81 FR 13380 - Office of Urban Indian Health Programs; 4-in-1 Grant Programs; Announcement Type: New and Competing Continuation Funding Announcement Number: HHS-2016-IHS-UIHP2-0001; Catalogue of Federal Domestic Assistance Number: 93.193

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service

Federal Register Volume 81, Issue 49 (March 14, 2016)

Page Range		13380-13395
FR Document		2016-05761

Federal Register, Volume 81 Issue 49 (Monday, March 14, 2016)

[Federal Register Volume 81, Number 49 (Monday, March 14, 2016)]
[Notices]
[Pages 13380-13395]
From the Federal Register Online [www.thefederalregister.org]
[FR Doc No: 2016-05761]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Office of Urban Indian Health Programs; 4-in-1 Grant Programs;
Announcement Type: New and Competing Continuation Funding Announcement
Number: HHS-2016-IHS-UIHP2-0001; Catalogue of Federal Domestic
Assistance Number: 93.193

Key Dates

Application Deadline Date: May 15, 2016.
Review Period: May 23, 2016-May 27, 2016.
Earliest Anticipated Start Date: June 1, 2016.

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting competitive grant
applications for the FY 2016 4-in-1 Title V Programs. This program is
authorized under the Snyder Act, 25 U.S.C. 13, Public Law 67-85, and
Title V of the Indian Health Care Improvement Act (IHCIA), Public Law
94-437, as amended, specifically the provisions codified at 25 U.S.C.
1652, 1653, and 1660a. This program is described in the Catalog of
Federal

[[Page 13381]]

Domestic Assistance (CFDA) under 93.193.

Background

Prior to the 1950's, most American Indians and Alaska Natives (AI/
ANs) resided on reservations, in nearby rural towns, or in Tribal
jurisdictional areas such as Oklahoma. In the era of the 1950's and
1960's, the Federal Government passed legislation to terminate its
legal obligations to the Indian Tribes, resulting in policies and
programs to assimilate Indian people into the mainstream of American
society. This philosophy produced the Bureau of Indian Affairs (BIA)
Relocation/Employment Assistance Programs (BIA Relocation) which
enticed Indian families living on impoverished Indian Reservations to
``relocate'' to various cities across the country, i.e., San Francisco,
Los Angeles, Chicago, Salt Lake City, Phoenix, etc. BIA Relocation
offered job training and placement, and was viewed by Indians as a way
to escape poverty on the reservation. Health care was usually provided
for six months through the private sector, unless the family was
relocated to a city near a reservation with an IHS facility service
area, such as Rapid City, Phoenix, and Albuquerque. Eligibility for IHS
was not forfeited due to Federal Government relocation.
The American Indian and Policy Review Commission found that in the
1950's and 1960's, the BIA relocated over 160,000 AI/ANs to selected
urban centers across the country. Today, over 61 percent of all AI/ANs
identified in the 2010 census reside off-reservation.
In the late 1960's, urban Indian community leaders began advocating
at the local, State and Federal levels for culturally appropriate
health programs addressing the unique social, cultural and health needs
of AI/ANs residing in urban settings. These community-based grassroots
efforts resulted in programs targeting health and outreach services to
the urban Indian community. Programs that were developed at that time
were in many cases staffed by volunteers, offering outreach and
referral-type services, and maintaining programs in storefront settings
with limited budgets and primary care services.
In response to efforts of the urban Indian community leaders in the
1960's, Congress appropriated funds in 1966, through the IHS, for a
pilot urban clinic in Rapid City. In 1973, Congress appropriated funds
to study the unmet urban Indian health needs in Minneapolis. The
findings of this study documented cultural, economic, and access
barriers to health care for urban Indian clinics in several BIA
relocation cities, i.e., Seattle, San Francisco, Tulsa, and Dallas.
The awareness of poor health status of all Indian people continued
to grow, and in 1976, Congress passed the Indian Health Care
Improvement Act (IHCIA), Public Law 94-437, establishing the urban
Indian health program under Title V. Congress reauthorized the IHCIA in
2010 under Public Law 111-148 (2010). This law is considered health
care reform legislation to improve the health and well-being of all AI/
ANs, including urban Indians. Title V specific funding is authorized
for the development of programs for AI/ANs residing in urban areas.
Since passage of this legislation, amendments to Title V provided
resources to and expanded urban Indian health programs in the areas of
direct medical services, alcohol services, mental health services,
human immunodeficiency virus (HIV) services, and health promotion--
disease prevention services.

Purpose

This grant announcement seeks to ensure the highest possible health
status for AI/ANs. Funding will be used to promote urban Indian
organizations' successful implementation of the priorities of the IHS
Strategic Plan 2006-2011. Additionally, funding will be utilized to
meet objectives for Government Performance Results Act/Government
Performance and Results Modernization Act (GPRA/GPRAMA) reporting,
collaborative activities with the Veterans Health Administration, and
four health programs that make health services more accessible to AI/
ANs living in urban areas. The four health services programs are: (1)
Health Promotion/Disease Prevention (HP/DP) services, (2)
Immunizations, and Behavioral Health Services consisting of (3)
Alcohol/Substance Abuse services, and (4) Mental Health Prevention and
Treatment services. These programs are integral components of the IHS
improvement in patient care initiative and the strategic objectives
focused on improving safety, quality, affordability, and accessibility
of health care.

II. Award Information

Type of Awards

Grants.

Estimated Funds Available

The total amount of funding identified for the current fiscal year
(FY) 2016 is approximately $8,300,000. Individual award amounts are
anticipated to be between $149,950 and $634,222. The amount of funding
available for competing and continuation awards issued under this
announcement are subject to the availability of appropriations and
budgetary priorities of the Agency. The IHS is under no obligation to
make awards that are selected for funding under this announcement.

Anticipated Number of Awards

Approximately 34 grants will be issued under this program
announcement.

Project Period

The project period is for three years and will run consecutively
from April 1, 2016-March 31, 2019.

III. Eligibility Information

1. Eligibility

To be eligible to apply for this New/Competing Continuation grant
under this announcement, applicants must have a Title V IHCIA contract
with the IHS in place as defined by 25 U.S.C. 1653(c)-(e), 1660a. Urban
Indian organizations are defined by 25 U.S.C. 1603(29) as a non-profit
corporate body situated in an urban center, governed by an urban Indian
controlled board of directors, and providing for the maximum
participation of all interested Indian groups and individuals, which
body is capable of legally cooperating with other public and private
entities for the purpose of performing the activities described in 25
U.S.C. 1653(a).
Current UIHP 4-in-1 grantees are eligible to apply for competing
continuation funding under this announcement and must demonstrate that
they have complied with previous terms and conditions of the UIHP 4-in-
1 grant in order to receive funding under this announcement. All prior
4-in-1 awardees from the grant segment ending in FY 2015, are required
to complete and submit their FY 2016 applications based on the funding
amounts received in FY 2015.

Note: Please refer to Section IV.2 (Application and Submission
Information/Subsection 2, Content and Form of Application Submission)
for additional proof of applicant status documents required such as
Tribal resolutions, proof of non-profit status, etc.

2. Cost Sharing or Matching

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

3. Other Requirements

If the application budget exceeds the highest dollar amount
outlined under

[[Page 13382]]

the ``Estimated Funds Available'' section within this funding
announcement, the application will be considered ineligible and will
not be reviewed for further consideration. If deemed ineligible, IHS
will not return the application. The applicant will be notified by
email by the Division of Grants Management (DGM) of this decision.
Proof of Non-Profit Status
Organizations claiming non-profit status must submit proof. A copy
of the 501(c)(3) Certificate must be received with the application
submission by the Application Deadline Date listed under the Key Dates
section on page one of this announcement.
An applicant submitting any of the above additional documentation
after the initial application submission due date is required to ensure
the information was received by the IHS by obtaining documentation
confirming delivery (i.e. FedEx tracking, postal return receipt, etc.).

IV. Application and Submission Information

1. Obtaining Application Materials

The application package and detailed instructions for this
announcement can be found at Grants.gov (www.grants.gov) or http://www.ihs.gov/dgm/funding/.
Questions regarding the electronic application process may be
directed to Mr. Paul Gettys at (301) 443-2114 or (301) 443-5204.

2. Content and Form of Application Submission

The application must include the project narrative as an attachment
to the application package. Mandatory documents for all applications
include:
Table of contents.
Abstract (one page) summarizing the key project
information.
Application forms:
[cir] SF-424, Application for Federal Assistance.
[cir] SF-424A, Budget Information--Non-Construction Programs.
[cir] SF-424B, Assurances--Non-Construction Programs.
Budget Justification and Narrative (must be single-spaced
and not exceed five pages).
Project Narrative (must be single-spaced and not exceed
twenty-five pages).
[cir] Background information on the organization.
[cir] Proposed scope of work, objectives, and activities that
provide a description of what will be accomplished, including a one-
page Timeframe Chart.
501(c)(3) Certificate.
Biographical sketches for all Key Personnel.
Contractor/Consultant resumes or qualifications and scope
of work.
Disclosure of Lobbying Activities (SF-LLL).
Certification Regarding Lobbying (GG-Lobbying Form).
Copy of current Negotiated Indirect Cost rate (IDC)
agreement (required) in order to receive IDC.
Organizational Chart (optional).
Documentation of current Office of Management and Budget
(OMB) A-133 or other required Financial Audit (if applicable).
Acceptable forms of documentation include:
[cir] Email confirmation from Federal Audit Clearinghouse (FAC)
that audits were submitted; or
[cir] Face sheets from audit reports. These can be found on the FAC
Web site: http://harvester.census.gov/sac/dissem/accessoptions.html?submit=Go+To+Database.
Public Policy Requirements
All Federal wide public policies apply to IHS grants with exception
of the Discrimination policy.
Requirements for Project and Budget Narratives
A. Project Narrative: The project narrative should be a separate
Word document that is no longer than 25 pages and must: Be single-
spaced, be type-written, have consecutively numbered pages, use black
type not smaller than 12 characters per one inch, and be printed on one
side only of standard size 8\1/2\ x 11 paper.
Be sure to succinctly address and answer all questions listed under
the narrative and place them under the evaluation criteria (refer to
Section V.1, Evaluation criteria in this announcement) and place all
responses and required information in the correct section (noted
below), or they shall not be considered or scored. These narratives
will assist the Objective Review Committee (ORC) in becoming familiar
with the applicant's activities and accomplishments prior to this grant
award. If the narrative exceeds the page limit, only the first 25 pages
will be reviewed. The 25-page limit for the narrative does not include
the table of contents, abstract, standard forms, budget justification
narrative, and/or other appendix items.
There are three parts to the narrative: Part A--Program
Information; Part B--Program Planning and Evaluation; and Part C--
Program Report. See below for additional details about what must be
included in the narrative.
Part A: Program Information (3 Page Limitation)
Section 1: Needs
Describe how the urban Indian organization has expertise and
administrative infrastructure to support activities of the 4-in-1 grant
requirements.
Part B: Program Planning and Evaluation (18 Page Limitation)
Section 1: Program Plans
Describe fully and clearly how the urban Indian organization plans
to address the four health service programs, including HP/DP,
immunization, alcohol/substance abuse, and mental health.
Section 2: Program Evaluation
Describe the urban Indian organization evaluation plan including
how the applicant will link program performance/services to budget
expenditures.
Part C: Program Report (4 Page Limitation)
Section 1: Describe Major Accomplishments for the Last Twelve Months
Section 2: Describe Major Activities Planned for the First 12 Months
B. Budget Narrative: This narrative must include a line item budget
with a narrative justification for all expenditures identifying
reasonable and allowable costs necessary to accomplish the goals and
objectives as outlined in the project narrative. Budget should match
the scope of work described in the project narrative. The budget
narrative should not exceed five pages.

3. Submission Dates and Times

Applications must be submitted electronically through Grants.gov by
11:59 p.m. Eastern Daylight Time (EDT) on the Application Deadline Date
listed in the Key Dates section on page one of this announcement. Any
application received after the application deadline will not be
accepted for processing, nor will it be given further consideration for
funding. Grants.gov will notify the applicant via email if the
application is rejected.
If technical challenges arise and assistance is required with the
electronic application process, contact Grants.gov Customer Support via
email to [email protected] or at (800) 518-4726. Customer Support is
available to address questions 24 hours a day, 7 days a week (except on
Federal holidays). If problems persist, contact Mr. Paul Gettys
([email protected]), DGM

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Grant Systems Coordinator, by telephone at (301) 443-2114 or (301) 443-
5204. Please be sure to contact Mr. Gettys at least ten days prior to
the application deadline. Please do not contact the DGM until you have
received a Grants.gov tracking number. In the event you are not able to
obtain a tracking number, call the DGM as soon as possible.
If the applicant needs to submit a paper application instead of
submitting electronically through Grants.gov, a waiver must be
requested. Prior approval must be requested and obtained from Mr.
Robert Tarwater, Director, DGM (see Section IV.6 below for additional
information). The waiver must: (1) Be documented in writing (emails are
acceptable), before submitting a paper application, and (2) include
clear justification for the need to deviate from the required
electronic grants submission process. A written waiver request must be
sent to [email protected] with a copy to [email protected].
Once the waiver request has been approved, the applicant will receive a
confirmation of approved email containing submission instructions and
the mailing address to submit the application. A copy of the written
approval must be submitted along with the hardcopy of the application
that is mailed to DGM. Paper applications that are submitted without a
copy of the signed waiver from the Senior Policy Analyst of the DGM
will not be reviewed or considered for funding. The applicant will be
notified via email of this decision by the Grants Management Officer of
the DGM. Paper applications must be received by the DGM no later than
5:00 p.m., EDT, on the Application Deadline Date listed in the Key
Dates section on page one of this announcement. Late applications will
not be accepted for processing or considered for funding.

4. Intergovernmental Review

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

5. Funding Restrictions

Pre-award costs are not allowed.
The available funds are inclusive of direct and
appropriate indirect costs.
Only one grant/cooperative agreement will be awarded per
applicant.
IHS will not acknowledge receipt of applications.

6. Electronic Submission Requirements

All applications must be submitted electronically. Please use the
http://www.Grants.gov Web site to submit an application electronically
and select the ``Find Grant Opportunities'' link on the homepage.
Download a copy of the application package, complete it offline, and
then upload and submit the completed application via the http://www.Grants.gov Web site. Electronic copies of the application may not
be submitted as attachments to email messages addressed to IHS
employees or offices.
If the applicant receives a waiver to submit paper application
documents, they must follow the rules and timelines that are noted
below. The applicant must seek assistance at least ten days prior to
the Application Deadline Date listed in the Key Dates section on page
one of this announcement.
Applicants that do not adhere to the timelines for System for Award
Management (SAM) and/or http://www.Grants.gov registration or that fail
to request timely assistance with technical issues will not be
considered for a waiver to submit a paper application.
Please be aware of the following:
Please search for the application package in http://www.Grants.gov by entering the CFDA number of the Funding Opportunity
Number. Both numbers are located in the header of this announcement.
If you experience technical challenges while submitting
your application electronically, please contact Grants.gov Support
directly at: [email protected] or (800) 518-4726. Customer Support is
available to address questions 24 hours a day, 7 days a week (except on
Federal holidays).
Upon contacting Grants.gov, obtain a tracking number as
proof of contact. The tracking number is helpful is there are technical
issues that cannot be resolved and a waiver from the agency must be
obtained.
If it is determined that a waiver is needed, the applicant
must submit a request in writing (emails are acceptable) to
[email protected] with a copy to [email protected]. Please
include a clear justification for the need to deviate from the standard
electronic submission process.
If the waiver is approved, the application should be sent
directly to the DGM by the Application Deadline Date listed in the Key
Dates section on page one of this announcement.
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
fifteen working days.
Please use the optional attachment feature in Grants.gov
to attach additional documentation that may be requested by the DGM.
All applicants must comply with any page limitation
requirements described in this funding announcement.
After electronically submitting the application, the
applicant will receive an automatic acknowledgement from Grants.gov
that contains a Grants.gov tracking number. The DGM will download the
application from Grants.gov and provide necessary copies to the
appropriate agency officials. Neither the DGM nor the Office of Urban
Indian Health Programs will notify the applicant that the application
has been received.
Email applications will not be accepted under this
announcement.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
All IHS applicants and grantee organizations are required to obtain
a DUNS number and maintain an active registration in the SAM database.
The DUNS number is a unique 9-digit identification number provided by
D&B which uniquely identifies each entity. The DUNS number is site
specific; therefore, each distinct performance site may be assigned a
DUNS number. Obtaining a DUNS number is easy, and there is no charge.
To obtain a DUNS number, please access it through http://fedgov.dnb.com/webform, or to expedite the process, call (866) 705-
5711.
All Department of Health and Human Services recipients are required
by the Federal Funding Accountability and Transparency Act of 2006, as
amended (``Transparency Act''), to report information on sub-awards.
Accordingly, all IHS grantees must notify potential first-tier sub-
recipients that no entity may receive a first-tier sub-award unless the
entity has provided its DUNS number to the prime grantee organization.
This requirement ensures the use of a universal identifier to enhance
the quality of information available to the public pursuant to the
Transparency Act.
System for Award Management (SAM)
Organizations that were not registered with Central Contractor
Registration and have not registered with SAM will need to obtain a
DUNS number first and then access the SAM online registration through
the SAM home page at https://www.sam.gov (U.S. organizations will also
need to provide an Employer Identification Number from the Internal
Revenue Service that may take an additional 2-5 weeks to become
active). Completing and

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submitting the registration takes approximately one hour to complete
and SAM registration will take 3-5 business days to process.
Registration with the SAM is free of charge. Applicants may register
online at https://www.sam.gov.
Additional information on implementing the Transparency Act,
including the specific requirements for DUNS and SAM, can be found on
the IHS Grants Management, Grants Policy Web site: http://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

The instructions for preparing the application narrative also
constitute the evaluation criteria for reviewing and scoring the
application. Weights assigned to each section are noted in parentheses.
The 25 page narrative should include only the first year activities;
information for multi-year projects should be included as an appendix.
See ``Multi-year Project Requirements'' at the end of this section for
more information. The narrative should be written in a manner that is
clear to outside reviewers unfamiliar with prior related activities of
the applicant. It should be well organized, succinct, and contain all
information necessary for reviewers to understand the project fully.
Points will be assigned to each evaluation criteria adding up to a
total of 100 points. A minimum score of 60 points is required for
funding. Points are assigned as follows:

1. Criteria

The narrative should address program progress for the first 12
months.
A. Introduction and Need for Assistance (30 Points)
1. Facility Capability
Urban Indian programs provide health care services within the
context of IHS Strategic Plan and four IHS priorities.
Describe the UIHP: (1) Accomplishments over the past twelve months,
and (2) define activities planned for the 2016 budget period in each of
the following areas:
a. IHS Priorities for American Indian/Alaska Native Health Care.
Current governmental trends and environmental issues impact AI/ANs
residing in urban locations and require clear and consistent support by
the Title V funded UIHP. The IHS Web site is http://www.ihs.gov.
(1) Renew and strengthen our partnerships with Tribes and urban
Indian health programs: The UIHPs have a hybrid relationship with the
IHS. With the passage of Pubic Law 111-148, the Indian Health Care
Improvement Act was made permanent.
Identify what the UIHP is doing to strengthen its
partnerships with Tribes and other urban Indian health programs.
a. Major accomplishments over the last twelve months.
b. Activities planned for the first 12 months, including
information on how results are shared with the community.
(2) Improve the IHS: In order to support health care improvement,
it must be demonstrated there is a willingness to change and improve,
i.e., in human resources and business practices.
Describe activities the UIHP is taking to ensure health
care improvement is being applied.
a. Major accomplishments over the last twelve months.
b. Activities planned for the first 12 months.
(3) Improve the quality of and access to care: Customer service is
the key to quality care. Treating patients well is the first step to
improving quality and access. This area also incorporates best
practices in customer service.
Identify activities that demonstrate the UIHP improving
quality of and access to care.
a. Major accomplishments over the last twelve months.
b. Activities planned for the first 12 months.
(4) Ensure that our work is transparent, accountable, fair, and
inclusive: Quality health care needs to be transparent, with all
parties held accountable for that care. Accountability for services is
emphasized.
Describe activities that demonstrate how this is
implemented in the UIHP program.
a. Major accomplishments over the last twelve months.
b. Activities planned for the first 12 months.
b. GPRA Reporting
All UIHPs report on IHS GPRA/GPRAMA clinical performance measures.
This is required of both urban facilities using the Resource and
Patient Management System (RPMS) and facilities not using RPMS. RPMS
users must use the Clinical Reporting System (CRS) for reporting. Non-
RPMS users must perform a 100% audit of all records and report results
on an Excel template provided by the National GPRA Support Team (NGST)
as per the quarterly reporting instructions distributed by the NGST.
Questions related to GPRA reporting may be directed to the IHS Area
Office GPRA Coordinator or the National GPRA Support Team at
[email protected].
The current GPRA Reporting Period is July 1, 2015 through June 30,
2016. GPRA reports are due for the 2nd, 3rd, and 4th quarters, which
end on December 31, March 31, and June 30, respectively. Each report is
cumulative, and must include data starting from July 1st of the current
GPRA year.
GPRA measures to report for FY2016 include 20 clinical measures and
one non-clinical measure.
FY 2016 Clinical GPRA/GPRAMA Measures
1. Diabetes DX Ever (no target, used for context only).
2. Documented A1c (no target, used for context only).
3. Diabetes: Good Glycemic Control (GPRAMA measure).
4. Diabetes: Controlled Blood Pressure.
5. Diabetes: Statin Therapy to Reduce CVD Risk in Patients with
Diabetes.
6. Diabetes: Nephropathy Assessment.
7. Influenza Vaccination Rates Among Children 6 months to 17 years.
8. Influenza Vaccination Rates Among Adults 18+.
9. Pneumococcal Immunization 65+.
10. Childhood Immunizations (GPRAMA).
11. Pap Screening Rates.
12. Mammography Screening Rates.
13. Colorectal Cancer Screening Rates.
14. Tobacco Cessation.
15. Alcohol Screening (FAS Prevention).
16. Domestic Violence/Intimate Partner Violence Screening.
17. Depression Screening (GPRAMA).
18. HIV Screening.
19. Breastfeeding Rates.
20. Childhood Weight Control (long-term measures, result will be
reported in FY2016).
FY 2016 NON CLINICAL GPRA/GPRAMA MEASURE
1. Suicide Surveillance (RPMS Programs only).
FY 2016 measure targets are attached. Note that since 2013, urban
measure targets are the same as the targets for Tribal and Federal
health programs.
1. The following GPRAMA measures should be prioritized for target
achievement: Good Glycemic Control, Childhood Immunizations and
Depression Screening. Briefly describe the steps/activities you will
take to ensure your program meets the FY 2016 target rates for these
measures.
2. Describe at least two actions you will complete to meet the FY
2016 GPRA/GPRAMA performance targets. A Performance Improvement Toolbox
with information on clinical GPRA measures, screening tools, and
guidelines is

[[Page 13385]]

available on the CRS Web site at: http://www.ihs.gov/crs/toolbox/http://www.ihs.gov/crs/index.cfm?module=crs_performance_improvement_toolbox.
3. GPRA Behavioral Health performance measures include Alcohol
Screening (to prevent Fetal Alcohol Syndrome), Domestic (Intimate
Partner) Violence Screening and Depression Screening (for adults over
age 18). Describe actions you will take to improve 2015-2016 desired
behavioral health performance outcomes/results.
4. Document your ability to collect and report on the required
performance measures to meet GPRA requirements. Include information
about your health information technology system.
c. Schedule of Charges and Maximization of Third Party Payments
1. Describe the UIHP established schedule of charges and
consistency with local prevailing rates.
If the UIHP is not currently billing for billable
services, describe the process the UIHP will take to begin third party
billing to maximize collections.
2. Describe how reimbursement is maximized from Medicare, Medicaid,
State Children's Health Insurance Program, private insurance, etc.
3. Describe how the UIHP achieves cost effectiveness in its billing
operations with a brief description of the following:
a. Establishes appropriate eligibility determination.
b. Reviews/updates and implements up-to-date billing and collection
practices.
c. Updates insurance at every visit.
d. Maintains procedures to evaluate necessity of services.
e. Identifies and describes financial information systems used to
track, analyze and report on the program's financial status by revenue
generation, by source, aged accounts receivable, provider productivity,
and encounters by payor category.
f. Indicates the date the UIHP last reviewed and updated its
Billing Policies and Procedures.
B. Program Narratives and Work Plans (40 Points)
A program narrative and a program specific work plan are required
for each health services program: (1) HD/DP, (2) Immunizations, (3)
Alcohol/Substance Abuse, and (4) Mental Health. Title V of the IHCIA,
Public Law 94-437, as amended, identifies eligibility for health
services as follows.
Each grantee shall provide health care services to eligible urban
Indians living within the urban service area. An ``Urban Indian''
eligible for services, as codified at 25 U.S.C. 1603(13), (27), and
(28), includes any individual who:
1. Resides in an urban center, which is any community that has a
sufficient urban Indian population with unmet health needs to warrant
assistance under the IHCIA, as determined by the Secretary, HHS; and
who
2. Meets one or more of the following criteria:
a. Irrespective of whether he or she lives on or near a
reservation, is a member of a Tribe, band, or other organized group of
Indians, including:
i. Those Tribes, bands, or groups terminated since 1940, and
ii. those recognized now or in the future by the State in which
they reside, or
b. Is a descendant, in the first or second degree, of any such
member described in a.; or
c. Is an Eskimo or Aleut or other Alaska Native; or
d. Is a California Indian; \1\ or
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\1\ Consistent with 25 U.S.C. 1603(3), (13), (28), and 1679,
eligibility of California Indians may be demonstrated by
documentation that the individual:
(1) Is a descendant of an Indian who was residing in the State
of California on June 1, 1852;
(2) Holds trust interests in public domain, national forest, or
Indian reservation allotments; or
(3) Is listed on the plans for distribution of assets of
California Rancherias and reservations under the Act of August 18,
1958 (72 Stat. 619), or is the descendant of such an individual.
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e. Is considered by the Secretary of the Department of the Interior
to be an Indian for any purpose; or
f. Is determined to be an Indian under regulations pertaining to
the Urban Indian Health Program that are promulgated by the Secretary,
HHS.
Each grantee is responsible for taking reasonable steps to confirm
that the individual is eligible for IHS services as an urban Indian.
1. HP/DP
Contact your IHS Area Office HP/DP Coordinator to discuss and
identify effective and innovative strategies to promote health and
enhance prevention efforts to address chronic diseases and conditions.
Identify one or more of the strategies you will conduct during the
first 12 months.
a. Applicants are encouraged to use evidence-based and promising
strategies which can be found at the IHS best practice database httpp:/
/www.ihs.gov/hpdp/, the National Registry for Effective Programs at
http://www.nrepp.samhsa.gov/, and the Guide to Community Preventive
Services at http://www.thecommunityguide.org/about/conclusionreport.html.
b. Program Narrative. Provide a brief description of the
collaboration activities that: (1) Were accomplished over the last 10
months, and (2) are planned and will be conducted between your UIHP and
the IHS Area Office HP/DP Coordinator during the budget period April 1,
2016 through March 31, 2017.
c. An example of an HP/DP work plan is provided on the following
pages. Develop and attach a copy of the UIHP HP/DP Work Plan for the
first 12 months.
2. IMMUNIZATION SERVICES
a. Program Management Required Activities
i. Provide assurance that your facility is participating in the
Vaccines for Children program.
ii. Provide assurance that your facility has look up capability
with State/regional immunization registry (where applicable). Contact
Cecile Town at [email protected], IHS Immunization Data Exchange
Coordinator, for more information.
b. Service Delivery Required Activities--For Sites Using RPMS
i. Provide trainings to providers and data entry clerks on the RPMS
Immunization package.
ii. Establish process for immunization data entry into RPMS (e.g.,
point of service or through regular data entry).
iii. Utilize RPMS Immunization package to identify 3-27 month old
children who are not up to date and generate reminder/recall letters.
c. Immunization Coverage Assessment Required Activities
i. Submit quarterly immunization reports to Area Immunization
Coordinator for the 3-27 month old, Two year old and Adolescent,
Influenza and Adult reports. Sites not using the RPMS Immunization
package should submit a Two Year old immunization coverage report--an
Excel spreadsheet with the required data elements that can be found
under the ``Report Forms for non-RPMS sites'' section at: http://www.ihs.gov/epi/index.cfm?module=epi_vaccine_reports.
d. Program Evaluation Required Activities
i. Report coverage with the 4313314* vaccine series for children
19-35 months old.
ii. Report coverage for patients (6 months and older) who received
at least one dose of seasonal flu vaccine during flu season.
iii. Report coverage for children 6 months-17 years and adults 18
years and older who received at least one dose

[[Page 13386]]

of seasonal flu vaccine during flu season.
iv. Report coverage with at least one dose of pneumococcal vaccine
for adults 65 years and older.
v. Establish baseline coverage on adult vaccines, specifically: 1
dose of Tdap for adults 19 years and older; 1 dose of HPV for females
19-26 years old; 3 doses HPV for females 19-26 years; 1 dose of HPV for
males 19-21 years old; 3 doses HPV for males 19-21 years; and 1 dose of
Zoster for patients 60+ years.
* The 4:3:1:3:3:1:4 vaccine series is defined as: 4 doses
diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and
tetanus toxoids, or diphtheria and tetanus toxoids and any pertussis
vaccine, 3 doses of oral or inactivated polio vaccine, 1 dose of
measles, mumps, and rubella vaccine, 3 or 4 doses of Haemophilus
influenzae type b vaccine depending on brand, 3 doses of hepatitis B
vaccine, 1 dose of varicella vaccine, and 4 doses of pneumococcal
conjugate vaccine (PCV).
3. ALCOHOL/SUBSTANCE ABUSE
a. Program Progress Report or Results/Outcomes for the past 10
months.
i. Briefly address the extent to which the program was able to
achieve its objectives over the last 10 months.
ii. Identify Specific Program Services Outcomes/Results:
1. State the number of patient encounters (or specific service) per
provider staff for this program service,
2. List populations and age groups that were targeted (homeless,
women, children, adolescent, elderly, men, special needs, etc.), and
3. Identify specific outcomes/results that were measured in
addition to the number of patient encounters/staff.
b. Narrative Description of Program Services for the first 12
months.
i. Program Objectives
1. Clearly state the outcomes of the health service.
2. Define needs related outcomes of the program health care
service.
3. Define who is going to do what, when, how much, and how you will
measure it.
4. Define the population to be served and provide specific numbers
regarding the number of eligible clients for whom services will be
provided.
5. State the time by which the objectives will be met.
6. Describe objectives in numerical terms--specify the number of
clients that will receive services.
7. Describe how achievement of the goals will produce meaningful
and relevant results (e.g., increase access, availability, prevention,
outreach, pre-services, treatment, and/or intervention).
8. Provide a one-year work plan that will include the primary
objectives, services or program, target population, process measures,
outcome measures, and data source for measures (see work plan sample in
Appendix 2).
a. Identify Services Provided: Primary Residential; Detox; Halfway
House; Counseling; Outreach and Referral; and Other (Specify)
b. Number of beds: Residential ___, Detox___; or Half way House
___.
c. Average monthly utilization for the past year.
d. Identify Program Type: Integrated Behavioral Health; Alcohol and
Substance Abuse only; Stand Alone; or part of a health center or
medical establishment.
9. Address methamphetamine-related contacts.
a. Identify the documented number of patient contacts during the
past twelve months, and estimate the number patient contacts during the
first 12 months..
b. Describe your formal methamphetamine prevention and education
program efforts to reduce the prevalence of methamphetamine abuse
related problems through increased outreach, education, prevention and
treatment of methamphetamine-related issues.
c. Describe collaborative programming with other agencies to
coordinate medical, social, educational, and legal efforts.
ii. Program Activities
1. Clearly describe the program activities or steps that will be
taken to achieve the desired outcomes/results. Describe who will
provide (program, staff) what services (modality, type, intensity,
duration), to whom (individual characteristics), and in what context
(system, community).
2. State reasons for selection of activities.
3. Describe sequence of activities.
4. Describe program staffing in relation to number of clients to be
served.
5. Identify number of Full Time Equivalents (FTEs) proposed and
adequacy of this number:
a. Percentage of FTEs funded by IHS grant funding; and
b. Describe clients and client selection.
6. Address the comprehensive nature of services offered in this
program service area.
7. Describe and support any unusual features of the program
services, or extraordinary social and community involvement.
8. Present a reasonable scope of activities that can be
accomplished within the time allotted for program and program
resources.
iii. Accreditation and Practice Model
1. Name of program accreditation.
2. Type of evidence-based practice.
3. Type of practice-based model.
iv. Attach the Alcohol/Substance Abuse Work Plan.
4. BEHAVIORAL HEALTH SERVICES
a. Program Progress Report or Results/Outcomes for the past twelve
months.
i. Briefly address the extent to which the program was able to
achieve its objectives over the past twelve months.
ii. Identify Specific Program Services Outcomes/Results:
1. State the number of patient encounters (or specific service) per
provider staff for this program service,
2. List populations and age groups that were targeted (homeless,
women, children, adolescent, elderly, men, special needs, etc.), and
3. Identify specific outcomes/results that were measured in
addition to the number of patient encounters/staff.
b. Narrative Description of Program Services for April 1, 2016--
March 31, 2017.
i. Program Objectives
1. Clearly state the outcomes of the health service.
2. Define needs related outcomes of the program health care
service.
3. Define who is going to do what, when, how much, and how you will
measure it.
4. Define the population to be served and provide specific numbers
regarding the number of eligible clients for whom services will be
provided.
5. State the time by which the objectives will be met.
6. Describe objectives in numerical terms--specify the number of
clients that will receive services.
7. Describe how achievement of the goals will produce meaningful
and relevant results (e.g., increase access, availability, prevention,
outreach, pre-services, treatment, and/or intervention).
8. Provide a one-year work plan that will include the primary
objectives, services or program, target population, process measures,
outcome measures, and data source for measures (see work plan sample in
Appendix 2).
a. Identify Services Provided: Community Outreach, Prevention
Initiatives Trainings, Court Ordered Evaluations (Adult and Juvenile),

[[Page 13387]]

Schools, Treatments, Domestic Violence Programs, Specific Groups,
Crisis Lines, Child Protection Assistance, and Other (Specify).
b. Identify average monthly utilization for the past year.
c. Identify Program Type: Integrated Behavioral Health, independent
agency, or part of a health center or medical establishment.
9. Address Behavioral Health related contacts.
a. Identify the documented number of patient contacts during the
past twelve months and estimate the number patient contacts during the
first 12 months.
b. Describe your formal behavioral health prevention and education
program efforts to increase access to services, outreach, education,
prevention and treatment of behavioral health related issues.
c. Describe collaborative programming with other agencies to
coordinate medical, social, educational, and legal efforts.
ii. Program Activities
1. Clearly describe the program activities or steps that will be
taken to achieve the desired outcomes/results. Describe who will
provide (program, staff) what services (modality, type, intensity,
duration), to whom (individual characteristics), and in what context
(system, community).
2. State reasons for selection of activities.
3. Describe sequence of activities.
4. Describe program staffing in relation to number of clients to be
served.
5. Identify number of FTEs proposed and adequacy of this number:
a. Percentage of FTEs funded by IHS grant funding; and
b. Describe clients and client selection.
6. Address the comprehensive nature of services offered in this
program service area.
7. Describe and support any unusual features of the program
services, or extraordinary social and community involvement.
8. Present a reasonable scope of activities that can be
accomplished within the time allotted for program and program
resources.
iii. Accreditation and Practice Model
1. Name of program accreditation.
2. Type of evidence-based practice.
3. Type of practice-based model.
iv. Attach the Behavioral Health Work Plan
C. Project Evaluation (15 Points)
1. Describe your evaluation plan. Provide a plan to determine the
degree to which objectives are met and methods are followed.
2. Describe how you will link program performance/services to
budget expenditures. Include a discussion of GPRA/GPRAMA Report
Measures here.
3. Include the following program specific information:
a. Describe the expected feasibility and reasonable outcomes (e.g.,
decreased drug use in those patients receiving services) and the means
by which you determined these targets or results.
b. Identify dates of reviews by the internal staff to assess
efficacy:
I. Assessment of staff adequacy.
II. Assessment of current position descriptions.
III. Assessment of impact on local community.
IV. Involvement of local community.
V. Adequacy of community/governance board.
VI. Ability to leverage IHS funding to obtain additional funding.
VII. Additional IHS grants obtained.
VIII. New initiatives planned for funding year.
IX. Customer satisfaction evaluations.
4. Describe your Quality Improvement Committee (QIC).
The UIHP QIC, a planned, organization-wide, interdisciplinary team,
systematically improves program performance as a result of its findings
regarding clinical, administrative and cost-of-care performance issues,
and actual patient care outcomes including the FY 2015 GPRA report
(results of care including safety of patients).
a. Identify the QIC membership, roles, functions, and frequency of
meetings. Frequency of meeting shall be at least quarterly.
b. Describe how the results of the QIC reviews provide regular
feedback to the program and community/governance board to improve
services.
1. Accomplishments during the past twelve months.
2. Activities planned for the first 12 months.
c. Describe how your facility is integrating the care model into
your health delivery structure:
1. Identify specific measures you are tracking as part of the
Improving Patient Care (IPC) work.
2. Identify community members that are part of your IPC team.
3. Describe progress meeting your program's goals for the use of
the IPC model within your healthcare delivery model.
D. Organizational Capabilities, Key Personnel and Qualifications (10
Points)
This section outlines the broader capacity of the organization to
complete the project outlined in the continuation application and
program specific work plans. This section includes the identification
of personnel responsible for completing tasks and the chain of
responsibility for successful completion of the project outlined in the
work plans.
1. Describe the organizational structure with a current approved
one page organizational chart that shows the board of directors, key
personnel, and staffing. Key positions include the Chief Executive
Officer or Executive Director, Chief Financial Officer, Medical
Director, and Information Officer.
2. Describe the board of directors that is fully and legally
responsible for operation and performance of the 501(c)(3) non-profit
urban Indian organization:
a. List all current board members by name, sex, and Tribe or race/
ethnicity,
b. Indicate their board office held,
c. Indicate their occupation or area of expertise,
d. Indicate if the board member uses the UIHP services,
e. Indicate if the board member lives in the health service area.
f. Indicate the number of years of continuous service.
g. Indicate number of hours of board of directors training
provided, training dates and attach a copy of the board of directors
training curriculum.
3. List key personnel who will work on the project.
a. Identify existing key personnel and new program staff to be
hired.
b. For all new key personnel only include position descriptions and
resumes in the appendix. Position descriptions should clearly describe
each position and duties indicating desired qualifications, experience,
and requirements related to the proposed project and how they will be
supervised. Resumes must indicate that the proposed staff member is
qualified to carry out the proposed project activities and who will
determine if the work of a contractor is acceptable.
c. Identify who will be writing the progress reports.
d. Indicate the percentage of time to be allocated to this project
and identify the resources used to fund the remainder of the
individual's salary if personnel are to be only partially funded by
this grant.
E. Categorical Budget and Budget Justification (5 Points)
This section should provide a clear estimate of the project program
costs and justification for expenses for the first 12 months.. The
budget and budget justification should be consistent with the tasks
identified in the work plan.

[[Page 13388]]

1. Categorical Budget (Form SF 424A, Budget Information Non-
Construction Programs) complete each of the budget periods requested.
a. Provide a narrative justification for all costs, explaining why
each line item is necessary or relevant to the proposed project.
Include sufficient details to facilitate the determination of cost
allowability.
b. If indirect costs are claimed, indicate and apply the current
negotiated rate to the budget. Include a copy of the current rate
agreement in the appendix.
Multi-Year Project Requirements
Projects requiring a second and/or third year must include a brief
project narrative and budget (one additional page per year) addressing
the developmental plans for each additional year of the project.
Additional Documents Can Be Uploaded as Appendix Items in Grant.gov
Work Plan, logic model and/or time line for proposed
objectives.
Position descriptions for key staff.
Resumes of key staff that reflect current duties.
Consultant or contractor proposed scope of work and letter
of commitment (if applicable).
Current Indirect Cost Agreement.
Organizational chart.
Map of area identifying project location(s).
Additional documents to support narrative (i.e. data
tables, key news articles, etc.).

2. Review and Selection

Each application will be prescreened by the DGM staff for
eligibility and completeness as outlined in the funding announcement.
Applications that meet the eligibility criteria shall be reviewed for
merit by the ORC based on evaluation criteria in this funding
announcement. The ORC could be composed of both Tribal and Federal
reviewers appointed by the IHS Program to review and make
recommendations on these applications. The technical review process
ensures selection of quality projects in a national competition for
limited funding. Incomplete applications and applications that are non-
responsive to the eligibility criteria will not be referred to the ORC.
The applicant will be notified via email of this decision by the Grants
Management Officer of the DGM. Applicants will be notified by DGM, via
email, to outline minor missing components (i.e., budget narratives,
audit documentation, key contact form) needed for an otherwise complete
application. All missing documents must be sent to DGM on or before the
due date listed in the email of notification of missing documents
required.
To obtain a minimum score for funding by the ORC, applicants must
address all program requirements and provide all required
documentation.

VI. Award Administration Information

1. Award Notices

The Notice of Award (NoA) is a legally binding document signed by
the Grants Management Officer and serves as the official notification
of the grant award. The NoA will be initiated by the DGM in our grant
system, GrantSolutions (https://www.grantsolutions.gov). Each entity
that is approved for funding under this announcement will need to
request or have a user account in GrantSolutions in order to retrieve
their NoA. The NoA is the authorizing document for which funds are
dispersed to the approved entities and reflects the amount of Federal
funds awarded, the purpose of the grant, the terms and conditions of
the award, the effective date of the award, and the budget/project
period.
Disapproved Applicants
Applicants who received a score less than the recommended funding
level for approval, 60 points, and were deemed to be disapproved by the
ORC, will receive an Executive Summary Statement from the IHS program
office within 30 days of the conclusion of the ORC outlining the
strengths and weaknesses of their application submitted. The IHS
program office will also provide additional contact information as
needed to address questions and concerns as well as provide technical
assistance if desired.
Approved But Unfunded Applicants
Approved but unfunded applicants that met the minimum scoring range
and were deemed by the ORC to be ``Approved,'' but were not funded due
to lack of funding, will have their applications held by DGM for a
period of one year. If additional funding becomes available during the
course of FY 2016, the approved, but unfunded, application may be re-
considered by the awarding program office for possible funding. The
applicant will also receive an Executive Summary Statement from the IHS
program office within 30 days of the conclusion of the ORC.
Note: Any correspondence other than the official NoA signed 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 IHS.

2. Administrative Requirements

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

3. Indirect Costs

This section applies to all grant recipients that request
reimbursement of indirect costs (IDC) in their grant application. In
accordance with HHS Grants Policy Statement, Part II-27, IHS requires
applicants to obtain a current IDC rate agreement prior to award. The
rate agreement must be prepared in accordance with the applicable cost
principles and guidance as provided by the cognizant agency or office.
A current rate covers the applicable grant activities under the current
award's budget period. If the current rate 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 is provided to
the DGM.
Generally, IDC rates for IHS grantees are negotiated with the
Division of Cost Allocation (DCA) https://rates.psc.gov/ and the
Department of Interior (Interior Business Center) https://www.doi.gov/ibc/services/finance/indirect-Cost-Services/indian-tribes. For
questions regarding the indirect cost policy, please call the Grants
Management Specialist listed under ``Agency Contacts'' or the main DGM
office at (301) 443-5204.

4. Reporting Requirements

The grantee must submit required reports consistent with the
applicable deadlines. Failure to submit required reports within the
time allowed may result in suspension or termination of an active
grant, withholding of

[[Page 13389]]

additional awards for the project, or other enforcement actions such as
withholding of payments or converting to the reimbursement method of
payment. Continued failure to submit required reports may result in one
or both of the following: (1) The imposition of special award
provisions; and (2) the non-funding or non-award of other eligible
projects or activities. This requirement applies whether the
delinquency is attributable to the failure of the grantee organization
or the individual responsible for preparation of the reports. Per DGM
policy, all reports are required to be submitted electronically by
attaching them as a ``Grant Note'' in GrantSolutions. Personnel
responsible for submitting reports will be required to obtain a login
and password for GrantSolutions. Please see the Agency Contacts list in
section VII for the systems contact information.
The reporting requirements for this program are noted below.
A. Progress Reports
Program progress reports are required semi-annually within 30 days
after the budget period ends. These reports must include a brief
comparison of actual accomplishments to the goals established for the
period, a summary of progress to date or, if applicable, provide sound
justification for the lack of progress, and other pertinent information
as required. A final report must be submitted within 90 days of
expiration of the budget/project period.
B. Financial Reports
Federal Financial Report FFR (SF-425), Cash Transaction Reports are
due 30 days after the close of every calendar quarter to the Payment
Management Services, HHS at: http://www.dpm.psc.gov. It is recommended
that the applicant also send a copy of the FFR (SF-425) report to the
grants management specialist. Failure to submit timely reports may
cause a disruption in timely payments to the organization.
Grantees are responsible and accountable for accurate information
being reported on all required reports: The Progress Reports and
Federal Financial Report.
C. 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.
IHS has implemented a Term of Award into all IHS Standard Terms and
Conditions, NoAs and funding announcements regarding the FSRS reporting
requirement. This IHS Term of Award is applicable to all IHS grant and
cooperative agreements issued on or after October 1, 2010, with a
$25,000 sub-award obligation dollar threshold met for any specific
reporting period. Additionally, all new (discretionary) IHS awards
(where the project period is made up of more than one budget period)
and where: (1) The project period start date was October 1, 2010 or
after and (2) the primary awardee will have a $25,000 sub-award
obligation dollar threshold during any specific reporting period will
be required to address the FSRS reporting. For the full IHS award term
implementing this requirement and additional award applicability
information, visit the DGM Grants Policy Web site at: http://www.ihs.gov/dgm/policytopics/.
D. GPRA Report
GPRA reports are required for the 2nd, 3rd, and 4th quarters,
ending on December 31, March 31, and June 30 of each year. These
reports are submitted to the site's IHS Area GPRA Coordinator by the
date listed on the GPRA/GPRAMA Quarterly Reporting Instructions that
are distributed each quarter by the NGST, usually 3-4 weeks after the
end of the quarter. RPMS users must use CRS to run a quarterly GPRA
report. Non-RPMS users must follow the quarterly instructions issued by
the NGST to perform a 100% audit of records, and use the Excel template
provided with the quarterly instructions to report GPRA data.
E. Quarterly Immunization Report
Immunization reports are required quarterly. These reports are
submitted to the IHS Area Immunization Coordinator.
F. Unmet Needs Report
An unmet needs report is required quarterly. These reports will
include information gathered to: (1) Identify gaps between unmet health
needs of urban Indians and the resources available to meet such needs;
and (2) make recommendations to the Secretary and Federal, State,
local, and other resource agencies on methods of improving health
service programs to meet the needs of urban Indians.
G. Compliance With Executive Order 13166 Implementation of Services
Accessibility Provisions for All Grant Application Packages and Funding
Opportunity Announcements
Recipients of federal financial assistance (FFA) from HHS must
administer their programs in compliance with federal civil rights law.
This means that recipients of HHS funds must ensure equal access to
their programs without regard to a person's race, color, national
origin, disability, age and, in some circumstances, sex and religion.
This includes ensuring your programs are accessible to persons with
limited English proficiency. HHS provides guidance to recipients of FFA
on meeting their legal obligation to take reasonable steps to provide
meaningful access to their programs by persons with limited English
proficiency. Please see http://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-VI/.
The HHS Office for Civil Rights also provides guidance on complying
with civil rights laws enforced by HHS. Please see http://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html; and http://www.hhs.gov/civil-rights/index.html. Recipients of FFA also have
specific legal obligations for serving qualified individuals with
disabilities. Please see http://www.hhs.gov/civil-rights/for-individuals/disability/index.html. Please contact the HHS Office for
Civil Rights for more information about obligations and prohibitions
under federal civil rights laws at http://www.hhs.gov/civil-rights/for-individuals/disability/index.html or call 1-800-368-1019 or TDD 1-800-
537-7697. Also note it is an HHS Departmental goal to ensure access to
quality, culturally competent care, including long-term services and
supports, for vulnerable populations. For further guidance on providing
culturally and linguistically appropriate services, recipients should
review the National Standards for Culturally and Linguistically
Appropriate Services in Health and Health Care at http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.
Pursuant to 45 CFR 80.3(d), an individual shall not be deemed
subjected to discrimination by reason of his/her exclusion from
benefits limited by federal law to individuals eligible for benefits
and services from the Indian Health Service.

[[Page 13390]]

Recipients will be required to sign the HHS-690 Assurance of
Compliance form which can be obtained from the following Web site:
http://www.hhs.gov/sites/default/files/forms/hhs-690.pdf, and send it
directly to the: U.S. Department of Health and Human Services, Office
of Civil Rights, 200 Independence Ave. SW., Washington, DC 20201.
H. Federal Awardee Performance and Integrity Information System
(FAPIIS)
The IHS is required to review and consider any information about
the applicant that is in the Federal Awardee Performance and Integrity
Information System (FAPIIS) before making any award in excess of the
simplified acquisition threshold (currently $150,000) over the period
of performance. An applicant may review and comment on any information
about itself that a federal awarding agency previously entered. IHS
will consider any comments by the applicant, in addition to other
information in FAPIIS in making a judgment about the applicant's
integrity, business ethics, and record of performance under federal
awards when completing the review of risk posed by applicants as
described in 45 CFR 75.205.
As required by 45 CFR part 75 Appendix XII of the Uniform Guidance,
non-federal entities (NFEs) are required to disclose in FAPIIS any
information about criminal, civil, and administrative proceedings, and/
or affirm that there is no new information to provide. This applies to
NFEs that receive federal awards (currently active grants, cooperative
agreements, and procurement contracts) greater than $10,000,000 for any
period of time during the period of performance of an award/project.
Mandatory Disclosure Requirements
As required by 2 CFR part 200 of the Uniform Guidance, and the HHS
implementing regulations at 45 CFR part 75, effective January 1, 2016,
the Indian Health Service must require a non-federal entity or an
applicant for a federal award to disclose, in a timely manner, in
writing to the IHS or pass-through entity all violations of federal
criminal law involving fraud, bribery,or gratutity violations
potentially affecting the federal award.
Submission is required for all applicants and recipients, in
writing, to the IHS and to the HHS Office of Inspector General all
information related to violations of federal criminal law involving
fraud, bribery, or gratuity violations potentially affecting the
federal award. 45 CFR 75.113
Disclosures must be sent in writing to: U.S. Department of Health
and Human Services, Indian Health Service, Division of Grants
Management, ATTN: Robert Tarwater, Director, 5600 Fishers Lane,
Mailstop 09E70, Rockville, Maryland 20857. (Include ``Mandatory Grant
Disclosures'' in subject line) Ofc: (301) 443-5204 Fax: (301) 594-0899
Email: [email protected].

AND

U.S. Department of Health and Human Services, Office of Inspector
General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330
Independence Avenue SW., Cohen Building, Room 5527, Washington, DC
20201. URL: http://oig.hhs.gov/fraud/reportfraud/index.asp. (Include
``Mandatory Grant Disclosures'' in subject line) Fax: (202) 205-0604
(Include ``Mandatory Grant Disclosures'' in subject line) or Email:
[email protected].
Failure to make required disclosures can result in any of the
remedies described in 45 CFR 75.371 Remedies for noncompliance,
including suspension or debarment (See 2 CFR parts 180 and 376 and 31
U.S.C. 3321).

VII. Agency Contacts

1. Questions on the programmatic issues may be directed to: Rick
Mueller, Public Health Advisor, Office of Urban Indian Health Programs,
5600 Fishers Lane, Mail Stop: 08E65B, Rockville, MD 20857, Phone: (301)
443-4680, Fax: (301) 443-4794, Email: [email protected].
2. Questions on grants management and fiscal matters may be
directed to: Pallop Chareonvootitam, Grants Management Specialist, 5600
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Phone: (301) 443-
5204, Fax: 301-594-0899, Email: [email protected].
3. Questions on systems matters may be directed to: Paul Gettys,
Grant Systems Coordinator, 5600 Fishers Lane, Mail Stop: 09E70,
Rockville, MD 20857, Phone: (301) 443-2114; or the DGM main line (301)
443-5204, Fax: (301) 594-0899, E-Mail: [email protected].

VIII. Other Information

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

Dated: March 4, 2016.
Elizabeth Fowler,
Deputy Director for Management Operations, Indian Health Service.

Sample 2016 HP/DP Work Plan

Goal: To address physical inactivity and consumption of unhealthy
food among youth who are in the 4th to 6th grade in the Watson,
Kennedy, Blackwood, and Rocky Hill Elementary schools.

[[Page 13391]]

3. Implement physical activity in 1. Contract with SPARK PE Program Coordinator 1. Training evaluation
at least four schools for grades to train classroom School Counselor and and number of
4th to 6th in first year of the teachers to implement PE teacher. participants.
funding. SPARK PE in the school by 2. Pre/post FITNESSGRAM
3rd Quarter. Data.
2. Train volunteers to
administer FITNESSGRAM to
collect baseline data and
post data to assess
changes..
----------------------------------------------------------------------------------------------------------------

Sample 2016 HP/DP Work Plan

Goal: To reduce tobacco use among residents of community X and Y.

----------------------------------------------------------------------------------------------------------------
Objectives Activities/time line Person responsible Evaluation
----------------------------------------------------------------------------------------------------------------
1. Establish a tobacco-free policy 1. Schedule a meeting with Tobacco Coordinator.. Documentation of the
in the schools and Tribal the Tribal Council and number of participants.
buildings in community X and Y by school board to increase
year 1. awareness of the health
effects of tobacco by
June 2016.
2. Schedule and conduct Tobacco Coordinator, Documentation of the
tobacco awareness Health Educator. number of participants.
education in the
community, schools, and
worksites by July 2016
through September 2017.
3. Draft a policy and Documentation of whether
present to the Tribal the policy was
Council for approval by established.
January 2017.
2. Coordinate and establish 1. Partner with American Tobacco Coordinator, Progress toward timeline.
tobacco cessation programs with Cancer Association and Health Educator
the local hospitals and clinics the Tribal Health Pharmacist.
in X and Y communities. Education Coordinators to
establish 8-week tobacco
cessation programs by
July 2016.
2. Meet with the hospital/ Tobacco Coordinator, Progress report
clinic administrators and Health Educator. indicating timeline is
pharmacist to discuss and being met.
develop a behavior-based
tobacco cessation program.
3. Train staff in tobacco Tobacco Coordinator.. # of staff trained in
cessation counseling. tobacco cessation.
Design and disseminate Tobacco Coordinator.. # of brochures
brochures and flyers of distributed.
tobacco cessation program
that are available in the
community and clinic.
4. Meet with nursing and Health Educator, # of staff trained and
medical provider staff to Tobacco Coordinator. document, changes in
increase patient referral practice.
to tobacco cessation
program.
6. Implement the 8-week Tobacco Coordinator.. RPMS data--baseline # of
tobacco cessation program referrals, # of
at the community X and Y participants who
clinic. completed program, # who
quit tobacco.
----------------------------------------------------------------------------------------------------------------

Sample Urban Grant FY 2016 Work Plan

Immunization
----------------------------------------------------------------------------------------------------------------
Service or Target
Primary prevention objective program population Process measure Outcome measures
----------------------------------------------------------------------------------------------------------------
Protect children and Immunization Children <3 On a quarterly basis: As of June 30th,
communities from vaccine Program. years. # of children 3-27 2016:
preventable diseases. months old. # of 19-35 month olds
# of children 3-27 up to date with the
months old who are 4313314 vaccine
up to date with age series.
appropriate % of 19-35 month olds
vaccinations. up to date with the
% of 3-27 month old 4313314 vaccine
children up to date series.
with age appropriate
vaccinations..
# of children 19-35
months old
# of children 19-35
months old who
received the 4313314
vaccine series..
% of children 19-35
months old who
received the 4313314
vaccine series..

[[Page 13392]]

Protect adolescents and Immunization Adolescents 13- On a quarterly basis: As of June 30th,
communities from vaccine Program. 17 years. # of adolescents 13- 2016:
preventable diseases. 17 years old. # of adolescents 13-
# of adolescents 13- 17 years old who are
17 years old who are up to date with
up to date with Tdap, Meningococcal
Tdap, Meningococcal, and 3 doses of HPV.
and 3 doses of HPV % of adolescents 13-
(males and females). 17 years old who are
% of adolescents 13- up to date with
17 years old who are Tdap, Meningococcal
up to date with and 3 doses of HPV.
Tdap, Meningococcal,
and 3 doses of HPV
(males and females).
Protect adults and communities Immunization 6 months and On a quarterly basis As of June 30th,
from influenza. Program. older. during flu season 2016:
(e.g., Sept-June) # of patients in each
# of patients 6 age group who
months or older. received a seasonal
# of patients 6 flu shot during the
months-17 years. flu season.
# of patients 18 % of patients. in
years and older. each age group who
# of patients in each received a seasonal
age group who flu shot during flu
received a seasonal season.
flu shot during the
flu season.
% of patients in each
age group who
received a seasonal
flu shot during flu
season.
Protect adults and communities Immunization Adults >= 65 On a quarterly basis: As of June 30th,
from influenza & Pneumovax. Program. years. # of adults >= 65 2016:
years. # of adults >= 65
# of adults >= 65 years.
years who received a % of adults >= 65+
pneumovax shot. years who received a
% of adults >= 65+ pneumovax shot ever.
years who received a
pneumovax shot.
----------------------------------------------------------------------------------------------------------------

IHS Urban Grant FY 2016 Work Plan
[Alcohol/Substance Abuse Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Objectives Service or program Target population Process measure Outcome measures Data source for
---------------------------------------------------------------------------------------------------------------------------------- measures
What information will ----------------------
What type of program Who do you hope to What information will you collect to find Where will you find
What are you trying to accomplish? do you propose? serve in your program? you collect about the out the results of the information you
program activities? your program? collect?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To prevent substance abuse among Community-based American Indian youth # of youth completing Incidence/prevalence Medical records, RPMS
urban American Indian youth. substance abuse ages 5-18 years old. the curriculum, # of of substance abuse/ behavioral health
prevention curriculum. sessions conducted, dependence. package, National
# of staff trained. Youth Survey.
To prevent substance abuse and After-school, summer, American Indian youth # of youth completing Incidence of Charts, RPMS
related problems. and weekend ages 5-14 years old. community-based substance abuse, behavioral health
activities (e.g. sessions, # of incidence of package, National
outdoor experiential parents completing negative and Youth Survey.
activities, camps, community-based positive attitudes
classroom based sessions, # of and behaviors,
problem solving community-based incidence of peer
activities). sessions. drug use.
Reduce drug use and increase Matrix model for American Indian adult # of clients Incidence of drug Medical records, RPMS
treatment retention. outpatient treatment. methamphetamine completing program, use, increase or behavioral health
clients. # of relapse decrease in package, Addiction
prevention sessions, treatment retention, Severity Index,
# of family and positive or negative results of urine
group therapies, # urine samples. tests.
of drug education
sessions, # of self-
help groups, # of
urine tests.
--------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 13393]]

IHS Urban Grant FY 2016 Work Plan
[Mental Health Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Objectives Service or program Target population Process measure Outcome measures Data source for
---------------------------------------------------------------------------------------------------------------------------------- measures
What information will ----------------------
What type of program Who do you hope to What information will you collect to find Where will you find
What are you trying to accomplish? do you propose? serve in your program? you collect about the out the results of the information you
program activities? your program? collect?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To promote mental health........... American Indian Life American Indian youth # of youth completing Feelings of Medical records, RPMS
Skills Development ages 13-17 years old. the curriculum, # of hopelessness, behavioral health
curriculum. sessions conducted, problem solving package, Beck
# of teachers skills. Hopelessness Scale,
trained, number of problem solving
community resource skills.
leaders trained.
Improve the mental health of Home-based, community- American Indian # of individual, Reduced child Medical records, RPMS
American Indian children and their based, and office- children and their couples, group, and involvement in behavioral health
families. based mental health families needing family counseling juvenile justice and package coping skill
counseling. services from our sessions, # of home, child welfare, measure, report
community-based community, and improved coping cards, attendance
program. office-based visits. skills, improved records.
school attendance
and grades.
Reduce symptoms related to trauma.. Mental health American Indian adults # of individual, Incidence of Post- Self-report PTSD,
counseling with couples, group, and Traumatic Stress Beck Depression
cognitive behavioral family counseling Disorder (PTSD) Inventory, coping
therapy intervention sessions, # of symptoms, incidence skills measure, peer
and historical trauma historical trauma of depression, and family support
intervention. groups, # of adults increased coping measure, medical
counseled. skills, increased records, RPMS
peer and family behavioral health
support. package.
--------------------------------------------------------------------------------------------------------------------------------------------------------

RPMS Suicide Reporting Form

Instructions for Completing

This form is intended as a data collection tool only. It does not
replace documentation of clinical care in the medical record and it is
not a referral form. HRN, Date of Act and Provider Name are required
fields. If the information requested is not known or not listed as an
option, choose ``Unknown'' or ``Other'' (with specification) as
appropriate. The form can be partially completed, saved and completed
at a later time if needed.

LOCAL CASE NUMBER:

Indicate internal tracking number if used, not required.

DATE FORM COMPLETED:

Indicate the date the Suicide Reporting Form was completed.

PROVIDER NAME:

Record the name of Provider completing the form.

DATE OF ACT:

Record Date of Act as mm/dd/yy. If exact day is unknown, use the
month, 1st day of the month (or another default day), year. If exact
date of act is unknown, all providers should use the same default day
of the month.

HEALTH RECORD NUMBER:

Record the patient's health record number.

DOB/AGE:

Record Date of Birth as mm/dd/yy and patient's age.

SEX:

Indicate Male or Female.

COMMUNITY WHERE ACT OCCURRED:

Record the community code or the name, county and state of the
community where the act occurred.

EMPLOYMENT STATUS:

Indicate patient's employment status, choose one.

RELATIONSHIP STATUS:

Indicate patient's relationship status, choose one.

EDUCATION:

Select the highest level of education attained and if less than a
High School graduate, record the highest grade completed. Choose one.

SUICIDAL BEHAVIOR:

Identify the self-destructive act, choose one. Generally, the
threshold for reporting should be ideation with intent and plan, or
other acts with higher severity, either attempted or completed.

LOCATION OF ACT:

Indicate location of act, choose one.

PREVIOUS ATTEMPTS:

Indicate number of previous suicide attempts, choose one.

METHOD:

Indicate method used. Multiple entries are allowed, check all that
apply. Describe methods not listed.

SUBSTANCE USE INVOLVED:

If known, indicate which substances the patient was under the
influence of at the time of the act. Multiple entries allowed, check
all that apply. List drugs not shown.

CONTRIBUTING FACTORS:

Multiple entries allowed, check all that apply. List contributing
factors not shown.

DISPOSITION:

Indicate the type of follow-up planned, if known.

NARRATIVE:

Record any other relevant clinical information not included above.
Last Updated 10/25/12
BILLING CODE 4165-16-P

[[Page 13394]]

[GRAPHIC] [TIFF OMITTED] TN14MR16.001

[[Page 13395]]

[GRAPHIC] [TIFF OMITTED] TN14MR16.002

[FR Doc. 2016-05761 Filed 3-11-16; 8:45 am]
BILLING CODE 4165-16-C

13380 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

HRSA specifically requests comments Request (ICR), described below, to the through OAH and the Centers for
on (1) the necessity and utility of the Office of Management and Budget Disease Control (CDC).
proposed information collection for the (OMB). Prior to submitting the ICR to The proposed information request
proper performance of the agency’s OMB, OS seeks comments from the includes instruments that will collect
functions; (2) the accuracy of the public regarding the burden estimate, data on: (1) Whether and how federally-
estimated burden; (3) ways to enhance below, or any other aspect of the ICR. funded programs have been sustained;
the quality, utility, and clarity of the DATES: Comments on the ICR must be (2) factors affecting program
information to be collected; and (4) the received on or before May 13, 2016. sustainability; (3) methods and
use of automated collection techniques ADDRESSES: Submit your comments to strategies employed by grantees to
or other forms of information Information.CollectionClearance@ sustain programs; (4) support and
technology to minimize the information hhs.gov or by calling (202) 690–6162. technical assistance that grantees
collection burden. FOR FURTHER INFORMATION CONTACT: received related to sustaining the
Jackie Painter, Information Collection Clearance staff, programs; and (5) key lessons learned
Director, Division of the Executive Secretariat. Information.CollectionClearance@ based on the outcomes of these efforts.
[FR Doc. 2016–05684 Filed 3–11–16; 8:45 am]
hhs.gov or (202) 690–6162. The data will be analyzed and
SUPPLEMENTARY INFORMATION: When incorporated into study deliverables
BILLING CODE 4165–15–P
submitting comments or requesting that clearly describe grantees’
information, please include the sustainability efforts for all audiences
DEPARTMENT OF HEALTH AND document identifier HHS–OS–0990– and highlight key challenges, successes,
HUMAN SERVICES new–60D for reference. and lessons learned for future funding
Information Collection Request Title: and program implementation.
Office of the Secretary Sustainability study of federally-funded
The data will be used for the study
programs designed to prevent or delay
[Document Identifier: HHS–OS–0990–new– team to identify key factors in program
teen pregnancy (TPP Sustainability
60D] sustainability, the strategies that either
Study).
Abstract: The Office of Adolescent worked or did not work in sustaining
Agency Information Collection programs over time, and the types of
Health (OAH), U.S. Department of
Activities; Proposed Collection; Public support and assistance grantees required
Health and Human Services (HHS) is
Comment Request in order to sustain programs. Collecting
requesting approval by OMB on a new
AGENCY: Office of the Secretary, HHS. collection. The TPP Sustainability this data is crucial to closing an existing
Study is a key piece of OAH’s broad and gap in OAH knowledge about how to
ACTION: Notice. support the sustainability efforts of
ongoing effort to comprehensively
SUMMARY: In compliance with section evaluate all of its teen pregnancy current and future grantees, including
3506(c)(2)(A) of the Paperwork prevention funding efforts which the 2015–2020 TPP grantee cohort and
Reduction Act of 1995, the Office of the consist of: (1) The Teen Pregnancy the 2013–2016 PAF cohort.
Secretary (OS), Department of Health Prevention Program (TPP); the (2) Likely Respondents: Program
and Human Services, announces plans Pregnancy Assistance Fund (PAF); and administrators at 117 grantee
to submit a new Information Collection the Communitywide program funded organizations.

TOTAL ESTIMATED ANNUALIZED BURDEN—HOURS
Average
Number of
Number of burden per Total burden
Form name responses per
respondents response hours
respondent (in hours)

Grantee Survey .............................................................................................. 39 1 0.41 16.0
In-Depth Interview Master Topic Guide ......................................................... 17 2 1.5 51.0

Total ........................................................................................................ 56 ........................ .......................... 66.0

OS specifically requests comments on DEPARTMENT OF HEALTH AND Earliest Anticipated Start Date: June
(1) the necessity and utility of the HUMAN SERVICES 1, 2016.
proposed information collection for the
Indian Health Service I. Funding Opportunity Description
proper performance of the agency’s
functions, (2) the accuracy of the Statutory Authority
Office of Urban Indian Health
estimated burden, (3) ways to enhance
Programs; 4-in-1 Grant Programs; The Indian Health Service (IHS) is
the quality, utility, and clarity of the Announcement Type: New and
information to be collected, and (4) the accepting competitive grant applications
Competing Continuation Funding for the FY 2016 4-in-1 Title V Programs.
use of automated collection techniques Announcement Number: HHS–2016–
or other forms of information This program is authorized under the
jstallworth on DSK7TPTVN1PROD with NOTICES

IHS–UIHP2–0001; Catalogue of Federal
technology to minimize the information Snyder Act, 25 U.S.C. 13, Public Law
Domestic Assistance Number: 93.193
collection burden. 67–85, and Title V of the Indian Health
Key Dates Care Improvement Act (IHCIA), Public
Terry S. Clark, Law 94–437, as amended, specifically
Application Deadline Date: May 15,
Asst Collection Clearance Officer. 2016. the provisions codified at 25 U.S.C.
[FR Doc. 2016–05603 Filed 3–11–16; 8:45 am] Review Period: May 23, 2016–May 27, 1652, 1653, and 1660a. This program is
BILLING CODE 4168–11–P 2016. described in the Catalog of Federal

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13382 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

the ‘‘Estimated Funds Available’’ • 501(c)(3) Certificate. Part A: Program Information (3 Page
section within this funding • Biographical sketches for all Key Limitation)
announcement, the application will be Personnel.
• Contractor/Consultant resumes or Section 1: Needs
considered ineligible and will not be
reviewed for further consideration. If qualifications and scope of work. Describe how the urban Indian
deemed ineligible, IHS will not return • Disclosure of Lobbying Activities organization has expertise and
the application. The applicant will be (SF–LLL). administrative infrastructure to support
notified by email by the Division of • Certification Regarding Lobbying activities of the 4-in-1 grant
Grants Management (DGM) of this (GG-Lobbying Form). requirements.
decision. • Copy of current Negotiated Indirect
Cost rate (IDC) agreement (required) in Part B: Program Planning and
Proof of Non-Profit Status order to receive IDC. Evaluation (18 Page Limitation)
Organizations claiming non-profit • Organizational Chart (optional). Section 1: Program Plans
• Documentation of current Office of
status must submit proof. A copy of the Describe fully and clearly how the
Management and Budget (OMB) A–133
501(c)(3) Certificate must be received urban Indian organization plans to
or other required Financial Audit (if
with the application submission by the applicable). address the four health service
Application Deadline Date listed under Acceptable forms of documentation programs, including HP/DP,
the Key Dates section on page one of include: immunization, alcohol/substance abuse,
this announcement. Æ Email confirmation from Federal and mental health.
An applicant submitting any of the Audit Clearinghouse (FAC) that audits
above additional documentation after Section 2: Program Evaluation
were submitted; or
the initial application submission due Æ Face sheets from audit reports. Describe the urban Indian
date is required to ensure the These can be found on the FAC Web organization evaluation plan including
information was received by the IHS by site: http://harvester.census.gov/sac/ how the applicant will link program
obtaining documentation confirming dissem/accessoptions.html?submit=Go+ performance/services to budget
delivery (i.e. FedEx tracking, postal To+Database. expenditures.
return receipt, etc.). Part C: Program Report (4 Page
Public Policy Requirements
IV. Application and Submission Limitation)
All Federal wide public policies
Information apply to IHS grants with exception of Section 1: Describe Major
1. Obtaining Application Materials the Discrimination policy. Accomplishments for the Last Twelve
Months
The application package and detailed Requirements for Project and Budget
instructions for this announcement can Narratives Section 2: Describe Major Activities
be found at Grants.gov (www.grants.gov) Planned for the First 12 Months
A. Project Narrative: The project
or http://www.ihs.gov/dgm/funding/. narrative should be a separate Word B. Budget Narrative: This narrative
Questions regarding the electronic document that is no longer than 25 must include a line item budget with a
application process may be directed to pages and must: Be single-spaced, be narrative justification for all
Mr. Paul Gettys at (301) 443–2114 or type-written, have consecutively expenditures identifying reasonable and
(301) 443–5204. numbered pages, use black type not allowable costs necessary to accomplish
2. Content and Form of Application smaller than 12 characters per one inch, the goals and objectives as outlined in
Submission and be printed on one side only of the project narrative. Budget should
standard size 81⁄2 × 11 paper. match the scope of work described in
The application must include the Be sure to succinctly address and the project narrative. The budget
project narrative as an attachment to the answer all questions listed under the narrative should not exceed five pages.
application package. Mandatory narrative and place them under the
documents for all applications include: 3. Submission Dates and Times
evaluation criteria (refer to Section V.1,
• Table of contents. Evaluation criteria in this Applications must be submitted
• Abstract (one page) summarizing announcement) and place all responses electronically through Grants.gov by
the key project information. and required information in the correct 11:59 p.m. Eastern Daylight Time (EDT)
• Application forms: section (noted below), or they shall not on the Application Deadline Date listed
Æ SF–424, Application for Federal be considered or scored. These in the Key Dates section on page one of
Assistance. narratives will assist the Objective this announcement. Any application
Æ SF–424A, Budget Information— Review Committee (ORC) in becoming received after the application deadline
Non-Construction Programs. familiar with the applicant’s activities will not be accepted for processing, nor
Æ SF–424B, Assurances—Non- and accomplishments prior to this grant will it be given further consideration for
Construction Programs. award. If the narrative exceeds the page funding. Grants.gov will notify the
• Budget Justification and Narrative limit, only the first 25 pages will be applicant via email if the application is
(must be single-spaced and not exceed reviewed. The 25-page limit for the rejected.
five pages). narrative does not include the table of If technical challenges arise and
• Project Narrative (must be single- contents, abstract, standard forms, assistance is required with the
spaced and not exceed twenty-five electronic application process, contact
jstallworth on DSK7TPTVN1PROD with NOTICES

budget justification narrative, and/or
pages). other appendix items. Grants.gov Customer Support via email
Æ Background information on the There are three parts to the narrative: to support@grants.gov or at (800) 518–
organization. Part A—Program Information; Part B— 4726. Customer Support is available to
Æ Proposed scope of work, objectives, Program Planning and Evaluation; and address questions 24 hours a day, 7 days
and activities that provide a description Part C—Program Report. See below for a week (except on Federal holidays). If
of what will be accomplished, including additional details about what must be problems persist, contact Mr. Paul
a one-page Timeframe Chart. included in the narrative. Gettys (Paul.Gettys@ihs.gov), DGM

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13384 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

submitting the registration takes the Indian Health Care Improvement The current GPRA Reporting Period is
approximately one hour to complete Act was made permanent. July 1, 2015 through June 30, 2016.
and SAM registration will take 3–5 • Identify what the UIHP is doing to GPRA reports are due for the 2nd, 3rd,
business days to process. Registration strengthen its partnerships with Tribes and 4th quarters, which end on
with the SAM is free of charge. and other urban Indian health programs. December 31, March 31, and June 30,
Applicants may register online at a. Major accomplishments over the respectively. Each report is cumulative,
https://www.sam.gov. last twelve months. and must include data starting from July
Additional information on b. Activities planned for the first 12 1st of the current GPRA year.
implementing the Transparency Act, months, including information on how GPRA measures to report for FY2016
including the specific requirements for results are shared with the community. include 20 clinical measures and one
DUNS and SAM, can be found on the (2) Improve the IHS: In order to non-clinical measure.
IHS Grants Management, Grants Policy support health care improvement, it
must be demonstrated there is a FY 2016 Clinical GPRA/GPRAMA
Web site: http://www.ihs.gov/dgm/ Measures
policytopics/. willingness to change and improve, i.e.,
in human resources and business 1. Diabetes DX Ever (no target, used
V. Application Review Information practices. for context only).
The instructions for preparing the • Describe activities the UIHP is 2. Documented A1c (no target, used
application narrative also constitute the taking to ensure health care for context only).
evaluation criteria for reviewing and improvement is being applied. 3. Diabetes: Good Glycemic Control
scoring the application. Weights a. Major accomplishments over the (GPRAMA measure).
assigned to each section are noted in last twelve months. 4. Diabetes: Controlled Blood
parentheses. The 25 page narrative b. Activities planned for the first 12 Pressure.
should include only the first year months. 5. Diabetes: Statin Therapy to Reduce
activities; information for multi-year (3) Improve the quality of and access CVD Risk in Patients with Diabetes.
projects should be included as an to care: Customer service is the key to 6. Diabetes: Nephropathy Assessment.
appendix. See ‘‘Multi-year Project quality care. Treating patients well is 7. Influenza Vaccination Rates Among
Requirements’’ at the end of this section the first step to improving quality and Children 6 months to 17 years.
for more information. The narrative access. This area also incorporates best 8. Influenza Vaccination Rates Among
should be written in a manner that is practices in customer service. Adults 18+.
clear to outside reviewers unfamiliar • Identify activities that demonstrate 9. Pneumococcal Immunization 65+.
with prior related activities of the the UIHP improving quality of and 10. Childhood Immunizations
applicant. It should be well organized, access to care. (GPRAMA).
succinct, and contain all information a. Major accomplishments over the 11. Pap Screening Rates.
necessary for reviewers to understand last twelve months. 12. Mammography Screening Rates.
the project fully. Points will be assigned b. Activities planned for the first 12 13. Colorectal Cancer Screening Rates.
to each evaluation criteria adding up to months. 14. Tobacco Cessation.
(4) Ensure that our work is 15. Alcohol Screening (FAS
a total of 100 points. A minimum score
transparent, accountable, fair, and Prevention).
of 60 points is required for funding.
inclusive: Quality health care needs to 16. Domestic Violence/Intimate
Points are assigned as follows:
be transparent, with all parties held Partner Violence Screening.
1. Criteria accountable for that care. Accountability 17. Depression Screening (GPRAMA).
The narrative should address program for services is emphasized. 18. HIV Screening.
progress for the first 12 months. • Describe activities that demonstrate 19. Breastfeeding Rates.
how this is implemented in the UIHP 20. Childhood Weight Control (long-
A. Introduction and Need for Assistance program. term measures, result will be reported in
(30 Points) a. Major accomplishments over the FY2016).
1. Facility Capability last twelve months.
FY 2016 NON CLINICAL GPRA/
b. Activities planned for the first 12
Urban Indian programs provide health GPRAMA MEASURE
months.
care services within the context of IHS 1. Suicide Surveillance (RPMS
Strategic Plan and four IHS priorities. b. GPRA Reporting Programs only).
Describe the UIHP: (1) All UIHPs report on IHS GPRA/ FY 2016 measure targets are attached.
Accomplishments over the past twelve GPRAMA clinical performance Note that since 2013, urban measure
months, and (2) define activities measures. This is required of both urban targets are the same as the targets for
planned for the 2016 budget period in facilities using the Resource and Patient Tribal and Federal health programs.
each of the following areas: Management System (RPMS) and 1. The following GPRAMA measures
a. IHS Priorities for American Indian/ facilities not using RPMS. RPMS users should be prioritized for target
Alaska Native Health Care. Current must use the Clinical Reporting System achievement: Good Glycemic Control,
governmental trends and environmental (CRS) for reporting. Non-RPMS users Childhood Immunizations and
issues impact AI/ANs residing in urban must perform a 100% audit of all Depression Screening. Briefly describe
locations and require clear and records and report results on an Excel the steps/activities you will take to
consistent support by the Title V funded template provided by the National ensure your program meets the FY 2016
jstallworth on DSK7TPTVN1PROD with NOTICES

UIHP. The IHS Web site is http:// GPRA Support Team (NGST) as per the target rates for these measures.
www.ihs.gov. quarterly reporting instructions 2. Describe at least two actions you
(1) Renew and strengthen our distributed by the NGST. Questions will complete to meet the FY 2016
partnerships with Tribes and urban related to GPRA reporting may be GPRA/GPRAMA performance targets. A
Indian health programs: The UIHPs directed to the IHS Area Office GPRA Performance Improvement Toolbox with
have a hybrid relationship with the IHS. Coordinator or the National GPRA information on clinical GPRA measures,
With the passage of Pubic Law 111–148, Support Team at caogpra@ihs.gov. screening tools, and guidelines is

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available on the CRS Web site at: ‘‘Urban Indian’’ eligible for services, as activities that: (1) Were accomplished
http://www.ihs.gov/crs/toolbox/http:// codified at 25 U.S.C. 1603(13), (27), and over the last 10 months, and (2) are
www.ihs.gov/crs/ (28), includes any individual who: planned and will be conducted between
index.cfm?module=crs_performance_ 1. Resides in an urban center, which your UIHP and the IHS Area Office HP/
improvement_toolbox. is any community that has a sufficient DP Coordinator during the budget
3. GPRA Behavioral Health urban Indian population with unmet period April 1, 2016 through March 31,
performance measures include Alcohol health needs to warrant assistance 2017.
Screening (to prevent Fetal Alcohol under the IHCIA, as determined by the c. An example of an HP/DP work plan
Syndrome), Domestic (Intimate Partner) Secretary, HHS; and who is provided on the following pages.
Violence Screening and Depression 2. Meets one or more of the following Develop and attach a copy of the UIHP
Screening (for adults over age 18). criteria: HP/DP Work Plan for the first 12
Describe actions you will take to a. Irrespective of whether he or she months.
improve 2015–2016 desired behavioral lives on or near a reservation, is a
health performance outcomes/results. member of a Tribe, band, or other 2. IMMUNIZATION SERVICES
4. Document your ability to collect organized group of Indians, including: a. Program Management Required
and report on the required performance i. Those Tribes, bands, or groups Activities
measures to meet GPRA requirements. terminated since 1940, and
ii. those recognized now or in the i. Provide assurance that your facility
Include information about your health is participating in the Vaccines for
information technology system. future by the State in which they reside,
or Children program.
c. Schedule of Charges and
b. Is a descendant, in the first or ii. Provide assurance that your facility
Maximization of Third Party Payments
1. Describe the UIHP established second degree, of any such member has look up capability with State/
schedule of charges and consistency described in a.; or regional immunization registry (where
c. Is an Eskimo or Aleut or other applicable). Contact Cecile Town at
with local prevailing rates.
Alaska Native; or cecile.town@ihs.gov, IHS Immunization
• If the UIHP is not currently billing d. Is a California Indian; 1 or
for billable services, describe the Data Exchange Coordinator, for more
e. Is considered by the Secretary of information.
process the UIHP will take to begin the Department of the Interior to be an
third party billing to maximize Indian for any purpose; or b. Service Delivery Required
collections. f. Is determined to be an Indian under Activities—For Sites Using RPMS
2. Describe how reimbursement is regulations pertaining to the Urban
maximized from Medicare, Medicaid, i. Provide trainings to providers and
Indian Health Program that are data entry clerks on the RPMS
State Children’s Health Insurance promulgated by the Secretary, HHS.
Program, private insurance, etc. Immunization package.
Each grantee is responsible for taking ii. Establish process for immunization
3. Describe how the UIHP achieves reasonable steps to confirm that the
cost effectiveness in its billing data entry into RPMS (e.g., point of
individual is eligible for IHS services as service or through regular data entry).
operations with a brief description of an urban Indian.
the following: iii. Utilize RPMS Immunization
a. Establishes appropriate eligibility 1. HP/DP package to identify 3–27 month old
determination. Contact your IHS Area Office HP/DP children who are not up to date and
b. Reviews/updates and implements Coordinator to discuss and identify generate reminder/recall letters.
up-to-date billing and collection effective and innovative strategies to c. Immunization Coverage Assessment
practices. promote health and enhance prevention Required Activities
c. Updates insurance at every visit. efforts to address chronic diseases and
d. Maintains procedures to evaluate conditions. Identify one or more of the i. Submit quarterly immunization
necessity of services. strategies you will conduct during the reports to Area Immunization
e. Identifies and describes financial first 12 months. Coordinator for the 3–27 month old,
information systems used to track, a. Applicants are encouraged to use Two year old and Adolescent, Influenza
analyze and report on the program’s evidence-based and promising strategies and Adult reports. Sites not using the
financial status by revenue generation, which can be found at the IHS best RPMS Immunization package should
by source, aged accounts receivable, practice database httpp://www.ihs.gov/ submit a Two Year old immunization
provider productivity, and encounters hpdp/, the National Registry for coverage report—an Excel spreadsheet
by payor category. Effective Programs at http:// with the required data elements that can
f. Indicates the date the UIHP last www.nrepp.samhsa.gov/, and the Guide be found under the ‘‘Report Forms for
reviewed and updated its Billing to Community Preventive Services at non-RPMS sites’’ section at: http://
Policies and Procedures. http://www.thecommunityguide.org/ www.ihs.gov/epi/
about/conclusionreport.html. index.cfm?module=epi_vaccine_reports.
B. Program Narratives and Work Plans
b. Program Narrative. Provide a brief d. Program Evaluation Required
(40 Points)
description of the collaboration Activities
A program narrative and a program
specific work plan are required for each 1 Consistent with 25 U.S.C. 1603(3), (13), (28), i. Report coverage with the 4313314*
health services program: (1) HD/DP, (2) and 1679, eligibility of California Indians may be vaccine series for children 19–35
demonstrated by documentation that the months old.
Immunizations, (3) Alcohol/Substance
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individual:
Abuse, and (4) Mental Health. Title V of (1) Is a descendant of an Indian who was residing ii. Report coverage for patients (6
the IHCIA, Public Law 94–437, as in the State of California on June 1, 1852; months and older) who received at least
amended, identifies eligibility for health (2) Holds trust interests in public domain, one dose of seasonal flu vaccine during
services as follows. national forest, or Indian reservation allotments; or flu season.
(3) Is listed on the plans for distribution of assets
Each grantee shall provide health care of California Rancherias and reservations under the
iii. Report coverage for children 6
services to eligible urban Indians living Act of August 18, 1958 (72 Stat. 619), or is the months–17 years and adults 18 years
within the urban service area. An descendant of such an individual. and older who received at least one dose

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13388 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

1. Categorical Budget (Form SF 424A, contact form) needed for an otherwise project director that an award has been
Budget Information Non-Construction complete application. All missing made to their organization is not an
Programs) complete each of the budget documents must be sent to DGM on or authorization to implement their
periods requested. before the due date listed in the email program on behalf of IHS.
a. Provide a narrative justification for of notification of missing documents
2. Administrative Requirements
all costs, explaining why each line item required.
is necessary or relevant to the proposed To obtain a minimum score for Grants are administered in accordance
project. Include sufficient details to funding by the ORC, applicants must with the following regulations, policies,
facilitate the determination of cost address all program requirements and and OMB cost principles:
allowability. provide all required documentation. A. The criteria as outlined in this
b. If indirect costs are claimed, program announcement.
indicate and apply the current VI. Award Administration Information B. Administrative Regulations for
negotiated rate to the budget. Include a 1. Award Notices Grants:
copy of the current rate agreement in the • Uniform Administrative
The Notice of Award (NoA) is a Requirements for HHS Awards, located
appendix.
legally binding document signed by the at 45 CFR part 75.
Multi-Year Project Requirements Grants Management Officer and serves C. Grants Policy:
Projects requiring a second and/or as the official notification of the grant • HHS Grants Policy Statement,
third year must include a brief project award. The NoA will be initiated by the Revised 01/07.
narrative and budget (one additional DGM in our grant system, D. Cost Principles:
page per year) addressing the GrantSolutions (https:// • Uniform Administrative
developmental plans for each additional www.grantsolutions.gov). Each entity Requirements for HHS Awards, ‘‘Cost
year of the project. that is approved for funding under this Principles,’’ located at 45 CFR part 75,
announcement will need to request or subpart E.
Additional Documents Can Be have a user account in GrantSolutions E. Audit Requirements:
Uploaded as Appendix Items in in order to retrieve their NoA. The NoA • Uniform Administrative
Grant.gov is the authorizing document for which Requirements for HHS Awards, ‘‘Audit
• Work Plan, logic model and/or time funds are dispersed to the approved Requirements,’’ located at 45 CFR part
line for proposed objectives. entities and reflects the amount of 75, subpart F.
• Position descriptions for key staff. Federal funds awarded, the purpose of
3. Indirect Costs
• Resumes of key staff that reflect the grant, the terms and conditions of
current duties. the award, the effective date of the This section applies to all grant
• Consultant or contractor proposed award, and the budget/project period. recipients that request reimbursement of
scope of work and letter of commitment indirect costs (IDC) in their grant
Disapproved Applicants
(if applicable). application. In accordance with HHS
• Current Indirect Cost Agreement. Applicants who received a score less Grants Policy Statement, Part II–27, IHS
• Organizational chart. than the recommended funding level for requires applicants to obtain a current
• Map of area identifying project approval, 60 points, and were deemed IDC rate agreement prior to award. The
location(s). to be disapproved by the ORC, will rate agreement must be prepared in
• Additional documents to support receive an Executive Summary accordance with the applicable cost
narrative (i.e. data tables, key news Statement from the IHS program office principles and guidance as provided by
articles, etc.). within 30 days of the conclusion of the the cognizant agency or office. A current
ORC outlining the strengths and rate covers the applicable grant
2. Review and Selection
weaknesses of their application activities under the current award’s
Each application will be prescreened submitted. The IHS program office will budget period. If the current rate is not
by the DGM staff for eligibility and also provide additional contact on file with the DGM at the time of
completeness as outlined in the funding information as needed to address award, the IDC portion of the budget
announcement. Applications that meet questions and concerns as well as will be restricted. The restrictions
the eligibility criteria shall be reviewed provide technical assistance if desired. remain in place until the current rate is
for merit by the ORC based on provided to the DGM.
evaluation criteria in this funding Approved But Unfunded Applicants
Generally, IDC rates for IHS grantees
announcement. The ORC could be Approved but unfunded applicants are negotiated with the Division of Cost
composed of both Tribal and Federal that met the minimum scoring range Allocation (DCA) https://rates.psc.gov/
reviewers appointed by the IHS Program and were deemed by the ORC to be and the Department of Interior (Interior
to review and make recommendations ‘‘Approved,’’ but were not funded due Business Center) https://www.doi.gov/
on these applications. The technical to lack of funding, will have their ibc/services/finance/indirect-Cost-
review process ensures selection of applications held by DGM for a period Services/indian-tribes. For questions
quality projects in a national of one year. If additional funding regarding the indirect cost policy, please
competition for limited funding. becomes available during the course of call the Grants Management Specialist
Incomplete applications and FY 2016, the approved, but unfunded, listed under ‘‘Agency Contacts’’ or the
applications that are non-responsive to application may be re-considered by the main DGM office at (301) 443–5204.
the eligibility criteria will not be awarding program office for possible
jstallworth on DSK7TPTVN1PROD with NOTICES

referred to the ORC. The applicant will funding. The applicant will also receive 4. Reporting Requirements
be notified via email of this decision by an Executive Summary Statement from The grantee must submit required
the Grants Management Officer of the the IHS program office within 30 days reports consistent with the applicable
DGM. Applicants will be notified by of the conclusion of the ORC. deadlines. Failure to submit required
DGM, via email, to outline minor Note: Any correspondence other than reports within the time allowed may
missing components (i.e., budget the official NoA signed by an IHS grants result in suspension or termination of
narratives, audit documentation, key management official announcing to the an active grant, withholding of

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13390 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

Recipients will be required to sign the Health Service must require a non- Indian Health Programs, 5600 Fishers
HHS–690 Assurance of Compliance federal entity or an applicant for a Lane, Mail Stop: 08E65B, Rockville, MD
form which can be obtained from the federal award to disclose, in a timely 20857, Phone: (301) 443–4680, Fax:
following Web site: http://www.hhs.gov/ manner, in writing to the IHS or pass- (301) 443–4794, Email: Rick.Mueller@
sites/default/files/forms/hhs-690.pdf, through entity all violations of federal ihs.gov.
and send it directly to the: U.S. criminal law involving fraud, bribery,or 2. Questions on grants management
Department of Health and Human gratutity violations potentially affecting and fiscal matters may be directed to:
Services, Office of Civil Rights, 200 the federal award. Pallop Chareonvootitam, Grants
Independence Ave. SW., Washington, Submission is required for all Management Specialist, 5600 Fishers
DC 20201. applicants and recipients, in writing, to Lane, Mail Stop: 09E70, Rockville, MD
H. Federal Awardee Performance and the IHS and to the HHS Office of 20857, Phone: (301) 443–5204, Fax:
Integrity Information System (FAPIIS) Inspector General all information 301–594–0899, Email:
related to violations of federal criminal Pallop.Chareonvootitam@ihs.gov.
The IHS is required to review and law involving fraud, bribery, or gratuity
consider any information about the 3. Questions on systems matters may
violations potentially affecting the
applicant that is in the Federal Awardee be directed to: Paul Gettys, Grant
federal award. 45 CFR 75.113
Performance and Integrity Information Systems Coordinator, 5600 Fishers
Disclosures must be sent in writing to:
System (FAPIIS) before making any Lane, Mail Stop: 09E70, Rockville, MD
U.S. Department of Health and Human
award in excess of the simplified 20857, Phone: (301) 443–2114; or the
Services, Indian Health Service,
acquisition threshold (currently DGM main line (301) 443–5204, Fax:
Division of Grants Management, ATTN:
$150,000) over the period of (301) 594–0899, E-Mail: Paul.Gettys@
Robert Tarwater, Director, 5600 Fishers
performance. An applicant may review ihs.gov.
Lane, Mailstop 09E70, Rockville,
and comment on any information about Maryland 20857. (Include ‘‘Mandatory VIII. Other Information
itself that a federal awarding agency Grant Disclosures’’ in subject line) Ofc:
previously entered. IHS will consider (301) 443–5204 Fax: (301) 594–0899 The Public Health Service strongly
any comments by the applicant, in Email: Robert.Tarwater@ihs.gov. encourages all cooperative agreement
addition to other information in FAPIIS and contract recipients to provide a
AND
in making a judgment about the smoke-free workplace and promote the
applicant’s integrity, business ethics, U.S. Department of Health and non-use of all tobacco products. In
and record of performance under federal Human Services, Office of Inspector addition, Public Law 103–227, the Pro-
awards when completing the review of General, ATTN: Mandatory Grant Children Act of 1994, prohibits smoking
risk posed by applicants as described in Disclosures, Intake Coordinator, 330 in certain facilities (or in some cases,
45 CFR 75.205. Independence Avenue SW., Cohen any portion of the facility) in which
As required by 45 CFR part 75 Building, Room 5527, Washington, DC regular or routine education, library,
Appendix XII of the Uniform Guidance, 20201. URL: http://oig.hhs.gov/fraud/ day care, health care, or early childhood
non-federal entities (NFEs) are required reportfraud/index.asp. (Include development services are provided to
to disclose in FAPIIS any information ‘‘Mandatory Grant Disclosures’’ in children. This is consistent with the
about criminal, civil, and administrative subject line) Fax: (202) 205–0604 HHS mission to protect and advance the
proceedings, and/or affirm that there is (Include ‘‘Mandatory Grant Disclosures’’ physical and mental health of the
no new information to provide. This in subject line) or Email: American people.
applies to NFEs that receive federal MandatoryGranteeDisclosures@
oig.hhs.gov. Dated: March 4, 2016.
awards (currently active grants,
cooperative agreements, and Failure to make required disclosures Elizabeth Fowler,
procurement contracts) greater than can result in any of the remedies Deputy Director for Management Operations,
$10,000,000 for any period of time described in 45 CFR 75.371 Remedies Indian Health Service.
during the period of performance of an for noncompliance, including Sample 2016 HP/DP Work Plan
award/project. suspension or debarment (See 2 CFR
parts 180 and 376 and 31 U.S.C. 3321). Goal: To address physical inactivity
Mandatory Disclosure Requirements and consumption of unhealthy food
As required by 2 CFR part 200 of the VII. Agency Contacts among youth who are in the 4th to 6th
Uniform Guidance, and the HHS 1. Questions on the programmatic grade in the Watson, Kennedy,
implementing regulations at 45 CFR part issues may be directed to: Rick Mueller, Blackwood, and Rocky Hill Elementary
75, effective January 1, 2016, the Indian Public Health Advisor, Office of Urban schools.
Objectives Activities/time line Person responsible Evaluation

1. Develop school policies to address phys- 1. Schedule a meeting with the school health Program Coordinator Progress report on status of policy and docu-
ical inactivity and consumption of board in the first quarter of the project. School Adminis- mentation of number of participants in par-
unhealthy foods in the first year of the 2. Establish a parent advisory committee to trator. ent advisory committee, and number of
funding year. assist with the development of the policy in meetings held.
2nd quarter.
2. Implement a classroom nutrition curriculum 1. Design pre/post test survey and pilot test Program Coordinator Pre/post knowledge, attitude, and behavior
to increase awareness about the impor- with group of students by 2nd quarter. IHS Nutritionist. survey.
tance of healthier foods in the four inter- 2. Schedule a meeting with the School Prin- Document the number of students who are
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vention schools by year two of the funding cipal to discuss dates of program imple- receiving nutrition education.
year. mentation by 3rd quarter.
3. Implement the ‘‘Healthy Eating’’ cur-
riculum, a 6 week program in the 2nd
quarter.
4. Collect pre/post survey at beginning and
end of the program to assess changes.

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Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices 13391

Objectives Activities/time line Person responsible Evaluation

3. Implement physical activity in at least four 1. Contract with SPARK PE to train class- Program Coordinator 1. Training evaluation and number of partici-
schools for grades 4th to 6th in first year of room teachers to implement SPARK PE in School Counselor pants.
the funding. the school by 3rd Quarter. and PE teacher. 2. Pre/post FITNESSGRAM Data.
2. Train volunteers to administer
FITNESSGRAM to collect baseline data
and post data to assess changes.

Sample 2016 HP/DP Work Plan
Goal: To reduce tobacco use among
residents of community X and Y.

Objectives Activities/time line Person responsible Evaluation

1. Establish a tobacco-free policy in the 1. Schedule a meeting with the Tribal Tobacco Coordi- Documentation of the number of par-
schools and Tribal buildings in com- Council and school board to in- nator. ticipants.
munity X and Y by year 1. crease awareness of the health ef-
fects of tobacco by June 2016.
2. Schedule and conduct tobacco Tobacco Coordi- Documentation of the number of par-
awareness education in the commu- nator, Health Ed- ticipants.
nity, schools, and worksites by July ucator.
2016 through September 2017.
3. Draft a policy and present to the Documentation of whether the policy
Tribal Council for approval by Janu- was established.
ary 2017
2. Coordinate and establish tobacco 1. Partner with American Cancer Asso- Tobacco Coordi- Progress toward timeline.
cessation programs with the local ciation and the Tribal Health Edu- nator, Health Ed-
hospitals and clinics in X and Y com- cation Coordinators to establish 8- ucator Phar-
munities. week tobacco cessation programs macist.
by July 2016.
2. Meet with the hospital/clinic admin- Tobacco Coordi- Progress report indicating timeline is
istrators and pharmacist to discuss nator, Health Ed- being met.
and develop a behavior-based to- ucator.
bacco cessation program.
3. Train staff in tobacco cessation Tobacco Coordi- # of staff trained in tobacco cessation.
counseling. nator.
Design and disseminate brochures and Tobacco Coordi- # of brochures distributed.
flyers of tobacco cessation program nator.
that are available in the community
and clinic.
4. Meet with nursing and medical pro- Health Educator, # of staff trained and document,
vider staff to increase patient referral Tobacco Coordi- changes in practice.
to tobacco cessation program. nator.
6. Implement the 8-week tobacco ces- Tobacco Coordi- RPMS data—baseline # of referrals, #
sation program at the community X nator. of participants who completed pro-
and Y clinic. gram, # who quit tobacco.

Sample Urban Grant FY 2016 Work
Plan

IMMUNIZATION
Primary prevention Service or program Target population Process measure Outcome measures
objective

Protect children and Immunization Pro- Children <3 years On a quarterly basis: As of June 30th, 2016:
communities from gram. # of children 3–27 months old ............ # of 19–35 month olds up to date with
vaccine prevent- # of children 3–27 months old who the 4313314 vaccine series.
able diseases. are up to date with age appropriate % of 19–35 month olds up to date
vaccinations. with the 4313314 vaccine series.
% of 3–27 month old children up to
date with age appropriate vaccina-
tions.
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# of children 19–35 months old
# of children 19–35 months old who
received the 4313314 vaccine se-
ries.
% of children 19–35 months old who
received the 4313314 vaccine se-
ries.

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13392 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices

IMMUNIZATION—Continued
Primary prevention Service or program Target population Process measure Outcome measures
objective

Protect adolescents Immunization Pro- Adolescents 13–17 On a quarterly basis: As of June 30th, 2016:
and communities gram. years. # of adolescents 13–17 years old ....... # of adolescents 13–17 years old who
from vaccine pre- # of adolescents 13–17 years old who are up to date with Tdap,
ventable diseases. are up to date with Tdap, Meningococcal and 3 doses of
Meningococcal, and 3 doses of HPV.
HPV (males and females). % of adolescents 13–17 years old
% of adolescents 13–17 years old who are up to date with Tdap,
who are up to date with Tdap, Meningococcal and 3 doses of
Meningococcal, and 3 doses of HPV.
HPV (males and females)
Protect adults and Immunization Pro- 6 months and On a quarterly basis during flu season As of June 30th, 2016:
communities from gram. older. (e.g., Sept–June) # of patients in each age group who
influenza. # of patients 6 months or older received a seasonal flu shot during
# of patients 6 months–17 years the flu season.
# of patients 18 years and older % of patients. in each age group who
# of patients in each age group who received a seasonal flu shot during
received a seasonal flu shot during flu season.
the flu season
% of patients in each age group who
received a seasonal flu shot during
flu season
Protect adults and Immunization Pro- Adults ≥ 65 years On a quarterly basis: As of June 30th, 2016:
communities from gram. # of adults ≥ 65 years ......................... # of adults ≥ 65 years.
influenza & # of adults ≥ 65 years who received a % of adults ≥ 65+ years who received
Pneumovax. pneumovax shot a pneumovax shot ever.
% of adults ≥ 65+ years who received
a pneumovax shot

IHS URBAN GRANT FY 2016 WORK PLAN
[Alcohol/Substance Abuse Program Sample Work Plan]

Objectives Service or program Target population Process measure Outcome measures Data source for
measures
What information will
Who do you hope to What information will
What are you trying to What type of program you collect to find out Where will you find
serve in your pro- you collect about the
accomplish? do you propose? the results of your the information you
gram? program activities? program? collect?

To prevent substance Community-based American Indian # of youth completing Incidence/prevalence Medical records,
abuse among urban substance abuse youth ages 5–18 the curriculum, # of of substance RPMS behavioral
American Indian prevention cur- years old. sessions con- abuse/dependence. health package,
youth. riculum. ducted, # of staff National Youth Sur-
trained. vey.
To prevent substance After-school, summer, American Indian # of youth completing Incidence of sub- Charts, RPMS behav-
abuse and related and weekend ac- youth ages 5–14 community-based stance abuse, inci- ioral health pack-
problems. tivities (e.g. outdoor years old. sessions, # of par- dence of negative age, National Youth
experiential activi- ents completing and positive atti- Survey.
ties, camps, class- community-based tudes and behav-
room based prob- sessions, # of com- iors, incidence of
lem solving activi- munity-based ses- peer drug use.
ties). sions.
Reduce drug use and Matrix model for out- American Indian adult # of clients com- Incidence of drug Medical records,
increase treatment patient treatment. methamphetamine pleting program, # use, increase or RPMS behavioral
retention. clients. of relapse preven- decrease in treat- health package,
tion sessions, # of ment retention, Addiction Severity
family and group positive or negative Index, results of
therapies, # of drug urine samples. urine tests.
education sessions,
# of self-help
groups, # of urine
tests.
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Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices 13393

IHS URBAN GRANT FY 2016 WORK PLAN
[Mental Health Program Sample Work Plan]

Objectives Service or program Target population Process measure Outcome measures Data source for
measures
What information will
Who do you hope to What information will
What are you trying to What type of program you collect to find out Where will you find
serve in your pro- you collect about the
accomplish? do you propose? the results of your the information you
gram? program activities? program? collect?

To promote mental American Indian Life American Indian # of youth completing Feelings of hopeless- Medical records,
health. Skills Development youth ages 13–17 the curriculum, # of ness, problem solv- RPMS behavioral
curriculum. years old. sessions con- ing skills. health package,
ducted, # of teach- Beck Hopelessness
ers trained, number Scale, problem
of community re- solving skills.
source leaders
trained.
Improve the mental Home-based, com- American Indian chil- # of individual, cou- Reduced child in- Medical records,
health of American munity-based, and dren and their fami- ples, group, and volvement in juve- RPMS behavioral
Indian children and office-based mental lies needing serv- family counseling nile justice and health package
their families. health counseling. ices from our com- sessions, # of child welfare, im- coping skill meas-
munity-based pro- home, community, proved coping ure, report cards,
gram. and office-based skills, improved attendance records.
visits. school attendance
and grades.
Reduce symptoms re- Mental health coun- American Indian # of individual, cou- Incidence of Post- Self-report PTSD,
lated to trauma. seling with cog- adults. ples, group, and Traumatic Stress Beck Depression
nitive behavioral family counseling Disorder (PTSD) Inventory, coping
therapy intervention sessions, # of his- symptoms, inci- skills measure,
and historical trau- torical trauma dence of depres- peer and family
ma intervention. groups, # of adults sion, increased support measure,
counseled. coping skills, in- medical records,
creased peer and RPMS behavioral
family support. health package.

RPMS Suicide Reporting Form HEALTH RECORD NUMBER: and plan, or other acts with higher
Record the patient’s health record severity, either attempted or completed.
Instructions for Completing
number. LOCATION OF ACT:
This form is intended as a data
collection tool only. It does not replace DOB/AGE: Indicate location of act, choose one.
documentation of clinical care in the Record Date of Birth as mm/dd/yy PREVIOUS ATTEMPTS:
medical record and it is not a referral and patient’s age.
form. HRN, Date of Act and Provider Indicate number of previous suicide
Name are required fields. If the SEX: attempts, choose one.
information requested is not known or Indicate Male or Female. METHOD:
not listed as an option, choose
COMMUNITY WHERE ACT Indicate method used. Multiple
‘‘Unknown’’ or ‘‘Other’’ (with
OCCURRED: entries are allowed, check all that apply.
specification) as appropriate. The form
Describe methods not listed.
can be partially completed, saved and Record the community code or the
completed at a later time if needed. name, county and state of the SUBSTANCE USE INVOLVED:
LOCAL CASE NUMBER: community where the act occurred. If known, indicate which substances
EMPLOYMENT STATUS: the patient was under the influence of
Indicate internal tracking number if at the time of the act. Multiple entries
used, not required. Indicate patient’s employment status, allowed, check all that apply. List drugs
DATE FORM COMPLETED: choose one. not shown.
Indicate the date the Suicide RELATIONSHIP STATUS: CONTRIBUTING FACTORS:
Reporting Form was completed. Indicate patient’s relationship status, Multiple entries allowed, check all
choose one. that apply. List contributing factors not
PROVIDER NAME:
EDUCATION: shown.
Record the name of Provider
completing the form. Select the highest level of education DISPOSITION:
jstallworth on DSK7TPTVN1PROD with NOTICES

attained and if less than a High School Indicate the type of follow-up
DATE OF ACT:
graduate, record the highest grade planned, if known.
Record Date of Act as mm/dd/yy. If completed. Choose one.
exact day is unknown, use the month, NARRATIVE:
1st day of the month (or another default SUICIDAL BEHAVIOR:
Record any other relevant clinical
day), year. If exact date of act is Identify the self-destructive act, information not included above.
unknown, all providers should use the choose one. Generally, the threshold for Last Updated 10/25/12
same default day of the month. reporting should be ideation with intent BILLING CODE 4165–16–P

VerDate Sep<11>2014 14:27 Mar 11, 2016 Jkt 238001 PO 00000 Frm 00084 Fmt 4703 Sfmt 4703 E:\FR\FM\14MRN1.SGM 14MRN1

Document Created: 2016-03-12 01:00:00
Document Modified: 2016-03-12 01:00:00

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Dates		May 15, 2016.
FR Citation		81 FR 13380

81 FR 13380 - Office of Urban Indian Health Programs; 4-in-1 Grant Programs; Announcement Type: New and Competing Continuation Funding Announcement Number: HHS-2016-IHS-UIHP2-0001; Catalogue of Federal Domestic Assistance Number: 93.193

DEPARTMENT OF HEALTH AND HUMAN SERVICESIndian Health Service

Federal Register Volume 81, Issue 49 (March 14, 2016)

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service