1. Describe the UIHP established schedule of charges and
consistency with local prevailing rates.
If the UIHP is not currently billing for billable
services, describe the process the UIHP will take to begin third party
billing to maximize collections.
2. Describe how reimbursement is maximized from Medicare, Medicaid,
State Children's Health Insurance Program, private insurance, etc.
3. Describe how the UIHP achieves cost effectiveness in its billing
operations with a brief description of the following:
a. Establishes appropriate eligibility determination.
b. Reviews/updates and implements up-to-date billing and collection
practices.
c. Updates insurance at every visit.
d. Maintains procedures to evaluate necessity of services.
e. Identifies and describes financial information systems used to
track, analyze and report on the program's financial status by revenue
generation, by source, aged accounts receivable, provider productivity,
and encounters by payor category.
f. Indicates the date the UIHP last reviewed and updated its
Billing Policies and Procedures.
B. Program Planning: Work Plans (40 Points)
A program narrative and a program specific work plan are required
for each health services program: (1) Health Promotion/Disease
Prevention, (2) Immunizations, (3) Alcohol/Substance Abuse, and (4)
Mental Health. Title V of the IHCIA, Public Law 94-437, as amended,
identifies eligibility for health services as follows.
Each grantee shall provide health care services to eligible Urban
Indians living within the urban service area. An ``Urban Indian''
eligible for services, as codified at 25 U.S.C. 1603(13), (27), (28),
includes any individual who:
(1) Resides in an urban center, which is any community that has a
sufficient urban Indian population with unmet health needs to warrant
assistance under Title V, as determined by the Secretary, HHS; and who
(2) Meets one or more of the following criteria:
(A) Irrespective of whether he or she lives on or near a
reservation, is a member of a Tribe, band, or other organized group of
Indians, including: (i) Those Tribes, bands, or groups terminated since
1940, and (ii) those recognized now or in the future by the State in
which they reside; or
(B) Is a descendant, in the first or second degree, of any such
member described in (A); or
(C) Is an Eskimo or Aleut or other Alaska Native; or
(D) Is the descendant of an Indian who was residing in the State of
California on June 1, 1852, so long as the descendant is now living in
said State; or \1\
(E) Is considered by the Secretary of the Department of the
Interior to be an Indian for any purpose; or
(F) Is determined to be an Indian under regulations pertaining to
the Urban Indian Health Program that are promulgated by the Secretary,
HHS.
1 Eligibility of California Indians may be demonstrated
by documentation that the individual:
(1) Holds trust interests in public domain, national forest, or
Indian reservation allotments; or
(2) Is listed on the plans for distribution of assets of California
Rancherias and reservations under the Act of August 18, 1958 (72 Stat.
619), or is the descendant of such an individual.
Each grantee is responsible for taking reasonable steps to confirm that
the individual is eligible for IHS services as an urban Indian.
Program Narratives and Workplans
(1) HP/DP
Program Narrative and Work Plan
Contact your IHS Area Office HP/DP Coordinator to discuss and
identify effective and innovative strategies to promote health and
enhance prevention efforts to address chronic diseases and conditions.
Identify one or more of the strategies you will conduct during budget
period April 1, 2011--March 31, 2012.
1. Applicants are encouraged to use evidence-based and promising
strategies which can be found at the IHS best practice database at
https://www.ihs.gov/hpdp/and the National Registry for Effective
Programs at https://modelprograms.samhsa.gov/
2. Program Narrative. Provide a brief description of the
collaboration activities that: (1) Were accomplished April 1, 2010-
December 31, 2010, and (2) are planned and will be conducted between
your UIHP and the IHS Area Office HP/DP Coordinator during the budget
period April 1, 2011 through March 31, 2012.
3. An example of an HP/DP work plan is provided on the following
pages. Develop and attach a copy of the UIHP HP/DP Work Plan for April
1, 2011 through March 31, 2012.
[[Page 9795]]
SAMPLE 2011 HP/DP Work plan
----------------------------------------------------------------------------------------------------------------
Objectives Activities/time line Person responsible Evaluation
----------------------------------------------------------------------------------------------------------------
Goal: To address physical inactivity and consumption of unhealthy food among youth who are in the 4th to 6th
grade in the Watson, Kennedy, Blackwood, and Rocky Hill Elementary schools.
----------------------------------------------------------------------------------------------------------------
1. Develop school policies to 1. Schedule a meeting with Program Coordinator.. Progress report on status
address physical inactivity and the school health board School Administrator. of policy and
consumption of unhealthy foods in in the first quarter of documentation of number
the first year of the funding the project. of participants in
year. 2. Establish a parent parent advisory
advisory committee to committee, and number of
assist with the meetings held.
development of the policy
in 2nd quarter.
2. Implement a classroom nutrition 1. Design pre/post test Program Coordinator.. Pre/post knowledge,
curriculum to increase awareness survey and pilot test IHS Nutritionist..... attitude, and behavior
about the importance of healthier with group of students by survey.
foods. 2nd quarter.
2. Schedule a meeting with ..................... .........................
the School Principal to
discuss dates of program
implementation by 3rd
quarter.
3. Implement the ``Healthy ..................... .........................
Eating'' curriculum, a 6-
week program in the 2nd
quarter.
4. Collect pre/post survey ..................... .........................
at beginning and end of
the program to assess
changes.
3. Implement physical activity in 1. Contract with SPARK PE Program Coordinator.. 1. Training evaluation
at least four schools for grades to train classroom School Counselor and and number of
4th to 6th in first year of the teachers to implement PE teacher. participants.
funding. SPARK PE in the school by
3rd Quarter.
2. Train volunteers to ..................... 2. Pre/post FITNESSGRAM
administer FITNESSGRAM to Data.
collect baseline data and
post data to assess
changes.
----------------------------------------------------------------------------------------------------------------
Goal: To reduce tobacco use among residents of community X and Y.
----------------------------------------------------------------------------------------------------------------
1. Establish a tobacco-free policy 1. Schedule a meeting with Tobacco Coordinator.. Documentation of the
in the schools and Tribal the Tribal Council and number of participants.
buildings by year 1. school board to increase
awareness of the health
effects of tobacco by
June 2010.
2. Schedule and conduct Tobacco Coordinator.. Documentation of the
tobacco awareness Health Educator...... number of participants.
education in the
community, schools, and
worksites by July 2010
through September 2010.
3. Draft a policy and ..................... Documentation of whether
present to the Tribal the policy was
Council for approval by established.
January 2011.
2. Coordinate and establish 1. Partner with the Tobacco Coordinator.. Progress toward timeline.
tobacco cessation programs with American Cancer Health Educator......
the local hospitals and clinics. Association and the Pharmacist...........
Tribal Health Education
Coordinators to establish
8-week tobacco cessation
programs by July 2010.
2. Meet with the hospital/ Tobacco Coordinator.. Progress report
clinic administrators and Health Educator...... indicating timeline is
pharmacist to discuss and being met.
develop a behavior-based
tobacco cessation program.
3. Design and disseminate Tobacco Coordinator.. Number of brochures
brochures and flyers of distributed.
the tobacco cessation
programs that are
available in the
community and clinic.
4. Meet with nursing and Health Educator .........................
medical provider staff to Tobacco Coordinator..
increase patient referral
to tobacco cessation
program.
5. Implement the 8-week Tobacco Coordinator RPMS data--baseline
tobacco cessation program of referrals,
at the community X and Y of
clinic. participants who
completed program,
who quit
tobacco.
----------------------------------------------------------------------------------------------------------------
[[Page 9796]]
(2) Immunization Services
Program Narrative and Work Plan
1. Program Management Required Activities.
A. Provide assurance that your facility is participating in the
Vaccines for Children program.
B. Provide assurance that your facility has look up capability with
State/regional immunization registry (where applicable). Please contact
Amy Groom, Immunization Program Manager at amy.groom@ihs.gov or (505)
248-4374 for more information.
2. Service Delivery Required Activities--For Sites using RPMS.
A. Provide trainings to providers and data entry clerks on the RPMS
Immunization package.
B. Establish process for immunization data entry into RPMS (e.g.,
point of service or through regular data entry).
C. Utilize RPMS Immunization package to identify 3-27 month old
children who are not up to date and generate reminder/recall letters.
3. Immunization Coverage Assessment Required Activities.
A. Submit quarterly immunization reports to Area Immunization
Coordinator for the 3-27 month old, Two year old and Adolescent and
influenza reports. Sites not using the RPMS Immunization package should
submit a Two Year old immunization coverage report--an Excel
spreadsheet with the required data elements that can be found under the
``Report Forms for non-RPMS sites'' section at: https://www.ihs.gov/Epi/index.cfm?module=epi_vaccine_reports.
4. Program Evaluation Required Activities.
A. Establish baseline for coverage with the 431331* and 4313314**
vaccine series for children 19-35 months old.
B. Establish baseline for coverage with influenza vaccine for
adults 65 years and older.
C. Establish baseline for coverage with at least one dose of
pneumococcal vaccine for adults 65 years and older.
D. Establish baseline coverage for patients (all ages) who received
at least one dose of seasonal flu vaccine during flu season.
* The 4:3:1:3:3:1 vaccine series is defined as: = 4 doses
diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and
tetanus toxoids, or diphtheria and tetanus toxoids and any pertussis
vaccine, = 3 doses of oral or inactivated polio vaccine, = 1 dose of
measles, mumps, and rubella vaccine, = 3 doses of Haemophilus
influenzae type b vaccine, = 3 doses of hepatitis B vaccine, and, = 1
of varicella vaccine.
** The 4:3:1:3:3:1:4 vaccine series includes the 4:3:1:3:3:1 series
outlined above, +4 or more doses of pneumococcal conjugate vaccine
(PCV).
Sample Urban Grant FY 2012 Work Plan Immunization
----------------------------------------------------------------------------------------------------------------
Service or Target
Primary prevention objective program population Process measure Outcome measures
----------------------------------------------------------------------------------------------------------------
Protect children and Immunization Children <3 On a quarterly basis: As of June 30th
communities from vaccine program. years. of children 3- 2012:
preventable diseases. 27 months old..
of children 3-
27 months old who are
children up to date with
age appropriate
vaccinations.
% of 3-27 month old % of 19-35 month
children up to date with olds up to date
age appropriate with the 431331 and
vaccinations. 4313314 vaccine
series.
of children 19-
35 months old.
of children 19-
35 months old who
received the 431331 and
4313314 vaccine series.
of children 19-
35 months old who
received the 431331 and
4313314 vaccine series.
Protect adolescents and Immunization Adolescents 13- On a quarterly basis: As of June 30th
communities from vaccine program. 17 years. of adolescents 2012:
preventable diseases. 13-17 years old..
of adolescents % of adolescents 13-
13-17 years old who are 17 years old who
up to date with Tdap, are up to date with
Tdap/Td, Meningococcal, Tdap.
and 1, 2 and 3 dose of
HPV (females only).
% of adolescents 13-17 % of adolescents 13-
years old who are up to 17 years old who
date with Tdap, Tdap/Td, are up to date with
Meningococcal, and 1, 2 Tdap, females only.
and 3 dose of HPV
(females only).
of
adolescents 13-17
years old who are
up to date with
Meningococcal
vaccine.
of
adolescents 13-17
years old who are
up to date with 1,
2 and 3 dose of HPV
(females only).
Protect adults and Immunization All ages....... On a quarterly basis As of June 30th,
communities from influenza. program. during flu season (e.g., 2012:
Sept-June)
of patients
(all ages)..
of patients who of
received a seasonal flu patients who
shot during the flu received a seasonal
season. flu shot during the
flu season.
[[Page 9797]]
% of patients who % of patients who
received a seasonal flu received a seasonal
shot during flu season. flu shot during the
flu season.
Protect adults and Immunization Adults >65 On a quarterly basis: As of June 30th,
communities from influenza & program. years. of adults 65+ 2012:
Pneumovax. years..
of adults 65+ % of adults 65+
years who received an years who received
influenza shot during an influenza shot
flu season. Sept. 1, 2010-June
of adults 65+ 30, 2011.
years who received a
pneumovax shot.
% of adults 65+ years who % of adults 65+
received an influenza years who received
shot during flu season. a pneumovax shot
% of adults 65+ years who ever
received a pneumovax
shot..
----------------------------------------------------------------------------------------------------------------
(3) Alcohol/Substance Abuse
Program Narrative and Work Plan
1. Program Progress Report or Results/Outcomes for April 1, 2010-
December 31, 2010.
A. Briefly address the extent to which the program was able to
achieve its objectives and demonstrate effective use of funding for
April 1, 2010-December 31, 2010.
B. Include quantifiable and qualitative information and describe
the relationship to the UDS data submitted for calendar year 2009.
C. Identify Specific Program Services Outcomes/Results:
State the number of patient encounters (or specific
service) per provider staff for this program service,
List populations and age groups that were targeted
(homeless, women, youth, elders, men, etc.), and
Identify specific outcomes/results that were measured in
addition to the number of patient encounters/staff (and not included in
the UDS).
2. Narrative Description of Program Services for April 1, 2011-
March 31, 2012 Continuation Budget Period.
A. Program Objectives
1. Clearly state the outcomes of the health service.
2. Define needs related outcomes of the program health care
service.
3. Define who is going to do what, when, how much, and how you will
measure it.
4. Define the population to be served and provide specific numbers
regarding the number of eligible clients for whom services will be
provided.
5. State the time by which the objectives will be met.
6. Describe objectives in numerical terms--specify the number of
clients that will receive services.
7. Describe how achievement of the goals will produce meaningful
and relevant results (e.g., increase access, availability, prevention,
outreach, pre-services, treatment, and/or intervention).
8. Provide a one-year work plan that will include the primary
objectives, services or program, target population, process measures,
outcome measures, and data source for measures (see work plan sample in
Appendix 2).
a. Identify Services Provided: Primary Residential; Detox; Halfway
House; Counseling; Outreach and Referral; and Other (Specify).
b. Number of beds: Residential -- , Detox-- ; or Halfway House --.
c. Average monthly utilization for the past year.
d. Identify Program Type: Integrated Behavioral Health; Alcohol and
Substance Abuse only; Stand Alone; or part of a health center or
medical establishment.
9. Address methamphetamine-related contacts:
a. Identify the documented number of patient contacts during the
April 1, 2010-December 31, 2010 budget period, and estimate the number
patient contacts during the continuation budget period, April 1, 2011-
March 31, 2012.
b. Describe your formal methamphetamine prevention and education
program efforts to reduce the prevalence of methamphetamine abuse
related problems through increased outreach, education, prevention and
treatment of methamphetamine-related issues.
c. Describe collaborative programming with other agencies to
coordinate medical, social, educational, and legal efforts.
B. Program Activities
1. Clearly describe the program activities or steps that will be
taken to achieve the desired outcomes/results. Describe who will
provide (program, staff) what services (modality, type, intensity,
duration), to whom (individual characteristics), and in what context
(system, community).
2. State reasons for selection of activities.
3. Describe sequence of activities.
4. Describe program staffing in relation to number of clients to be
served.
5. Identify number of Full Time Equivalents (FTEs) proposed and
adequacy of this number:
Percentage of FTEs funded by IHS grant funding; and
Describe clients and client selection.
6. Address the comprehensive nature of services offered in this
program service area.
7. Describe and support any unusual features of the program
services, or extraordinary social and community involvement.
8. Present a reasonable scope of activities that can be
accomplished within the time allotted for program and program
resources.
C. Accreditation and Practice Model
Name of Program Accreditation
Type of evidence-based practice
Type of practice-based model
D. Attach the Alcohol/Substance Abuse Work Plan.
IHS Urban Grant FY 2011 Work Plan
[[Page 9798]]
Alcohol/Substance Abuse Program Sample Work Plan
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Objectives Service or program Target population Process measure Outcome measures Data source for
---------------------------------------------------------------------------------------------------------------------------------- measures
What information will ----------------------
What type of program Who do you hope to What information will you collect to find Where will you find
What are you trying to accomplish? do you propose? serve in your program? you collect about the out the results of the information you
program activities? your program? collect?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To prevent substance abuse among Community-based American Indian youth of youth Incidence/prevalence Medical records, RPMS
urban American Indian youth. substance abuse ages 5-18 years old. completing the of substance abuse/ behavioral health
prevention curriculum. curriculum, of sessions Youth Survey.
conducted,
of staff trained.
To prevent substance abuse and Afterschool, summer, American Indian youth of youth Incidence of Charts, RPMS
related problems. and weekend ages 5-14 years old. completing community- substance abuse, behavioral health
activities (e.g. based sessions, incidence of package, National
outdoor experiential of parents negative and Youth Survey.
activities, camps, completing community- positive attitudes
classroom based based sessions, and behaviors,
problem solving of incidence of peer
activities). community-based drug use.
sessions.
Reduce drug use and increase Matrix model for American Indian adult of clients Incidence of drug Medical records, RPMS
treatment retention. outpatient treatment. methamphetamine completing program, use, increase or behavioral health
clients. of relapse decrease in package, Addiction
prevention sessions, treatment retention, Severity Index,
of family positive or negative results of urine
and group therapies, urine samples. tests.
of drug
education sessions,
of self-
help groups, of urine tests.
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(4) MENTAL HEALTH SERVICES
Program Narrative and Work Plan
Use the alcohol/substance abuse
