Epidemiology Program for American Indian/Alaska Native Tribes and Urban Indian Communities, 41058-41073 [2021-16281]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 86, Number 144 (Friday, July 30, 2021)]
[Notices]
[Pages 41058-41073]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-16281]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Epidemiology Program for American Indian/Alaska Native Tribes and 
Urban Indian Communities

    Announcement Type: New and Competing Continuation.
    Funding Announcement Number: HHS-2021-IHS-EPI-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.231.

Key Dates

    Application Deadline Date: September 1, 2021.
    Earliest Anticipated Start Date: September 30, 2021.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for a 
cooperative agreement for Tribal Epidemiology Centers (TECs) serving 
American Indian/Alaska Native (AI/AN) Tribes and Urban Indian 
communities. This program is authorized under: The Snyder Act, 25 
U.S.C. 13; the Transfer Act, 42 U.S.C. 2001(a); and the Indian Health 
Care Improvement Act (IHCIA), as amended, 25 U.S.C. 1621m. 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 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 Administrative Areas. The funding 
opportunity announcement is open to currently funded TECs.
    TECs are uniquely positioned within Tribes, Tribal organizations, 
and Urban Indian organizations (UIO) to conduct disease surveillance, 
research, prevention, and control of disease, injury, or disability, 
and to assess the effectiveness of AI/AN public health programs. Some 
of the existing TECs have already developed innovative strategies to 
monitor the health status of Tribes and Urban Indian communities,

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including development of Tribal health registries and use of 
sophisticated record linkage computer software to correct existing 
state data sets for racial misclassification.
    TECs provide critical support for activities that promote Tribal 
Self-Governance and effective management of Tribal and Urban Indian 
health programs. Data generated locally and analyzed by TECs enable 
Tribes and Urban Indian communities to effectively plan and make 
decisions that best meet the needs of their communities. In addition, 
TECs can immediately provide feedback to local data systems, which will 
lead to improvements in Indian health data overall.
    As more Tribes choose to operate health programs in their 
communities, TECs ultimately will provide additional public health 
services such as disease control and prevention programs. Some existing 
TECs provide assistance to Tribal and Urban Indian communities in such 
areas as sexually transmitted disease (STD) control and cancer 
prevention.
    They also assist Tribes and Urban Indian communities to establish 
baseline data for successfully evaluating intervention and prevention 
activities.
    Sexually transmitted infections (STIs) remain a major public health 
challenge in the United States (U.S.) with an estimated 20 million new 
infections occurring each year; half of them occur among adolescents 
and young adults ages 15-24. Many STIs, like chlamydia and gonorrhea, 
can be asymptomatic; however, if left untreated, STIs can lead to 
infertility and increase the risk of acquiring other STIs. For pregnant 
women, there are additional risks of ectopic pregnancy, miscarriage, 
stillbirth, and early infant death.
    Although widespread across the U.S. among all populations, the STI 
epidemic disproportionately affects certain racial and ethnic groups, 
including AI/AN people. Such disparities in STI incidence are complex 
to understand but may be rooted in a number of social factors such as 
poverty, inadequate access to health care, lack of education, social 
inequality, and cultural influences. Recent surveillance data 
demonstrate that STI rates continue to increase in Indian Country. The 
latest surveillance report showed that AI/AN people have 3.8 times the 
incidence rate of chlamydia compared with whites and a 4.4 times higher 
rate of gonorrhea. For more information, please visit https://www.ihs.gov/epi/includes/themes/responsive2017/display_objects/documents/STI/Indian_Health_Surveillance_Report_STI_2015.pdf. AI/AN 
people have the second highest rates for both chlamydia and gonorrhea 
compared to other races/ethnicities. Gonorrhea rates have continued to 
increase since 2011. Regional differences in STIs in Indian Country are 
observed. Recurrent STIs can increase the likelihood of human 
immunodeficiency virus (HIV) transmission, and gonorrhea and syphilis 
often present as co-morbid conditions with HIV diagnosis, particularly 
among men who have sex with men (MSM).
    AI/AN youth and AI/AN women, particularly women of reproductive 
age, have a disparate and increased STI burden. In addition, recent 
outbreaks of syphilis have been observed among AI/AN communities, 
resulting in a dramatic increase in congenital syphilis cases in recent 
years. Some of these outbreaks are also connected to the use of 
injection drugs and methamphetamines. Particularly concerning is the 
dramatic increase in syphilis cases among AI/AN women and the rise in 
congenital syphilis (CS) cases. The CDC national STI surveillance 
report demonstrated that from 2014 to 2018 CS cases, among all races, 
in the U.S. increased from 462 to 1,306 (183 percent). In 2018, AI/AN 
mothers had the highest rate of reported CS cases nationally. The rate 
of increase in reported CS cases among AI/AN mothers is higher than for 
any other race or ethnicity in the U.S. (from 13.2 cases per 100,000 
live births in 2014 to 79.2 in 2018).
    Untreated CS can cause miscarriage, stillbirth, prematurity, low 
birth weight, or death shortly after birth. The impact of CS depends on 
when a pregnant woman contracts syphilis and whether she has access to 
treatment for the infection. Up to 40 percent of babies born to 
pregnant women with untreated syphilis may be stillborn or die from the 
infection as a newborn. According to CDC data, analysis of CS cases 
born to AI/AN mothers in 2018 identified gaps in prenatal care and 
access to timely and appropriate treatment.
    The STI National Strategic Plan, released on December 17, 2020, 
aims to reverse the recent dramatic rise in STIs in the U.S. Please 
visit https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf for the most recent documents, outlining the 
following goals and selected objectives:
    1. Goal 1: Prevent New STIs
    a. Objective 1.1--Increase awareness of STIs and sexual health.
    b. Objective 1.2--Expand implementation of quality, comprehensive 
STI primary prevention activities.
    c. Objective 1.3--Increase completion rates of routinely 
recommended human papillomavirus (HPV) vaccination.
    d. Objective 1.4--Increase the capacity of public health, health 
care delivery systems, and the health workforce to prevent STIs.
    2. Goal 2: Improve the Health of People by Reducing Adverse 
Outcomes of STIs
    a. Objective 2.1--Expand high-quality affordable STI secondary 
prevention, including screening, care, and treatment, in communities 
and populations most impacted by STIs.
    b. Objective 2.2--Work to effectively identify, diagnose, and 
provide holistic care and treatment for people with STIs by increasing 
the capacity of public health, health care delivery systems, and the 
health workforce.
    3. Goal 3: Accelerate Progress in STI Research, Technology, and 
Innovation
    a. Objective 3.4--Identify, evaluate, and scale up best practices 
in STI prevention and treatment, including through translational, 
implementation, and communication science research.
    4. Goal 4: Reduce STI-Related Health Disparities and Health 
Inequities
    a. Objective 4.1--Reduce stigma and discrimination associated with 
STIs.
    b. Objective 4.2--Expand culturally competent and linguistically 
appropriate STI prevention, care, and treatment services in communities 
disproportionately impacted by STIs.
    c. Objective 4.3--Address social determinants of health and co-
occurring conditions.
    5. Goal 5: Achieve Integrated, Coordinated Efforts that Address the 
STI Epidemic
    a. Objective 5.1--Integrate programs to address the syndemic of 
STIs, HIV, viral hepatitis, and substance use disorders.
    b. Objective 5.2--Improve quality, accessibility, timeliness, and 
use of data related to STIs and social determinants of health.
    c. Objective 5.3--Improve mechanisms to measure, monitor, evaluate, 
report, and disseminate progress toward achieving national STI goals.
    Furthermore, the STI National Strategic Plan identifies the 
following priority groups: Adolescents and young adults; MSM; and, 
pregnant women.
    The STI National Strategic Plan also puts emphasis on other 
subgroups including racial and ethnic minorities (including AI/AN 
people) and geographic focus on regions with high STI burden. This 
national plan outlines goals, objectives, and indicators that

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specifically focus on health disparities and particularly addresses 
disparities in CS among Tribal communities. Applicants should create 
their action plans in the context of these goals, objectives, and 
indicators.
    The TEC program will continue to enhance the ability of the Indian 
health system to collect and manage data more effectively and to better 
understand and develop the link between public health problems and 
behavior, socioeconomic conditions, and geography. The TEC program will 
also support Tribal and Urban Indian communities by providing technical 
training in public health practice and prevention-oriented research and 
by promoting public health career pathways serving AI/AN populations.

Purpose

    The purpose of this IHS cooperative agreement is to strengthen 
public health capacity and to fund Tribes, Tribal organizations, and 
UIOs, and inter-Tribal consortia in identifying relevant health status 
indicators and priorities to support Public Health interventions that 
reduce morbidity and mortality in the population using sound 
epidemiologic principles. Work plans submitted in response to this 
announcement must incorporate the applicant's desired objectives and 
all of the required activities of the program's four goal sets, which 
are combined from the seven TEC core functional areas as outlined in 
the Indian Health Care Improvement Act (IHCIA) at 25 U.S.C. 1621m(b). 
The seven core functions of the TECs are:
    (1) Collect data relating to, and monitor progress made toward 
meeting, each of the health status objectives of the Service, the 
Indian Tribes, Tribal organizations, and UIOs in the service area;
    (2) Evaluate existing delivery systems, data systems, and other 
systems that impact the improvement of Indian health;
    (3) Assist Indian Tribes, Tribal organizations, and UIOs in 
identifying highest-priority health status objectives and the services 
needed to achieve those objectives, based on epidemiological data;
    (4) Make recommendations for the targeting of services needed by 
the populations served;
    (5) Make recommendations to improve health care delivery systems 
for Indians and Urban Indians;
    (6) Provide requested technical assistance to Indian Tribes, Tribal 
organizations, and UIOs in the development of local health service 
priorities and incidence and prevalence rates of disease and other 
illness in the community; and
    (7) Provide disease surveillance and assist Indian Tribes, Tribal 
organizations, and Urban Indian communities to promote public health.
    The seven core functions, included in the four goal sets are:
Goal Set 1: Public Health Promotion
    Collect health status data, provide disease surveillance and assist 
Tribes, Tribal organizations, and UIOs to promote public health.
Goal Set 2: Evaluation
    Evaluate existing delivery systems, data systems, and other systems 
that impact the improvement of Indian health.
Goal Set 3: Recommendation
    Assist Indian Tribes, Tribal organizations, and UIOs in identifying 
highest-priority health status objectives and the services needed to 
achieve those objectives, based on epidemiological data. Make 
recommendations for the targeting of services needed by the populations 
served. Make recommendations to improve health care delivery systems 
for Indians and Urban Indians.
Goal Set 4: Technical Assistance
    Provide technical assistance to Indian Tribes, Tribal 
organizations, and UIOs in the development of local health service 
priorities and determine incidence and prevalence rates of disease and 
other illness in the community.
    Applicant objectives may include activities beyond the required 
activities but must address them. Additional activities must still fall 
within the seven core functions and the four Goal sets.
    Required activities under the core funding are: Community Health 
Profiles (CHP); Data collection and Disease Surveillance; Public Health 
Preparedness and Response; STD Activities; technical assistance to 
Indian Tribes, Tribal organizations, and UIOs; evaluate and support 
Area-wide interventions that promote severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2) vaccine uptake; and, evaluate and support 
Area-wide interventions that promote SARS-CoV-2 outbreak response and 
recovery.
    See Section I: Required, Optional, and Allowable Activities for 
full details.
    It is the intent of IHS to fund sufficient TECs to serve Tribes and 
Urban Indian communities in all 12 IHS administrative areas.
    Each TEC selected for funding will act under a cooperative 
agreement with the IHS. During funded activities, the TECs may receive 
Protected Health Information (PHI) for the purpose of preventing or 
controlling disease, injury, or disability, including, but not limited 
to, reporting of disease, injury, vital events, such as birth or death, 
and the conduct of public health surveillance, public health 
investigation, and public health interventions for the Tribal and Urban 
Indian communities that they serve. TECs acting under a cooperative 
agreement with IHS are public health authorities for which the 
disclosure of PHI by covered entities is authorized by the Privacy 
Rule, 45 CFR 164.512(b).
Required, Optional, and Allowable Activities
    Goal Set 1: Collect health status data, provide disease 
surveillance, and assist Tribes, Tribal organizations, and UIOs to 
promote public health (Core Functions 1 and 7).
    Required Activities under Goal Set 1:
    (1) CHPs
    a. Develop culturally appropriate community health assessments 
encompassing all the Tribal and/or Urban Indian communities served by 
the TEC.
    b. CHPs should include information appropriate to allow Tribal and 
Urban Indian leaders to make informed decisions, prioritize health 
problems, and develop, implement, and evaluate their community health 
improvement plans.
    c. Provide and enact a plan that includes a project overview, 
specific health indicators, and means of dissemination for both Tribe-
specific and regional CHPs.
    d. Participate in local, regional, and national committees that 
address public health priorities and, as appropriate, with other 
Federal agencies.
    e. Establish and maintain an advisory council that can provide 
overall program direction and guidance. The advisory council should 
include some members with technical expertise in epidemiology and 
public health (e.g., from state health departments or county health 
departments) and include representation from the Tribal health and 
Urban Indian health programs within the TECs regional area.
    f. Translate available data and/or results of analyses on disease 
incidence/prevalence and determined risk factors into useful products, 
messaging, and outreach to effectively guide stakeholders' 
interventions addressing public health priorities.
    (2) Data collection and Disease Surveillance

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    a. Establish and maintain data sharing agreements and Memorandums 
of Understanding (MOU) to support data collection and analysis. 
Agreements may be needed with local organizations, Tribal governments, 
state authorities, and Federal agencies.
    b. Provide disease surveillance and assist Indian Tribes, Tribal 
organizations, and UIOs to promote public health.
    Optional Activities with Budget Support under Goal Set 1:
    (1) IHS-funded UIOs Technical Assistance
    These activities are eligible for a supplemental budget of up to 
$100,000 per award.
    The grantee will support 41 IHS-funded UIOs located in 22 states 
through the following activities:
    a. Providing training and technical assistance on planning, 
conducting, and implementing community health needs assessment;
    b. developing new and updating existing CHPs; and
    c. providing ongoing training and tutorials on how to interpret 
data, such as the Census and American Community Survey data.
    These activities have additional reporting requirements including 
quarterly progress reports that are due 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 of progress, and other pertinent information as required.
    (2) Group A HIV/STI Activities
    These activities are eligible for a supplemental budget of up to 
$100,000 per awardee.
    Activities under this supplement are organized under the 
operational strategies of the Ending the HIV Epidemic: A Plan for 
America initiative (EHE).
    TEC sites serving areas that do not include the EHE Phase One 
priority Geographic area(s) and Location(s) are eligible to apply for 
this supplemental funding. For a list of Phase One priority Geographic 
Areas and Locations, please visit https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one.
    Coordination Operational Strategy
    a. 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 HIV/acquired Immunodeficiency syndrome 
(AIDS). The budget should include travel and associated costs for 
participation.
    b. Grantees will participate in the IHS National AI/AN STI 
Prevention workgroup.
    Diagnosis Operational Strategy
    c. The TECs will provide technical assistance and/or disease 
surveillance support to Tribal and Urban communities by developing 
analytical reports to examine the burden of HIV and other relevant 
comorbidities such as STIs and hepatitis C virus (HCV) in Tribal and 
Urban communities.
    Treatment Operational Strategy
    d. The TECs will provide support to Tribal and Urban communities in 
the development of enhanced activities and expanded capacity to better 
identify AI/AN 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.
    Respond Operational Strategy
    e. 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 Tribal and Urban communities on the 
following activities:
    i. Develop or accelerate the refinement of HIV, STI, and HCV 
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.
    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.
    (3) Group B HIV/STI Activities
    These activities are eligible for a supplemental budget of up to 
$250,000 per awardee.
    Applicants may either request Group A or Group B activities based 
on their geographic service area. Applicants should not apply for both 
Group A and Group B activities.
    Activities under this supplement are organized under the 
operational strategies of the EHE.
    TEC sites serving areas that do include the EHE Phase One priority 
Geographic area(s) and Location(s) are eligible to apply for this 
supplemental funding.
    For a list of Phase One priority Geographic Areas and Locations, 
please visit https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one.
    Applications for Group B HIV Activities must include the following 
activities.
    Coordination Operational Strategy
    a. 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. The budget should include travel and 
associated costs for participation.
    b. Grantees will participate in the IHS National AI/AN STI 
Prevention workgroup.
    Diagnosis Operational Strategy
    c. 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.
    Treatment Operational Strategy
    d. 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.
    Respond Operational Strategy
    e. 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 and/or refinement 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.
    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.
    Further Activities under this Supplement
    Applications are required to address the above activities, and must 
propose activities addressing at least two of the additional 
operational strategies below.
    Diagnosis Operational Strategy
    a. Diagnose all people with HIV, STIs, and HCV as early as possible 
after infection and connect them to immediate treatment. The TECs will 
provide technical assistance and/or direct support to AI/AN communities 
on the following activities:
    i. Implementing HIV testing recommendations through the rapid 
replication of proven or innovative HIV screening models;
    ii. Developing and implementing innovative testing and health care

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engagement strategies focused on meeting the needs of groups at higher 
risk, including MSM, transgender individuals, high-risk heterosexuals, 
and persons who inject drugs.
    Protection Operational Strategy
    b. Protect people at risk for HIV using potent and proven 
prevention interventions, including Pre-Exposure Prophylaxis (PrEP), a 
medication that can prevent new HIV infections. The TECs will provide 
technical assistance and/or direct support to communities on the 
following activities:
    i. Support efforts to increase the awareness of, access to, and 
utilization of PrEP among identified populations;
    ii. Support efforts to incentivize providers and community-based 
health care organizations to integrate HIV testing, linkage, and 
referral to care, and linkage or referral to medical prevention (i.e., 
PrEP) services into primary care services, particularly for their 
higher-risk patients;
    iii. Raise awareness about the prevention benefits of ``Treatment 
as Prevention'' (TasP) and ``Undetectable = Untransmittable'' (U=U) 
among providers, people living with and at risk for HIV, and the 
general population;
    iv. As an entry point to recovery services and overdose and 
infection prevention, support the development, expansion, 
implementation, and evaluation of harm-reduction services for people 
who inject drugs.
    v. Evaluate the local acceptability and opportunities for 
establishing or increasing syringe services programs (SSPs) including: 
Linkage to substance use disorder treatment; access to and disposal of 
sterile syringes and injection equipment; and vaccination, testing, and 
linkage to care and treatment for infectious diseases.
    vi. Promote early identification of individuals with recurrent STI 
events with focus on chlamydia, gonorrhea, and syphilis through 
analysis of clinical or other locally available data.
    vii. Promote linkage to care including PrEP or other appropriate 
services to aid the prevention of HIV and other infectious disease 
transmission, especially for those diagnosed with STIs.
    viii. Promote and support Expedited Partner Therapy (EPT) for 
individuals diagnosed with chlamydia and gonorrhea to control 
transmission.
    ix. Promote enhanced STI screening among youth and MSM and engage 
providers in adopting best practices, such as obtaining a thorough 
sexual history and promoting an adolescent-friendly clinic environment.
    Respond Operational Strategy
    c. Respond rapidly to detect and characterize growing HIV, STI, or 
Viral hepatitis clusters and prevent new infections. The TECs will 
provide technical assistance and/or public health surveillance support 
to communities on the following activities:
    i. Establish and support boots-on-the-ground public health 
workforce capacity that is culturally competent and committed to 
ensuring implementation of community-based HIV, STI, and/or Viral 
hepatitis control plans, including facilitating and troubleshooting 
collaborative community-wide disease control efforts;
    ii. Develop or expand the capacity to detect and respond to all 
established or emerging HIV, STI, and/or Viral hepatitis clusters to 
reduce disease transmission.
    Allowable Activities Under Goal Set 1:
    (1) Enhance or develop disease surveillance systems. Surveillance 
systems can address infectious and chronic diseases, record linkage 
studies to improve existing surveillance systems, suicide data 
tracking, regional health registries, influenza surveillance, among 
others.
    (2) Carry out at least one new disease surveillance activity per 
cycle, complete with evaluation and the use of measurable outcomes.
    Goal Set 2: Evaluate existing delivery systems, data systems, and 
other systems that impact the improvement of Indian health (Core 
Function 2).
    Required Activities under Goal Set 2: None required.
    Optional Activities with Budget Support under Goal Set 2:
    (1) Annual Cancer Survivorship Leadership Training
    This activity is eligible for a supplemental budget of up to 
$85,000 per awardee. One award is anticipated.
    This activity supports the CDC National Center for Chronic Disease 
Prevention and Health Promotion activity Annual Cancer Survivorship 
Leadership Training. Grantee will organize and implement at least two, 
three-day cancer support leadership trainings for 15-25 AI/AN 
participants, nationally. The training will be designed to give 
participants a unique opportunity to work together in a safe, 
supportive environment to learn and practice skills to help people 
affected by cancer in their communities. The training will be based on 
the model, A Gathering of Cancer Support, using the Gathering of Native 
Americans (GONA) teaching methods.
    Outcome:
    Participants will show change in knowledge/understanding of the 
below elements:
    Wellness from a Native American Perspective
    a. Using a group discussion method such as Rez Caf[eacute], 
identify two AI/AN core values that support wellness and healing.
    b. Using a group discussion method such as Rez Caf[eacute], 
identify two AI/AN core values to draw from to help facilitate a 
support group.
    Cancer 101
    c. Describe two ways to take personal action to reduce cancer risk
    Exploring Emotional Peer Support Skills and How to Start Up Cancer 
Support in Your Community.
    d. Determine best role for self in setting up cancer support.
    e. Identify at least two steps for starting up cancer support in 
your community.
    (2) Tribal Public Health Departments
    This activity is eligible for a supplemental budget of up to 
$150,000 per awardee. Six awards are anticipated.
    a. Conduct Ecological Assessments on Tribal public health programs 
and services in your Area.
    b. Develop plans with specific Tribes on strengthening Tribal 
public health programs and services.
    c. Support the establishment and/or expansion of one or more Tribal 
public health department(s) in your Area.
    Allowable Activities Under Goal Set 2:
    (1) Evaluate sufficiency of IHS electronic health record data to 
determine AI/AN health status, to create seamless data linkages, and to 
meet the health information needs for Tribes and Tribal programs. This 
should include an assessment of the ability for the health information 
systems to meet those needs, create seamless data linkages, and meet 
data access needs for Tribes and Tribal organizations.
    Goal Set 3: Assist Indian Tribes, Tribal organizations, and UIOs in 
identifying highest-priority health status objectives and the services 
needed to achieve those objectives, based on epidemiological data.
    Make recommendations for the targeting of services needed by the 
populations served.
    Make recommendations to improve health care delivery systems for 
Indians and Urban Indians (Core Functions 3, 4, and 5).
    Required Activities Under Goal Set 3:
    (1) Public Health Preparedness and Response
    a. Strengthen Tribally-focused surveillance systems and data.
    b. Conduct outbreak investigations and response.

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    c. Lead community assessments for disaster preparedness, response, 
and recovery.
    d. Develop response plans for major public health emergencies.
    e. Lead, coordinate, or participate in Federal, Tribal, state, or 
local emergency response exercises and activities.
    f. Promote and facilitate planning and response activities among 
Tribes.
    g. Build partnerships among government agencies, Tribes, and other 
organizations to advance emergency preparedness in Indian country.
    (2) STD Activities
    The grantees will conduct activities in this announcement to 
support the above STI National Strategic Plan goals and indicators 
pertaining to chlamydia, gonorrhea, Primary and Secondary Syphilis and 
congenital syphilis. While the STI National Strategic Plan includes HPV 
as an additional focus, applicants should not emphasize HPV in their 
application. However, HPV-related activities can be incorporated into 
project plans as a secondary focus if desired, as appropriate and if 
relevant or complementary to primary work.
    a. Community Profiles
    In year 1 of award, the grantees will develop an assessment of the 
overall burden of the following STIs: Chlamydia, gonorrhea, primary and 
secondary syphilis, and congenital syphilis within the communities they 
serve.
    To support the profile, the grantees will analyze current, existing 
data or generate their own data related to STI burden with particular 
emphasis on priority groups listed above and any other priority groups 
identified during the assessment phase. When analyzing existing data, 
grantees will ensure analyses are novel and not duplicative of analytic 
approaches or products available from other sources. Data may include 
publically available data, surveillance data, clinical data, 
qualitative data, or other relevant health data source. Applicants 
should prioritize data that describe STI burden in Tribal communities 
within their jurisdiction, such as through partnerships with public 
health authorities at the Tribal, local or state level. Although 
historic data may be reviewed, analysis must incorporate data on the 
burden of STIs generated within the last 5 years. The applicants are 
encouraged to create assessments that examine STI burden at different 
Tribal communities and report those results accordingly; regional or 
IHS Area level results or national level results can be used for 
comparison purposes.
    Special focus should be on indicators and priority areas outlined 
in the STI National Strategic Plan.
    The assessment will serve as a living document and will be updated 
minimally on year 3 and year 5 of the award.
    During years, 2-5 of the award the grantees should: (1) Work to 
obtain information from community members and Tribal leaders on 
defining gaps and opportunities to further improve STI prevention and 
care and (2) conduct relevant interventions to improve STI prevention 
and care services. The grantees will create a report describing the 
findings from their community engagement and outlining any relevant 
feasibility, gaps, and opportunities identified in the interventions 
conducted. Interventions can be expanded to more communities depending 
on results, feasibility, and acceptability.
    b. Communication of findings
    At the end of year one grantees will create a report outlining 
analytic findings of the community profile assessments and also create 
and include a strategic plan and road map on how to address STI burden 
within the supported AI/AN communities. Applicants are encouraged to 
align their strategic approach with the vision and goals of the 
National STI Strategic Plan and implementing the objectives and 
strategies most relevant to their role and communities. In addition, 
applicants should use available data to identify where their resources 
will have the most impact and to determine indicators and targets best 
suited to measure their progress towards selected goals. The applicant 
strategic plan is meant to serve as a living document and be updated 
based on inputs from supported communities and lessons learned as the 
work progresses. Please visit https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf for further background.
    The grantees will create or adapt communication materials for 
appropriate audiences (community members, Tribal leaders, health care 
providers) and convene meetings to share findings with community 
members and other stakeholders such as Tribal leadership, medical 
providers, public health partners, etc.
    The grantees will work with selected communities to create detailed 
strategic plans on how to improve STI prevention with specific focus on 
aligning to any STI National Strategic plan goals, objectives, and 
indicators and convene a coalition with diverse partners (community 
members, public health professionals, trainers, health care providers 
and others). Communities can self-identify or be selected in 
collaboration with the applicant based on available epidemiologic 
evidence. Each grantee will work with at least two communities.
    c. Meetings
    Grantees will meet with IHS Division of Epidemiology and Disease 
Prevention (DEDP) staff quarterly to discuss activity progress and 
garner technical assistance.
    Grantees will regularly participate in IHS National STI program 
workgroup meetings. Each grantee is requested to present once a year on 
their activities relating to this announcement at these meetings.
    Grantees are encouraged to share knowledge gained by presenting 
findings at Tribal meetings, regional meetings and/or publishing in 
peer-reviewed journals.
    Grantees will attend one national STI-focused meeting such as the 
National Coalition of STD Directors annual meeting or the National STD 
conference and are strongly encouraged to submit abstracts for 
presentations. When such meetings are held in person, applicant's 
budget should include travel costs for up to three staff to attend.
    d. Outcomes
    The applicant will provide evidence of direct dissemination of 
assessment results to Tribal communities including Tribal leadership.
    Dissemination could include meetings, online reports (and number of 
views), media releases, and newsletters.
    Optional Activities with Budget Support under Goal Set 3:
    (1) Targeted STD Activities
    This activity is eligible for a supplemental budget of up to 
$150,000 per awardee. Six awards are anticipated.
    To qualify for targeted STD activities, the applicant must 
demonstrate an increased incidence of congenital syphilis or syphilis 
among women of reproductive age within their jurisdiction.
    The STI National Strategic Plan specifically outlines a focus on 
congenital syphilis (CS) in Tribal communities and includes a disparity 
indicator to reduce CS rate among AI/AN people/communities.
    In order to achieve a reduction in CS rates among AI/AN people, a 
comprehensive approach to reduce syphilis rates among women of 
reproductive age is necessary. Grantees will conduct activities in one 
or more of the following domains with the goal to address the STI 
Disparity Indicator focusing on the reduction of CS cases among AI/AN 
people. Applicants can propose additional relevant work to address CS 
among their communities.

[[Page 41064]]

Activities are intended to complement and expand from required STD 
activities and develop a logic model specific to this activity apart 
from the program-wide logic model.
    a. Linkage to prenatal care
    Applicants will address gaps in prenatal care that contribute to 
late maternal syphilis screening and treatment. Applicants should 
prioritize hard to reach populations, including, but not limited to, 
persons experiencing homelessness and Persons Who Inject Drugs (PWID), 
and design interventions to link these populations to care. Applicants 
will determine whether third trimester screening is occurring within 
their jurisdictions and evaluate its ability to (a) avert cases before 
birth; and (b) detect and treat additional CS cases. Applicants may 
partner with health care providers to test different scalable 
interventions; for example, the feasibility and impact of Electronic 
Health Record reminders and/or screening at delivery.
    b. Surveillance
    Applicants will design activities to address surveillance gaps to 
capture and accurately report syphilis cases among AI/AN women 
(particularly women of reproductive age) and understand risk factors 
associated with transmission.
    c. Outbreak response plans and trainings
    Applicants will assess gaps in current practices to respond to 
syphilis outbreaks within their jurisdiction. Applicants will develop 
comprehensive syphilis outbreak response plans that incorporate and 
enhance health education and training for providers and disease 
investigators serving the community. Feasibility of response plans will 
be assessed with Tribes and Tribal leadership within their 
jurisdiction. Applicants can include other STIs in outbreak response 
plans. Applicants will assess training needs and identify providers/
Disease Intervention Specialists in need of training and arrange or 
develop resources. Applicants will connect with existing resources like 
the STD Prevention Training Centers to create trainings for providers 
in their community that are tailored to local needs and that are 
culturally appropriate. Applicants may find more information on the STD 
Prevention Training Centers at https://www.nnptc.org/.
    d. Screening in alternative locations
    Applicants will create an inventory of any screening currently 
conducted in alternative locations within their jurisdiction and pilot 
novel screening programs for syphilis (but also including other STIs) 
that may reach heterosexual populations. Applicants will evaluate the 
effectiveness of such interventions at case-finding and treatment. This 
could include jails, inpatient or Emergency Department settings, and 
substance abuse treatment centers.
    e. Communication of findings
    The grantee will create a report outlining findings and develop a 
local strategic plan and road map on how to address CS and syphilis 
burden within the supported AI/AN communities. This plan will 
differentiate from the work conducted under Part A activities.
    The grantees will create or adapt communication materials for 
appropriate audiences (community members, Tribal leaders, health care 
providers) and convene meetings to share findings with community 
members and other stakeholders such as Tribal leadership, medical 
providers, public health partners, etc.
    Grantee will convene a coalition with diverse partners (community 
members, public health professionals, trainers, health care providers 
and others) to create concrete action steps to target CS in their 
jurisdiction and to inform further adaptation of the local strategic 
plan.
    f. Meetings and Reporting
    Grantees will meet with IHS DEDP staff quarterly to discuss 
activity progress and garner technical assistance.
    Grantees will provide reports two times a year summarizing progress 
towards outcomes in Logic Model.
    Grantees will participate in any IHS National STI program workgroup 
meetings focusing on CS and share their activities with other 
participants.
    Grantees will present on their CS activities minimally once per 
year.
    Grantees are encouraged to share knowledge gained by presenting 
findings at Tribal, regional, or national meetings and/or publishing in 
peer-reviewed journals.
    g. Outcomes
    Demonstrated improvement in capturing of syphilis cases among women 
of reproductive age and ascertainment of CS cases. Demonstrated 
improvement of linkage to care and screening for syphilis with 
particular emphasis on hard to reach populations, including, but not 
limited to, persons experiencing homelessness and PWID.
    The grantees will provide evidence of direct dissemination of 
findings to Tribal communities including Tribal leadership. 
Dissemination could include meetings, online reports (and number of 
views), media releases, and newsletters.
    Allowable Activities Under Goal Set 3:
    (1) Public Health Response
    Grantees may conduct further activities not addressed above 
including:
    a. Infectious Disease control.
    b. Outbreak Response.
    c. Assess and support Environmental Health emerging needs of local 
communities.
    Goal Set 4: Provide technical assistance to Indian Tribes, Tribal 
organizations, and UIOs in the development of local health service 
priorities and to determine incidence and prevalence rates of disease 
and other illness in the community (Core Function 6).
    Required Activities Under Goal Set 4:
    (1) Provide culturally appropriate training and technical support 
based on the needs of Indian Tribes, Tribal organizations, and UIOs 
served. Topics may include but are not limited to program evaluation, 
data analysis, data quality, survey design and administration, program 
planning, community health assessment, and outbreak response.
    a. Implement and evaluate at least one public health intervention 
(conducted by grantee or by supported community) to promote health or 
address disparities in AI/AN communities.
    (2) Evaluate and support Area-wide interventions that promote SARS-
CoV-2 vaccine uptake. Assess community attitudes/knowledge/beliefs 
around vaccine availability, vaccine coverage, and uptake among AI/AN 
populations and the IHS/Tribal/Urban health care workforce. Address 
sufficiency and/or gaps regarding vaccine messaging and public 
communication campaigns and develop implementation strategies to 
maximize vaccine coverage among AI/AN communities.
    This requirement will have a separate budget of $250,000 per TEC.
    a. Explain how the TEC will develop, maintain and strengthen 
relationships with other public health authorities (e.g., Tribal, 
county, state) in order to facilitate Public Health assessment, 
response, communications and dissemination relevant to vaccine 
implementation to enhance uptake and overall coverage.
    b. The TEC will develop a comprehensive needs assessment relevant 
to the ongoing SARS-CoV-2 vaccine implementation efforts within their 
relevant IHS Area.
    i. Assessment should include implementation gaps and opportunities 
for improvement in local vaccination activities.
    ii. Based on needs assessment findings, develop and implement 
intervention strategies to address gaps

[[Page 41065]]

and enhance opportunities related to improving local vaccine 
implementation, uptake, and communications.
    iii. Perform ongoing evaluation of activities to determine 
effectiveness and impacts and to inform future efforts.
    c. Perform an assessment of existing vaccination capacity, 
implementation, and uptake for years 1-3 of this funding cycle. Plans 
for years 4-5 should use this assessment to continue, adapt, and 
evaluate changes in local conditions and respond to ongoing vaccination 
needs and goals.
    (3) Evaluate and support Area-wide interventions that promote 
coronavirus disease 2019 (COVID-19) pandemic response, mitigation, and 
recovery.
    This requirement should have a budget of at least $1,000,000 per 
site.
    (a) Explain how the TEC will develop, maintain, and strengthen 
relationships with other public health authorities (e.g., Tribal, 
county, state) in order to facilitate collaborative pandemic outbreak 
response activities at the local and regional level.
    (b) These COVID funds are to meet immediate needs in the response, 
mitigation, and recovery from the COVID-19 pandemic. Plans for 
activities should be explicitly tied to measurable pandemic response, 
mitigation, and recovery outcomes.
    Optional Activities with Budget Support under Goal Set 4
    (1) SASP/DVP/FHC Technical Assistance
    This activity is eligible for a supplemental budget of up to 
$265,000 per awardee.
    Twelve awards are anticipated.
    Objective: To provide Technical Assistance (TA) to the Substance 
Abuse and Suicide Prevention (SASP), Domestic Violence Prevention 
(DVP), and Forensic Health Care (FHC) projects funded within their 
regional area. Technical Assistance (TA) should apply to Tribes, Tribal 
organizations, UIOs, and Federal facilities that receive grants from 
IHS Behavioral Health. TA should assist projects in meeting required 
reporting activities.
    a. Cross-Site/Group TA
    i. Representatives from TECs participate in monthly calls with IHS 
Division of Behavioral Health (DBH) program staff.
    ii. The TECs will facilitate or participate in scheduled Area 
Project Officer (APO) monthly conference calls/webinars to include all 
grantees within their respective IHS Area.
    iii. Organize and facilitate quarterly webinars related to the 
expectations and required activities of the SASP, DVP and FHC grant 
programs.
    iv. Provide at least one opportunity per year for individual 
grantees to meet with local TEC annually at regional or national 
meeting forum (for example, regional behavioral health conferences).
    v. Coordinate in-person, virtual, or teleconference peer-to-peer 
support opportunities for grantees.
    b. Individualized Training and Technical Assistance (TTA)
    i. Engage in regular communication with grantee project directors 
and/or project coordinators, providing individualized TTA to SASP/DVP/
FHC grantees based on the needs of individual grant community to meet 
the expectations and required activities of the grant program.
    ii. Provide monthly, individual virtual site visits.
    iii. Document individual one-on-one meetings that occurred at 
regional or national meetings, such as regional behavioral health 
conferences.
    iv. Develop an individualized data collection tracker to assist 
grantees with local data collection.
    v. TECs will work with grantees to establish baseline data related 
to the SASP/DVP/FHC funded projects, DBH Alcohol and Substance Abuse 
(ASA) Government Performance and Results Act (GPRA) measures and other 
IHS Strategic Plan Goals.
    vi. Technical assistance provided by TECs in this cooperative 
agreement are limited to efforts that support grantee submission of the 
required DBH annual progress report (APR) and grantee-specific 
interventions outlined in the applicant project narrative.
    vii. TECs should outline available resources and technology, 
including software technology for project data analysis and management. 
TECs may use resources available to them to enhance TA support 
including software, maintenance, and storage capabilities. However, it 
is recommended that these activities include an established agreement 
between the TEC and the grantee.
    c. Development of Resources
    i. Support grantee development of publications and/or presentation 
for use in their program.
    ii. Provide subject matter expertise, tools, and resources to 
enhance grantee development of culturally competent, community-based 
methods for local evaluation and data collection plans.
    iii. Create individualized training plans for use with grantees.
    iv. Support development of MOUs related to project needs (e.g., 
provide templates for establishing data collection plans and data 
sharing agreements, partnerships, and/or services).
    v. Develop TTA material including public health messages, and aid 
in public health messaging practice guides to assist grantees in 
developing documents identified as grant required activities.
    (2) Zero Alcohol and Substance Abuse (ASA) Suicide Initiative 
Technical Assistance
    This activity is eligible for a supplemental budget of up to 
$125,000 per awardee.
    One award is anticipated.
    Objective: To provide technical assistance that supports the data 
collection and data analysis requirements of local projects funded 
under the two IHS Alcohol and Substance Abuse Pilot Project 
Initiatives; the Community Opioid Intervention Pilot Project (COIPP) 
and the Youth Regional Treatment Center (YRTC) Aftercare Pilot Project. 
Technical assistance should apply to Tribes, Tribal organizations, UIOs 
and Federal facilities that receive grants from IHS Behavioral Health.
    a. Data Collection, Analysis, and Reporting
    i. Support local grantee efforts to develop data plans that will 
support grant objectives, project activities and evaluation efforts. 
Each grantee was highly recommended to develop a logic/model or theory 
of change as part of their project description.
    1. Technical assistance provided by TECs in this cooperative 
agreement shall support data collection, analysis, and reporting. Data 
shall be coordinated and submitted with local grantee evaluation 
efforts and required annual progress reports.
    2. Work with grantees to establish baseline data related to pilot 
project.
    3. Work with grantees to establish a local data collection plan, 
including project data collection tracker related to proposed 
activities and evaluation efforts. Data will include a compilation of 
quantitative and qualitative data that addresses the project impact 
including outcomes such as performance measures related to evaluation 
outcomes and intended results.
    4. TECs will assist grantees to include and prioritize the 
collection and reporting of DBH ASA GPRA measures and other IHS 
Strategic Plan Goals.
    ii. Technical assistance provided by TECs in this cooperative 
agreement shall support grantee submission of the required DBH APR.
    iii. TECs should outline available resources and technology, 
including software technology for project data analysis and management. 
TECs may use resources available to them to enhance TA support 
including software,

[[Page 41066]]

maintenance, and storage capabilities. However, it is recommended that 
these activities include an established agreement between the TEC and 
the grantee.
    b. Individualized TTA
    i. Engage in regular communication with grantee project directors 
and/or project coordinators, providing individualized TTA based on the 
needs of individual pilot project and Tribal community to meet the 
expectations and required activities of the grant program.
    ii. Provide monthly, individual virtual site visits.
    iii. Document individual one-on-one meetings that occurred at 
regional or national meetings, such as regional behavioral health 
conferences.
    c. Development of Resources
    i. Support grantee development of publications and/or presentation 
for use in their program.
    ii. Provide subject matter expertise, tools, and resources to 
enhance grantee development of culturally competent, community-based 
methods for local evaluation and data collection plans.
    iii. Support development of MOUs related to project needs (e.g., 
provide templates for establishing data collection plans and data 
sharing agreements, partnerships, and/or services).
    (3) Diabetes Activities
    This activity is eligible for a supplemental budget of up to 
$100,000 per awardee.
    One award is anticipated.
    a. Provide data technical assistance to the Urban Indian Health 
Organization (UIHO) Special Diabetes Program for Indians (SDPI) 
grantees to support their diabetes prevention and treatment services.
    b. Develop the annual Urban Diabetes Care and Outcomes Summary 
Report, which provides an overview of the UIHO data submitted into the 
IHS Diabetes Care and Outcomes Audit. These reports provide data on the 
diabetes care provided as well as the outcomes achieved in the UIHO 
patient population, including identifying areas for improvement.
    Allowable Activities under Goal Set 4: None additional.
    Pre-Conference Grant Requirements
    The awardee is required to comply with the ``HHS Policy on 
Promoting Efficient Spending: Use of Appropriated Funds for Conferences 
and Meeting Space, Food, Promotional Items, and Printing and 
Publications,'' dated January 23, 2015 (Policy), as applicable to 
conferences funded by grants and cooperative agreements. The Policy is 
available at https://www.hhs.gov/grants/contracts/contract-policies-regulations/efficient-spending/?language=es.
    The awardee is required to:
    Provide a separate detailed budget justification and narrative for 
each conference anticipated. The cost categories to be addressed are as 
follows: (1) Contract/Planner, (2) Meeting Space/Venue, (3) 
Registration website, (4) Audio Visual, (5) Speakers Fees, (6) Non-
Federal Attendee Travel, (7) Registration Fees, and (8) Other (explain 
in detail and cost breakdown). For additional questions please contact 
Lisa C. Neel at (301) 443-4305 or email at [email protected].

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2021 is 
approximately $30,750,000. Individual award amounts for the first 
budget year are anticipated to be between $1,070,000 and $3,000,000. 
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.
    Funding for this award will be provided through: The IHS Office of 
Public Health Support, the IHS Office of Urban Indian Health Programs, 
the IHS Office of Clinical and Preventive Services, National Human 
Immunodeficiency Virus (HIV) & Viral Hepatitis C (HCV) Program in 
partnership with the U.S. Department of Health and Human Services (HHS) 
Minority HIV/AIDS Fund (MHAF), the Centers for Disease Control and 
Prevention's (CDC) National Center for Chronic Disease Prevention and 
Health Promotion, and the National Institutes of Health's (NIH) 
National Institute on Minority Health and Health Disparities (NIMHD). 
The authorities for CDC and NIH funding will be exercised through an 
Intra-Departmental Delegation of Authority (IDDA) with IHS. The 
administration will be carried out through an Intra-agency Agreement 
(IAA) between CDC, NIH, and IHS. Portions of this award will be funded 
by the Office of the Assistant Secretary for Health, HHS, as authorized 
under the statutory earmark for minority AIDS prevention and treatment 
activities, and are to be carried out pursuant to Title III of the 
Public Service Act. The funding is being made available through an IDDA 
to award specific funding for fiscal year (FY) 2021.
Anticipated Number of Awards
    Approximately 12 awards will be issued under this program 
announcement.
Period of Performance
    The period of performance is for five 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 the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
    (1) Provide funded TECs with ongoing consultation and technical 
assistance to plan, implement, and evaluate each component as described 
under Recipient Activities. Consultation and technical assistance may 
include, but not be limited to, the following areas:
    (a) Interpretation of current scientific literature related to 
epidemiology, statistics, surveillance, Healthy People 2030 objectives, 
and other public health issues;
    (b) Design and implementation of each program component such as 
surveillance, epidemiologic analysis, outbreak investigation, 
development of epidemiologic studies, development of disease control 
programs, and coordination of activities; and
    (c) Overall operational planning and program management.
    (2) Coordinate all IHS epidemiologic activities on a national scope 
including development and management of disease surveillance systems, 
generation of related reports, and investigation of disease outbreaks.
    (3) Conduct routine site visits to TECs and/or coordinate TEC 
visits to IHS 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.
    (4) Participate in annual TEC meeting for information sharing, 
problem solving, or training.
    (5) Provide training in the use of data from the Epidemiology Data 
Mart (EDM) and other IHS systems for the purposes of creating reports 
for disease surveillance, epidemiologic analysis, and epidemiologic 
studies. Training can be provided online or onsite, depending on staff 
availability.

[[Page 41067]]

    (6) Coordinate opportunities for training of TEC staff where 
applicable. Examples include webinars on the EDM and data use, 
technical assistance, use of statistical software, and fellowship 
opportunities.

III. Eligibility Information

1. Eligibility

    To be eligible for this FY 2021 funding opportunity applicants 
must:
    A. Be one of the following as defined by 25 U.S.C. 1603:
    1. A Federally-recognized Indian Tribe as defined by 25 U.S.C. 
1603(14). The term ``Indian Tribe'' means any Indian Tribe, band, 
nation, or other organized group or community, including any Alaska 
Native village or group or regional or village corporation as defined 
in or established pursuant to the Alaska Native Claims Settlement Act 
(85 Stat. 688) [43 U.S.C. 1601 et seq.], which is recognized as 
eligible for the special programs and services provided by the U.S. to 
Indians because of their status as Indians.
    2. A Tribal organization as defined by 25 U.S.C. 1603(26). The term 
``Tribal organization'' has the meaning given the term in section 4 of 
the Indian Self-Determination and Education Assistance Act (25 U.S.C. 
5304): ``Tribal organization'' means the recognized governing body of 
any Indian Tribe; any legally established organization of Indians which 
is controlled, sanctioned, or chartered by such governing body or which 
is democratically elected by the adult members of the Indian community 
to be served by such organization and which includes the maximum 
participation of Indians in all phases of its activities: Provided 
that, in any case where a contract is let or grant made to an 
organization to perform services benefiting more than one Indian Tribe, 
the approval of each such Indian Tribe shall be a prerequisite to the 
letting or making of such contract or grant. Applicant shall submit 
letters of support and/or Tribal Resolutions from the Tribes to be 
served.
    3. An Intertribal Consortium or Indian organization as defined by 
25 U.S.C. 1621m(d)(2) as: (A) Incorporated for the primary purpose of 
improving Indian health; and (B) representative of the Indian Tribes or 
Urban Indian communities residing in the area in which the Intertribal 
consortium is located.
    B. Demonstrate that they have complied with previous terms and 
conditions of the Epidemiology Program for AI/AN Tribes and Urban 
Indian Communities grant in order to receive funding under this 
announcement; and
    C. Represent or serve a population of at least 60,000 AI/AN people 
or 70 percent of the Tribal governments in the Area to be eligible, as 
demonstrated by Tribal Resolutions, blanket Tribal Resolutions, Tribal 
Letters of Support (LoS) or LoS from Urban Indian clinic directors and/
or Chief Executive Officers (CEOs). Applicants must describe the 
population of AI/AN people and Tribes that will be represented. The 
number of AI/AN people served must be substantiated by documentation 
describing IHS user populations, U.S. Census Bureau data, clinical 
catchment data, or any method that is scientifically and 
epidemiologically valid. Resolutions or LoS from each Tribe, AN village 
and LoS from each Urban Indian community represented must be included 
in the application package. Resolutions or LoS must be current (e.g., 
not pre-date inception of the applicant epidemiology center) and 
express explicit support for the applicant epidemiology center. 
Collaborations with IHS Areas, Federal agencies such as the CDC, state, 
academic institutions, or other organizations are encouraged (letters 
of support and collaboration should be included in the application). If 
applicants do not have 100 percent Tribal support for their work, 
applicants must report the proportion and estimated population of the 
Tribes in their Area that do not support their work explicitly through 
LoS or resolution.
    The DEDP will notify any applicants deemed ineligible.
    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 Section II Award Information, Estimated Funds 
Available, or exceed the Period of Performance outlined under Section 
II Award Information, Period of Performance will be considered not 
responsive and will not be reviewed. The Division of Grants Management 
(DGM) will notify the applicant.
Tribal Resolution
    The DGM must receive an official, signed Tribal Resolution prior to 
issuing a Notice of Award (NoA) to any applicant selected for funding. 
An Indian Tribe or Tribal organization that is proposing a project 
affecting another Indian Tribe must include resolutions from all 
affected Tribes to be served. However, if an official, signed Tribal 
Resolution cannot be submitted with the application prior to the 
application deadline date, a draft Tribal Resolution must be submitted 
with the application by the deadline date in order for the application 
to be considered complete and eligible for review. The draft Tribal 
Resolution is not in lieu of the required signed resolution, but is 
acceptable until a signed resolution is received. If an application 
without a signed Tribal Resolution is selected for funding, the 
applicant will be contacted by the Grants Management Specialist (GMS) 
listed in this funding announcement and given 90 days to submit an 
official, signed Tribal Resolution to the GMS. If the signed Tribal 
Resolution is not received within 90 days, the award will be forfeited.
    Tribes organized with a governing structure other than a Tribal 
council may submit an equivalent document commensurate with their 
governing organization.

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:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
     Project Narrative (not to exceed 12 pages). See Section 
IV.2.A Project Narrative for instructions.
    1. Background information on the organization.
    2. Proposed scope of work, objectives, and activities that provide 
a description

[[Page 41068]]

of what the applicant plans to accomplish.
     Proposed logic model.
     Budget Justification and Narrative (not to exceed five 
pages). See Section IV.2.B Budget Narrative for instructions.
     One-page Timeframe Chart.
     Tribal Resolution(s) or Letters of Support.
     Letters of Support from organization's Board of Directors.
     501(c)(3) Certificate, if applicable.
     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 (optional).
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    1. Email confirmation from Federal Audit Clearinghouse (FAC) that 
audits were submitted; or
    2. Face sheets from audit reports. Applicants can find these on the 
FAC website at https://harvester.census.gov/facdissem/Main.aspx.
Public Policy Requirements
    All Federal public policies apply to IHS grants and cooperative 
agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be 
deemed subjected to discrimination by reason of their exclusion from 
benefits limited by Federal law to individuals eligible for benefits 
and services from the IHS. See https://www.hhs.gov/grants/grants/grants-policies-regulations/.
Requirements for Project and Budget Narratives
A. Project Narrative
    This narrative should be a separate document that is no more than 
12 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 will not be reviewed. The 12-page limit for the 
narrative does not include the work plan, standard forms, Tribal 
Resolutions or LoS, budget, budget justifications, narratives, and/or 
other items.
    There are three parts to the narrative: Part 1--Program 
Information; Part 2--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: Introduction and Need for Assistance
    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).
Section 2: Organizational Capabilities
    The applicant must describe staff capabilities or hiring plans for 
the key personnel with appropriate expertise in epidemiology, health 
sciences, and program management. The applicant must also demonstrate 
access to specialized expertise such as a doctoral level epidemiologist 
and/or a biostatistician. Applicants must include an organizational 
chart and provide position descriptions and biographical sketches of 
key personnel including consultants or contractors. The position 
description should clearly describe each position and its duties. 
Resume should indicate that proposed staff is qualified to carry out 
the project activities.
Section 3: User Population
    The number of AI/AN people served must be substantiated by 
documentation describing IHS user populations, U.S. Census Bureau data, 
clinical catchment data, or any method that is scientifically and 
epidemiologically valid.
Part 2: Program Planning and Evaluation (Limit--5 pages)
Section 1: Program Plans
    Applicant must include a work plan that describes program goals, 
objectives, activities, timeline, and responsible person for carrying 
out the objectives/activities. The applicant must include at least a 
minimum of four of the seven core functions of the IHCIA and other 
activities listed under the Required, Optional, and Allowable 
Activities.
Section 2: Program Evaluation
    Applicant must define the criteria to be used to evaluate 
activities listed in the work plan under the Grantee Cooperative 
Agreement Award Activities. Criteria must include the collection, 
management, and reporting of established TEC IHS GPRA measures. They 
must explain the methodology that will be used to determine if the 
needs identified for the objectives are being met and if the outcomes 
identified are being achieved and describe how evaluation findings will 
be disseminated to the IHS, co-funders, and the population served. The 
evaluation plan must include a logic model (not counted in the page 
limit) with at least one measurable outcome per required activity. 
Applicants are strongly encouraged to base their logic model on the 
Draft Logic Model supplied with this notice.
Part 3: Program Report (Limit--4 pages)
Section 1: Describe Major Accomplishments Over the Last 24 Months
    Please identify and describe significant program achievements 
associated with the delivery of quality health services. 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.
Section 2: Describe Major Activities Over the Last 24 Months
    Please identify and summarize recent, major project activities 
related to the work proposed in the last 24 months.
Section 3: Describe Epidemiology Activities Over the Last 5 Years
    Please identify and summarize substantial epidemiology center 
activities conducted over the last five years, especially those you 
propose to continue.
B. Budget Narrative (Limit--5 pages)
    Provide a budget narrative that explains the amounts requested for 
each line item of the budget from the SF-424A (Budget Information for 
Non-Construction Programs). 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 (see 
Multi-Year Project Requirements in Section V.1. Application Review 
Information, Evaluation Criteria), the narrative

[[Page 41069]]

should highlight the changes from year 1 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 Time 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]), Acting Director, DGM, by 
telephone at (301) 443-2114 or (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.
    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 cooperative agreement 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. Paul Gettys, Acting Director, DGM. A written waiver request 
must be sent to [email protected] with a copy to 
[email protected]. The waiver request 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 Acting 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., Eastern Time, 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 9-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 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 must have a DUNS 
number first, then access the SAM online registration through the SAM 
home page at https://www.sam.gov/SAM/ (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/SAM/.
    Additional information on implementing the Transparency Act, 
including the specific requirements for DUNS and SAM, are available on 
the DGM Grants Management, Policy Topics web page: https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The 12-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

[[Page 41070]]

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. Evaluation Criteria

    The instructions for preparing the application narrative also 
constitute the evaluation criteria for reviewing and scoring the 
application. Points are assigned as follows:
A. Introduction and Need for Assistance (10 points)
    a. Describe the applicant's current public health activities 
including programs or services currently provided, interactions with 
other public health authorities in the regions (state, local, or 
Tribal) and how long it has been operating. Specifically describe 
current epidemiologic capacity and history of support for such 
activities.
    b. Provide a physical location of the TEC and area to be served by 
the proposed program, including a map (include the map in the 
attachments) and specifically describe the office space and how it is 
going to be paid for.
    c. Describe the applicant's user population. The applicant must 
demonstrate AI/AN people will be served and must be substantiated by 
using documentation describing IHS user populations, U.S. Census Bureau 
data, clinical catchment data, or any method that is scientifically and 
epidemiologically valid data.
B. Project Objectives, Work Plan, and Approach (35 points)
    a. State in measurable and realistic terms the objectives and 
appropriate activities to achieve each objective for the projects as 
listed in the Required, Optional, and Allowable Activities. The work 
plan needs to include the grantees desired objectives and must 
demonstrate a minimum of four of the seven TEC core functional areas as 
outlined in the IHCIA.
    b. Identify the expected results, benefits, and outcomes or 
products to be derived from each objective of the project.
    c. Include a work plan for each objective that indicates when the 
objectives and major activities will be accomplished and who will 
conduct the activities.
C. Program Evaluation (10 points)
    a. Define the criteria to be used to evaluate activities listed in 
the work plan under the Required, Optional, and Allowable Activities.
    b. Explain the methodology that will be used to determine if the 
needs identified for the objectives are being met and if the outcomes 
identified are being achieved. Be explicit about how the logic model 
relates to the objectives and activities. Include the logic model in 
the appendix.
    c. Explain how the organization will participate in cross-
organization evaluation activities, as needed.
    d. Describe how evaluation findings will be disseminated to 
stakeholders.
D. Organizational Capabilities, Key Personnel, and Qualifications (10 
points)
    a. Explain both the management and administrative structure of the 
organization, including documentation of current certified financial 
management systems from the Bureau of Indian Affairs, IHS, or a 
Certified Public Accountant and an updated organizational chart 
(include in appendix).
    b. Describe the ability of the organization to manage a program of 
the proposed scope.
    c. Provide position descriptions and biographical sketches of Key 
Personnel, including those of consultants or contractors in the Other 
Attachments form in Grants.gov. Position descriptions should very 
clearly describe each position and its duties, indicating desired 
qualification and experience requirements related to the project. 
Resumes should indicate that the proposed staff is qualified to carry 
out the project activities. Applicants with expertise in epidemiology 
will receive priority.
    d. Applicant must at least have two epidemiologists as part of the 
proposal.
E. Epidemiology Center Capacity (30 points)
    a. Applicant must demonstrate current capacity and successes over 
time (five years) in providing epidemiology center services to Tribes 
and Tribal populations in their area.
F. Categorical Budget and Budget Justification (5 points)
    a. The five points for Categorical Budget only applies to Year 1. 
Provide a line item budget and budget narrative for Year 1.
    b. Provide a justification by line item in the budget including 
sufficient cost and other details to facilitate the determination of 
cost allowance and relevance of these costs to the proposed project. 
The funds requested should be appropriate and necessary for the scope 
of the project. Be aware of and incorporate budget limits and 
requirements listed in the Required, Optional, and Allowable Activities 
in Section I.
    i. IHS recommends that applicants review https://www.ihs.gov/dper/evaluation/evaluation-policy/ and plan their budget proposals in 
compliance with the general Evaluation Policy of IHS.
    c. If use of consultants or contractors are proposed or 
anticipated, provide a detailed budget and scope of work that clearly 
defines the deliverables or outcomes anticipated.
    d. If the applicant will be hosting a conference, the applicant 
must include a separate detailed budget justification and narrative for 
the conference. The cost categories to be addressed are as follows: (1) 
Contract/Planner, (2) Meeting Space/Venue, (3) Registration website, 
(4) Audio Visual, (5) Speakers Fees, (6) Non-Federal Attendee Travel, 
(7) Registration Fees, and (8) Other (explain in detail and cost 
breakdown).
    e. Applicant is required to submit a line item budget and budget 
narrative by category for years 2-5 as an appendix to show the five-
year plan of the proposal.
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 timeline 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).
     Logic model.
     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

[[Page 41071]]

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 
(budget limit, project period limit) 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 Office of Public Health Support 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 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, Cost Principles, and 
Audit Requirements for HHS Awards currently in effect or implemented 
during the period of award, other Department regulations and policies 
in effect at the time of award, and applicable statutory provisions. At 
the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/content/pkg/CFR-2020-title45-vol1/pdf/CFR-2020-title45-vol1-part75.pdf.
     Please review all HHS regulatory provisions for 
Termination at 45 CFR 75.372, at https://www.ecfr.gov/cgi-bin/retrieveECFR?gp&;SID=2970eec67399fab1413ede53d7895d99&mc=true&
;n=pt45.1.75&r=PART&ty=HTML&se45.1.75_1372#se45.1.75_1372.
    C. Grants Policy:
     HHS Grants Policy Statement, Revised 01/07, at https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
    D. Cost Principles:
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' at 45 CFR part 75, subpart E.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' at 45 CFR part 75, subpart F.
    F. As of August 13, 2020, 2 CFR 200 has been updated to include a 
prohibition on certain telecommunications and video surveillance 
services or equipment. This prohibition is described in 2 CFR 200.216. 
This will also be described in the terms and conditions of every IHS 
grant and cooperative agreement awarded on or after August 13, 2020.

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 and submit it to the DGM prior to 
the DGM issuing an 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.
    Per 45 CFR 75.414(f) Indirect (F&A) costs, ``any non-Federal entity 
[i.e., applicant] that has never received a negotiated indirect cost 
rate, . . . may elect to charge a de minimis rate of 10 percent of 
modified total direct costs (MTDC) which may be used indefinitely. As 
described in Section 75.403, costs must be consistently charged as 
either indirect or direct costs, but may not be double charged or 
inconsistently charged as both. If chosen, this methodology once 
elected must be used consistently for all Federal awards until such 
time as the non-Federal entity chooses to negotiate for a rate, which 
the non-Federal entity may apply to do at any time.''
    Electing to charge a de minimis rate of 10 percent only applies to 
applicants that have never received an approved negotiated indirect 
cost rate from HHS or another cognizant federal agency. Applicants 
awaiting approval of their indirect cost proposal may request the 10 
percent de minimis rate. When the applicant chooses this method, costs 
included in the indirect cost pool must not be charged as direct costs 
to the grant.
    Available funds are inclusive of direct and appropriate indirect 
costs. Approved indirect funds are awarded as part of the award amount, 
and no additional funds will be provided.
    Generally, IDC rates for IHS grantees are negotiated with the 
Division of Cost Allocation (DCA) at https://rates.psc.gov/ or the 
Department of the Interior (Interior Business Center) at https://ibc.doi.gov/ICS/tribal. For questions regarding the indirect cost 
policy, please call the GMS 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 the imposition of special award 
provisions, and/or 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 awardee organization 
or the individual responsible for preparation of the reports. Per DGM 
policy, all reports must 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.

[[Page 41072]]

    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required semi-annually. The progress 
reports are due within 30 days after the reporting period ends 
(specific dates will be listed in the NoA Terms and Conditions). 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 of progress, 
and other pertinent information as required. A final report must be 
submitted within 90 days of expiration of the period of performance.
B. Financial Reports
    Federal Cash Transaction Reports are due 30 days after the close of 
every calendar quarter to the Payment Management Services at https://pms.psc.gov. Failure to submit timely reports may result in adverse 
award actions blocking access to funds.
    Federal Financial Reports are due 30 days after the end of each 
budget period, and a final report is due 90 days after the end of the 
Period of Performance.
    Grantees are responsible and accountable for reporting accurate 
information on all required reports: The Progress Reports, the Federal 
Cash Transaction Report, and the Federal Financial Report.
C. Data Collection and Reporting
    Based on the required activities in Section II, describe how 
grantee plans to collect data for the proposed project and activities. 
Identify any type(s) of evaluation(s) that will be used and how you 
will collaborate with partners to complete any evaluation efforts or 
data collection. Progress reports will include compilation of 
quantitative data (e.g., number served; screenings completed) and 
qualitative or narrative (text) data. Reporting elements should be 
specific to activities/programs, processes, and outcomes such as 
performance measures and other data relevant to evaluation outcomes, 
including intended results (i.e., impact and outcomes). Grantees will 
be required to collect and submit responses to specific data calls upon 
request, as well as semi-annual and annual progress reports.
D. Post Conference Grant Reporting
    The following requirements were enacted in Section 3003 of the 
Consolidated Continuing Appropriations Act, 2013, Public Law 113-6, 127 
Stat. 198, 435 (2013), and; Office of Management and Budget Memorandum 
M-17-08, Amending OMB Memorandum M-12-12: All HHS/IHS awards containing 
grants funds allocated for conferences will be required to complete a 
mandatory post award report for all conferences. Specifically: The 
total amount of funds provided in this award/cooperative agreement that 
were spent for ``Conference X,'' must be reported in final detailed 
actual costs within 15 calendar days of the completion of the 
conference. Cost categories to address should be: (1) Contract/Planner, 
(2) Meeting Space/Venue, (3) Registration website, (4) Audio Visual, 
(5) Speakers Fees, (6) Non-Federal Attendee Travel, (7) Registration 
Fees, and (8) Other.
E. 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 1 70.
    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.
    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 threshold met for any specific 
reporting period.
    For the full IHS award term implementing this requirement and 
additional award applicability information, visit the DGM Grants 
Management website at https://www.ihs.gov/dgm/policytopics/.
F. 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 HHS must 
administer their programs in compliance with Federal civil rights laws 
that prohibit discrimination on the basis of race, color, national 
origin, disability, age and, in some circumstances, religion, 
conscience, and sex. This includes ensuring programs are accessible to 
persons with limited English proficiency. The HHS Office for Civil 
Rights provides guidance on complying with civil rights laws enforced 
by HHS. Please see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/ and https://www.hhs.gov/ocr/civilrights/understanding/section1557/.
     Recipients of FFA must ensure that their programs are 
accessible to persons with limited English proficiency. 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/fact-sheet-guidance/ and https://www.lep.gov. 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.
     Recipients of FFA also have specific legal obligations for 
serving qualified individuals with disabilities. Please see https://www.hhs.gov/ocr/civilrights/understanding/disability/.
     HHS funded health and education programs must be 
administered in an environment free of sexual harassment. Please see 
https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/; https://www2.ed.gov/about/offices/list/ocr/docs/shguide.html; and https://www.eeoc.gov/eeoc/publications/fs-sex.cfm.
     Recipients of FFA must also administer their programs in 
compliance with applicable Federal religious nondiscrimination laws and 
applicable Federal conscience protection and associated anti-
discrimination laws. Collectively, these laws prohibit exclusion, 
adverse treatment, coercion, or other discrimination against persons or 
entities on the basis of their consciences, religious beliefs, or moral 
convictions. Please see https://www.hhs.gov/conscience/conscience-protections/ and https://www.hhs.gov/conscience/religious-freedom/.
    Please contact the HHS Office for Civil Rights for more information 
about obligations and prohibitions under Federal civil rights laws at 
https://www.hhs.gov/ocr/about-us/contact-us/ or call 1-800-
368-1019 or TDD 1-800-537-7697.

[[Page 41073]]

G. 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 
$250,000) 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, 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 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: Paul Gettys, Acting 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).

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: Lisa C. 
Neel, MPH, Public Health Advisor, Indian Health Service, Office of 
Public Health Support, Division of Epidemiology & Disease Prevention, 
Indian Health Service, 5600 Fishers Lane, Mailstop 09E10D, Rockville, 
MD 20857, Phone: (301) 443-4305, Email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: John Hoffman, Senior Grants Management Specialist, Indian 
Health Service, Division of Grants Management, 5600 Fishers Lane, 
Mailstop 09E70, Rockville, MD 20857, Phone: (301) 443-2116, Email: 
[email protected].
    3. Questions on systems matters may be directed to: Paul Gettys, 
Acting Director, Indian Health Service, Division of Grants Management, 
5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Phone: (301) 
443-2114; or the DGM main line (301) 443-5204, E-Mail: 
[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.

Elizabeth A. Fowler,
Acting Director, Indian Health Service.
[FR Doc. 2021-16281 Filed 7-29-21; 8:45 am]
BILLING CODE 4165-16-P