Special Diabetes Program for Indians, 68630-68639 [2023-22057]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 88, Number 191 (Wednesday, October 4, 2023)]
[Notices]
[Pages 68630-68639]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22057]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Special Diabetes Program for Indians

    Announcement Type: New.
    Funding Announcement Number: HHS-2024-IHS-SDPI-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.237.

Key Dates

    Application Deadline Date: November 29, 2023.
    Earliest Anticipated Start Date: January 1, 2024.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for the 
Special Diabetes Program for Indians (SDPI--formerly Community-Directed 
SDPI). This program is authorized under the Snyder Act, 25 U.S.C. 13; 
the Transfer Act, 42 U.S.C. 2001(a); and Section 330C of the Public 
Health Service Act, codified at 42 U.S.C. 254c-3. The Assistance 
Listings section of SAM.gov (https://sam.gov/content/home) describes 
this program under 93.237.

Background

    Diabetes is a complex and costly chronic disease that requires 
tremendous long-term efforts to prevent and treat. Although diabetes is 
a nationwide public health problem, American Indian/Alaska Native (AI/
AN) people are disproportionately affected. In 2019, 14.5 percent of 
AI/AN people aged 18 years or older had diagnosed diabetes, compared to 
7.4 percent of non-Hispanic white people [CDC, 2021. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-diabetes.html]. 
In addition, AI/AN people have higher rates of diabetes-related 
morbidity and mortality than the general U.S. population [O'Connell, 
2010 (https://diabetesjournals.org/care/article/33/7/1463/39326/Racial-Disparities-in-Health-StatusA-comparison-of); Cho, 2014 (https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2014.301968)]. 
Strategies to address the prevention and treatment of diabetes in AI/AN 
communities are urgently needed.
    In response to the burgeoning diabetes epidemic among AI/AN people, 
Congress established the SDPI through the Balanced Budget Act of 1997. 
SDPI is a $150 million per year program that provides awards for 
diabetes treatment and prevention services. The IHS

[[Page 68631]]

administers SDPI, with programmatic oversight provided by the IHS 
Division of Diabetes Treatment and Prevention (DDTP).

Purpose

    The purpose of this program is to provide diabetes treatment and/or 
prevention activities and/or services (also referred to as 
``activities/services'') for AI/AN communities. Recipients will 
implement one SDPI Diabetes Best Practice (also referred to as ``Best 
Practice'') and report data on the Best Practice's Required Key Measure 
(RKM). Recipients may also implement other activities/services based on 
diabetes-related community needs and develop an evaluation plan. 
Activities/services will be aimed at reducing the risk of diabetes in 
at-risk individuals, providing high quality care to those with 
diagnosed diabetes, and/or reducing the complications of diabetes.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for this announcement's period of 
performance is approximately $40 million, with the IHS awarding 
approximately $10 million each budget year, starting with fiscal year 
(FY) 2024. Individual award amounts for the first budget year are 
anticipated to be between $25,000 and $600,000.
    The funding formula, which determines the funds available to each 
IHS area, has been determined through Tribal consultation. Within each 
area, recipient Tribes provide input on the formula, which determines 
the amount of funding available for each successful applicant.
     Previously awarded SDPI recipients applying to this 
announcement should budget for the same amount as they received in 
previous years. However, funding amounts may change. See the paragraph 
below for additional information.
     New SDPI award applicants should apply for a $25,000 base 
amount. However, funding amounts may change based on each specific 
Area's funding formula. See the paragraph above.
    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 to applicants selected for funding under 
this announcement.
Anticipated Number of Awards
    Approximately 7-20 awards will be issued under this program 
announcement.
Period of Performance
    The period of performance is for 4 years.
Cooperative Agreement
    Cooperative agreements awarded by the Department of Health and 
Human Services (HHS) are administered under the same policies as 
grants. However, the funding agency, IHS, is anticipated to have 
substantial programmatic involvement in the project during the entire 
period of performance. Below is a detailed description of the level of 
involvement required of the IHS.
    Substantial Agency Involvement Description for Cooperative 
Agreement
    A. DDTP will provide programmatic oversight, including:
1. Award Requirements
    a. Create and maintain Best Practices: focused areas for 
improvement of diabetes prevention and treatment outcomes in 
communities and clinics.
    b. Annual Progress Report: Create and provide instructions and 
template(s).
2. Data Collection and Analysis
    a. IHS Diabetes Care and Outcomes Audit: Provide resources, tools, 
support, and training.
    b. SDPI Outcomes System (SOS): Create and provide resources, tools, 
support, and training. Recipients will use the SOS to track and report 
on RKM data for their selected Best Practice.
3. Training, Communication, and Technical Assistance
    a. Provide extensive SDPI award-related trainings: Topics include 
Application, Annual Progress Report, and others. Most trainings are 
provided via live webinars. Webinars will be recorded and made 
available on the SDPI website based on importance.
    b. Provide updates and announcements via email.
    c. Maintain and update the IHS SDPI website (https://www.ihs.gov/sdpi/), which provides information and resources regarding this 
cooperative agreement, including:
    i. Best Practices.
    ii. Additional resources--Documents and links from DDTP and the 
Division of Grants Management (DGM).
    iii. New to SDPI--Information for new recipients and/or staff.
4. Diabetes Trainings and Resources
    a. Provide diabetes-related live, recorded, and online education 
developed by the DDTP, designed for clinicians and other health 
professionals serving in the Indian health system.
    b. Provide clinical updates and announcements via email.
    c. Maintain and update the DDTP website, which provides additional 
resources for recipients including:
    i. Clinician resources--online continuing education opportunities, 
diabetes treatment algorithms, IHS Standards of Care and Clinical 
Practice Recommendations for Type 2 Diabetes, and IHS Diabetes Care and 
Outcomes Audit resources.
    ii. Patient education resources--free materials that can be 
ordered, printed, or downloaded from the online catalog.
    B. The Indian Health Care Improvement Act, amended in 1987, 
established that each of the 12 IHS Areas should have an Area Diabetes 
Consultant (ADC). The ADCs are health care professionals with expertise 
in diabetes. They play a critical role in supporting SDPI diabetes 
treatment and prevention activities for their Area including:
    1. Oversee SDPI awards within their specified Area to ensure 
compliance with programmatic Terms and Conditions.
    2. Serve as a liaison between the SDPI award programs, DDTP, and 
DGM.
    3. Provide training and resources to SDPI recipients. Some 
resources may be in the form of additional staff serving as ADC 
support.
    4. Review or assign a designee to review annual continuation 
applications.
    5. May serve as the Program Officer for the SDPI award programs in 
their IHS Area. The Program Officer is a Federal staff person who is 
responsible for managing and monitoring the progress of recipients in 
GrantSolutions. If the ADC is not eligible (i.e., not Federal program 
staff), another individual may serve as the Program Officer in a 
limited capacity. Program Officer's duties include: creating funding 
commitments and memos, providing programmatic review/approval of 
amendments, and assisting in uploading documents and information as 
Grant Notes in GrantSolutions.

Required, Optional, and Allowable Activities

Required
    All recipients will need to meet the following requirements:
    1. Activities/Services: Recipients must provide activities/services 
that:
    a. meet the purpose of the SDPI, which is to provide diabetes 
treatment

[[Page 68632]]

and/or prevention services and activities for AI/AN communities;
    b. are targeted at reducing risk factors for diabetes and diabetes-
related conditions;
    c. address diabetes-related issues as identified in the recipient's 
application; and
    d. use SDPI funds as outlined in the recipient's Budget Narrative.
    2. IHS Diabetes Care and Outcomes Audit (Diabetes Audit): SDPI 
recipients are required to participate in the Annual Diabetes Audit 
(https://www.ihs.gov/diabetes/audit/). Recipients will submit data, 
review results, and provide a copy of their Annual Diabetes Audit 
Report with their Continuation Applications. Non-clinical or community-
based awardees that are not able to directly participate in the 
Diabetes Audit, will need to obtain a copy of the Annual Diabetes Audit 
Report from their local facility or Area Diabetes Consultant (https://www.ihs.gov/diabetes/about-us/area-diabetes-consultants-adc/).
    3. Best Practices: The Best Practices (https://www.ihs.gov/sdpi/sdpi-community-directed/diabetes-best-practices/) include the latest 
scientific findings and recommendations. Recipients must select one 
Best Practice and implement activities/services aimed at improving the 
associated RKM. Recipients will report on RKM data via the SOS.
    4. Collaboration: Recipients must:
    a. Consult with and accept guidance from DDTP, DGM, and their ADC/
ADC Support/Federal Program Officer(s) and/or designated assignee(s).
    b. Respond promptly to requests for information.
    c. Attend required meetings and trainings.
    d. Provide short presentations on their processes and successes, as 
requested.
    e. Keep the entities (see item a. above) informed of emerging 
issues, developments, and challenges that may affect the recipient's 
ability to comply with the award Terms and Conditions and/or any 
requirements.
    5. Project Director: Recipients must have an officially approved 
Project Director (approved by the Grants Management Officer in 
consultation with the Program Official) who has the following 
qualifications:
    a. Relevant health or wellness education and/or experience.
    b. Experience with award program management, including skills in 
program coordination, budgeting, reporting, and staff supervision.
    c. Working knowledge of diabetes.
    The Project Director should routinely update relevant SDPI award 
program staff with information and requirements regarding their 
program's activities/services.
    6. Annual Progress Report: Per DGM policy, the recipient must 
complete an annual progress report and submit it within 90 days of the 
end of the budget period. The recipient will submit the report by 
uploading it into a Grant Note in GrantSolutions. DDTP will post 
instructions, template(s), and other information on the SDPI 
Application/Report website (https://www.ihs.gov/sdpi/sdpi-community-directed/application-reports/).
    7. Required Trainings: Recipients must participate in SDPI required 
trainings provided by DDTP. These will primarily be live webinars, 
which will be recorded and posted on the SDPI website for those not 
able to attend. Recipients will be expected to keep track of 
participation (both live and recorded webinars). Information about the 
SDPI awardee training requirements will be provided on the SDPI Grant 
Training website (https://www.ihs.gov/sdpi/sdpi-community-directed/sdpi-grant-training/).
Optional
    1. Optional Trainings: In addition to required training, DDTP also 
provides optional trainings. Recipients may participate in SDPI 
optional trainings depending on their need for the information that 
will be presented. These will primarily be live webinars, which will be 
recorded and posted on the SDPI website for those not able to attend. 
Recipients are not expected to keep track of participation, but a 
training tracking tool is made available and updated regularly, 
providing all required and optional trainings hosted by DDTP for the 
year. Information about the SDPI recipient training requirements will 
be provided on the SDPI Grant Training website (https://www.ihs.gov/sdpi/sdpi-community-directed/sdpi-grant-training/).
    2. Diabetes in Indian Country Conference: DDTP occasionally hosts a 
conference that provides continuing education opportunities and 
collaboration on issues related to improving outcomes for people with 
diabetes and those at risk for developing diabetes. SDPI award training 
sessions are provided during this conference. SDPI recipient attendance 
is encouraged but not required.
Allowable
    1. Allowable Activities/Services: There are many types of 
activities/services allowed under this award as long as they meet the 
activities/services requirement (see Required.1. above) and are within 
the scope of work defined in the Project Narrative. For questions, 
contact DDTP.

III. Eligibility Information

1. Eligibility

    To be eligible for this FY 2024 funding opportunity, applicants 
must be one of the following as required by 42 U.S.C. 254c-3(b):
     An Indian health program operated by an Indian Tribe or 
Tribal organization pursuant to a contract, grant, cooperative 
agreement, or compact with the Indian Health Service pursuant to the 
Indian Self-Determination and Education Assistance Act [25 U.S.C. 5321 
et seq.].
     An urban Indian health program operated by an urban Indian 
Organization pursuant to a grant or contract with the Indian Health 
Service pursuant to title V of the Indian Health Care Improvement Act 
[25 U.S.C. 1651 et seq.].
     The Indian Health Service. Under this announcement, only 
one SDPI grant will be awarded per entity. If a Tribe submits an 
application or already has an SDPI grant, their local IHS facility 
cannot apply; if the Tribe does not submit an application or does not 
already have an SDPI grant, the IHS facility can apply. Tribes that are 
awarded grant funds may sub-contract with local IHS facilities to 
provide specific clinical services. In this case, the Tribe would be 
the primary SDPI grantee and the Federal entity would have a sub-
contract within the Tribe's SDPI grant.
     Not a current SDPI grant recipient.
    The Division of Grants Management (DGM) will notify any applicants 
deemed ineligible.

2. Additional Information on Eligibility

    The IHS does not fund concurrent projects. If an applicant is 
successful under this announcement, any subsequent applications in 
response to other SDPI announcements from the same applicant will not 
be funded. Applications on behalf of individuals (including sole 
proprietorships) and foreign organizations are not eligible. 
Applications deemed ineligible will be disqualified from competitive 
review and funding under this funding opportunity.

    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 nonprofit status, 
etc.


[[Page 68633]]



3. Cost Sharing or Matching

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

4. 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, are considered not 
responsive and will not be reviewed. The DGM will notify the applicant.
Additional Required Documentation
Tribes and Tribal Organizations
Tribal Resolution
    The DGM must receive an official, signed Tribal Resolution prior to 
issuing a Notice of Award (NoA) to any Tribe or Tribal organization 
selected for funding. An applicant 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.
    Applicants organized with a governing structure other than a Tribal 
council may submit an equivalent document commensurate with their 
governing organization.
Proof of Nonprofit Status
    Organizations claiming nonprofit status must submit a current copy 
of the 501(c)(3) Certificate with the application.

IV. Application and Submission Information

    Grants.gov uses a Workspace model for accepting applications. The 
Workspace consists of several online forms and three forms in which to 
upload documents--Project Narrative, Budget Narrative, and Other 
Documents. Give your files brief descriptive names. The filenames are 
key in finding specific documents during the objective review and in 
processing awards. Upload all requested and optional documents 
individually, rather than combining them into a package. Creating a 
package creates confusion when trying to find specific documents. Such 
confusion can contribute to delays in processing awards, and could lead 
to lower scores during the objective review.

1. Obtaining Application Materials

    The application package and detailed instructions for this 
announcement are available at https://www.Grants.gov.
    Please direct questions regarding the application process to 
[email protected].

2. Content and Form Application Submission

    Mandatory documents for all applications are listed below. An 
application is incomplete if any of the listed mandatory documents are 
missing. Incomplete applications will not be reviewed.
     Application forms:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
    4. Project Abstract Summary Form.
     Project Narrative (not to exceed 18 pages). See Section 
IV.2.A, Project Narrative for more information.
     Budget Justification and Narrative (not to exceed seven 
pages). See Section IV.2.B, Budget Narrative for instructions.
     One-page Timeframe Chart.
     2022 and 2023 Annual Diabetes Audit reports (DRAFT report 
for 2023 is acceptable) or copies of Audit waivers provided by DDTP.
     Letter(s) of Support from one or more of the following:
    1. Board of Directors (Urban Indian health programs).
    2. Chief Executive Officer (IHS facilities).
    3. Tribes served (highly recommended for IHS facilities).
     Biographical sketches for all Key Personnel.
     Key contacts form for diabetes program coordinator.
     Certification Regarding Lobbying (GG-Lobbying Form).
    The documents listed here may be required. Please read this list 
carefully.
     Tribal Resolution(s) as described in Section III, 
Eligibility.
     501(c)(3) Certificate.
     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Contractor/Consultant resumes or qualifications and scope 
of work.
     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://facdissem.census.gov/.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Work plan, logic model, and/or timeline for proposed 
objectives.
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Organizational chart.
     Map of area identifying project location(s).
     Additional documents to support narrative (for example, 
data tables, and key news articles).
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 and Other Programmatic 
Reports
A. Project Narrative
    This narrative should be a separate document that is no more than 
18 pages and must: (1) have consecutively numbered pages; (2) use black 
font 12 points or larger (applicants may use 10-point font for tables); 
(3) be single-spaced; and (4) be formatted to fit standard letter paper 
(8\1/2\ x 11 inches). DDTP provides an optional PDF template on the 
SDPI Application website at https://www.ihs.gov/sdpi/sdpi-community-directed/application-reports/, which applicants can use to provide the 
required information instead of developing their own format.
    Be sure to succinctly answer all questions listed under the 
evaluation

[[Page 68634]]

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 
overall page limit, the reviewers will be directed to ignore any 
content beyond the page limit. The 18-page limit for the project 
narrative does not include the work plan, standard forms, Tribal 
Resolutions, budget, budget narratives, and/or other items. Page limits 
for each section within the project narrative are guidelines, not hard 
limits.
    There are six parts to the Project Narrative:
Part A: Program Identifiers/Experience (Limit--2 pages)
    Information to identify your program including past experience with 
diabetes treatment and preventions in the AI/AN Communities (include 
years of experience), geographic location, food resources, and 
relationship or role with local Indian health clinic.
Part B: Needs Assessment (Limit--3 pages)
Section 1: Diabetes Needs
    Assessment--identify key diabetes-related health issues and 
diabetes prevalence.
Section 2: Review of Diabetes Audit Reports
    Obtain and review of 2022 and 2023 Annual Diabetes Audit Reports, 
to provide 2-3 items/elements that need to be improved and how your 
program will address those items/elements.
Section 3: Challenges
    Identify and describe challenges your program experiences or may 
face related to prevention and/or treatment of diabetes.
Part C: Program Support and Resources (Limit--3 pages)
Section 1: Leadership Support
    Identify at least one organization administrator or Tribal leaders 
(other than your Program Coordinator) who has agreed to support your 
SDPI program for 2024 and describe how they will be actively involved 
with your program.
Section 2: Key Personnel
    List all key personnel that will be involved in your program's 
activities/services. This may be your ``Diabetes Team.'' You must also 
separately provide a brief resume or biographical sketch for all key 
personnel listed.
Section 3: Partnerships and Collaborations
    List current active partnerships related to your SDPI program and 
describe any new partnerships and collaborations that your SDPI program 
is planning to implement. Include information about how these partners 
and collaborators will contribute to the activities/services you plan 
to provide.
Part D: SDPI Diabetes Best Practice (Limit--3 pages)
Section 1: Best Practice Selection
    Applicants must select one Best Practice that addresses one of the 
needs that was identified in the needs assessment (Part B). There is a 
list of all the Best Practices on the Best Practices website: https://www.ihs.gov/sdpi/sdpi-community-directed/diabetes-best-practices/. For 
each Best Practice, there is a brief statement on the importance, RKM 
information, and guidance for selecting a Target Group, and tools and 
resources.
Section 2: Best Practice Activities
    Provide a list of activity(ies)/service(s) to implement that would 
improve the RKM of the selected Best Practice. Each activity/service 
should include a brief description and a timeline for implementation.
Section 3: Target Group Number and Description
    Recipients will be required to report RKM data for one Target Group 
for their selected Best Practice. A Target Group is the largest number 
of patients/participants that you can realistically include in the 
activities/services you provided in the Best Practice activities for 
the budget period. The following should be considered in selecting your 
Target Group:
    a. The size and characteristics (e.g., ages, health status, 
settings, locations) of the community or patient population that you 
are going to draw your Target Group from;
    b. Intensity of the activities/services you plan to do;
    c. and SDPI funding and other resources available to provide 
activities/services.
Part E: Activities/Services not related to selected Best Practice 
(Optional. Limit--5 pages)
    Provide information for up to five major activities/services, 
supported by SDPI funds, to address needs that were identified in the 
needs assessment (Part B). Activities/services reported here should be 
based on the following criteria:
    a. Use the most award funding and program time.
    b. Address significant needs/challenges.
Part F: Additional Information (Limit--2 pages)
    Provide additional information as specified by program office.
B. Budget Narrative (Limit--7 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) for the first year of the project. The 
applicant can submit with the budget narrative a more detailed 
spreadsheet than is provided by the SF-424A (the spreadsheet will not 
be considered part of the budget narrative). 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 additional pages should 
highlight the changes from the first year 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.
C. IHS Diabetes Care and Outcomes Audit
    The IHS Diabetes Care and Outcomes Audit is a process to assess 
care and health outcomes for AI/AN people with diagnosed diabetes. IHS, 
Tribal, and Urban Indian health care facilities nationwide participate 
in this process each year by auditing medical records for their 
patients with diabetes. Applicants who are able to must submit copies 
of their local facility's 2022 and 2023 Annual Diabetes Audit reports 
or copies of the Audit waivers provided by DDTP.
    Annual Diabetes Audit reports can be obtained in the following 
ways:
    a. Via the WebAudit: https://www.ihs.gov/diabetes/audit/.
    b. Request from their local facility.
    c. Request from their ADC: https://www.ihs.gov/diabetes/about-us/area-diabetes-consultants-adc/.
    For programs that received Audit waivers, these can be found in 
GrantSolutions (as a Grant Note).
    If the applicant is unable to obtain their local facility's 2022 
and 2023 Annual Diabetes Audit Reports, they must provide an 
explanation in their

[[Page 68635]]

Project Narrative (Part B). For any questions, contact DDTP.

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, Deputy Director, DGM, by email at [email protected]. Please 
be sure to contact Mr. Gettys at least 10 days prior to the application 
deadline. Please do not contact the DGM until you have received a 
Grants.gov tracking number. In the event you are not able to obtain a 
tracking number, call the DGM as soon as possible by email at 
[email protected].
    The IHS will not acknowledge receipt of applications.
4. Intergovernmental Review
    Executive Order 12372 requiring intergovernmental review is not 
applicable to this program.
5. Funding Restrictions
     Pre-award costs are allowable up to 90 days before the 
start date of the award provided the costs are otherwise allowable if 
awarded. Pre-award costs are incurred at the risk of the applicant.
     The available funds are inclusive of direct and indirect 
costs.
     Only one 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 you cannot submit an application through Grants.gov, you must 
request a waiver prior to the application due date. You must submit 
your waiver request by email to [email protected]. Your waiver request must 
include clear justification for the need to deviate from the required 
application submission process. The IHS will not accept any 
applications submitted through any means outside of Grants.gov without 
an approved waiver.
    If the DGM approves your waiver request, you will receive a 
confirmation of approval email containing submission instructions. You 
must include a copy of the written approval with the application 
submitted to the DGM. Applications that do not include a copy of the 
waiver approval from 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 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, you will receive an 
automatic acknowledgment from Grants.gov that contains a Grants.gov 
tracking number. The IHS will not notify you that the application has 
been received.
System for Award Management
    Organizations that are not registered with the System for Award 
Management (SAM) must access the SAM online registration through the 
SAM home page at https://sam.gov. Organizations based in the United 
States (U.S.) 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://sam.gov.
Unique Entity Identifier
    Your SAM.gov registration now includes a Unique Entity Identifier 
(UEI), generated by SAM.gov, which replaces the DUNS number obtained 
from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS 
number.
    Check your organization's SAM.gov registration as soon as you 
decide to apply for this program. If your SAM.gov registration is 
expired, you will not be able to submit an application. It can take 
several weeks to renew it or resolve any issues with your registration, 
so do not wait.
    Check your Grants.gov registration. Registration and role 
assignments in Grants.gov are self-serve functions. One user for your 
organization will have the authority to approve role assignments, and 
these must be approved for active users in order to ensure someone in 
your organization has the necessary access to submit an application.
    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 recipients must notify 
potential first-tier sub-recipients that no entity may receive a first-
tier sub-award unless the entity has provided its UEI number to the 
prime recipient 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.
    Additional information on implementing the Transparency Act, 
including the specific requirements for SAM, are available on the DGM 
Grants Management, Policy Topics web page at https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The project narrative and budget narrative should include only the 
first year of activities; information for multi-year projects should be 
included as a separate document. See ``Multi-year Project 
Requirements'' at the end of this section for more information. The 
project narrative should be written in a manner that is clear to 
outside reviewers unfamiliar with prior related activities of the 
applicant. It should be well

[[Page 68636]]

organized, succinct, and contain all information necessary for 
reviewers to fully understand the project. Attachments requested in the 
criteria do not count toward the page limit for the narratives. 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

A. Introduction and Need for Assistance (15 points)
(i) Program Identifiers/Experience (Project Narrative Part A)
    (1) Was program identifier information adequately provided?
    (2) Did applicant provide sufficient information to establish their 
location and relationship to their local Indian Health Clinic?
(ii) Needs Assessment (Project Narrative Part B)
    (1) Did the applicant adequately describe the key diabetes-related 
health issues identified by their community/leadership?
    (2) Were numbers provided for applicant's local user population and 
people with diagnosed diabetes?
    (3) Did the applicant appropriately identify Diabetes Audit items 
(or diabetes-related issues if Audit Reports were not provided) that 
need to be improved?
    (4) Did the applicant adequately describe how they will address the 
Diabetes Audit items or diabetes-related issues that need to be 
improved?
    (5) Did the applicant adequately describe challenges?
B. Project Objective(s), Work Plan and Approach (30 points)
(i) SDPI Diabetes Best Practice (Project Narrative Part D)
    (1) Did the applicant provide an adequate description of 
activities/services to improve the RKM?
    (2) Are the activities/services proposed appropriate for the 
selected Best Practice and Target Group?
    (3) Do the planned activities/services appear to be reasonable 
given the constraints of timeframe, resources, and staff?
(ii) If Applicable: Activities/Services Not Related to Selected Best 
Practice (Project Narrative Part E)
    (1) Do activities/services address diabetes-related issues 
identified in the needs assessment in Part B?
    (2) Are activities/services aimed at reducing risk factors for 
diabetes and/or related conditions?
    (3) Are activities/services adequately described?
    (4) Do the planned activities/services appear to be reasonable 
given the constraints of timeframe, resources, and staff?
C. Program Evaluation (15 points)
(i) SDPI Diabetes Best Practice (Project Narrative Part D)
    (1) Was a Best Practice selected?
    (2) Was the number of patients/participants in the Target Group 
provided?
    (3) Was the Target Group adequately described?
    (4) Are the Target Group and number of patients/participants 
reasonable given the information the applicant provided in their needs 
assessment and program resources sections?
(ii) If Applicable: Activities/Services Not Related to Selected Best 
Practice (Project Narrative Part E)
    (1) Was an appropriate target group identified for each activity/
service?
    (2) Did the applicant specify how improvement and reduction in risk 
factors will be evaluated?
D. Organizational Capabilities, Key Personnel, and Qualifications (30 
points)
(i) Program Identifiers/Experience (Project Narrative Part A)
    (1) Does the applicant have experience with diabetes treatment and 
prevention services in AI/AN communities?
    (2) Is the experience provided recent? (within 5 years)
(ii) Program Support (Project Narrative Part C)
    (1) Does the program propose to provide sufficient and appropriate 
staff to carry out planned activities?
    (2) Did the applicant identify an appropriate organization 
administrator or Tribal leader, other than the Program Coordinator, to 
support their SDPI program?
    (3) Did the applicant describe how this leader will be involved 
with the SDPI program?
    (4) Did the applicant provide appropriate and adequate information 
about key personnel in the Project Narrative?
    (5) Did the applicant provide appropriate and adequate information 
about partnerships and collaborations in the Project Narrative?
E. Categorical Budget and Budget Justification (10 points)
    (i) Does the budget match the scope of work described in the 
Project Narrative?
    (ii) Was each line item adequately specified and justified?
    (iii) Do funding totals match between the SF-424A, budget line 
item, and justification?
    (iv) Is the budget reasonable and realistic?
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.

2. Review and Selection

    Each application will be prescreened for eligibility and 
completeness as outlined in this funding announcement. The Review 
Committee (RC) will review applications that meet the eligibility 
criteria. The RC will review the applications for merit based on the 
evaluation criteria. Incomplete applications and applications that are 
not responsive to the administrative thresholds (budget limit, period 
of performance limit) will not be referred to the RC and will not be 
funded. The DGM will notify the applicant 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 DDTP within 30 days of the conclusion of the review 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 award, the terms and conditions of the 
award, the effective date of the award, the budget period, and period 
of performance. 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 1 year. If funding becomes

[[Page 68637]]

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

    Awards issued under this announcement are subject to, and are 
administered in accordance with, the following regulations and 
policies:
    A. The criteria as outlined in this program announcement.
    B. Administrative Regulations for Awards:
     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-2022-title45-vol1/pdf/CFR-2022-title45-vol1-part75.pdf.
     If you receive an award, HHS may terminate it if any of 
the conditions in 2 CFR 200.340(a)(1)-(4) are met. Please review all 
HHS regulatory provisions for Termination at 45 CFR 75.372, at the time 
of this publication located at https://www.govinfo.gov/content/pkg/CFR-2022-title45-vol1/pdf/CFR-2022-title45-vol1-sec75-372.pdf.
    C. Grants Policy:
     HHS Grants Policy Statement, Revised January 2007, 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, at the time of this 
publication located at https://www.govinfo.gov/content/pkg/CFR-2022-title45-vol1/pdf/CFR-2022-title45-vol1-part75-subpartE.pdf.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' at 45 CFR part 75 subpart F, at the time of 
this publication located at https://www.govinfo.gov/content/pkg/CFR-2022-title45-vol1/pdf/CFR-2022-title45-vol1-part75-subpartF.pdf.
    F. As of August 13, 2020, 2 CFR part 200 was 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 IDC in their application budget. In accordance with HHS Grants 
Policy Statement, Part II-27, the 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 award 
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 2 
CFR 200.414(f) Indirect (F&A) costs,

any non-Federal entity (NFE) [i.e., applicant] that does not have a 
current negotiated rate, . . . may elect to charge a de minimis rate 
of 10 percent of modified total direct costs which may be used 
indefinitely. As described in Section 200.403, 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 NFE chooses to negotiate for a rate, 
which the NFE may apply to do at any time.

    Electing to charge a de minimis rate of 10 percent can be used by 
applicants that have 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 
award. 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 recipients are negotiated with the 
Division of Cost Allocation 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 write 
to [email protected].

3. Reporting Requirements

    The recipient 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 
award, 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 recipient 
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 use the form under the 
Recipient User section of https://www.grantsolutions.gov/home/getting-started-request-a-user-account/. Download the Recipient User Account 
Request Form, fill it out completely, and submit it as described on the 
web page and in the form.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required 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. Recipient must submit a 
final report within 120 days of the period of performance end date. 
Instructions, template(s), and other information will be posted on the 
SDPI website at https://www.ihs.gov/sdpi/sdpi-community-directed/application-reports/.
B. Financial Reports
    Federal Financial Reports are due 90 days after the end of each 
budget period, and a final report is due 120 days after the end of the 
period of performance.
    Recipients are responsible and accountable for reporting accurate 
information on all required reports: the Progress Reports and the 
Federal Financial Report.

[[Page 68638]]

    Failure to submit timely reports may result in adverse award 
actions blocking access to funds.
C. Data Collection and Reporting
    SOS RKM Data Requirements: Data for the selected Best Practice RKM 
will be submitted using the SOS. Recipients will submit results for 
their RKM for their selected Best Practice into this system at the 
start (baseline) and end (final) of the budget period, with the option 
to submit more frequently. The system will generate SOS RKM data 
reports to meet the SDPI outcomes reporting requirements. These results 
will be stored in the system and will be accessible to program staff, 
as needed. Recipients will need to appoint at least one person in their 
program to get access to and submit data into the SOS.
    i. Baseline data: Data is to be submitted into the SOS by the last 
business day of February each year (e.g., 2024 baseline data will be by 
Thursday, February 29, 2024). A report from the SOS showing baseline 
data submission will be due with continuation applications.
    ii. Final data: Data for the prior budget period is to be submitted 
into the SOS by the last business day of January, each year (e.g., 2024 
final data will be due by Friday, January 31, 2025). A report from the 
SOS showing baseline and final data submission will be due with the 
Annual Progress Report.
    Refer to the SDPI website (https://www.ihs.gov/sdpi/) for the 
latest information on report templates, due dates, webinars and 
submission instructions.
    Diabetes Care and Outcomes Audit: SDPI recipients are required to 
participate in the Annual Diabetes Audit (https://www.ihs.gov/diabetes/audit/). Recipients will submit data, review results, and provide a 
copy of their Annual Diabetes Audit Report with their annual SDPI 
applications. Diabetes Annual Audit data are to be submitted into the 
WebAudit each year around mid-March, (e.g., 2024 Audit data collecting 
annual data will be due approximately March 15, 2024). Non-clinical or 
community-based recipients, that are not able to directly participate 
in the Diabetes Audit, will need to obtain a copy of the Annual 
Diabetes Audit Report from their local facility or Area Diabetes 
Consultant (https://www.ihs.gov/diabetes/about-us/area-diabetes-consultants-adc/).
D. Federal Sub-award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The Transparency Act requires the OMB to establish a single 
searchable database, accessible to the public, with information on 
financial assistance awards made by Federal agencies. The Transparency 
Act also includes a requirement for recipients of Federal grants to 
report information about first-tier sub-awards and executive 
compensation under Federal assistance awards.
    The IHS has implemented a Term of Award into all IHS Standard Terms 
and Conditions, NoAs, and funding announcements regarding the FSRS 
reporting requirement. This IHS Term of Award is applicable to all IHS 
grant and cooperative agreements issued on or after October 1, 2010, 
with a $25,000 sub-award obligation 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/.
E. Non-Discrimination Legal Requirements for Recipients of Federal 
Financial Assistance (FFA)
    If you receive an award, you must follow all applicable 
nondiscrimination laws. You agree to this when you register in SAM.gov. 
You must also submit an Assurance of Compliance (HHS-690). To learn 
more, see https://www.hhs.gov/civil-rights/for-providers/laws-regulations-guidance/laws/. 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.
F. Federal Awardee Performance and Integrity Information System 
(FAPIIS)
    The IHS is required to review and consider any information about 
the applicant that is in the FAPIIS at https://www.fapiis.gov/fapiis/#/home 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. The 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, 
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 million 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 an NFE 
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.
    All applicants and recipients must disclose in writing, in a timely 
manner, 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: Marsha Brookins, Director, 5600 
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, (Include 
``Mandatory Grant Disclosures'' in subject line), Office: (301) 443-
4750, 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 part 180 and 2 CFR part 
376).

[[Page 68639]]

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to:

Applicant's Area Diabetes Consultant: https://www.ihs.gov/diabetes/about-us/area-diabetes-consultants-adc/, IHS Division of Diabetes 
Treatment and Prevention, 5600 Fishers Lane, Mailstop: 08N34A, 
Rockville, MD 20857, Phone: (844) 447-3387, Fax: (301) 594-6213, Email: 
[email protected] and [email protected], Division of Diabetes website: 
https://www.ihs.gov/diabetes/ and https://www.ihs.gov/sdpi/

    2. Questions on awards management and fiscal matters may be 
directed to:

Indian Health Service, Division of Grants Management, 5600 Fishers 
Lane, Mail Stop: 09E70, Rockville, MD 20857, Email: [email protected].

    3. For technical assistance with Grants.gov, please contact the 
Grants.gov help desk at (800) 518-4726, or by email at 
[email protected].
    4. For technical assistance with GrantSolutions, please contact the 
GrantSolutions help desk at (866) 577-0771, or by email at 
[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.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-22057 Filed 10-3-23; 8:45 am]
BILLING CODE 4166-14-P