Division of Epidemiology and Disease Prevention; Epidemiology Program for American Indian/Alaska Native Tribes and Urban Indian Communities Ending the HIV Epidemic in Indian Country, 38256-38264 [2019-16760]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 84, Number 151 (Tuesday, August 6, 2019)]
[Notices]
[Pages 38256-38264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-16760]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Division of Epidemiology and Disease Prevention; Epidemiology 
Program for American Indian/Alaska Native Tribes and Urban Indian 
Communities Ending the HIV Epidemic in Indian Country

Announcement Type: Competing Supplement

Funding Announcement Number: HHS-2019-IHS-EPI-0001

Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.231

Key Dates

Application Deadline Date: September 5, 2019
Earliest Anticipated Start Date: September 30, 2019

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) Office of Public Health Support, 
Division of Epidemiology and Disease Prevention (DEDP), in partnership 
with the IHS Office of Clinical and Preventive Services (OCPS) National 
Human Immunodeficiency Virus (HIV) & Viral Hepatitis C (HCV) Program 
and the U.S. Department of Health and Human Services (HHS) Minority 
HIV/AIDS Fund (MHAF) is accepting applications for competitive 
supplemental funds to enhance activities in the Epidemiology Program 
for American Indian/Alaska Native (AI/AN) Tribes and Urban Indian 
communities. This program is funded by the Office of the Assistant 
Secretary for Health, HHS, is authorized under the statutory earmark 
for minority AIDS prevention and treatment activities, and is to be 
carried out pursuant to Title III of the Public Service Act. The 
funding is being made available through an intra-Departmental 
Delegation of Authority (IDDA) to award specific funding for fiscal 
year (FY) 2019. This program is described in the Assistance Listings 
located at https://beta.sam.gov (formerly known as Catalog of Federal 
Domestic Assistance) under 93.231.

Background

    The Tribal Epidemiology Center (TEC) program was authorized by 
Congress in 1996 as a way to provide public health support to multiple 
Tribes and Urban Indian communities in each of the IHS Areas. Only 
current TEC grantees are eligible to apply for the competing 
supplemental funding under this announcement and must demonstrate that 
they have complied with previous terms and conditions of the TEC 
program.
    The Office of Infectious Disease and HIV/AIDS Policy (OIDP) is 
located within the Office of the Assistant Secretary for Health HHS. 
The OIDP has directed the IHS to make awards to conduct projects and 
activities in support of the Ending the HIV Epidemic: A Plan for 
America initiative (EHE). The purpose of MHAF is to reduce new HIV 
infections, improve HIV-related health outcomes, and to reduce HIV-
related health disparities for racial and ethnic minority communities 
by supporting innovation, collaboration, and the integration of best 
practices,

[[Page 38257]]

effective strategies, and promising emerging models in the response to 
HIV among minority communities.
    Current data on the burden of HIV in the United States (U.S.) tells 
us where HIV transmission occurs more frequently than other 
jurisdictions. In 2016 and 2017, more than 50% of new HIV diagnoses 
occurred in 48 counties and the jurisdictions of Washington, District 
of Columbia (DC) and San Juan, Puerto Rico. In addition, seven states 
have a substantial rural burden reflecting more than 75 cases and 10% 
or more of their diagnoses in rural areas.
    Our national investments in HIV for nearly four decades have shown 
remarkable results in preventing new infections, improving health 
outcomes, and reducing deaths in hundreds of thousands of Americans. 
Despite this, progress has plateaued and additional effort is needed to 
ensure that all affected groups derive benefit equally. Some groups, 
like American Indian/Alaska Native, African American and Latino gay and 
bisexual men, transgender individuals, or people living in the South, 
have a higher burden of HIV and experience health disparities at each 
stage of the HIV care continuum. Southern states today account for an 
estimated 44% of all people living with an HIV diagnosis in the 
U.S.,\1\ despite having only about one-third (37%) of the overall U.S. 
population.\2\ Diagnosis rates for people in the South are higher than 
for Americans overall. Eight of the 10 states and all 10 metropolitan 
statistical areas with the highest rates of new HIV diagnoses are in 
the South. In addition to the severe burden in the South, nationally 
there is a high incidence of HIV among transgender individuals, high-
risk heterosexuals, and persons who inject drugs.\3\
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    \1\ Centers for Disease Control and Prevention (CDC). HIV 
Surveillance Report, 2014; vol. 26. Available at https://www.cdc.gov/hiv/library/reports/surveillance/. Published December 2015.
    \2\ U.S. Census Bureau. Annual Estimates of the Resident 
Population: April 1, 2010 to July 1, 2014. Available at https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2014_PEPANNRES&src=pt. Accessed November 
13, 2015.
    \3\ Department of Health and Human Services, Centers for Disease 
Control and Prevention. HIV in the United States and dependent 
areas. https://www.cdc.gov/hiv/statistics/overview/ataglance.html. 
Updated January 29, 2019. Accessed February 5, 2019.
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    As recognized by the President during the February 2019 State of 
the Union address, we have an unprecedented opportunity to end the HIV 
epidemic in America. We have access to the most powerful HIV prevention 
and treatment tools in history and new technology that allows us to 
pinpoint where infections are spreading most rapidly. By effectively 
equipping all at-risk communities with these tools, we can end the HIV 
epidemic in America. The EHE acts boldly on this unprecedented 
opportunity by providing the hardest hit communities with the 
additional expertise, technology, and resources required to address the 
HIV epidemic in their communities. Phase One of the EHE focuses on the 
areas of the nation that comprised more than 50% of the new HIV 
diagnoses in 2016 and 2017, including 7 states with marked rural HIV 
burden, 48 individual counties among other states and the jurisdictions 
of Washington, DC, and San Juan, Puerto Rico. See https://www.hiv.gov 
and https://files.hiv.gov/s3fs-public/Ending-the-HIV-Epidemic-Counties-and-Territories.pdf for more information about the EHE and its Phase 
One focus jurisdictions. The utilization of the MHAF for this funding 
announcement given its mission and goals, is a critical building block 
in this effort and reflects our decision to act now.
    HHS recently developed a set of critical health priorities for the 
nation known as ``Leading Health Indicators'' (or LHIs) that are a call 
to action in critical public health areas. HHS will use the LHIs to 
assess the health of the U.S. population over the next decade, to 
facilitate collaboration among diverse groups, and to motivate 
individuals and communities to take action to improve their health. The 
following LHIs also will be used by policymakers and public health 
professionals to track progress in local communities as they work 
toward meeting these key national health goals:
    (1) Diagnose 95 percent of persons aged 13 years and older living 
with HIV who are aware of their HIV infection by 2025, working from a 
baseline of 85.8 percent in 2016.
    (2) Treat 95 percent of persons aged 13 years and older via linkage 
to appropriate care within one month of diagnosis by 2025, working from 
a baseline of 78.3 percent in 2017.
    (3) Treat 95 percent of persons aged 13 years and older diagnosed 
with HIV via sufficient viral suppression (viral load, 200 copies/ml) 
by 2025, working from a baseline of 61.5 percent in 2016.
    (4) Prevent new HIV infections by achieving 50-60 percent PrEP 
coverage among those for whom PrEP was indicated by 2025.
    There are notable concerns in new HIV diagnoses in AI/AN 
populations compared to some other race/ethnicities: (1) New HIV 
diagnoses among AI/AN people increased by 70% from 2011 to 2016; (2) 
AI/AN patients have the lowest three-year survival rates of any race/
ethnicity after an AIDS diagnosis; and (3) both male and female AI/AN 
people had the highest percent of estimated diagnoses of HIV infection 
attributed to injection drug use.\4\ Mortality data also found that AI/
AN individuals have significantly higher death rates from HIV/AIDS than 
whites, which could be attributable to later diagnosis, lack of linkage 
to care, difficulty accessing care, challenges to treatment adherence, 
or other factors or combination of factors.
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    \4\ https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf.
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    Another common co-morbidity for bloodborne HIV infection is 
Hepatitis C Virus (HCV) infection. In 2009, approximately 21% of HIV-
infected adults who were tested for past or present HCV infection 
tested positive, although co-infection prevalence varies substantially 
according to HIV-infected risk group (e.g., men who have sex with men 
(MSM), high-risk heterosexuals, and persons who inject 
drugs).5 6 7 As HCV is a bloodborne virus primarily 
transmitted through direct contact with the blood of an infected 
person, coinfection with HIV and HCV is common (62-80%) among HIV-
infected injection-drug users.8 9 10 Although transmission 
via injection drug use remains the most common mode of HCV acquisition 
in the U.S.,\9\ sexual transmission is an important mode of acquisition 
among certain groups, including HIV-infected MSM with certain risk 
factors.\11\ Data have shown

[[Page 38258]]

that HCV disproportionately affects AI/AN people, with HCV-related 
mortality more than double the national rate.\12\ In a recent IHS 
survey, almost 50% of the AI/AN individuals diagnosed with HCV were 
born after 1965 and younger than the targeted birth cohort for HCV 
screening campaigns (1945-1965, `Baby Boomers'). Untreated HCV can lead 
to a myriad of extrahepatic manifestations and cirrhosis with 
complications such as portal hypertension, end stage liver disease, and 
hepatocellular carcinoma (HCC). Early diagnosis and treatment of HCV 
infection prevents the development of extrahepatic manifestations, and 
progressive liver disease including cirrhosis. Recently developed 
treatments for HCV are more accessible and highly effective at greatly 
reducing HCV- and HCC-related mortality. Treatment for HCV can be 
highly successful at the primary care level with appropriate planning 
and support.
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    \5\ Garg S, Brooks J, Luo Q, Skarbinski J. Prevalence of and 
Factors Associated with Hepatitis C Virus (HCV) Testing and 
Infection Among HIV-infected Adults Receiving Medical Care in the 
United States. Infectious Disease Society of America (IDSA). 
Philadelphia, PA, 2014.
    \6\ Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, 
Berry SA, et al. Hepatitis C virus testing in adults living with 
HIV: A need for improved screening efforts. PLoS ONE 
2014;9(7):e102766. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0102766.
    \7\ Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis 
C virus infection among patients in the HIV Outpatient Study, 1996-
2007. J Acquir Immune Defic Syndr 2010;53:388-396.
    \8\ Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, 
Berry SA, et al. Hepatitis C virus testing in adults living with 
HIV: A need for improved screening efforts. PLoS ONE 
2014;9(7):e102766. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0102766.
    \9\ Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis 
C virus infection among patients in the HIV Outpatient Study, 1996-
2007. J Acquir Immune Defic Syndr 2010;53:388-396.
    \10\ Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm. 
Atlanta: US Department of Health and Human Services, Centers for 
Disease Control and Prevention; 2017.
    \11\ Panel on Opportunistic Infections in HIV-Infected Adults 
and Adolescents. Guidelines for the prevention and treatment of 
opportunistic infections in HIV-infected adults and adolescents: 
Recommendations from the Centers for Disease Control and Prevention, 
the National Institutes of Health, and the HIV Medicine Association 
of the Infectious Diseases Society of America. Available at https://www.ncbi.nlm.nih.gov/pubmed/19357635 July 6, 2018.
    \12\ https://aspe.hhs.gov/system/files/pdf/260026/HepC.pdf.
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    Data also show that Sexually Transmitted Infection (STI) rates 
remain elevated in Indian Country. Recurrent STIs can increase the 
likelihood of HIV transmission. Gonorrhea and syphilis often present as 
co-morbid conditions with HIV diagnosis, particularly among MSM. The 
latest Indian Health Surveillance Report: Sexually Transmitted Diseases 
2015 \13\ showed that AI/AN people have 3.8 times the incidence rate of 
whites for chlamydia and 4.4 times the rate of whites for gonorrhea. 
Compared to other races/ethnicities, AI/AN people have the second 
highest rates for both chlamydia and gonorrhea. Gonorrhea rates have 
continued to increase drastically since 2011. Regional differences in 
STI incidence in Indian Country are also observed. There is a disparate 
and increased STI burden among AI/AN youth and AI/AN women, 
particularly women of reproductive age. In addition, recent outbreaks 
of syphilis have been observed among AI/AN communities. Some of these 
outbreaks are connected to the use of injection drugs and 
methamphetamines, all known risk factors for HIV transmission.
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    \13\ https://www.ihs.gov/epi/includes/themes/responsive2017/display_objects/documents/std/Indian_Health_Surveillance_Report_STD_2015.pdf.
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    Finally, treatment for substance use disorders can be difficult to 
access in IHS catchment areas, as the appropriated budget includes 
fewer dollars per patient compared to other federal direct-care 
networks. Untreated substance use disorders can exacerbate risk-taking 
behavior and reduce adherence to treatment.
    Confronting these intersecting epidemics requires collaboration 
across sectors and disciplines and the use of existing public health 
and clinical infrastructures. Lasting changes to these trends for HIV 
and related comorbidities among AI/AN people will also require 
innovative new approaches, incorporating existing and new data sources, 
all driven by community input.

Purpose

    The purpose of this IHS competitive supplement is to support 
communities in reducing new HIV infections and relevant co-morbidities, 
specifically STI and HCV infections, improve HIV-, STI- and HCV-related 
health outcomes, and to reduce HIV-, STI- and HCV-related health 
disparities among AI/AN people.
    The MHAF is funding IHS grantees to meet the four strategies of 
EHE--diagnose, treat, protect, and respond. Our goal is ambitious and 
the pathway is clear--employ strategic practices in Indian Country to: 
(1) Diagnose all people with HIV as early as possible after infection; 
(2) treat the infection rapidly and effectively to achieve sustained 
viral suppression; (3) respond rapidly to detect and respond to growing 
HIV clusters and prevent new HIV infections and (4) establish local 
teams committed to the success of the initiative in each jurisdiction.
    To reach the EHE goal of 75% reduction in new HIV infections in 5 
years and at least 90% reduction in 10 years, the IHS, through an IDDA 
to obligate specific amounts from MHAF, is offering this funding 
opportunity to the TECs to support activities across Indian Country 
within the Community Planning Domain.

Developing the Foundation for Phase 1 of EHE: The Community Planning 
Domain

    Each application must address the Community Planning Domain of the 
EHE. Aspects to include are listed below and are priority areas for 
this Notice of Funding Opportunity (NOFO). However, applications may 
include other aspects of the community planning domain not specifically 
mentioned below. Proposed activities should focus on HIV but should 
also include opportunities to address relevant STIs and HCV.

Limited Competition Justification

    The IHS enters into cooperative agreements with TECs under the 
authority of Section 214(a)(1) of the Indian Health Care Improvement 
Act, Public Law 94-437, as amended by Public Law 102-573. The TECs 
carry out a variety of functions specified in statute. These functions 
include data collection and analysis; evaluation of existing delivery 
systems, data systems, and other systems that impact the improvement of 
Indian health; making recommendations for the targeting of services; 
and provision of requested technical assistance to Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations [25 U.S.C. 
1621m(b)]. Other organizations do not have the capacity to provide this 
support. With respect to access to information, TECs are treated as 
public health authorities for the purposes of the Health Insurance 
Portability and Accountability Act of 1996 (Pub. L. 104-191). Unlike 
their counterparts, they have no or little funding from their 
jurisdictional governments to perform these public functions.
    This limited-eligibility NOFO will allow the TECs to directly 
support the communities they serve in their HIV/HCV/STI diagnosis, 
prevention, treatment, and response efforts. The TECs already possess 
technical expertise in program management, community-based 
interventions and educational tool development. The TECs must have 
demonstrated their ability to methodically and effectively reach Tribal 
members and efficiently work with AI/AN populations on their public 
health capacity building. Selected organizations that have previous 
experience working effectively with Tribal governments will help ensure 
that interventions and infrastructure are culturally appropriate and 
locally-minded.

II. Award Information

Funding Instrument

    Cooperative Agreement.

Estimated Funds Available

    The total funding identified for FY 2019 is approximately $500,000. 
Individual award amounts will be up to $100,000 total costs per year 
(direct costs plus indirect costs). The funding available for competing 
and subsequent continuation awards issued under this announcement is 
subject to the availability of appropriations and budgetary priorities 
of the Agency. The IHS is under no obligation to make awards that are 
selected for funding under this announcement.

[[Page 38259]]

    The TEC sites serving areas that do not include the Phase One 
priority jurisdictions are eligible to apply for the funding under this 
announcement.

Anticipated Number of Awards

    Approximately five awards will be issued under this program 
announcement.

Period of Performance

    The period of performance is for two years.

Cooperative Agreement

    Cooperative agreements awarded by the HHS are administered under 
the same policies as a grant. However, the funding agency (IHS) is 
anticipated to have substantial programmatic involvement in the project 
during the entire award segment. Below is a detailed description of the 
level of involvement required for IHS.

Substantial Involvement Description for Cooperative Agreement

    (1) The IHS Office of Public Health Support (OPHS) Division of 
Epidemiology and Disease Prevention (DEDP) and the IHS Office of 
Clinical and Preventive Services (OCPS), Division of Clinical and 
Community Services (DCCS) will provide ongoing consultation and 
technical assistance to plan, implement, and evaluate each component as 
described under Recipient Activities.
    (2) The IHS will conduct site visits to TECs and/or coordinate TEC 
visits to IHS and other federal, state, county, or AI/AN-serving 
agencies to assess work plans and ensure data security, confirm 
compliance with applicable laws and regulations, assess program 
activities, and to mutually resolve problems, as needed.
    (3) The IHS OPHS/DEDP and OCPS/DCCS will provide a forum for 
outreach and education to advance the goals of this program through 
existing and new partnerships. The IHS will facilitate TECs' 
participation in the IHS National AI/AN STD Prevention workgroup, a 
forum that includes approximately 150 participants from clinical, 
public health, advocacy and education sectors working in HIV/STI 
control.
    (4) The IHS OPHS/DEDP and OCPS/DCCS will coordinate reporting and 
technical assistance as required.

III. Eligibility Information

1. Eligibility

    Only current TEC awardees are eligible to apply for the competing 
supplemental funding under this announcement and must demonstrate that 
they have complied with previous terms and conditions of the TEC 
program.
    TEC sites serving areas that do not include the Phase One priority 
jurisdictions are eligible to apply for the funding under this 
announcement.
    Note: Please refer to Section IV.2 (Application and Submission 
Information/Subsection 2, Content and Form of Application Submission) 
for additional proof of applicant status documents required, such as 
Tribal resolutions, proof of non-profit status, etc.

2. Cost Sharing or Matching

    The IHS does not require matching funds or cost sharing for grants 
or cooperative agreements.

3. Other Requirements

    Applications with budget requests that exceed the highest dollar 
amount outlined under the Award Information, Estimated Funds Available 
section, or exceed the Period of Performance outlined under the Award 
Information, Period of Performance section will be considered not 
responsive and will not be reviewed. The Division of Grants Management 
(DGM) will notify the applicant.

IV. Application and Submission Information

1. Obtaining Application Materials

    The application package and detailed instructions for this 
announcement are hosted on https://www.Grants.gov.
    Please direct questions regarding the application process to Mr. 
Paul Gettys at (301) 443-2114 or (301) 443-5204.

2. Content and Form Application Submission

    The applicant must include the project narrative as an attachment 
to the application package. Mandatory documents for all applicants 
include:
     Abstract (one page) summarizing the project.
     Application forms:
    [cir] SF-424, Application for Federal Assistance.
    [cir] SF-424A, Budget Information--Non-Construction Programs.
    [cir] SF-424B, Assurances--Non-Construction Programs.
     Project Narrative (not to exceed 10 pages). See IV.2.A 
Project Narrative for instructions.
    [cir] Background information on the organization.
    [cir] Proposed goals, specific, measurable, achievable, realistic 
and time-bound) (SMART) objectives (see https://www.cdc.gov/tb/programs/Evaluation/Guide/PDF/b_write_objective.pdf, for more 
information), scope of work, and activities (to be included in a one-
page timeframe chart) that provide a description of what the applicant 
plans to accomplish.
     Budget Justification and Narrative (not to exceed 5 
pages). See IV.2.B Budget Narrative for instructions.
     One-page Timeframe Chart.
     Glossary of terms and acronyms used in the application.
     Letters of Support from organization's Board of Directors 
(optional).
     Biographical sketches for all Key Personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL).
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost rate (IDC) 
agreement (required in order to receive IDC).
     Organizational Chart.
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    [cir] Email confirmation from Federal Audit Clearinghouse (FAC) 
that audits were submitted; or
    [cir] Face sheets from audit reports. Applicants can find these on 
the FAC website: https://harvester.census.gov/facdissem/Main.aspx,
Public Policy Requirements
    All federal public policies apply to IHS grants and cooperative 
agreements with the exception of the Discrimination Policy.
Requirements for Project and Budget Narratives
    A. Project Narrative: This narrative should be a separate document 
that is no more than 10 pages and must: (1) Have consecutively numbered 
pages; (2) use black font 12 points or larger; (3) be single-spaced; 
(4) and be formatted to fit standard letter paper (8-1/2 x 11 inches).
    Be sure to succinctly answer all questions listed under the 
evaluation criteria (refer to Section V.1, Evaluation Criteria) and 
place all responses and required information in the correct section 
noted below or they will not be considered or scored. If the narrative 
exceeds the page limit, the application will be considered not 
responsive and not be reviewed. The 10-page limit for the narrative 
does not include the work plan, standard forms, Tribal resolutions, 
budget, budget justifications, narratives, and/or other appendix items.
    There are three parts to the narrative: Part 1--Program 
Information; Part 2--

[[Page 38260]]

Program Planning and Evaluation; and Part 3--Program Report. See below 
for additional details about what must be included in the narrative. 
The page limits below are for each narrative and budget submitted.

Part 1: Program Information (limit--3 pages)

    Section 1: Needs. Describe the TEC's current health program 
activities, how long it has been operating, and what programs or 
services are currently being provided by the organization. Describe how 
the Tribal Organization has determined it has the administrative 
infrastructure to support the activities proposed.

Part 2: Program Planning and Evaluation (limit--3 pages)

    Section 1: Program Plans. Describe fully and clearly the activities 
the TEC plans to conduct this work.
    Section 2: Program Evaluation. Describe fully and clearly the 
improvements that will be made by the TEC to meet the public health 
needs of the community in the context of the funding requirements.

Part 3: Program Report (limit--4 pages)

    Section 1: Describe your organization's significant program 
activities and accomplishments over the past five years associated with 
the goals of this announcement.
    Please identify and describe significant program activities and 
achievements associated with the proposed activities. Provide a 
comparison of the actual accomplishments to the goals established for 
the project period, or if applicable, provide justification for the 
lack of progress.
    B. Budget Narrative: (limit--5 pages) Provide a budget narrative 
that explains the amounts requested for each line of the budget. The 
budget narrative should specifically describe how each item will 
support the achievement of proposed objectives. Be very careful about 
showing how each item in the ``other'' category is justified. For 
subsequent budget years, the narrative should highlight the changes 
from year one or clearly indicate that there are no substantive budget 
changes during the period of performance. Do NOT use the budget 
narrative to expand the project narrative.

3. Submission Dates and Times

    Applications must be submitted through Grants.gov by 11:59 p.m. 
Eastern Daylight Time (EDT) on the Application Deadline Date. Any 
application received after the application deadline will not be 
accepted for review. Grants.gov will notify the applicant via email if 
the application is rejected.
    If technical challenges arise and assistance is required with the 
application process, contact Grants.gov Customer Support (see contact 
information at https://www.grants.gov). If problems persist, contact 
Mr. Paul Gettys ([email protected]), DGM Grant Systems Coordinator, 
by telephone at (301) 443-2114 or (301) 443-5204. Please be sure to 
contact Mr. Gettys at least 10 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.
    The IHS will not acknowledge receipt of applications.

4. Intergovernmental Review

    Executive Order 12372 requiring intergovernmental review is not 
applicable to this program.

5. Funding Restrictions

     Pre-award costs are allowable up to 90 days before the 
start date of the award provided the costs are otherwise allowable if 
awarded. Pre-award costs are incurred at the risk of the applicant.
     The available funds are inclusive of direct and indirect 
costs.
     Only one supplement will be awarded per applicant.

6. Electronic Submission Requirements

    All applications must be submitted via Grants.gov. Please use the 
https://www.Grants.gov website to submit an application. Find the 
application by selecting the ``Search Grants'' link on the homepage. 
Follow the instructions for submitting an application under the Package 
tab. No other method of application submission is acceptable.
    If the applicant cannot submit an application through Grants.gov, a 
waiver must be requested. Prior approval must be requested and obtained 
from Mr. Robert Tarwater, Director, DGM. A written waiver request must 
be sent to [email protected] with a copy to [email protected]. 
The waiver must: (1) Be documented in writing (emails are acceptable) 
before submitting an application by some other method, and (2) include 
clear justification for the need to deviate from the required 
application submission process.
    Once the waiver request has been approved, the applicant will 
receive a confirmation of approval email containing submission 
instructions. A copy of the written approval must be included with the 
application that is submitted to the DGM. Applications that are 
submitted without a copy of the signed waiver from the Director of the 
DGM will not be reviewed. The Grants Management Officer of the DGM will 
notify the applicant via email of this decision. Applications submitted 
under waiver must be received by the DGM no later than 5:00 p.m., EDT, 
on the Application Deadline Date. Late applications will not be 
accepted for processing. Applicants that do not register for both the 
System for Award Management (SAM) and Grants.gov and/or fail to request 
timely assistance with technical issues will not be considered for a 
waiver to submit an application via alternative method.
    Please be aware of the following:
     Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the 
Funding Opportunity Number. Both numbers are located in the header of 
this announcement.
     If you experience technical challenges while submitting 
your application, please contact Grants.gov Customer Support (see 
contact information at https://www.grants.gov).
     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 a waiver from the agency must be 
obtained.
     Applicants are strongly encouraged not to wait until the 
deadline date to begin the application process through Grants.gov as 
the registration process for SAM and Grants.gov could take up to 20 
working days.
     Please follow the instructions on Grants.gov to include 
additional documentation that may be requested by this funding 
announcement.
     Applicants must comply with any page limits described in 
this funding announcement.
     After submitting the application, the applicant will 
receive an automatic acknowledgment from Grants.gov that contains a 
Grants.gov tracking number. The IHS will not notify the applicant that 
the application has been received.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
    Applicants and grantee organizations are required to obtain a DUNS 
number and maintain an active registration in the SAM database. The 
DUNS number is a unique nine-digit identification number provided by 
D&B that uniquely identifies each 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

[[Page 38261]]

charge. To obtain a DUNS number, please access the request service 
through https://fedgov.dnb.com/webform, or call (866) 705-5711.
    The Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), requires all HHS recipients to report 
information on sub-awards. Accordingly, 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. This requirement ensures the use of a 
universal identifier to enhance the quality of information available to 
the public pursuant to the Transparency Act.
System for Award Management (SAM)
    Organizations that are not registered with SAM will need to obtain 
a DUNS number first and then access the SAM online registration through 
the SAM home page at https://www.sam.gov (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). Please see SAM.gov for details on the registration process and 
timeline. Registration with the SAM is free of charge, but can take 
several weeks to process. Applicants may register online at https://www.sam.gov.
    Additional information on implementing the Transparency Act, 
including the specific requirements for DUNS and SAM, are available on 
the DGM Grants Management, Policy Topics website: https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Weights assigned to each section are noted in parentheses. The 10-
page project narrative should include only the first year of 
activities; information for multi-year projects should be included as 
an appendix. See ``Multi-year Project Requirements'' at the end of this 
section for more information. The narrative section should be written 
in a manner that is clear to outside reviewers unfamiliar with prior 
related activities of the applicant. It should be well organized, 
succinct, and contain all information necessary for reviewers to 
understand the project fully. Points will be assigned to each 
evaluation criteria adding up to a total of 100 possible points. Points 
are assigned as follows:

1. Criteria

A. Introduction and Need for Assistance (10 Points)
    Must include the applicant's background information, a description 
of epidemiological service, epidemiologic capacity and history of 
support for such activities. Applicants need to include current public 
health activities, what program services are currently being provided, 
and interactions with other public health authorities in the region 
(state, local, or Tribal).
    Please describe how the TEC will make improvements in capacity to 
address IHS, Tribal and Urban (I/T/U), local-level, and/or Area-level 
HIV/HCV/STI burden. In order to significantly reduce transmission of 
HIV/HCV/STI, I/T/U need baseline and annual measurements of HIV/HCV/STI 
diagnoses, linkage to care, and viral load measurements, as applicable. 
TECs will also help evaluate geographies with higher burden of HIV/HCV/
STI and assist communities in targeting interventions.
B. Project Objective(s), Work Plan and Approach (25 Points)
    a. Clearly identify the operational strategies to be addressed by 
the TEC. Activities in at least two of the EHE's key operational 
strategies should be planned for completion within the program period 
(indicate these two activities in bold).
    b. Applicants will outline their approach for addressing the 
operational strategies in the work plan or logic model. Outline 
overarching activities, short-term and long term-outcomes. Make note of 
proposed timelines and partners who will be involved in each activity.
Activities
    Applications must include the following activities:

1. Coordination Operational Strategy

    i. Grantees will send at least one representative to the annual HIV 
Coordination meeting, scheduled in September of each year to coincide 
with the U.S. Conference on AIDS. Budget should include travel and 
associated costs for participation.
    ii. Grantees will participate in the IHS National AI/AN STI 
Prevention workgroup.

2. Diagnosis Operational Strategy

    The TECs will provide technical assistance and/or disease 
surveillance support to communities by developing analytical reports to 
examine the burden of HIV and other relevant comorbidities such as STIs 
and HCV in Tribal communities.

3. Treatment Operational Strategy

    The TECs will provide support to communities in the development of 
enhanced activities and expanded capacity to better identify people who 
are not in care, including those who were never linked to care 
following an HIV, STI, or HCV diagnosis and those who have fallen out 
of care.

4. Respond Operational Strategy

    Respond rapidly to detect and characterize growing HIV, STI, or HCV 
clusters and prevent new infections. TECs will provide technical 
assistance and/or direct support to communities on the following 
activities:
    i. Develop or accelerate the development of community plans that 
are customized for AI/AN communities. Extensive community engagement in 
this process will help ensure that community-specific social norms and 
unique epidemic attributes are addressed. Initial community-specific 
plans will be requested by May 31, 2020. Planning should reflect the 
time-sensitive nature of this activity.
    ii. Develop collaborative partnerships among Tribal, state, and 
local health departments, the clinical community, and community-based 
organizations to expand and routinize HIV diagnosis, treatment, 
prevention and response.
C. Program Evaluation (30 Points)
    a. Clearly identify plans for program evaluation to ensure that 
objectives of the program are met at the conclusion of the funding 
period.
    b. Include (SMART) evaluation criteria.
    c. Evaluation should minimally include summaries of activities in 
each of the proposed key operational strategies.
D. Organizational Capabilities, Key Personnel and Qualifications (30 
Points)
    a. Include an organizational capacity statement which demonstrates 
the ability to execute program strategies within the program period.
    b. Project management and staffing plan. Detail that the 
organization has the current staffing and expertise to address each of 
the program activities. If current capacity does not exist please 
describe the actions that the TEC will take to fulfill this gap within 
a specified timeline.
    c. Demonstrate local partners' willingness to work with TEC on 
proposed efforts. Applicants are particularly encouraged to collaborate 
with other federally-funded organizations such as their local health 
departments and Ryan White HIV/AIDS Program awardees.

[[Page 38262]]

    d. Demonstrate that the TEC has previous successful experience 
providing technical or programmatic support to Tribal communities.
E. Categorical Budget and Budget Justification (5 Points)
    a. Provide a detailed budget and accompanying narrative to explain 
the activities being considered and how they are related to proposed 
program objectives.
Multi-Year Project Requirements
    Applications must include a brief project narrative and budget (one 
additional page per year) addressing the developmental plans for each 
additional year of the project. This attachment will not count as part 
of the project narrative or the budget narrative.
Additional Documents Can Be Uploaded as Appendix Items in Grants.gov
     Work plan, logic model and/or time line for proposed 
objectives.
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Rate Agreement.
     Organizational chart.
     Map of area identifying project location(s).
     Glossary of terms and acronyms used in the application.
     Additional documents to support narrative (i.e., data 
tables, key news articles, etc.).

2. Review and Selection

    Each application will be prescreened for eligibility and 
completeness as outlined in the funding announcement. Applications that 
meet the eligibility criteria shall be reviewed for merit by the 
Objective Review Committee (ORC) based on evaluation criteria. 
Incomplete applications and applications that are not responsive to the 
administrative thresholds will not be referred to the ORC and will not 
be funded. The applicant will be notified of this determination.
    Applicants must address all program requirements and provide all 
required documentation.

3. Notifications of Disposition

    All applicants will receive an Executive Summary Statement from the 
IHS OPHS within 30 days of the conclusion of the ORC outlining the 
strengths and weaknesses of their application. The summary statement 
will be sent to the Authorizing Official identified on the face page 
(SF-424) of the application.
A. Award Notices for Funded Applications
    The Notice of Award (NoA) is the authorizing document for which 
funds are dispersed to the approved entities and reflects 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. Each entity approved for funding must have a 
user account in GrantSolutions in order to retrieve the NoA. Please see 
the Agency Contacts list in Section VII for the systems contact 
information.
B. Approved but Unfunded Applications
    Approved applications not funded due to lack of available funds 
will be held for one year. If funding becomes available during the 
course of the year, the application may be reconsidered.

    Note:  Any correspondence other than the official NoA executed 
by an IHS grants management official announcing to the project 
director that an award has been made to their organization is not an 
authorization to implement their program on behalf of the IHS.

VI. Award Administration Information

1. Administrative Requirements

    Cooperative agreements are administered in accordance with the 
following regulations and policies:
    A. The criteria as outlined in this program announcement.
    B. Administrative Regulations for Grants:
     Uniform Administrative Requirements for HHS Awards, 
located at 45 CFR part 75.
    C. Grants Policy:
     HHS Grants Policy Statement, Revised 01/07.
    D. Cost Principles:
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' located at 45 CFR part 75, subpart E.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' located at 45 CFR part 75, subpart F.

2. Indirect Costs

    This section applies to all recipients that request reimbursement 
of indirect costs (IDC) in their application budget. In accordance with 
HHS Grants Policy Statement, Part II-27, IHS requires applicants to 
obtain a current IDC 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 agreement is not on file with the DGM at 
the time of award, the IDC portion of the budget will be restricted. 
The restrictions remain in place until the current rate agreement is 
provided to the DGM.
    Generally, IDC rates for IHS grantees are negotiated with the 
Division of Cost Allocation https://rates.psc.gov/ and the Department 
of Interior (Interior Business Center) https://www.doi.gov/ibc/services/finance/indirect-Cost-Services/indian-tribes. For questions 
regarding the indirect cost policy, please call the Grants Management 
Specialist listed under ``Agency Contacts'' or the main DGM office at 
(301) 443-5204.

3. Reporting Requirements

    The grantee must submit required reports consistent with the 
applicable deadlines. Failure to submit required reports within the 
time allowed may result in suspension or termination of an active 
grant, 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 non-
award of other eligible projects or activities. This requirement 
applies whether the delinquency is attributable to the failure of the 
grantee organization or the individual responsible for preparation of 
the reports. Per DGM policy, all reports are required to be submitted 
electronically by attaching them as a ``Grant Note'' in GrantSolutions. 
Personnel responsible for submitting reports will be required to obtain 
a login and password for GrantSolutions. Please see the Agency Contacts 
list in section VII for the systems contact information.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required semi-annually within 30 days 
after the budget period ends. These reports must include a brief 
comparison of actual accomplishments to the goals established for the 
period, a summary of progress to date or, if applicable, provide sound 
justification for the lack

[[Page 38263]]

of progress, and other pertinent information as required.
    Additional quarterly reports and quarterly calls discussing 
progress on a standardized form are required for this funding. Post-
award, the standard form will be disseminated to all funded programs.
    Special attention should be devoted to reporting on the development 
of community plans required under the Respond Operational Strategy.
    A final report must be submitted within 90 days of expiration of 
the period of performance.
B. Financial Reports
    Federal Financial Report (FFR or SF-425), Cash Transaction Reports 
are due 30 days after the close of every calendar quarter to the 
Payment Management Services, HHS at https://pms.psc.gov. The applicant 
is also requested to upload a copy of the FFR (SF-425) into our grants 
management system, GrantSolutions. Failure to submit timely reports may 
result in adverse award actions blocking access to funds.
    Grantees are responsible and accountable for accurate information 
being reported on all required reports: The Progress Reports and 
Federal Financial Report.
C. Data Collection and Reporting
    The TEC must report annually (by their respective IHS Area or 
Tribal health board) the progress towards EHE goals via a standardized 
form.
    The TEC will participate in quarterly calls with the program 
office.
D. Federal Sub-Award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The 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 sub-awards and executive 
compensation under federal assistance awards.
    The IHS has implemented a Term of Award into all IHS Standard Terms 
and Conditions, NoAs and funding announcements regarding the FSRS 
reporting requirement. This IHS Term of Award is applicable to all IHS 
grant and cooperative agreements issued on or after October 1, 2010, 
with a $25,000 sub-award obligation dollar threshold met for any 
specific reporting period. Additionally, all new (discretionary) IHS 
awards (where the period of performance is made up of more than one 
budget period) and where: (1) The period of performance start date was 
October 1, 2010 or after, and (2) the primary awardee will have a 
$25,000 sub-award obligation dollar threshold during any specific 
reporting period will be required to address the FSRS reporting.
    For the full IHS award term implementing this requirement and 
additional award applicability information, visit the DGM Grants Policy 
website at https://www.ihs.gov/dgm/policytopics/.
E. Compliance With Executive Order 13166 Implementation of Services 
Accessibility Provisions for All Grant Application Packages and Funding 
Opportunity Announcements
    Recipients of federal financial assistance (FFA) from the HHS must 
administer their programs in compliance with federal civil rights law. 
This means that recipients of HHS funds must ensure equal access to 
their programs without regard to a person's race, color, national 
origin, disability, age and, in some circumstances, sex and religion. 
This includes ensuring your programs are accessible to persons with 
limited English proficiency. The HHS provides guidance to recipients of 
FFA on meeting their legal obligation to take reasonable steps to 
provide meaningful access to their programs by persons with limited 
English proficiency. Please see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-VI/.
    The HHS Office for Civil Rights (OCR) also provides guidance on 
complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/civil-rights/for-individuals/section-1557/; and 
https://www.hhs.gov/civil-rights/. Recipients of FFA also 
have specific legal obligations for serving qualified individuals with 
disabilities. Please see https://www.hhs.gov/civil-rights/for-individuals/disability/. Please contact the HHS OCR for more 
information about obligations and prohibitions under federal civil 
rights laws at https://www.hhs.gov/ocr/about-us/contact-us/ 
or call (800) 368-1019 or TDD (800) 537-7697. Also note it is an HHS 
Departmental goal to ensure access to quality, culturally competent 
care, including long-term services and supports, for vulnerable 
populations. For further guidance on providing culturally and 
linguistically appropriate services, recipients should review the 
National Standards for Culturally and Linguistically Appropriate 
Services in Health and Health Care at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.
    Pursuant to 45 CFR 80.3(d), an individual shall not be deemed 
subjected to discrimination by reason of his/her exclusion from 
benefits limited by federal law to individuals eligible for benefits 
and services from the IHS.
    Recipients will be required to sign the HHS-690 Assurance of 
Compliance form which can be obtained from the following website: 
https://www.hhs.gov/sites/default/files/forms/hhs-690.pdf, and send it 
directly to the: U.S. Department of Health and Human Services, Office 
of Civil Rights, 200 Independence Ave. SW, Washington, DC 20201.
F. Federal Awardee Performance and Integrity Information System 
(FAPIIS)
    The IHS is required to review and consider any information about 
the applicant that is in the Federal Awardee Performance and Integrity 
Information System (FAPIIS), at https://www.fapiis.gov, before making 
any award in excess of the simplified acquisition threshold (currently 
$150,000) over the period of performance. An applicant may review and 
comment on any information about itself that a federal awarding agency 
previously entered. IHS will consider any comments by the applicant, in 
addition to other information in FAPIIS in making a judgment about the 
applicant's integrity, business ethics, and record of performance under 
federal awards when completing the review of risk posed by applicants 
as described in 45 CFR 75.205.
    As required by 45 CFR part 75 Appendix XII of the Uniform Guidance, 
non-federal entities (NFEs) are required to disclose in FAPIIS any 
information about criminal, civil, and administrative proceedings, and/
or affirm that there is no new information to provide. This applies to 
NFEs that receive federal awards (currently active grants, cooperative 
agreements, and procurement contracts) greater than $10,000,000 for any 
period of time during the period of performance of an award/project.
Mandatory Disclosure Requirements
    As required by 2 CFR part 200 of the Uniform Guidance, and the HHS 
implementing regulations at 45 CFR part 75, effective January 1, 2016, 
the IHS must require a non-federal entity or an applicant for a federal 
award to disclose, in a timely manner, in writing to the

[[Page 38264]]

IHS or pass-through entity all violations of federal criminal law 
involving fraud, bribery, or gratuity violations potentially affecting 
the federal award.
    Submission is required for all applicants and recipients, in 
writing, to the IHS and to the HHS Office of Inspector General all 
information related to violations of federal criminal law involving 
fraud, bribery, or gratuity violations potentially affecting the 
federal award. 45 CFR 75.113.
    Disclosures must be sent in writing to: U.S. Department of Health 
and Human Services, Indian Health Service, Division of Grants 
Management, ATTN: Mr. Robert Tarwater, Director, 5600 Fishers Lane, 
Mail Stop: 09E70, Rockville, MD 20857 (Include ``Mandatory Grant 
Disclosures'' in subject line), Office: (301) 443-5204, Fax: (301) 594-
0899, Email: [email protected].
    And,
    U.S. Department of Health and Human Services, Office of Inspector 
General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 
Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 
20201, URL: https://oig.hhs.gov/fraud/report-fraud/, (Include 
``Mandatory Grant Disclosures'' in subject line), Fax: (202) 205-0604 
(Include ``Mandatory Grant Disclosures'' in subject line) or Email: 
[email protected].
    Failure to make required disclosures can result in any of the 
remedies described in 45 CFR 75.371 Remedies for noncompliance, 
including suspension or debarment (See 2 CFR parts 180 & 376 and 31 
U.S.C. 3321).

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: Ms. 
Lisa C. Neel, Public Health Advisor, Office of Public Health Support, 
Division of Epidemiology & Disease Prevention, Indian Health Service, 
5600 Fishers Lane, Mailstop: 09E17B, Rockville, MD 20857, Phone: (301) 
443-4305, Email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Mr. John Hoffman, Senior Grants Management Specialist, 
5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Phone: (301) 
443-2116, Fax: (301) 594-0899, Email: [email protected].
    3. Questions on systems matters may be directed to: Mr. Paul 
Gettys, Grant Systems Coordinator, 5600 Fishers Lane, Mail Stop: 09E70, 
Rockville, MD 20857, Phone: (301) 443-2114; or the DGM main line (301) 
443-5204, Fax: (301) 594-0899, Email: [email protected].

VIII. Other Information

    The Public Health Service strongly encourages all grant, 
cooperative agreement and contract recipients to provide a smoke-free 
workplace and promote the non-use of all tobacco products. In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of the facility) in 
which regular or routine education, library, day care, health care, or 
early childhood development services are provided to children. This is 
consistent with the HHS mission to protect and advance the physical and 
mental health of the American people.

    Dated: July 31, 2019.
Michael D. Weahkee,
Assistant Surgeon General, U.S. Public Health Service, Principal Deputy 
Director, Indian Health Service.
[FR Doc. 2019-16760 Filed 8-5-19; 8:45 am]
 BILLING CODE 4165-16-P