FR Doc 03-13222

[Federal Register: May 28, 2003 (Volume 68, Number 102)]
[Notices]
[Page 31707-31720]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28my03-63]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 03032]

Addressing Asthma From a Public Health Perspective; Notice of
Availability of Funds

Application Deadline: July 14, 2003.

A. Authority and Catalog of Federal Domestic Assistance Number

This program is authorized under section 301 and 317 of the Public
Health Service Act [42 U.S.C. section 241 and 247b], as amended. The
Catalog of Federal Domestic Assistance number is 93.283.

B. Purpose

The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 2003 funds for a cooperative agreement
program for ``Addressing Asthma from a Public Health Perspective.''
This program addresses the ``Healthy People 2010'' focus areas
Environmental Health, Occupational Safety and Health, and Respiratory
Diseases.
The purpose of the program is to provide the impetus to begin
development of program capacity to address asthma from a public health
perspective in order to bring about: (1) A focus of asthma-related
activity within the agency; (2) an increased understanding of asthma-
related data and its application to program planning through
development of an ongoing surveillance system; (3) an increased
recognition within the public health structure of the state or
territory of the potential to use a public health approach to reduce
the burden of asthma; (4) linkages of the agency to the many agencies
and organizations addressing asthma in the population; and (5)
participation in intervention program activities. Epidemiological
surveillance is ``the ongoing systematic collection, analysis, and
interpretation of health data essential to the planning,
implementation, and evaluation of public health practice, closely
integrated with the timely dissemination of these data to those who
need to know. The final link in the surveillance chain is the
application of these data to prevention and control. A surveillance
system includes a functional capacity for data collection, analysis,
and dissemination linked to public health programs.'' Refer to Boss,
L.; Kreutzer, R.; Luttinger, D.; Leighton, J.; Wilcox, K.; and Redd, S.
The Public Health Surveillance of Asthma, Journal of Asthma, 38(1), 83-
89, 2001.
This program announcement has three parts: (1) Part A: Developing
State Capacity to Address Asthma, (2) Part A Enhanced: Enhancing State
Capacity to Address Asthma, and (3) Part B: Implementation of State
Asthma Plans.
Measurable outcomes of the program will be in alignment with the
following performance goal for the National Center for Environmental
Health (NCEH): Reduce the burden of asthma.

C. Eligible Applicants

Applications may be submitted by:
[sbull] Federally recognized Indian tribal governments.
[sbull] Indian tribes.
[sbull] Indian tribal organizations.
[sbull] State public health departments or their bona fide agents
(this includes the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, the Commonwealth of the Northern Marianna
Islands, American Samoa, Guam, the Federated States of Micronesia, the
Republic of the Marshall Islands, and the Republic of Palau).
Part A: Developing State Capacity to Control Asthma. Eligible
applicants are those entities listed above that do not have a final,
approved, comprehensive, asthma plan or a well-developed asthma
surveillance system. Grantees currently funded by CDC Announcement
99109, 01106, or 02085 are not eligible to
apply because they have already received funds to conduct activities in
Part A: Developing State Capacity to Control Asthma. See Attachment II
for a list of states funded by these announcements. All attachments
referenced in this announcement are posted with the announcement on the
CDC Web site, Internet address: http://www.cdc.gov, click on
``Funding'', then click on ``Grants and Cooperative Agreements.''
Part A Enhanced: Enhancing State Capacity to Address Asthma.
Eligible applicants are those entities that are currently funded by CDC
Announcement 99109, are in the latter stages of finishing the
capacity building process, and are preparing to begin implementing
interventions. These states are Colorado, Iowa, Maine, New Jersey, New
Mexico, Rhode Island, and Vermont.
Applicants for Part A Enhanced: Enhancing State Capacity to Address
Asthma must:
1. Submit a copy of the final, approved, comprehensive State Asthma
Plan. Approval can be documented with a letter from the Agency's Health
or Medical Director and letters from key partners or by appropriate
sign-offs on the asthma plan. Plans that are pending final approval may
be accepted if the draft plan is accompanied by letters from the
Agency's Health or Medical Director and key partners stating their
commitment to and approval of the plan, a time frame for final
approval, as well as a description of the plan's approval process
status.
2. Have an operational surveillance system for asthma. This may be
demonstrated through submission of your most recent and comprehensive
published surveillance report that describes asthma within the
jurisdiction, including, if available, a report on asthma in the
Medicaid population.
Applications for Part A Enhanced: Enhancing State Capacity to
Address Asthma that fail to submit evidence requested will be
considered non-responsive and returned without review.

[[Page 31708]]

Part B: Implementation of State Asthma Plans. Eligible applicants
are those entities that have a final, approved, comprehensive, State
Asthma Plan and an operational surveillance system for asthma. The
states of California, Illinois, Michigan, Minnesota, New York, and
Oregon are not eligible to apply for any parts: Part A: Developing
State Capacity to Address Asthma; Part A Enhanced: Enhancing State
Capacity to Address Asthma; or Part B: Implementation of State Asthma
Plans, because they are currently funded by CDC Program Announcement
01106 (Part B) or 02085 to implement State asthma
activities. See Attachment II for a list of states funded by these
announcements.
Applicants for Part B: Implementation of State Asthma Plans must:
1. Submit a copy of the final, approved, comprehensive State Asthma
Plan. Approval may be documented with a letter from the Agency's Health
or Medical Director and letters from key partners or by appropriate
sign-offs on the asthma plan. Plans that are pending final approval may
be accepted if the draft plan is accompanied by letters from the
Agency's Health or Medical Director and key partners stating their
commitment to and approval of the plan. Include a description of the
plan's approval process status.
2. Have an operational surveillance system for asthma. This may be
demonstrated through submission of your most recent, comprehensive
published surveillance report that describes asthma within the State,
territory, tribe, or jurisdiction, including, if available, a report on
asthma in the Medicaid population.
Applications for Part B: Implementation of State Asthma Plans that
fail to submit evidence requested will be considered non-responsive and
returned without review.
Based on eligibility requirements described in Section C Eligible
Applicants, an applicant may apply for:
[sbull] Part A: Developing State Capacity to Address Asthma,
* Part A Enhanced: Enhancing State Capacity to Address Asthma,
* Part B: Implementation of State Asthma Plans, or
[sbull] Any combination

However, only one award per applicant will be made. Applicants must
submit a separate application for each part they are applying for.

Note: Title 2 of the United States Code section 1611 states that
an organization described in section 501 (c)(4) of the Internal
Revenue Code that engages in lobbying activities is not eligible to
receive Federal funds constituting an award, grant or loan.

D. Funding

Availability of Funds

Approximately $4,450,000 is available in FY 2003 to fund
approximately 9-12 awards.
Part A: Developing State Capacity to Address Asthma. Approximately
$600,000 is available to fund approximately one to three awards. It is
expected that the average award will be $200,000.

Part A Enhanced: Enhancing State Capacity to Address Asthma

Approximately $2,450,000 is available to fund approximately seven
awards. It is expected that the average award will be $350,000.

Part B: Implementation of State Asthma Plans.

Approximately $1,400,000 is available to fund approximately one to
two awards. It is expected that the average award will be $700,000.
It is expected that awards under this program announcement will
begin on or about August 1, 2003 and will be made for a 12-month budget
period for the first year that will end on August 31, 2004. The project
period for Part A: Developing State Capacity to Address Asthma will be
up to three years, Part A Enhanced: Enhancing State Capacity to Address
Asthma for up to three years, and Part B: Implementation of State
Asthma Plans for up to five years. Funding estimates may change.
Continuation awards within an approved project period will be made
on the basis of satisfactory progress as evidenced by required reports
and the availability of funds.

Use of Funds

Cooperative agreement funds may be used to support costs directly
related to the program activities and consistent with the scope of the
cooperative agreement. Funds under this program announcement may not be
used to conduct research projects. Surveillance and evaluation
activities that are for the purposes of monitoring program performance
are not considered research. Funds under this program announcement may
not be used for screening or registry activities. Federal funds awarded
under this program announcement may not be used to supplant State or
local funds.

Recipient Financial Participation

Matching funds are not required for this program.

Funding Preferences

Funding preferences may include (1) geographic distribution, and
(2) racial and ethnic populations with a disproportionate asthma
burden.

E. Program Requirements

In conducting activities to achieve the purpose of this program,
the recipient will be responsible for the activities listed in 1.
Recipient Activities, and CDC will be responsible for the activities
listed in 2. CDC Activities.

Part A: Developing State Capacity To Address Asthma

1. Recipient Activities
a. Implement a new (or enhance an existing) asthma surveillance
system in order to gather and interpret data that will quantify the
burden of asthma within the State, and upon which to base the
development of the State Asthma Plan. Include asthma morbidity,
mortality and work-related asthma.
b. Develop a comprehensive State Asthma Plan.
c. Develop and implement an evaluation plan that measures the
effectiveness of the program as a whole as well as each intervention.
Systematically document lessons learned.
d. Develop and organize collaborative linkages with appropriate
agencies and organizations statewide to together (1) systematically
describe the asthma problem in the State; (2) identify available
resources; and (3) in conjunction with partners, develop a
comprehensive State Asthma Plan.
e. Establish a strong agency commitment within the State Health
Department to support the asthma program.
f. Participate in CDC convened meetings and periodic conference
calls for grantees to share experiences, data, and materials.

Part A Enhanced: Enhancing State Capacity To Address Asthma

1. Recipient Activities
a. Enhance the existing asthma surveillance system to include
asthma hospitalizations. Conduct analysis and interpretation of
surveillance data and disseminate these data through reports to local,
State, and Federal partners and agencies.
b. If not already completed, obtain final approval for a
comprehensive State Asthma Plan. This activity should be completed
within three months of the year one budget period.
c. Implement a subset of interventions described in the State
Asthma Plan.
d. Develop and implement an evaluation plan that measures the
effectiveness of your program as a whole as well as each intervention.

[[Page 31709]]

Systematically document lessons learned.
e. Maintain existing or expand (as appropriate) statewide coalition
and partnership activities; including a workgroup to address work-
related asthma if one does not exist. Include as members of this
workgroup representatives from State governmental agencies (e.g. state
department of labor), Federal agencies, public health agencies, and
professional care organizations conducting or interested in
occupational health activities.
f. Maintain a strong agency commitment within the State Health
Department to support continued efforts of the asthma program.
g. Participate in CDC convened meetings and periodic conference
calls for grantees to share experiences, data, and materials.

Part B: Implementation of State Asthma Plans

1. Recipient Activities
a. Expand existing surveillance efforts for, but not limited to,
asthma prevalence, severity, management, mortality, hospitalizations,
emergency care, costs of asthma and other indicators in order to
monitor the effectiveness of the intervention activities. Include
surveillance of work-related asthma.
b. Conduct analysis and interpretation of surveillance data and
disseminate these data through appropriate surveillance reports to
local, state, and federal partners and agencies.
c. Develop and implement an evaluation plan that measures the
effectiveness of your program as a whole and each intervention.
Systematically document lessons learned.
d. Maintain existing statewide coalition and partnership activities
to oversee implementation and evaluation of the State Asthma Plan.
Expand partnership activities as appropriate.
e. Implement defined aspects of the final, approved, comprehensive
State Asthma Plan. Maintain existing asthma-related activities
currently underway in the health agency and expand as appropriate.
Assure institutionalization of asthma intervention activities.
f. Maintain a strong agency commitment within the State Health
Department to support continued efforts of the asthma program.
g. Participate in CDC convened meetings and periodic conference
calls for grantees to share experiences, data, and materials.
2. CDC Activities for Part A: Developing State Capacity to Address
Asthma, Part A Enhanced: Enhancing State Capacity to Address Asthma,
and Part B: Implementation of State Asthma Plans
a. Participate with recipients in further development and
enhancement of existing surveillance activities, including data
collection methods and data analysis.
b. Collaborate with recipients on data analysis and interpretation
of individual state surveillance data and release of surveillance
reports.
c. Provide technical and scientific assistance and consultation on
program development, implementation of the State Asthma Plan,
intervention activities and operational issues.
d. Serve as a facilitator for communication between states to share
expertise regarding various topics, including the expansion and
development of partnerships, implementation of State Asthma Plans, and
surveillance activities.
e. Facilitate working group conference calls with recipients.
f. Collaborate on the development of an appropriate evaluation plan
that measures the effectiveness of the program as a whole and each
intervention.
g. Convene meetings and periodic conference calls for grantees to
share experiences, data, and materials.

F. Content

Letter of Intent (LOI)

A LOI is optional for this program. The Program Announcement title
and number must appear in the LOI. The narrative should be no more than
one page, double-spaced, printed on one side, with one-inch margins,
and unreduced 12-point font. Your letter will be used to ascertain the
level of interest in this announcement and to assist in determining the
size and composition of the independent review panel. It should include
the following information:
1. Name and address of organization.
2. Name, address, telephone number, fax number, and e-mail address
of the organization's primary contact for writing and submitting the
application.
3. A clear description of which part of the program announcement
(Part A: Developing State Capacity To Address Asthma, Part A Enhanced:
Enhancing State Capacity to Address Asthma, Part B: Implementation of
State Asthma Plans, or any combination) you are applying for.

Applications

The Program Announcement title and number must appear in the
application. Use the information in the Program Requirements, Other
Requirements, Evaluation Criteria, and this section to develop the
application content. Your application will be evaluated on the criteria
listed, so it is important to follow them in laying out your program
plan. The narrative should be no more than 30 pages for Part A:
Developing State Capacity to Address Asthma, 35 pages for Part A
Enhanced: Enhancing State Capacity to Address Asthma, or 40 pages for
Part B: Implementation of State Asthma Plans, double-spaced, printed on
one side, with one-inch margins, and unreduced 12-point font. The
application must be submitted unstapled and unbound. Appendices are
limited to a maximum of 100 pages and must be submitted unstapled and
unbound.
Part A: Developing State Capacity To Address Asthma
Include each of the following sections:
1. Description of the Problem
Describe what is known about the asthma burden in the State,
territory, tribe, or jurisdiction and efforts to begin to
systematically address the problem. Identify existing initiatives,
capacity, and infrastructure of the agency within which asthma programs
will occur. Describe the barriers that need to be addressed to develop
a comprehensive asthma program in the State.
2. Workplan
Provide specific goals, objectives, and activities that describe
what the agency intends to accomplish by the end of the three-year
project period. These goals, objectives and activities should be
measurable, realistic, related to Recipient Activities, and reflect
activities in year one, two, and three of the project. Include a
project time-line that indicates when the proposed goals, objectives,
and activities will be met. Document how progress made toward meeting
the objectives will be evaluated. Provide measures for evaluating
process, impact, and outcome for each goal and objective. Refer to
``Framework for Program Evaluation in Public Health,'' Morbidity and
Mortality Weekly Report, September 17, 1999/48(RR-11); 1-40 at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm
or other evaluation
resources on the CDC website at http://www.cdc.gov/eval/index).
In addition, describe how lessons learned will be systematically
gathered, documented, and included as an integral part of the program
evaluation process.

[[Page 31710]]

3. Surveillance Plan
Describe the current operational asthma surveillance system within
the health agency (if one exists). Provide a surveillance plan
containing the following information: (a) A description of data
currently available to the program; (b) additional data the agency will
obtain and methods for obtaining it; (c) plans for identifying specific
populations at-risk for poorly controlled asthma (e.g. gender, age
groups, racial/ethnic groups, socio-economic groups, and/or geographic
areas); (d) how the agency will use data to develop (or enhance) an
ongoing surveillance system; and (e) how the surveillance data will be
used to support policy, program development, implementation, and
evaluation activities. At a minimum, the surveillance system should
include measures to track asthma morbidity, asthma mortality, and work-
related asthma. For more information about work-related asthma, refer
to:
``Surveillance of Work-Related Asthma in Selected U.S. States Using
Surveillance Guidelines for State Health Departments--California,
Massachusetts, Michigan and New Jersey, 1993-1995,'' Morbidity and
Mortality Weekly Report, June 25, 1999/48 (SS03); 1-20 at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4803a1.htm
.
Workgroup Report ``The Role of States in a Nationwide Comprehensive
Surveillance System for Work-related Diseases, Injuries and Hazards''
at http://www.cste.org/occupationalhealth.htm.
``Minimum and Comprehensive State-Based Activities in Occupational
Safety and Health,'' June 1995--DHHS (NIOSH) Publication No. 95-107 at
http://www.cdc.gov/niosh/95-107.html.
Applicants funded by this announcement will be expected to use the
Behavioral Risk Factor Surveillance System (BRFSS) supplemental asthma
module within the first year of the project.
Describe a strategy to conduct analysis, interpret surveillance
data, and disseminate data through published reports to local, state,
and federal partners and agencies.
Present a detailed plan for evaluating whether the asthma
surveillance system is useful for monitoring trends over time. Refer to
``Updated Guidelines for Evaluating Surveillance Systems,
Recommendations from the Guidelines Working Group,'' Morbidity and
Mortality Weekly Report, July 27, 2001/(50)RR-13; 1-35 or http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm4.
State Asthma Plan
Describe the process by which a comprehensive State Asthma Plan
will be developed. The plan must address all persons with asthma in the
State regardless of age, race/ethnicity, gender or geographic area.
Include key environments in which persons with asthma spend significant
time (e.g. home, school, and workplace). If a specific population in
the State is not affected by asthma, clearly identify and describe this
population.
Include information about the agencies and organizations that will
participate in developing the State Asthma Plan. Describe each
partner's roles and responsibilities. Explain how the collaborative
relationships will be used after the plan is in place and the agency is
ready to implement interventions.
Describe how data collected in the asthma surveillance system will
be used to identify priority areas and guide the development of program
goals and objectives. Explain how the State Asthma Plan will evolve and
change based on surveillance data, evaluation of interventions, and
other outside factors that affect the overall climate in the State.
5. Collaboration Plan
Describe experiences with collaborative relationships around asthma
or with other chronic or environmentally-related or occupationally-
related disease requiring extensive collaborative relationships both
within and outside the agency. Specifically define the approach to be
used to establish or further develop these relationships.
Document partnerships with the clinical community; local health
agencies; physician organizations; community health centers; local,
State, or regional asthma or respiratory health organizations (such as
the American Lung Association); local education authorities; and groups
or organizations that serve minority or other populations experiencing
a disproportionate burden of asthma. If one or more of these partners
will not be included, the applicant should explain why.
Describe how the collaboration will (1) establish leadership, (2)
develop consensus regarding goals, (3) identify roles and
responsibilities of members, (4) develop procedures and patterns of
communications, and (5) sustain the participation of members over time.
Provide letters of commitment from each specific organization,
including a statement of how they intend to collaborate, as well as
their expertise, and capacity to carry out assigned responsibilities.
Grant funds may be used to leverage asthma program development in
the State, territory, tribe or jurisdiction along with resources from
other agencies and organizations.
Present a plan to determine the effectiveness of collaborations.
6. Management and Staffing Plan
Demonstrate the applicant's organizational commitment to the asthma
program by describing how the agency as a whole will focus its efforts
on asthma. Provide a plan to maintain a strong commitment within the
State Health Department to support continued efforts of the asthma
program.
Describe the organizational location of the proposed staff, their
relation to the State's asthma contact (the position in the agency
currently responsible for contact with CDC on asthma issues), and the
support within the organizational structure for the activities defined
for the project staff. Attach an organizational chart for the unit
where asthma activities will be located and, at a minimum, the next two
levels above it.
Describe the qualifications and roles of trained public health
professionals to serve as a full-time asthma coordinator for the agency
to manage the planning process and conduct other programmatic
activities; a full-time epidemiologist to develop and implement
surveillance activities for the asthma project; and a supervisor who
will assure support for the project staff. Other program positions may
also be proposed. Attach position descriptions, qualifications, and
curricula vitae for all staff positions.
For each position, describe the primary roles and responsibilities
for the project staff over the three-year grant period. Also, include
the specific staff activities that will contribute to meeting each
objective.
Provide a plan to expedite filling of the staff position(s) and
assure that they have been or will be approved by the applicant's
personnel system. Include a letter of support from the agency
guaranteeing hiring of personnel and support for the asthma program.
Also, describe positions in the asthma program that are currently
filled, but will not be funded by resources under this cooperative
agreement.
Document assurance of the ability of key project staff to
participate in conferences or grantee meetings convened by CDC and
willingness to share innovations, information, data, and materials.

[[Page 31711]]

7. Budget
Include a detailed first-year budget and narrative justifications
as well as annual budget projections for years two and three. The
applicant should describe the program purpose for each budget item. For
each contract contained within the budget, provide (1) the name the
contractor(s); (2) method of selection; (3) period of performance; (4)
description of activities; and (5) an itemized budget with narrative
justifications. If this information is not available when the
application is submitted, and the contract(s) is approved by the CDC,
then the funds for the contract(s) will be restricted for expenditure
on the award.
The budget should include travel funds for project staff to attend
a yearly conference or grantee meeting convened by CDC. In addition,
the applicant should include costs for one person to travel to Atlanta,
GA, to attend the 6th National Environmental Health Conference on
December 3-5, 2003. Review the CDC/NCEH web site for additional
information concerning this conference: http://www.cdc.gov/nceh/default.htm
.
List other funds, outside this cooperative agreement, that will be
used to support this program.
Part A Enhanced: Enhancing State Capacity To Address Asthma
1. Description of the Problem
Describe what is known about the asthma burden in the State,
territory, tribe or jurisdiction and efforts to systematically address
the problem. Include a description of populations at increased risk of
poorly controlled asthma (e.g. gender, age groups, racial/ethnic
groups, socio-economic groups, and geographic areas).
Identify existing initiatives, capacity, and infrastructure of the
agency within which the asthma programs will occur.
Describe how barriers, identified when developing the State Asthma
Plan, were addressed.
2. Workplan
Provide specific goals, objectives, and activities that describe
what the agency intends to accomplish by the end of the three-year
project period. These goals, objectives and activities should be
measurable, realistic, related to Recipient Activities, and reflect
activities in year one, two, and three of the project. Include a
project time-line that indicates when the proposed goals, objectives,
and activities will be met.
Document how progress made toward meeting the objectives will be
evaluated. Provide measures for evaluating process, impact, and outcome
for each goal and objective. Refer to ``Framework for Program
Evaluation in Public Health,'' MMWR, September 17, 1999/48 RR-11; 1-40
at http://www.cdc.gov/mmwr/ preview/mmwrhtml/rr4811a1.htm or other
evaluation resources on the CDC website at http://www.cdc.gov/eval/index
).
In addition, describe how lessons learned will be systematically
gathered, documented, and included as an integral part of the
evaluation process.
3. Surveillance Plan
Describe the current operational asthma surveillance system within
the health agency. Submit copies of the most recent and comprehensive
published surveillance report that describes asthma within the State,
territory, tribe or jurisdiction, including if available, a report of
asthma in the Medicaid population and for enrollees of the State
Children's Health Insurance Program (SCHIP).
Provide a surveillance plan containing the following information:
(a) A description of data currently available to the program; (b)
additional data the agency will obtain and methods for obtaining it;
(c) plans for identifying specific populations at risk for poorly
controlled asthma (e.g. gender, age groups, racial/ethnic groups,
socio-economic groups, or geographic areas); (d) how the agency will
use data to develop or enhance an ongoing surveillance system; and (e)
how the surveillance data will be used to support policy, program
development, implementation, and evaluation activities.
At a minimum, the surveillance system should include measures to
track asthma morbidity, asthma mortality, work-related asthma, and
asthma hospitalizations. For more information about work-related
asthma, refer to the following references:
``Surveillance of Work-Related Asthma in Selected U.S. States Using
Surveillance Guidelines for State Health Departments--California,
Massachusetts, Michigan and New Jersey, 1993-1995,'' Morbidity and
Mortality Weekly Report, June 25, 1999/48 (SS03); 1-20 at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4803a1.htm
.
Workgroup Report ``The Role of States in a Nationwide Comprehensive
Surveillance System for Work-related Diseases, Injuries and Hazards''
at http://www.cste.org/occupationalhealth.htm.
``Minimum and Comprehensive State-Based Activities in Occupational
Safety and Health,'' June 1995--DHHS (NIOSH) Publication No. 95-107 at
http://www.cdc.gov/niosh/95-107.html.
Applicants funded by this announcement will be expected to use the
Behavioral Risk Factor Surveillance System (BRFSS) supplemental asthma
module within the first year of the project.
Describe the methods that will be used to conduct analysis,
interpret surveillance data, and a strategy for disseminating data
through published reports to local, State, and Federal partners and
agencies.
Present a detailed plan to determine whether the asthma
surveillance system is useful for monitoring asthma trends over time,
determining the effectiveness of interventions, and modifying the State
Asthma Plans. Refer to ``Updated Guidelines for Evaluating Surveillance
Systems, Morbidity and Mortality Weekly Report, July 27, 2001/(50)RR13;
1-35 at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm.
4. State Asthma Plan
Submit a copy of the final, approved, comprehensive State Asthma
Plan. Approval may be documented with a letter from the agency's Health
or Medical Director and letters from key partners or by appropriate
sign-offs on the plan. State Asthma Plans that are pending final
approval may be accepted if the draft plan is accompanied by letters
from the agency's Health or Medical Director and key partners stating
their commitment to and approval of the plan, a time frame for final
approval, as well as a description of the approval process status. The
letters should assure that the State Asthma Plan would be completed
within the first three months of the year one budget period.
Describe the process by which the comprehensive State Asthma Plan
was developed and how it addresses all persons with asthma in the State
regardless of age, race/ethnicity, gender, or geographic area and
includes key environments in which persons with asthma spend
significant time (e.g. home, school, workplace). If a specific
population in the State is not affected by asthma, clearly identify and
describe this population.
Include information about the agencies and organizations that are
participating in the planning process and describe their roles and
responsibilities.
Explain how the collaborative relationships will be used after the
plan is in place and the agency is ready to implement interventions.
Describe how data collected in the asthma surveillance system is
used to

[[Page 31712]]

identify priority areas and guide the development of program goals and
objectives. If a State Asthma Plan already exists, describe the subset
of interventions to be implemented with these grant funds. Note that a
statewide approach is encouraged. If focusing on one part of the
state's population, explain and justify the rationale for this
approach.
Proposed activities to meet the plan's objectives may include, but
are not limited to, efforts to (1) expand surveillance for asthma; (2)
improve provider compliance with the National Asthma Education and
Prevention Program's (NAEPP) ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.
97-4051, April 1997); (3) improve the skills of patients and families
affected by asthma to manage the disease; (4) review legislation and
policies impacting people with asthma; (5) identify environmental
factors that contribute to asthma prevalence and morbidity, and reduce
or eliminate exposure to these factors; and (6) communicate between
those implementing and those affected by planned activities.
Explain how the State Asthma Plan will evolve and change based on
analysis of surveillance data, evaluation of interventions, and other
outside factors that affect the overall climate in the State.
5. Collaboration Plan
Describe experiences with collaborative relationships around asthma
or with other chronic or environmentally-related or occupationally-
related disease requiring extensive collaborative relationships both
within and outside the agency. Specifically define the approach to be
used to establish or further develop these relationships.
Document partnerships with the clinical community; local health
agencies; physician organizations; community health centers; local,
State, or regional asthma or respiratory health organizations (e.g.
American Lung Association); local education authorities, and groups or
organizations that serve minority or other populations experiencing a
disproportionate burden of asthma. If one or more of these partners is
not listed, the applicant should explain why.
Describe how the collaboration (1) established leadership, (2)
developed consensus regarding goals, (3) identified roles and
responsibilities, (4) developed procedures and patterns for
communication, (5) and sustained the participation of members over
time.
Provide letters of commitment from each specific organization,
including a statement of how they are or intend to collaborate, as well
as their expertise, and capacity to carry out assigned
responsibilities.
Describe how the partners who developed the State Asthma Plan will
continue to work together to implement and monitor the intervention
strategies and modify the plan over time. Expand partnership activities
as appropriate.
Grant funds may be used to leverage asthma program development in
the State, territory, tribe or jurisdiction along with resources from
other collaborative agencies and organizations.
6. Implementation Plan
Provide specific, realistic, measurable, and time-phased objectives
for each of the interventions to be implemented over the three-year
project period using resources of this announcement. If objectives and
interventions from the plan are addressed using other resources,
explain how they are related. While the overall State Asthma Plan must
address all populations, interventions should be prioritized based on
surveillance data, focusing on high priority and disparate populations
first.
Interventions that change systems and individuals to provide
improved disease management or education are preferred. This discussion
might include the guidelines that the applicant will use for work-
related asthma (e.g., adapted from generic Minimum and Comprehensive
State-Based Activities in Occupational Safety Health, June 1995--DHHS
(NIOSH) Publication No. 95-107) at http:/www.cdc.gov/niosh/95-107.html;
or from the Workgroup Report ``The Role of States in a Nationwide
Comprehensive Surveillance System for Work-related Diseases, Injuries
and Hazards'' (refer to http://www.cste.org/occupationalhealth.htm).
Include an assessment of existing and needed resources to implement
these strategies.
Describe how the State Asthma Plan implementation activities were
developed and how members of the statewide partnership group determined
that these particular objectives and strategies would be addressed
first. Demonstrate the extent to which the intervention plan is
supported in the community by the inclusion of letters of support from
key members of the community. Describe how the partners who developed
the asthma plan will continue to work together to implement and monitor
the intervention strategies and modify the plan over time. Expand
partnership activities as appropriate.
Demonstrate the scientific basis for proposed interventions. If
proposed interventions include case management programs, assure that
patients enrolled are those with moderate to severe persistent asthma
and are receiving care consistent with the National Asthma Education
and Prevention Program (NAEPP) Guidelines for the Diagnosis and
Management of Asthma. Refer to ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.97-
4051, April 1997) or link to http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
.
Provide the methodology and specific measures for monitoring
progress in meeting all objectives related to implementation of
activities in the asthma plan.
Describe how process, impact, and outcome objectives will be
evaluated. (Refer to ``Framework for Program Evaluation in Public
Health,'' Morbidity and Mortality Weekly Report, September 17, 1999/48
RR-11; 1-40 at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm or
other evaluation resources on the CDC Web site at http://www.cdc.gov/eval/index
).
7. Management and Staffing
Demonstrate the applicant's organizational commitment to the asthma
program by describing how the agency as a whole will focus its efforts
on asthma. Provide a plan to maintain a strong agency commitment within
the State Health Department to support continued efforts of the asthma
program.
Describe the organizational location of the proposed staff, their
relation to the State's asthma contact (the position in the agency
currently responsible for contact with CDC on asthma issues), and the
support within the organizational structure for the activities defined
for the project staff. Attach an organizational chart for the unit
where asthma activities will be located and, at a minimum, the next two
levels above it.
Describe the qualifications and roles of trained public health
professionals to serve as a full-time asthma coordinator for the agency
to manage the planning process and conduct other programmatic
activities; a full-time epidemiologist to develop and implement
surveillance activities for the

[[Page 31713]]

asthma project; and a supervisor who will assure support for the
project staff. Other program positions may also be proposed. Attach
position descriptions, qualifications and curricula vitae for all staff
positions.
For each position, describe the primary roles and responsibilities
for the project staff over the three-year grant period. Also, include
the specific staff activities that will contribute to meeting each
objective.
Provide a plan to expedite filling of the staff position(s) and
assure that they have been or will be approved by the applicant's
personnel system. Include a letter of support from the agency
guaranteeing hiring of personnel and support for the asthma program.
Also, describe positions in the asthma program that are currently
filled, but will not be funded by resources under this cooperative
agreement.
Document assurance of the ability of key project staff to
participate in the conferences or grantee meetings convened by CDC and
willingness to share innovations, information, data, and materials.
8. Budget
Include a detailed first-year budget, narrative justifications, as
well as annual budget projections for years two and three. The
applicant should describe the program purpose for each budget item. For
each contract contained within the budget, provide (1) the name the
contractor(s); (2) method of selection; (3) period of performance; (4)
description of activities; and (5) an itemized budget with narrative
justifications. If this information is not available when the
application is submitted, and CDC approves the contract(s), then the
funds for the contract(s) will be restricted for expenditure on the
award.
The budget should include travel funds for project staff to attend
a yearly conference or grantee meeting convened by CDC. In addition,
the applicant should include costs for one person to travel to Atlanta,
GA, to attend the 6th National Environmental Health Conference on
December 3-5, 2003. Review the CDC/NCEH web site for additional
information concerning this conference: http://www.cdc.gov/nceh/default.htm
.
If applicable, list other funds outside of this cooperative
agreement that will be used to support this program.
Part B: Implementation of State Asthma Plans
Include each of the following sections:
1. Description of Problem
Describe what is known of the asthma problem in the State,
territory, tribe, or jurisdiction and efforts to systematically address
the problem. Include a description of populations at increased risk of
poorly controlled asthma (e.g. gender, age groups, racial/ethnic
groups, socio-economic groups, or geographic areas).
Describe existing asthma initiatives, capacity, and infrastructure
of the agency within which the asthma programs occur.
2. Workplan
Provide specific goals, objectives and activities that describe
what the agency intends to accomplish by the end of the five-year
project period. These goals, objectives and activities should be
measurable, realistic, related to the Recipient Activities, and reflect
plans in year one through five of the project. Include a project time-
line that indicates when the proposed goals, objectives, and activities
will be met.
Document how progress made toward meeting the objectives will be
evaluated. Provide measures for evaluating process, impact, and outcome
for each goal and objective. Refer to ``Framework for Program
Evaluation in Public Health,'' MMWR, September 17, 1999/48 RR-11; 1-40
at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm or other
evaluation resources on the CDC website at http://www.cdc.gov/eval/index
).
In addition, describe how lessons learned will be systematically
gathered, documented, and included as an integral part of the
evaluation process.
3. Surveillance Plan
Describe the current operational asthma surveillance system within
the health agency. Submit copies of the most recent, comprehensive
published surveillance report that describes asthma within the State,
territory, tribe, or jurisdiction, including if available, a report of
asthma in the Medicaid population and for enrollees of the State
Children's Health Insurance Program (SCHIP).
Provide a surveillance plan containing the following information:
(a) A description of data currently available to the program; (b)
additional data the agency will obtain and methods for obtaining it;
(c) plans for identifying specific populations at risk for poorly
controlled asthma (e.g. gender, age groups, racial/ethnic groups,
socio-economic groups, or geographic areas); (d) how the agency will
use data to develop or enhance an ongoing surveillance system; and (e)
how the surveillance data will be used to support policy, program
development, implementation, and evaluation activities.
Describe all asthma indicators to be assessed over time including,
but not limited to, prevalence, severity, management, mortality,
hospitalization, emergency care, and costs of asthma. Refer to Boss,
L.; Kreutzer, R.; Luttinger, D.; Leighton, J.; Wilcox, K.; and Redd, S.
``The Public Health Surveillance of Asthma,'' Journal of Asthma, 38(1),
83-89, 2001.
Discuss the use of the Behavioral Risk Factor Surveillance System
(BRFSS) asthma module(s) and the frequency of its use.
Include surveillance and public health intervention of work-related
asthma. Provide the applicant's definition of work-related asthma.
(Refer to ``Surveillance of Work-Related Asthma in Selected U.S. States
Using Surveillance Guidelines for State Health Departments--California,
Massachusetts, Michigan and New Jersey, 1993-1995,'' Morbidity and
Mortality Weekly Report, June 25, 1999/48 (SS03); 1-20) at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4803a1.htm
.
Describe the methods that will be used to conduct analysis,
interpret surveillance data, and a strategy for disseminating this data
(e.g. published reports) to local, State, and Federal partner and
agencies.
Present a detailed plan to determine whether the asthma
surveillance system is useful for monitoring asthma trends over time,
determining the effectiveness of asthma interventions, and modifying
the State Asthma Plan. (Refer to ``Updated Guidelines for Evaluating
Surveillance Systems,'' Morbidity and Mortality Weekly Report, July 27,
2001/(50)RR13; 1-35) at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm
.
4. Approved State Asthma Plan
Submit a copy of the final, approved, comprehensive State Asthma
Plan. Approval may be documented with a letter from the agency's Health
or Medical Director and letters from key partners, or by appropriate
sign-offs on the plan. State Asthma Plans that are pending final
approval may be accepted if the draft plan is accompanied by letters
from the agency's Health or Medical Director and key partners stating
their commitment to and approval of the plan. Also include a
description of the plan's approval process and a time-line for final
approval.

[[Page 31714]]

The approved plan (or attachments to the plan) must include:
a. Background information that defines the current condition and
describes why asthma should be a public health priority, and an
assessment of the asthma burden in the State, territory, tribe, or
jurisdiction using population-based data. The plan must address all
persons with asthma in the State regardless of age, race/ethnicity, or
gender and include key environments in which persons with asthma spend
significant time (e.g. home, school, or workplace). If a specific
population in the State is not affected by asthma, the plan should
clearly identify and describe this population.
b. A description of the process by which the plan was developed, a
list of partners that participated in the development of the plan, and
how they contributed to the process.
c. A description of the established asthma priorities within the
State, territory, tribe, or jurisdiction based on the results of
surveillance activities. These objectives should be time-phased and
organized in accordance with the priorities identified in the State
Asthma Plan. Highlight issues unique to your region and note how your
priorities may differ or coincide with national asthma control
priorities.
d. Proposed activities to meet the plan's objectives including, but
not limited to, efforts to (1) expand surveillance for asthma; (2)
improve provider compliance with the National Asthma Education and
Prevention Program's (NAEPP) ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.
97-4051, April 1997); (3) improve the skills of patients and families
affected by asthma to manage the disease; (4) review legislation and
policies impacting people with asthma; (5) identify environmental
factors that contribute to asthma prevalence and morbidity, and reduce
or eliminate exposure to these factors; and (6) communicate between
those implementing and those affected by planned activities.
5. Collaboration Plan
Describe experiences with collaborative relationships around asthma
or with other chronic or environmentally related or occupationally
related disease requiring extensive collaborative relationships both
within and outside the agency. Specifically define the approach to be
used to establish or further develop these relationships.
Document partnerships with the clinical community; local health
agencies; physician organizations; community health centers; local,
State, or regional asthma or respiratory health organizations (e.g.
American Lung Association); local education authorities; and groups or
organizations that serve minority or other populations experiencing a
disproportionate burden of asthma. If one or more of these partners
will not be included, the applicant should explain why.
Describe how the collaboration will (1) establish leadership, (2)
develop consensus regarding goals, (3) identify roles and
responsibilities of members, (4) develop procedures and patterns of
communications, and (5) sustain the participation of members over time.
Provide letters of commitment from each specific organization,
including a statement of how they intend to collaborate, as well as
their expertise, and capacity to carry out assigned responsibilities.
Describe how partners who developed the State Asthma Plan will
continue to work together to implement and monitor intervention
strategies and modify the plan over time. Expand partnership activities
as appropriate.
Note that grant funds may be used to leverage asthma program
development in the State, territory, tribe or jurisdiction along with
resources from other agencies and organizations.
Present a plan to determine the effectiveness of collaborations.
6. Implementation Plan
Provide specific, realistic, measurable, and time-phased objectives
for each of the interventions to be implemented over the five-year
project period using resources of this announcement. If objectives and
interventions from the plan are addressed using other resources,
explain how they are related. While the overall State Asthma Plan must
address all populations, implementation strategies should be
prioritized based on surveillance data, focusing on high priority and
disparate populations first. Interventions that change systems and
individuals to provide improved disease management or education are
preferred.
Discuss guidelines the applicant will use for work-related asthma
(e.g., adapted from generic Minimum and Comprehensive State-Based
Activities in Occupational Safety Health, June 1995--DHHS (NIOSH)
Publication No. 95-107) at http:/www.cdc.gov/niosh/95-107.html; or from
the Workgroup Report ``The Role of States in a Nationwide Comprehensive
Surveillance System for Work-related Diseases, Injuries and Hazards''
at http://www.cste.org/occupationalhealth.htm).
Include an assessment of existing and needed resources to implement
these strategies.
Describe how the State Asthma Plan implementation activities were
developed and how members of the statewide partnership group determined
that these particular objectives and strategies would be addressed.
Demonstrate the extent to which the intervention plan is supported in
the community by including letters of support from key members of the
community.
Demonstrate the scientific basis for proposed interventions. If
proposed interventions include case management programs, assure that
patients enrolled are those with moderate to severe persistent asthma
and are receiving care consistent with the National Asthma Education
and Prevention Program (NAEPP) Guidelines for the Diagnosis and
Management of Asthma. Refer to ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.
97-4051, April 1997) at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
.
Provide the methodology and specific measures for monitoring
progress in meeting all objectives related to implementation of
activities in the asthma plan. Discuss how process, impact and outcome
objectives will be evaluated. Refer to ``Framework for Program
Evaluation in Public Health,'' Morbidity and Mortality Weekly Report,
September 17, 1999/48 RR-11; 1-40 at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm
or other evaluation resources on the CDC Web site
at http://www.cdc.gov/eval/index).
7. Management and Staffing Plan
Demonstrate the applicant's organizational commitment to the asthma
program by describing how the agency as a whole will focus its efforts
on asthma. Explain how the overall asthma program will be
institutionalized and sustained upon completion of funding from this
cooperative agreement.
Describe the organizational location of proposed staff, their
relation to the State's asthma contact (the position in the agency
currently responsible for contact with the CDC on asthma issues), and
the support within the

[[Page 31715]]

organizational structure for the activities defined for the project
staff. Attach an organizational chart for the unit where the asthma
activities will be located and, at a minimum, the next two levels above
it.
Describe the qualifications and roles of trained public health
professionals who will serve as a full-time asthma coordinator for the
agency to manage programmatic activities; 2 full-time epidemiologists
to develop and implement surveillance activities for the asthma
project; and a supervisor who will assure support for the project
staff. Other program positions may also be proposed. Attach position
descriptions, qualifications, and curricula vitae for all staff
positions.
Include a description of existing asthma program staff within the
health department, the current function of these staff members, their
role in developing this project plan, and management structure of the
asthma program. Describe asthma surveillance staff and their role
within the project activities.
For each position, describe the primary roles and responsibilities
for the program staff over the five-year project period. Include
specific activities that will contribute to meeting stated program
goals/objectives.
Document assurance of ability to access and utilize funds, if
awarded, for the purposes of this announcement.
If intervention activities will be implemented through contracts,
define the process by which these contracts will be awarded and
monitored.
Discuss the role of the statewide partnership group and oversight
of intervention activities.
Document assurance of ability of key project staff to participate
in the conferences or grantee meetings convened by CDC and willingness
to share innovations, information, data, and materials.
8. Budget
Include a detailed first-year budget, narrative justifications, as
well as annual budget projections for years two through five. The
applicant should describe the program purpose for each budget item. For
each contract contained within the budget, applicants should provide
(1) the name the contractor(s); (2) method of selection; (3) period of
performance; (4) description of activities; and (5) an itemized budget
with narrative justifications. If this information is not available
when the application is submitted, and CDC approves the contract(s),
then the funds for the contract(s) will be restricted for expenditure
on the award.
The budget should include travel for key project staff to attend a
yearly conference or grantee meeting convened by CDC. In addition, the
applicant should include costs for one person to travel to Atlanta, GA,
to attend the 6th National Environmental Health Conference on December
3-5, 2003. Review the CDC/NCEH web site for additional information
concerning this conference: http://www.cdc.gov/nceh/default.htm.
If applicable, list other funds outside this cooperative agreement
that will be used to support this program.

G. Submission and Deadline

Letter of Intent (LOI) Submission

On or before June 27, 2003, submit the LOI to the Grants Management
Officer identified in the ``Where to Obtain Additional Information''
section of this announcement.

Application Forms

Submit the signed original and two copies of PHS 5161-1 (OMB Number
0920-0428). Forms are available at the following Internet address:
http://www.cdc.gov/od/pgo/forminfo.htm.
If you do not have access to the Internet, or if you have
difficulty accessing the forms on-line, you may contact the CDC
Procurement and Grants Office Technical Information Management Section
(PGO-TIMS) at: (770) 488-2700. Application forms can be mailed to you.

Submission Date, Time, and Address

The application must be received by 4 p.m. Eastern Time on July 14,
2003. Submit the application to: Technical Information Management--
PA03032, Procurement and Grants Office, 2920 Brandywine Road,
Atlanta, GA 30341-4146.
Applications may not be submitted electronically.

CDC Acknowledgement of Application Receipt

A postcard will be mailed by PGO-TIM, notifying you that CDC has
received your application.

Deadline

Letters of intent and applications shall be considered as meeting
the deadline if they are received before 4 p.m. Eastern Time on the
deadline date. Any applicant who sends their application by the United
States Postal Service or commercial delivery services must ensure that
the carrier will be able to guarantee delivery of the application by
the closing date and time. If an application is received after closing
due to (1) carrier error, when the carrier accepted the package with a
guarantee for delivery by the closing date and time, or (2) significant
weather delays or natural disasters, CDC will upon receipt of proper
documentation, consider the application as having been received by the
deadline.
Any application that does not meet the above criteria will not be
eligible for competition, and will be discarded. The applicant will be
notified of their failure to meet the submission requirements.

H. Evaluation Criteria

Application

Applicants are required to provide measures of effectiveness that
will demonstrate the accomplishment of the various identified
objectives of the cooperative agreement. Measures of effectiveness must
relate to the performance goal as stated in purpose section of this
announcement. Measures must be objective and quantitative and must
measure the intended outcome. These measures of effectiveness must be
submitted with the application and will be an element of evaluation.
An independent review group appointed by CDC will evaluate each
application against the following criteria:
Part A: Developing State Capacity To Address Asthma
1. Workplan (25 points)
The extent to which:
a. The applicant identifies goals, objectives, and activities that
are consistent with the Recipient Activities; are specific, measurable
and realistic; and reflect activities in year one, two, and three of
the project period.
b. Objectives will contribute to accomplishment of the goals.
c. Activities are likely to achieve objectives.
d. The time-line for accomplishing proposed goals, objectives, and
activities is reasonable.
e. Measures for monitoring and evaluating the process, impact, and
outcome of each goal and objective are specific and appropriate.
f. The plan to systematically gather and document lessons learned
is incorporated into the program evaluation process.
2. Management and Staffing Plan (20 points)
The extent to which:
a. The agency demonstrates a high level of commitment and
organizational support for the asthma program. Organizational charts
show where the asthma program is located.

[[Page 31716]]

b. The roles of proposed staff members are defined and appropriate
for carrying out stated responsibilities.
c. The staffing plan identifies at least a full-time asthma
coordinator, at least a full-time epidemiologist, and a supervisor.
d. Job descriptions, qualifications, and curricula vitae indicate
that each proposed staff member has the credentials, knowledge,
training, and experience to perform assigned tasks.
e. The plan to expedite filling of the staff position(s), assuring
that they will be approved by the applicant's personnel system, is
realistic.
f. The applicant plans to attend CDC conferences/meetings and is
willing to share innovations, information, data, and materials.
3. Surveillance Plan (20 points)
The extent to which the plan:
a. Provides a comprehensive description of data currently available
to the program, additional data the agency will obtain, and methods for
obtaining it.
b. Identifies populations at risk for poorly controlled asthma,
such as specific age groups, ethnic groups, socio-economic groups, or
geographic areas.
c. The applicant provides a reasonable approach for how the agency
will develop or enhance an ongoing surveillance system and how the data
will be used to support policy, program development, implementation,
and evaluation.
d. Uses appropriate measures to track asthma morbidity, asthma
mortality, and work-related asthma over time.
e. Includes the Behavioral Risk Factor Surveillance System
supplemental asthma module within the first year of the project period.
f. Uses appropriate strategies for conducting analysis,
interpreting surveillance data, and disseminating data through
published reports.
g. Includes reasonable strategies for evaluating whether the asthma
surveillance system is useful for monitoring trends over time.
4. State Asthma Plan (15 points)
The extent to which:
a. The applicant describes how the comprehensive State Asthma Plan
will be developed.
b. The plan addresses all persons with asthma regardless of age,
race/ethnicity, gender, or geographic area and includes key
environments in which persons with asthma spend significant time (e.g.
home, school, workplace).
c. The number and type of agencies and organizations proposed to
participate in developing the State Asthma Plan are appropriate.
Partner's roles and responsibilities are fully described and
reasonable.
d. Collaborative relationships will be used appropriately when
implementing interventions.
e. Data collected in the asthma surveillance system will be used to
identify priority areas and guide the development of program goals and
objectives.
f. The process of making changes to the State Asthma Plan is
reasonable.
5. Collaboration Plan (10 points)
The extent to which:
a. The applicant demonstrates prior successful collaborations that
address asthma or other chronic or environmentally-related or
occupationally-related problems.
b. Collaborating organizations and agencies include a wide variety
of appropriate partners in the clinical community; local health
agencies; physician organizations; community health centers; local,
state or regional asthma or respiratory health organizations (such as
the American Lung Association), local education authorities; and groups
or organizations that serve populations experiencing a disproportionate
burden of asthma. If one or more of these partners are not included,
the applicant explains why.
c. Partners will work together to: (1) Establish leadership, (2)
develop a consensus regarding goals, (3) identify roles and
responsibilities through a negotiated process, (4) develop routine and
consistent patterns of communications, and (5) sustain the
participation of members over time.
d. Letters of commitment from key organizations demonstrate their
willingness, expertise, and capacity to carry out assigned
responsibilities.
e. The plan for determining the effectiveness of collaborations is
reasonable.
6. Description of the Problem (10 points)
The extent to which:
a. The applicant fully describes what is known about the asthma
burden in the State, tribe, territory or jurisdiction; identifies
populations at increased risk of poorly controlled asthma (regardless
of gender, age, race/ethnicity, or geographic area); and explains
efforts to systematically address the problem.
b. The applicant identifies existing initiatives, capacity, and
infrastructure of the agency within which asthma programs will occur.
c. The applicant identifies barriers that need to be resolved in
order to develop comprehensive asthma program in the State.
d. The applicant demonstrates the agency's commitment to addressing
asthma by accomplishments to date and understanding of the problem.
7. Budget (reviewed, but not scored)
The extent to which:
a. The budget is comprehensive and includes details for year one
projections and details for year two and three of the budget period.
b. The budget contains justifications that are consistent with
stated goals, objectives, activities, and the intended use of
cooperative agreement funds.
c. The budget is reasonable and includes funds for project staff to
attend a yearly conference or grantee meeting convened by CDC. In
addition, the applicant should include costs for one person to travel
to Atlanta, GA, to attend the 6th National Environmental Health
Conference on December 3-5, 2003. Review the CDC/NCEH web site for
additional information concerning this conference: http://www.cdc.gov/nceh/default.htm
.
8. Performance Goals (reviewed, but not scored)
The extent to which the applicant will reduce the burden of asthma
in the State, territory, tribe or jurisdiction.
Part A Enhanced: Enhancing State Capacity To Address Asthma
1. Workplan (25 points)
The extent to which:
a. The applicant identifies goals, objectives, and activities that
are consistent with the Recipient Activities, are specific, measurable
and realistic, and reflect activities in year one, two, and three of
the project period.
b. Objectives will contribute to accomplishment of the goals.
c. Activities are likely to achieve objectives.
d. The time-line for accomplishing proposed goals, objectives, and
activities is reasonable.
e. Measures for monitoring and evaluating the process, impact, and
outcome of each goal and objective are specific and appropriate.
f. The plan to systematically gather and document lessons learned
is incorporated into the program evaluation process.
2. Management and Staffing Plan (20 points)
The extent to which:
a. The agency demonstrates a high level of commitment and
organizational support for the asthma program. Organizational charts
show where the asthma program is located.

[[Page 31717]]

b. The roles of proposed staff members are defined and appropriate
for carrying out stated responsibilities.
c. The staffing plan includes at least a full-time asthma
coordinator, at least a full time epidemiologist, and a supervisor.
d. Job descriptions, qualifications, and curricula vitae indicate
that each proposed staff member has the credentials, knowledge,
training, and experience to perform assigned tasks.
e. The plan to expedite filling of the staff position(s), assuring
that they will be approved by the applicant's personnel system, is
realistic.
f. The applicant plans to attend CDC conferences and meetings and
is willing to share innovations, information, data, and materials.
3. State Asthma Plan (15 points)
The extent to which:
a. The State Asthma Plan is comprehensive and approved by the state
health agency. If not already approved, the applicant provides
assurance that the State Asthma Plan will be completed within 3 months
of the first budget year.
b. The plan addresses all persons with asthma regardless of gender,
age, race/ethnicity, or geographic area and includes key environments
in which persons with asthma spend significant time (e.g. home, school,
workplace).
c. The number and type of agencies and organizations that
participated in developing the State Asthma Plan are appropriate.
Partner's roles and responsibilities are fully described and
reasonable.
d. The applicant describes the collaboration's progress in (1)
establishing leadership, (2) developing a consensus regarding goals,
(3) identifying roles and responsibilities through a negotiated
process, (4) developing routine and consistent patterns of
communications, and (5) sustaining the participation of members over
time.
e. Collaborative relationships are used after the plan is in place
and the agency begins to implement selected interventions.
f. Proposed activities to meet the plan's objectives include, but
are not limited to, efforts to (1) expand surveillance for asthma; (2)
improve provider compliance with the National Asthma Education and
Prevention Program's (NAEPP) ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.
97-4051, April 1997); (3) improve the skills of patients and families
affected by asthma to manage the disease; (4) review legislation and
policies impacting people with asthma; (5) identify environmental
factors that contribute to asthma prevalence and morbidity, and reduce
or eliminate exposure to these factors; and (6) communicate between
those implementing and those affected by planned activities.
g. Data collected in the asthma surveillance system was (and will
be) used to identify priority areas and guide the development of
program goals and objectives.
h. The applicant describes how the State Asthma Plan will evolves
over time and the process by which changes are made.
4. Surveillance Plan (15 points)
The extent to which:
a. The applicant has an operational surveillance system for asthma.
b. Attached surveillance reports are of high quality and fully
describe the burden of asthma within State, territory, tribe, or
jurisdiction, including, if available a report on asthma in the
Medicaid population.
c. The applicant describes data currently available, additional
data the agency will obtain, and methods for obtaining it.
d. The applicant clearly identifies populations at risk for poorly
controlled asthma such as specific age groups, ethnic/racial groups,
socio-economic groups, or geographic areas.
e. The applicant explains how the agency will enhance an ongoing
surveillance system and how data will be used to support policy,
program development, implementation, and evaluation activities.
f. The plan uses appropriate measures to track asthma morbidity,
asthma mortality, work-related asthma, and asthma hospitalizations over
time.
g. The applicant plans to use the Behavioral Risk Factor
Surveillance System supplemental asthma module within the first year of
the project period.
h. The surveillance plan describes appropriate strategies to
conduct analysis, interpret surveillance data, and disseminate data
through published reports.
i. Includes reasonable strategies for evaluating whether the asthma
surveillance system is useful for monitoring trends over time.
5. Collaboration Plan (10 points)
The extent to which:
a. The applicant has had previous experience collaborating with
other chronic or environmentally related or occupationally related
agencies.
b. Collaborating organizations and agencies include a wide variety
of appropriate partners in the clinical community; local health
agencies; physician organizations; community health centers; local,
state or regional asthma or respiratory health organizations (such as
the American Lung Association), local education authorities; and groups
or organizations that serve populations experiencing a disproportionate
burden of asthma. If one or more of these partners are not included,
the applicant explains why.
c. The applicant describes how the collaboration's progress in: (1)
Establishing leadership, (2) developing a consensus regarding goals,
(3) identifying roles and responsibilities through a negotiated
process, (4) developing routine and consistent procedures and patterns
of communications, and (5) sustaining the participation of members over
time will be documented and monitored.
d. Letters of commitment from key organizations demonstrate their
willingness, expertise, and capacity to carry out assigned
responsibilities.
e. The applicant fully describes how partners who developed the
State Asthma Plan will continue to work together to monitor the
intervention strategies over time.
f. The plan for determining the effectiveness of collaborations is
reasonable.
6. Implementation Plan (10 points)
The extent to which:
a. The applicant presents specific, realistic, measurable and time-
phased objectives for each intervention proposed.
b. Interventions focus on high priority and disparate populations.
Priorities are based on surveillance data.
c. Interventions will change systems and individuals to provide
improved disease management or education.
d. The community supports the intervention plan.
e. The applicant demonstrates a scientific basis for each
intervention.
f. The methods and measures for monitoring progress of
interventions are appropriate.
7. Description of the Problem (5 points)
The extent to which:
a. The applicant provides a comprehensive description of what is
known about the asthma burden in the State, tribe, territory or
jurisdiction including all ages, race/ethnic groups, and geographic
areas.
b. The applicant fully identifies existing initiatives, capacity,
and

[[Page 31718]]

infrastructure of the agency within which the asthma programs will
occur.
c. The barriers identified when developing the State Asthma Plan
were addressed.
d. The agency's commitment to addressing asthma is demonstrated by
accomplishments to date and understanding of the problem.
8. Budget (reviewed, but not scored)
The extent to which:
a. The budget is comprehensive and includes details for year one
and projections for year two and three of the project period.
b. The budget contains justifications that are consistent with
stated goals, objectives, activities, and the intended use of
cooperative agreement funds.
c. The budget is reasonable and includes funds for project staff to
attend a yearly conference or grantee meeting convened by CDC. In
addition, the applicant included costs for one person to travel to
Atlanta, GA, to attend the 6th National Environmental Health Conference
on December 3-5, 2003.
9. Performance Goals (reviewed, but not scored)
The extent to which the applicant will reduce the burden of asthma
in the State, tribe, territory, tribe or jurisdiction.
Part B: Implementation of State Asthma Plan
1. Implementation Plan (25 Points)
The extent to which:
a. Implementation objectives are specific, realistic, measurable
and time-phased for each of the interventions.
b. High priority interventions are based on surveillance data and
focus on disparate populations first. Strategies that change systems
and individuals to provide improved disease management are included.
c. There is a clear link between the State Asthma Plan and the
proposed interventions, including an assessment of existing and needed
resources to implement these strategies.
d. The intervention plan is supported in the community and this is
demonstrated by the inclusion of letters of support from key members of
the community.
e. Statewide partners are involved in implementing and monitoring
the plan over time.
f. Proposed intervention strategies are appropriate and have a
scientific basis. Asthma management activities are consistent with the
National Asthma Education and Prevention Program (NAEPP) ``Guidelines
for the Diagnosis and Management of Asthma.''
g. Methods and measures for monitoring intervention activities are
specific, reasonable, and likely to assess the effectiveness of
activities in reaching program goals and objectives. Process, impact,
and outcome objectives are included.
2. Management and Staffing Plan (20 Points)
The extent to which:
a. The applicant demonstrates a high level of commitment and
organizational support for the asthma program. Organizational charts
demonstrate clear lines of authority and coordination with related
programs at the State health department such as tobacco control,
environmental health, or maternal and child health. The plan for
institutionalizing and sustaining the asthma program beyond the 5-year
project period is achievable.
b. Job descriptions and curricula vitae indicate that each proposed
staff member has the credentials, knowledge, training and experience to
perform assigned tasks.
c. The roles of proposed staff members are defined and appropriate
for carrying out stated responsibilities.
d. The staffing plan includes at least a full-time asthma
coordinator, at least 2 full-time epidemiologists, and a supervisor.
Other staff position(s) are also included.
e. The plan to expedite filling of the staff position(s), assuring
that they will be approved by the applicant's personnel system, is
realistic.
f. The role of the statewide partnership group is appropriate for
the oversight of intervention activities.
g. The applicant documents assurance that key personnel will attend
scheduled grantee meetings and CDC-sponsored national asthma
conferences, and that the applicant agrees to share innovations,
information, data and materials.
3. Workplan (15 Points)
The extent to which:
a. The applicant identifies goals, objectives and activities that
are specific, measurable, realistic, related to the Recipient
Activities, and reflect plans in year one through five of the project.
b. Objectives will contribute to the accomplishment of the stated
goals.
c. Activities are likely to achieve related objectives.
d. Project time-line is realistic and indicates when each goal,
objective, and activity will be met.
e. Measures for monitoring and evaluating the process, impact, and
outcome of each goal and objective are appropriate and specific.
4. Surveillance System (15 Points)
The extent to which:
a. The applicant has an operational surveillance system for asthma
within the health agency.
b. Attached surveillance reports are of high quality and
comprehensively describe the asthma burden within the State, territory,
tribe, or jurisdiction, including, if available, a report on asthma in
the Medicaid population and the State Children's Health Insurance
Program (SCHIP).
c. The applicant identifies all data currently available to the
program as well as additional data the agency will obtain and methods
for obtaining it. Plan includes use of the Behavioral Risk Factor
Surveillance System (BRFSS) asthma module(s).
d. The plan identifies populations at risk for poorly controlled
asthma such as specific racial/ethnic groups, socio-economic groups,
and/or geographic areas.
e. The applicant presents a reasonable approach for how the agency
will enhance an ongoing surveillance system and how the data will be
used to support policy, program development, implementation, and
evaluation activities.
f. The plan describes appropriate measures for asthma prevalence,
severity, management, mortality, hospitalization, emergency care, and
costs of asthma.
g. The plan includes surveillance and public health interventions
for work-related asthma.
h. The approach for conducting analysis, interpreting surveillance
data, and disseminating data through published reports is appropriate.
i. The plan for evaluating the asthma surveillance system addresses
all program goals and objectives, will be effective in monitoring
asthma trends over time, will determine the effectiveness of asthma
interventions, and will support modifications to the State Asthma Plan.
5. Approved State Asthma Plan (15 Points)
The extent to which:
a. A commitment by the Agency to implement this plan is
demonstrated by the inclusion of a letter of support from the Secretary
of Health or the Agency's Medical Director. If the State Asthma Plan is
not already approved, the applicant provides assurance that it will be
completed within 3 months of the first budget year.
b. The State Asthma plan is comprehensive, addressing all persons
with asthma regardless of age, race/

[[Page 31719]]

ethnicity, gender, or geographic area. It also includes key
environments in which persons with asthma spend significant time such
as the home, school, and workplace.
c. The Plan defines the current status of asthma, why asthma should
be a public health priority, and an assessment of the asthma burden in
the State, territory, tribe, or jurisdiction. Applicant also lists
asthma priorities and provides evidence that these priorities are
directly related to analysis of population-based surveillance data.
Objectives are time-phased and organized in accordance with the
priorities identified in the State Asthma Plan.
d. The applicant fully describes how the Plan was developed and how
partners participated in the process. The number and type of agencies
that participated and their contributions in developing the State
Asthma Plan are appropriate.
e. Proposed activities to meet the plan's objectives include, but
are not limited to, efforts to: (1) Expand surveillance for asthma; (2)
improve provider compliance with the National Asthma Education and
Prevention Program's (NAEPP) ``Guidelines for the Diagnosis and
Management of Asthma,'' (Clinical Practice Guidelines, Guidelines for
the Diagnosis and Management of Asthma. National Institutes of Health
(NIH), National Heart, Lung and Blood Institute. NIH publication No.
97-4051, April 1997); (3) improve the skills of patients and families
affected by asthma to manage the disease; (4) review legislation and
policies impacting people with asthma; (5) identify environmental
factors that contribute to asthma prevalence and morbidity, and reduce
or eliminate exposure to these factors; and (6) communicate between
those implementing and those affected by planned activities.

6. Collaboration Plan (5 Points)

The extent to which:
a. The applicant has experience collaborating with partners around
asthma or other chronic or environmental related or occupationally
related diseases both within and outside the agency.
b. Collaborating organizations and agencies include a wide variety
of appropriate partners in the clinical community; local health
agencies; physician organizations; community health centers; local,
state or regional asthma or respiratory health organizations (such as
the American Lung Association), local education authorities; and groups
or organizations that serve populations experiencing a disproportionate
burden of asthma. If one or more of these partners are not included,
the applicant explains why.
c. The applicant includes a description of the collaboration's
progress in: (1) Establishing leadership, (2) developing a consensus
regarding goals, (3) identifying roles and responsibilities through a
negotiated process, (4) developing routine and consistent patterns of
communications, and (5) sustaining the participation of members over
time.
d. Letters of commitment from key organizations demonstrate their
willingness, expertise, and capacity to carry out assigned
responsibilities.
e. The applicant presents a sound plan to determine the
effectiveness of collaborations.
7. Description of the Problem (5 Points)
The extent to which:
a. The applicant provides a comprehensive description on what is
known about the asthma burden in the State, tribe, territory, or
jurisdiction, and a description of populations at increased risk of
poorly controlled asthma within the jurisdiction (e.g., ethnic groups,
socio-economic groups, and geographic areas).
b. The applicant identifies existing initiatives, capacity, and
infrastructure of the agency within which the asthma programs will
occur.
c. The agency's commitment to addressing asthma is demonstrated by
accomplishments to date and understanding of the problem.
8. Budget (reviewed, but not scored)
The extent to which:
a. The budget is comprehensive and includes details for year one
and projections for year two and three of the project period.
b. The budget contains justifications that are consistent with
stated goals, objectives, activities, and the intended use of
cooperative agreement funds.
c. The budget is reasonable and includes funds for project staff to
attend a yearly conference or grantee meeting convened by CDC. In
addition, the applicant included costs for one person to travel to
Atlanta, GA, to attend the 6th National Environmental Health Conference
on December 3-5, 2003.
9. Performance Goals (reviewed, but not scored)
The extent to which the applicant will reduce the burden of asthma
in the State, territory, tribe or jurisdiction.

I. Other Requirements

Technical Reporting Requirements

Provide CDC with original plus two copies of:
1. Interim progress report, no less than 90 days before the end of
the budget period. The progress report will serve as your non-competing
continuation application, and must contain the following elements:
a. Current Budget Period Activities Objectives.
b. Current Budget Period Financial Progress.
c. New Budget Period Program Proposed Activity Objectives.
d. Detailed Line-Item Budget and Justification.
e. Additional Requested Information.
2. Financial status report, no more than 90 days after the end of
the budget period.
3. Final financial and performance reports, no more than 90 days
after the end of the project period.
Send all reports to the Grants Management Specialist identified in
the ``Where to Obtain Additional Information'' section of this
announcement.

Additional Requirements

The following additional requirements are applicable to this
program. For a complete description of each, see Attachment I of the
program announcement as posted on the CDC web site.

AR-7 Executive Order 12372
AR-9 Paperwork Reduction Act Requirements
AR-10 Smoke-Free Workplace Requirements
AR-11 Healthy People 2010
AR-12 Lobbying Restrictions
AR-21 Small, Minority and Women-owned Business

J. Where To Obtain Additional Information

This and other CDC announcements, the necessary applications, and
associated forms can be found on the CDC web site, Internet address:
http://www.cdc.gov. Click on ``Funding'' then ``Grants and Cooperative
Agreements''.
For general questions about this announcement, contact: Technical
Information Management, CDC Procurement and Grants Office, 2920
Brandywine Road, Atlanta, GA 30341-4146, Telephone: (770) 488-2700.
For business management and budget assistance, contact: Mildred
Garner, Grants Management Officer, Procurement and Grants Office,
Centers for Disease Control and Prevention, 2920 Brandywine Road,
Atlanta, GA

[[Page 31720]]

30341-4146, Telephone: (770) 488-2745, e-mail address: mqg4@cdc.gov. For business management and budget assistance in the territories,
contact: Charlotte Flitcraft, Grants Management Officer, Procurement
and Grants Office, Centers for Disease Control and Prevention, 2020
Brandywine Rd., Atlanta, GA 30319, Telephone: (770) 488-2632, e-mail
address: caf5@cdc.gov. For program technical assistance, contact: Kathie Sunnarborg, MPH,
CHES, Public Health Advisor, Air Pollution and Respiratory Health
Branch, National Center for Environmental Health, Centers for Disease
Control and Prevention, 1600 Clifton Rd., NE, Mailstop E-17, Atlanta,
GA 30333, Telephone number: (404) 498-1451, e-mail address:
ksunnarborg@cdc.gov.
Dated: May 21, 2003.
Sandra R. Manning,
Director, Procurement and Grants Office, Centers for Disease Control
and Prevention.
[FR Doc. 03-13222 Filed 5-27-03; 8:45 am]

BILLING CODE 4163-18-P