Draft Program Announcement and Availability of Funds for Fiscal Year 1997 Cooperative Agreements for Community-Based Human Immunodeficiency Virus (HIV) Prevention Projects

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Announcement No. 704]

Draft Program Announcement and Availability of Funds for Fiscal

Year 1997 Cooperative Agreements for Community-Based Human

Immunodeficiency Virus (HIV) Prevention Projects

Agency: Centers for Disease Control and Prevention (CDC), Department of

Health and Human Services.

Action: Request for comments.

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Summary: CDC is preparing to announce the availability of fiscal year

(FY) 1997 funds to support HIV prevention projects for minority and

other community-based organizations (CBOs). This program will assist

the Nation's disease prevention efforts by providing assistance to CBOs

in developing and implementing effective community-based HIV prevention

programs and promoting collaboration and coordination of HIV prevention

efforts among CBOs and local activities of HIV prevention service

agencies, public agencies including local and State health departments

(and HIV prevention community planning groups), substance abuse

agencies, educational agencies, criminal justice systems, and

affiliates of national and regional organizations. Because of the

unique nature of this program, CDC invites comments from organizations

and individuals on the draft of this announcement. Based on comments

received, the final announcement is expected to be published in

September 1996.

Dates: Written comments to this notice should be submitted to the

Office of the Director, National Center for HIV, STD, and TB

Prevention, Attention: Gary West, Centers for Disease Control and

Prevention (CDC), Mailstop D-21, Altanta, GA 30333. Comments must be

received on or before September 16, 1996.

For Further Information Contact: Gary West, Office of the Director,

National

[[Page 42620]]

Center for HIV, STD and TB Prevention, telephone (404) 639-0902.

Supplementary Information: The following is the complete text of the

draft program announcement for community-based human immunodeficiency

virus (HIV) prevention projects.

Introduction

The Centers for Disease Control and Prevention (CDC) announces the

availability of fiscal year (FY) 1997 funds for cooperative agreements

for HIV prevention projects for minority and other community-based

organizations (CBOs) serving populations at increased risk of acquiring

or transmitting HIV infection.

(A cooperative agreement is a legal agreement between CDC and the

recipient in which CDC provides financial assistance and substantial

Federal programmatic involvement with the recipient during the

performance of the project.)

Preapplication technical assistance workshops to assist all

prospective applicants for these projects will be held during October

and November 1996. The purpose of these workshops is to assist

prospective applicants in understanding CDC application requirements

and program priorities. During the workshops, information will be

presented on application and business management requirements,

programmatic priorities, HIV prevention community planning, and how to

access additional preapplication resources relevant to application

development. Prospective applicants are encouraged to attend a workshop

in their area. For additional information on the preapplication

workshops in your area (a schedule will be included in the final

announcement), please contact your State or local health department or

CDC at telephone (404) 639-8317.

CDC is committed to achieving the health promotion and disease

prevention objectives of Healthy People 2000, a national activity to

reduce morbidity and mortality and improve the quality of life. This

announcement relates to the priority areas of Educational and

Community-Based Programs, HIV Infection, and Sexually Transmitted

Diseases (STDs). It addresses the ``Healthy People 2000'' objectives by

providing support for primary prevention for persons at increased risk

for HIV infection and by increasing the availability and coordination

of prevention and early intervention services for HIV-infected persons.

A summary of the HIV-related objectives will be included in the

application kit. (To order a copy of ``Healthy People 2000,'' see the

section entitled ``Where to Obtain Additional Information.'')

Authority

This program is authorized under section 317(k)(2) [42 U.S.C.

247b(k)(2)] of the Public Health Service Act, as amended.

Smoke-Free Workplace

CDC strongly encourages all grant recipients to provide a smoke-

free workplace and promote the non-use of all tobacco products, and

Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in

certain facilities that receive Federal funds in which education,

library, day care, health care, and early childhood development

services are provided to children.

Eligible Applicants

To be eligible for funding under this announcement, applicants must

be a tax-exempt, non-profit CBO whose net earnings in no part accrue to

the benefit of any private shareholder or person. Tax-exempt status is

determined by the Internal Revenue Service (IRS) Code, Section

501(c)(3). Tax-exempt status may be proved by either providing a copy

of the pages from the IRS' most recent list of 501(c)(3) of tax-exempt

organizations or a copy of the current IRS Determination Letter. Proof

of tax-exempt status must be provided with the application.

Note: Organizations described in section 501(c)(4) of the

Internal Revenue Code of 1986 that engage in lobbying are not

eligible to receive Federal grant/cooperative agreement funds.

CBOs may apply as either (1) minority CBOs or (2) CBOs serving

other high-risk populations. To apply as a minority CBO the applicant

organization must have the following: (1) A governing board composed of

more than 50% racial or ethnic minority members, (2) a significant

number of minority individuals in key program positions, and (3) an

established record of service to a racial or ethnic minority community

or communities. In addition, if the applicant organization is a local

affiliate of a larger organization with a national board, the larger

organization must meet the same requirements listed above. If applying

as a minority CBO, proof of minority status must be provided with the

application. Affiliates of national organizations must provide proof of

their national organization's eligibility and include with the

application an original, signed letter from their chief executive

officer assuring their understanding of the intent of this program

announcement and the responsibilities of recipients.

Organizations applying as a CBO serving other high-risk populations

are not required to meet the minority requirements listed above.

CDC will not accept an application without proof of tax-exempt

status, minority status (if applicable), and proof of eligibility for

affiliates of national organizations (if applicable).

Applications requesting funds to support only administrative and

managerial functions will not be accepted.

Governmental or municipal agencies, their affiliate organizations

or agencies (e.g., health departments, school boards, public

hospitals), and private or public universities and colleges are not

eligible for funding under this announcement.

CBOs requesting funds under this announcement will be categorized

into one of two mutually exclusive groups: (1) High prevalence

Metropolitan Statistical Areas (MSAs); or (2) lower prevalence

geographic areas. For the purposes of this program, high prevalence

MSAs are defined by (1) greater than 500 reported AIDS cases in racial

or ethnic minorities (African Americans, Alaskan Natives, American

Indians, Asian Americans, Latinos/Hispanics, and Pacific Islanders) in

the 3-year period 1993, 1994, and 1995, or as Title I eligible

metropolitan areas (EMAs) for FY 1996 under the Ryan White

Comprehensive AIDS Resources Emergency (CARE) Act. (Title I EMAs are

defined as communities which as of March 31, 1995, reported a

cumulative total of more than 20,000 cases of AIDS within the EMA, or

that had a per capita incidence of cumulative cases of AIDS equal to or

exceeding 0.0025.) Eligible high prevalence MSAs (and the corresponding

OMB Federal Identification Processing (FIPS) code) are the following:

Arizona: Phoenix-Mesa (6200)

California: Los Angeles-Long Beach (4480), Oakland (5775), Orange

County (5945), Riverside-San Bernardino (6780), Sacramento (6920), San

Diego (7320), San Francisco (7360), San Jose (7400), Santa Rosa (7500)

Colorado: Denver (2080)

Connecticut: Hartford (3283), New Haven-Bridgeport-Stamford-Danbury-

Waterbury (5483)

Delaware-Maryland: Wilmington-Newark (9160)

District of Columbia-Maryland-Virginia-West Virginia: Washington, D.C.

(8840)

Florida: Ft. Lauderdale (2680), Jacksonville (3600), Miami (5000),

[[Page 42621]]

Orlando (5960), Tampa-St. Petersburg-Clearwater (8280), West Palm

Beach-Boca Raton (8960)

Georgia: Atlanta (520)

Illinois: Chicago (1600)

Louisiana: New Orleans (5560)

Maryland: Baltimore (720)

Massachusetts-New Hampshire: Boston-Worcester-Lawrence-Lowell-Brockton

(1123)

Michigan: Detroit (2160)

Minnesota-Wisconsin: Minneapolis-St. Paul (5120)

Missouri-Kansas: Kansas City (3760)

Missouri-Illinois: St. Louis (7040)

New Jersey: Newark (5640), Jersey City (3640), Bergan-Passaic (875),

Middlesex-Somerset-Hunterdon (5015), Monmouth-Ocean (5190), Vineland-

Millville-Bridgeton (8760)

New York: Duchess County (2281), New York City (5600), Nassau-Suffolk

(5380)

North Carolina-South Carolina: Charlotte-Gastonia-Rock Hill (1520)

Ohio: Cleveland-Lorain-Elyria (1680)

Oregon-Washington: Portland-Vancouver (6440)

Pennsylvania-New Jersey: Philadelphia (6160)

Puerto Rico: Caguas (1310), Ponce (6360), San Juan-Bayamon (7440)

South Carolina: Columbia (1760)

Tennessee-Arkansas-Mississippi: Memphis (4920)

Texas: Austin-San Marcos (640), Dallas (1920), Ft. Worth-Arlington

(2800), Houston (3360), San Antonio (7240)

Virginia-North Carolina: Norfolk-Virginia Beach-Newport News (5720),

Richmond-Petersburg (6760)

Washington: Seattle-Bellevue-Everett (7600)

CBOs not located in the aforementioned list of high prevalence MSAs

will be categorized as lower prevalence geographic areas.

Availability of Funds

In FY 1997, CDC expects a total of up to $17,000,000 to be

available for funding approximately 80 CBOs (70 in high prevalence MSAs

and 10 in lower prevalence geographic areas).

A. High Prevalence MSAs

Up to $16,000,000 of the total $17,000,000 will be made available

to CBOs in high prevalence MSAs. The estimated awards will average

$200,000 and will range from $75,000 to $300,000. In high prevalence

MSAs, $12,000,000 is dedicated to supporting minority CBOs that

represent and serve racial or ethnic minority persons and that meet the

criteria outlined in the section entitled Eligible Applicants. The

remaining $4,000,000 is dedicated to supporting CBOs serving other

high- risk populations in high prevalence MSAs.

B. Lower Prevalence Geographic Areas

The remaining $1,000,000 of the total funds expected will be made

available to fund CBOs in lower prevalence geographic areas. These

estimated awards will average $100,000. Of the $1,000,000 available, up

to $750,000 will support minority CBOs and at least $250,000 will

support CBOs serving other high-risk populations.

These estimates are subject to change based on the following: the

actual availability of funds; the scope and the quality of applications

received; appropriateness and reasonableness of the budget request;

proposed use of project funds; and the extent to which the applicant is

contributing its own resources to HIV/AIDS prevention activities.

However, no organization will be awarded more than $300,000 (direct and

indirect costs) per year. Applications for more than $300,000 will be

deemed ineligible and will not be accepted by CDC.

Funds available under this announcement must support activities

directly related to primary HIV prevention. However, intervention

activities which involve preventing other STDs and drug use as a means

of reducing or eliminating the risk of HIV infection may be supported.

No funds will be provided for direct patient medical care (including

substance abuse treatment, medical prophylaxis or drugs). These funds

may not be used to supplant or duplicate existing funding. Although

applicants may contract with other organizations under these

cooperative agreements, applicants must perform a substantial portion

of the activities (including program management and operations and

delivery of prevention services) for which funds are requested.

Awards will be made for a 12-month budget period within a 3-year

project period. (Budget period is the interval of time into which the

project period is divided for funding and reporting purposes. Project

period is the total time for which a project has been programmatically

approved.)

Noncompeting continuation awards for a new budget period within an

approved project period will be made on the basis of satisfactory

progress in meeting project objectives and the availability of funds.

Progress will be determined by site visits by CDC representatives,

progress reports, and the quality of future program plans. Proof of

eligibility will be required with the noncompeting continuation

application.

Background

The HIV epidemic constitutes a significant threat to the public

health of the United States. There are specific high-risk behaviors

that result in the transmission of HIV. HIV may also be transmitted

perinatally. Some of the important means currently available to reduce

the prevalence of behaviors placing individuals at risk of HIV

infection or transmission include:

A. Effective education and counseling to assist persons in

assessing their own high-risk behaviors and in planning behavior

change; to support and sustain behavior change; and to facilitate

linkages to other needed services;

B. Interpersonal skills training in negotiating and sustaining

appropriate behavior change; and

C. Influencing community norms in support of safer behaviors.

Purpose

This program will provide assistance to CBOs to: (1) Develop and

implement effective community-based HIV prevention programs (see the

section entitled Community Planning for HIV Prevention) consistent with

achieving national program goals, and the HIV prevention priorities

outlined in their State/local health department's comprehensive HIV

prevention plan (where available); and (2) promote collaboration and

coordination of HIV prevention efforts among CBOs and the local

activities of HIV prevention service agencies, public agencies

including local and State health departments (and HIV prevention

community planning groups), substance abuse agencies, educational

agencies, criminal justice systems, and affiliates of national and

regional organizations.

The national strategic goals for HIV, STD, and TB prevention are

to:

A. Increase public understanding of, involvement in, and support

for HIV, STD, and TB prevention.

B. Ensure completion of therapy for persons identified with active

TB or TB infection.

C. Prevent or reduce behaviors or practices that place persons at

risk for HIV and STD infection or, if already infected, place others at

risk.

D. Increase individual knowledge of HIV serostatus and improve

referral systems to appropriate prevention and treatment services.

E. Assist in building and maintaining the necessary State, local,

and community support infrastructure and technical capacity to carry

out prevention programs.

F. Strengthen current systems and develop new systems to accurately

[[Page 42622]]

monitor the HIV epidemic, STDs, and TB, as a basis for assessing and

directing prevention programs.

In order to maximize the effective use of CDC funds, each applicant

must conduct at least one, but no more than two, of the priority Health

Education/Risk Reduction (HE/RR) interventions described below.

Although activities may cross from one intervention type to another

(e.g., individual or group level interventions may be a part of a

community-level intervention), no more than two of the primary

interventions listed below should be undertaken.

HE/RR interventions include programs and services to reach persons

at increased risk of becoming HIV-infected or, if already infected, of

transmitting the virus to others. The goal of HE/RR interventions is to

reduce the risk of these events occurring. These interventions should

be directed to persons whose behaviors or personal circumstances place

them at high risk.

The following have been identified as successful HE/RR

interventions for HIV prevention and will be funded within the scope of

this announcement: Individual Level Interventions (including prevention

case management), Group Level Interventions, Community Level

Interventions, and Street and Community Outreach. The Guidelines for

Health Education and Risk Reduction Activities (included in the

application kit) will provide additional information on these

interventions. A brief description of the priority interventions

follows:

A. Individual Level Interventions provide a range of one-on-one

client services that offer counseling, assist clients in assessing

their own behavior and planning individual behavior change, support and

sustain behavior change, and facilitate linkages to services in clinic

and community settings (e.g., substance abuse treatment programs) in

support of behaviors and practices that prevent the transmission of

HIV. Some clients may be at very high risk of becoming HIV-infected or,

if already infected, of transmitting the virus to others. Additional

prevention counseling, as appropriate to the needs of these clients

should be offered.

Prevention Case Management is an individual level intervention

directed at persons who need highly individualized support, including

substantial psychosocial, interpersonal skills training, and other

support, to remain seronegative or to reduce the risk of HIV

transmission to others. HIV prevention case management services are not

intended as substitutes for medical case management or extended social

services. Services provided under this component should concentrate on

the identification, coordination, and receipt of appropriate prevention

services. Prevention case management services should complement ongoing

HIV prevention services such as HIV antibody counseling, testing,

referral, and partner notification (CTRPN), and early medical

intervention programs. Coordination with HIV counseling and testing

clinics, STD clinics, TB testing sites, substance abuse treatment

programs, and other health service agencies is essential to

successfully recruiting or referring persons at high risk who are

appropriate for this type of intervention.

B. Group Level Interventions shift the delivery of service from

individual to groups of varying sizes. Group level interventions

provide education and support in group settings to promote and

reinforce safer behaviors and to provide interpersonal skills training

in negotiating and sustaining appropriate behavior change to persons at

increased risk of becoming infected or, if already infected, of

transmitting the virus to others. The content of the group session

should be consistent with the format, i.e., groups can meet one time or

on an on-going basis. One-time sessions can provide participants an

opportunity to hear and learn from one another's experiences, role play

with peers, and offer and receive support. Ongoing sessions may offer

stronger social influence with potential for developing emergent norms

that can support risk reduction. A group level intervention can include

more tailored individual level interventions with some of the group

members.

C. Community Level Interventions are directed at changing community

norms, rather than the individual or a group, to increase community

support of the behaviors known to reduce the risk for HIV infection and

transmission. While individual and group level interventions also may

be taking place within the community, interventions that target the

community level are unique in their purpose and are likely to lead to

different strategies than other types of interventions. Community level

interventions aim to reduce risky behaviors by changing attitudes,

norms, and practices through health communications, social (prevention)

marketing, community mobilization and organization, and community-wide

events. The primary goals of these programs are to improve health

status, to promote healthy behaviors, and to change factors that affect

the health of community residents. The community may be defined in

terms of a neighborhood, region, or some other geographic area, but

only as a mechanism to capture the social networks that may be located

within those boundaries. These networks may be changing and

overlapping, but should represent some degree of shared communications,

activities, and interests. Community level interventions are designed

to impact on the social norms or shared beliefs and values held by

members of the community. Specific activities include:

Identifying and describing (through needs assessments and

ongoing feedback from the community) structural, environmental,

behavioral, and psychosocial facilitators and barriers to risk

reduction in order to develop plans to enhance facilitators and

minimize or eliminate barriers.

Developing and implementing, with participation from the

community, culturally competent, developmentally appropriate,

linguistically specific, and sexual-identity-sensitive interventions to

influence specific structural, environmental, behavioral, and

psychosocial factors thought to promote risk reduction.

Persuading community members who are at risk of acquiring

or transmitting HIV infection to accept and use HIV prevention

measures.

D. Street and Community Outreach Interventions are defined by their

locus of activity and by the content of their offerings. Street and

community outreach programs reach persons at high risk, individually or

in small groups, on the street or in community settings, and provide

them prevention messages, information materials, and other services,

and assist them in obtaining other primary and secondary HIV-prevention

services such as HIV-antibody counseling and testing, HIV risk-

reduction counseling, STD and TB treatment, substance abuse prevention

and treatment, family planning services, tuberculin testing, and HIV

medical intervention. Street and Community Outreach is an activity

conducted outside a more traditional, institutional health care setting

for the purpose of providing direct HE/RR services or referrals. The

fundamental principle of these outreach activities is that the outreach

worker/specialist establishes face-to-face contact with the client in

his/her own environment to provide HIV/AIDS risk reduction information,

services, and referrals.

Community Planning for HIV Prevention

In 1994, the 65 State and local health departments that received

CDC Federal funds for HIV prevention began an HIV

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prevention community planning process. The goal of HIV Prevention

Community Planning is to improve the effectiveness of HIV prevention

programs by strengthening the scientific basis and targeting prevention

interventions. Together, representatives of affected populations,

epidemiologists, behavioral scientists, HIV/AIDS prevention service

providers, health department staff, and others analyze the course of

the epidemic in their jurisdiction, determine their priority prevention

needs, and identify HIV prevention interventions to meet those needs.

Community planning groups are responsible for developing comprehensive

HIV prevention plans that are directly responsive to the epidemics in

their jurisdictions. Minority and other CBOs submitting applications

under this announcement must contact their State/local health

departments to obtain a copy of the current comprehensive HIV

prevention plan (if available). Program proposals must address high

priority needs identified in this plan. More information on the HIV

prevention community planning process is available from the HIV/AIDS

Program in your jurisdiction's health department. A list of the names

and telephone numbers of State health department points of contact to

obtain a copy of the jurisdiction's comprehensive HIV prevention plan

is provided with the application kit.

Program Requirements

In a cooperative agreement, there are roles and responsibilities

shared between the CDC (grantor) and the recipient of Federal funds

(awardee). In conducting activities to achieve the purpose of this

program, the recipient shall be responsible for the activities under A.

below; the CDC shall be responsible for activities under B. below; and

both the CDC and the recipient shall be responsible for the activities

under C. below:

A. Recipient Activities

The following four Health Education and Risk Reduction (HE/RR)

Interventions will be conducted. These include Individual Level

Interventions, Group Level Interventions, Community Level

Interventions, and Street and Community Outreach Interventions. Each

awardee must conduct at least one, but not more than two of the

priority HE/RR interventions. Recipient activities are listed below:

1. Coordinate and collaborate with other organizations and agencies

involved in HIV prevention activities, especially those serving the

target populations in the local area.

2. Coordinate with HIV counseling and testing clinics, STD clinics,

TB testing sites, substance abuse treatment programs, and other health

service agencies to recruit and refer persons of high risk who are

appropriate for individual level intervention.

3. Provide education and support in group settings to promote and

reinforce safer behaviors and to provide interpersonal skills training

in negotiating and sustaining appropriate behavior change to persons at

increased risk of becoming infected or, if already infected, of

transmitting the virus to others.

4. Identify the HIV/AIDS needs assessment of the community and

develop a linguistically specific and sexual-identity-sensitive

intervention plan to minimize barriers and to promote risk reduction.

5. Develop a street outreach program of face-to-face contact with

persons of high risk to provide HIV/AIDS risk reduction information,

services and referrals.

B. CDC Activities

1. Provide consultation and technical assistance in planning,

operating, and evaluating prevention activities.

2. Provide up-to-date scientific information on the risk factors

for HIV infection, prevention measures, and program strategies for

prevention of HIV infection.

3. Assist in the evaluation of program activities and services.

4. Assist recipients in collaborating with State and local health

departments and other HHS-supported HIV/AIDS recipients.

5. Facilitate the transfer of successful prevention interventions

and program models to other areas through convening meetings of

grantees, workshops, conferences, newsletters, and communications with

project officers.

6. Monitor the recipient's performance of program activities,

protection of client confidentiality, and compliance with other

requirements.

7. Facilitate exchange of program information and technical

assistance between community organizations, health departments, and

national and regional organizations.

8. Assist prospective applicants in obtaining preapplication

technical assistance and in obtaining copies of the comprehensive HIV

prevention plan.

C. Recipient and CDC Responsibility Regarding Confidentiality

All personally identifying information obtained in connection with

the delivery of services provided to any individual in any program

supported under this announcement shall not be disclosed unless

required by a law of a State or political subdivision or unless such an

individual provides written, voluntary informed consent.

1. Non-personally identifying, unlinked information, which

preserves the individual's anonymity, derived from any such program may

be disclosed without consent:

a. In summary, statistical, or other similar form, or

b. For clinical or research purposes.

2. Personally identifying information: Recipients of CDC funds that

must obtain and retain personally identifying information as part of

their CDC-approved work plan must:

a. Maintain the physical security of such records and information

at all times;

b. Have procedures in place and staff trained to prevent

unauthorized disclosure of client-identifying information;

c. Obtain informed client consent by explaining the possible risks

from disclosure and the recipient's policies and procedures for

preventing unauthorized disclosure;

d. Provide written assurance to this effect including copies of

relevant policies; and

e. Obtain assurances of confidentiality by agencies to which

referrals are made.

An Institutional Review Board (IRB) approval or a certificate of

confidentiality may be required for some projects.

Reporting Requirements

Quarterly narrative progress reports will be required 30 days after

the end of each quarter. Quarterly progress reports should document

services provided and problems encountered, with careful attention to

answering questions and documenting accomplishments and problems

encountered in meeting program objectives. Annual financial status

reports are required no later than 90 days after the end of each budget

period. Final financial status and performance reports are required 90

days after the end of the project period.

Application Requirements and Content

A. All applicants must develop their applications in accordance

with PHS Form 5161-1, and the general instructions, information, and

examples contained in the program announcement and section headings

listed below. In addition, applicants should request an application kit

(see section Where to Obtain Additional Information).

[[Page 42624]]

B. Applicants are required to show how the proposed priority HE/RR

intervention(s) and the target populations for which they are intended

to complement the HIV prevention priorities identified in the

jurisdiction's comprehensive HIV prevention plan. The applicant should

reference specific sections and pages in the comprehensive HIV

prevention plan that support their proposed plan. A list of the names

and telephone numbers of State health department points of contact from

whom applicants may obtain a copy of the jurisdiction's comprehensive

HIV prevention plan is provided with the application kit. If the

jurisdiction's comprehensive HIV prevention plan is not available or

does not adequately provide the necessary information, the applicant is

expected to justify the need and the priority of their proposed program

activities and summarize how the activities address prevention gaps and

complement ongoing prevention efforts. Technical assistance is

available to help with this.

C. The application for funding must include a detailed description

of the first year activities and a brief description of future year

activities.

D. In developing the application, CDC requires that applicants

follow the instructions and format outlined below:

1. a. Introduction (not to exceed 2 pages): Applicants should

briefly summarize the program for which funds are requested, including

the target population to be served, activities to be undertaken, and

services to be provided. Also, briefly describe proposed future year

activities.

b. Organizational History and Capacity: The applicant should

briefly describe as follows:

(1) A summary of programs provided in the past, both HIV prevention

and general service and education programs;

(2) Organizational structure, the interests and constituencies

represented, and examples of demonstrated or predicted ability to

implement outreach and education programs to reduce the spread of HIV;

(3) Commitment and ability (i) to work with a variety of

organizations and governmental programs including those providing HIV

prevention services, and (ii) to coordinate program development with

existing governmental and private educational efforts.

(4) Capacity to provide culturally competent and appropriate

education and outreach which responds effectively to the cultural,

environmental, social, and multilingual character of the target

populations, including documentation of any history of such outreach or

education.

2. Description of the Priority Target Population (not to exceed 2

pages): The applicant should clearly and specifically describe the

priority target population(s) to be served through the proposed

program, including the approximate number of individuals to be reached.

Using the comprehensive HIV prevention plan as the basis, the applicant

should describe the impact of the AIDS epidemic on the priority

population and their community and any specific environmental, social,

cultural, or multilingual characteristics of the priority populations

which the applicant has considered and addressed in developing

prevention strategies, such as:

a. HIV prevalence and reported AIDS cases in persons practicing

risky behaviors;

b. HIV/AIDS-related baseline knowledge, attitudes, beliefs, and

behavior;

c. Patterns of substance abuse and rates of STDs and tuberculosis

(TB); and

d. Other relevant information.

3. Description of the Needs Assessment (not to exceed 3 pages).

Using the State/local health department's comprehensive HIV prevention

plan as the basis, applicants should describe how their proposed HE/RR

interventions fill gaps or unmet needs identified in the area's

comprehensive HIV prevention plan. If requesting funds to support

continued implementation of an HE/RR intervention that is already in

place, the applicant should describe the gap or unmet need that would

result from discontinuation of services. In addition, the applicant

should describe ongoing HIV prevention and risk-reduction efforts

underway among the priority population(s), if any, and explain how

proposed interventions complement these ongoing services. Additionally,

the applicant should:

a. Explain any specific barriers to the dissemination of adequate

HIV-prevention information and education which exist or have existed;

and

b. Identify and describe the HIV prevention needs of the target

population(s) which the proposed program directly addresses.

If the jurisdiction's comprehensive HIV prevention plan is not

available or does not adequately provide the necessary information for

items B. and D.3. above, the applicant is expected to justify the need

and the priority of their proposed target population and program

activities, and summarize how the activities address prevention gaps

and complement ongoing prevention efforts. The available technical

assistance for these tasks is outlined in the section on Where to

Obtain Additional Information.

4. Program Plan (not to exceed 8 pages): The specific behaviors and

practices that the interventions are designed to promote should be

described, such as, increases in correct and consistent condom use,

knowledge of serological status, not sharing needles, and enrollment in

drug treatment and other preventive programs. The proposed plan should

also describe the opportunities available for representatives of the

target population to become active in planning, implementing, and

evaluating activities and services. In addition, the proposed plan

should describe how the proposed priority interventions and services

implemented to accomplish the proposed objectives are culturally

competent (i.e., program and services provided in a style and format

respectful of the cultural norms, values, and traditions that are

endorsed by community leaders and accepted by the target population),

sensitive to issues of sexual identity, developmentally appropriate

(i.e., information and services provided at a level of comprehension

that is consistent with learning skills of persons to be served),

linguistically-specific (i.e., information is presented in dialect and

terminology consistent with the target population's traditional

language and style of communication), and educationally appropriate.

The program plan should describe and explain:

a. Project objectives: What the project will accomplish (i.e.,

specific, time-phased, and measurable objectives for the project).

Approved programs must have objectives related to their jurisdiction's

comprehensive HIV prevention plan (if available) and national HIV

prevention goals, and should describe in realistic terms the expected

outcomes of program activities on its priority population(s).

b. Plan of Operation: How the project will work (i.e., what

specific activities will be conducted and services provided to

accomplish the objectives). The applicant should outline the major

steps or activities necessary to attain specified objectives, and note

the approximate dates by which activities will be accomplished. The

applicant should note all major activities which will represent

necessary milestones in the attainment of objectives. The plan should

describe, where possible, how the applicant will obtain participation

and input into the program by State or local health departments,

community planning groups, members of the target population, and other

appropriate service groups or organizations; and

[[Page 42625]]

how collaborative relationships with other agencies and organizations

will be established and maintained. Applicants must provide the

following as attachments: (a) A list of major community resources and

health care providers to which referrals will be made; (b) a plan for

ongoing training to ensure that staff are knowledgeable about HIV and

STD risks and prevention measures; (c) a plan to assess the performance

of staff to ensure that they are providing information and services

accurately and effectively; (d) a mechanism to initiate and verify

referrals; and (e) protocols to guide and document training,

activities, services, and referrals (e.g., applicants seeking funds for

Street and Community Outreach Interventions must provide a description

of the policies and procedures that will be followed to assure the

safety of outreach staff).

5. Plan of Evaluation (not to exceed 4 pages): How project

activities will be evaluated (i.e., a plan which will help determine if

the methods used to deliver these services are effective and the

objectives are being achieved). The applicant should clearly identify

specific methods it will use to measure progress toward attaining

objectives and monitoring activities during the first year of the

program. The applicant should describe how information will be

obtained, including a description of methods which will be implemented

to gather and record data, and in what manner it will be summarized.

The following are recommendations for the evaluation plan, the minimum

data that should be collected, and the systems for collecting the data.

Activities undertaken under the evaluation plan should be capable of

the following:

a. Providing a detailed description of:

(1) Each program activity and the documented need for that

activity; and

(2) Progress toward achieving each stated objective in the

cooperative agreement,

b. Providing detailed information for:

(1) The specific service or intervention that was provided and how

it differed from the planned services;

(2) The description and the number of persons who received the

service, including demographics such as age, race and ethnicity,

gender, and if appropriate and available, sexual orientation and risk

exposure, and how the persons actually served differed from those the

program intended to serve;

(3) When and how often the service or intervention was provided and

how this differed from program plans; and,

(4) Where the service or intervention was provided (e.g., CTRPN

site, STD clinic, street corner, housing project) and a comparison of

these data to the expected locations of service delivery.

c. Documenting and describing program successes, unmet needs,

barriers and problems encountered in planning, implementing, or

providing services, or in coordinating services with other

organizations and agencies serving target populations.

d. Documenting and describing the success of referral systems,

including the numbers of persons referred and the number actually

receiving services by site, and how well the system functions in

identifying sources of services and in assisting persons in obtaining

and receiving them.

e. Documenting and describing problems that affect planning or

implementing program activities (e.g., recruiting, hiring, or retaining

staff; training or ensuring quality staff performance; establishing or

maintaining contracts with other CBOs or ensuring the quality of their

performance), and

f. Describing client satisfaction with HIV prevention services.

Client satisfaction should be assessed periodically via quantitative or

qualitative methods (e.g., periodic focus groups with current or former

clients).

Because of the additional cost and need for scientific support

beyond the scope of these cooperative agreements, applicants should not

conduct outcome evaluations with these funds (i.e., long-term effects

of the program in terms of changes in behavior or health status, such

as changes in HIV incidence after the intervention). CDC will continue

to support special projects to evaluate the behavioral and other

outcomes of interventions commonly used by CBOs and other

organizations, and disseminate information and lessons learned from

this research to CBOs, health departments, community planning groups,

and other organizations and agencies involved in HIV prevention

programs.

6. Applicant Coordination of Efforts (not to exceed 4 pages):

In this section, applicants should document and describe how

proposed HE/RR priority intervention(s) and activities will be

coordinated with other organizations and agencies involved in HIV

prevention and education programs, especially those serving the target

population in the local area. Such organizations must include State and

local health departments and community planning groups, and should

include, as appropriate the following:

a. Community groups and organizations, including churches and

religious groups;

b. HIV/AIDS service organizations;

c. Ryan White CARE planning bodies;

d. Schools, boards of education, and other State or local education

agencies;

e. State and local substance abuse agencies and drug treatment or

detoxification programs;

f. Federally funded community projects, such as those funded by

Center for Substance Abuse Treatment (CSAT), Center for Substance Abuse

Prevention (CSAP), Health Resource Services Administration (HRSA),

Office of Minority Health (OMH), and other Federal agencies;

g. Providers of services to youth in high risk situations (e.g.,

youth in shelters);

h. State or local departments of mental health;

i. Juvenile and adult criminal justice, correctional or parole

systems and programs;

j. Family planning and women's health agencies; and

k. STD and TB clinics and programs.

Applicants should submit and include as attachments memoranda of

understanding or agreement as evidence of these established or agreed-

upon collaborative relationships. Evidence of continuing collaboration

must be submitted each year to ensure that the collaborative

relationships are still in place.

7. Personnel: The applicant should describe in detail each existing

or proposed position for this program by job title, function, general

duties, and activities. This should include the level of effort and

allocation of time for each project activity by staff positions. If the

identity of any key personnel who will fill a position is known, her/

his name and curriculum vitae (not to exceed one page each) should be

attached. Experience and training related to the proposed project

should be noted.

8. Budget Breakdown and Justification: The applicant should provide

a detailed budget for each HE/RR intervention (i.e., individual level,

group level, community level, or street and community outreach) to be

undertaken, with accompanying justification of all operating expenses

that is consistent with the stated objectives and planned priority

activities. CDC may not approve or fund all proposed activities.

Applicants should be precise about the program purpose of each budget

item, and should itemize calculations wherever appropriate.

For the personnel section, the job title, annual salary/rate of

pay, and

[[Page 42626]]

percentage of time spent on this program should be indicated.

For contracts contained within the application budget, applicants

should name the contractor, if known; describe the services to be

performed; justify the use of a third party; and provide a breakdown of

and justification for the estimated costs of the contracts; the kinds

of organizations or parties to be selected; the period of performance;

and the method of selection.

Attachments

The applicant must also provide the following as attachments:

A. Proof of its nonprofit status, as set forth under the Eligible

Applicants section. No awards will be made without acceptable proof of

nonprofit status;

B. A list of the members of its governing body and, for minority

CBO applicants, their racial/ethnic backgrounds;

C. An organizational chart of existing and proposed staff,

including volunteer staff (minority CBOs should include racial/ethnic

backgrounds);

D. A description of any funding being received from CDC or other

sources to conduct similar activities which includes:

1. A summary of funds and income received to conduct HIV/AIDS

programs and other programs targeting the population proposed in the

program plan. This summary must include the name of the sponsoring

organization/source of income, level of funding, a description of how

the funds have been used, and the budget period. In addition, identify

proposed personnel devoted to this project who are supported by other

funding sources and the activities they are supporting;

2. A summary of the objectives and activities of the funded

program(s);

3. A description of how funds requested in this application will be

used differently or in ways that will expand upon the funds already

received, applied for, or being received; and

4. An assurance that the funds being requested will not duplicate

or supplant funds received from any other Federal or non-Federal

source.

E. Evidence of collaboration between the health department and

other organizations serving the target population.

F. Independent audit statements from a certified public accountant

for the previous 2 years.

G. Other information that may be required of organizations seeking

support for priority HE/RR intervention(s).

H. Typing and Mailing

Applicants are required to submit an original and 2 copies of the

application. Pages must be clearly numbered, and a complete index to

the application and its appendices must be included. Please begin each

separate section of the application on a new page. The original and

each copy of the application set must be submitted unstapled and

unbound. All material must be typewritten, single spaced, with

unreduced type on 8\1/2\'' by 11'' paper, with at least 1'' margins,

headings and footers, and printed on one side only. Materials which

should be part of the basic plan will not be accepted if placed in the

appendices.

Review and Evaluation Criteria

Eligible applications will be evaluated by a two-step process. Step

1 is a review of the merits of the application against the criteria

listed in A.1. below. If an exceptionally large number of applications

are received, CDC may conduct a two-phased review in which all

applications receive a preliminary review ((A.1.-A.3. below) and the

applications with high ratings receive the second phase of the review

(A.1.-A.7.). Step 2 is a predecisional site visit.

CDC-convened Special Emphasis Panels will evaluate each application

by the following criteria:

A. Application

Each application will be evaluated based on the following criteria:

1. Extent of experience in providing HIV prevention services to the

target population; (15 points)

2. Extent of need for the program as evidenced by the comprehensive

HIV prevention plan and other needs assessment information provided by

the applicant; (15 points)

3. Extent that the applicant in the program plan identifies and

describes how proposed HE/RR interventions address prevention gaps

related to their proposed priority population(s); (10 points)

4. Degree to which the proposed objectives are specific,

measurable, time-phased, related to the proposed activities, related to

prevention priorities outlined in the jurisdiction's comprehensive HIV

prevention plan and national HIV prevention goals, and consistent with

the applicant organization's overall mission; (20 points)

5. The quality of the applicant's plan for conducting program

activities, and the potential effectiveness of the proposed activities

in meeting objectives; (20 points)

6. Degree of collaboration and coordination with other

organizations serving the same priority population(s). This includes

signed work plans, agreements, or other evidence of collaboration that

describe previous, current, as well as future areas of collaboration;

and (10 points)

7. The potential of the evaluation plan to measure the

accomplishment of program objectives. (10 points)

B. Predecisional Site Visits

Before final award decisions are made, CDC may make site visits to

CBOs whose applications are highly ranked. The purpose of these site

visits will be to assess the organizational and financial capability of

the applicant to implement the proposed program.

A fiscal Recipient Capability Audit may be required of some

applicants prior to the award of funds.

Funding Priorities

In making awards, priority will be given to (1) Ensuring a

geographic balance of funded CBOs (the number of funded CBOs may be

limited in each eligible area based on the number of reported AIDS

cases, e.g., no more than one funded CBO for each 1,000 reported AIDS

cases in minority populations in 1993, 1994, and 1995), (2) providing

support to racial and ethnic minority CBOs and CBOs serving other high

risk populations with proven records of effectively reaching their

target populations, and (3) supporting activities that address the HIV

prevention priorities identified in the health department's

comprehensive HIV prevention plan (if available).

Executive Order 12372 Review

Applications are subject to review as governed by Executive Order

(E.O.) 12372, Intergovernmental Review of Federal Programs. E.O. 12372

sets up a system for State and local government review of proposed

Federal assistance applications. Applicants should contact their State

single point of contact (SPOC) as early as possible to alert them to

the prospective applications and receive instructions on the State

process. For proposed projects serving more than one State, the

applicant is advised to contact the SPOC for each State. A current list

of SPOCs is included in the application kit. If SPOCs have any State

process recommendations on applications submitted to CDC, they should

forward them to Van Malone, Grants Management Officer, Grants

Management Branch, Procurement and Grants Office, Centers for Disease

Control and Prevention (CDC), 255 East

[[Page 42627]]

Paces Ferry Road, NE., Room 300, Mail Stop E-15, Atlanta, GA 30305, no

later than 60 days after the application deadline date CDC does not

guarantee to accommodate or explain State process recommendations it

receives after that date.

Public Health System Reporting Requirements

This program is subject to the Public Health System Reporting

Requirements. Under these requirements, all community-based

nongovernmental applicants must prepare and submit the items identified

below to the head of the appropriate State and/or local health

agency(s) in the program area(s) that may be impacted by the proposed

project no later than the receipt date of the Federal application. The

appropriate State and/or local health agency is determined by the

applicant. The following information must be provided:

A. A copy of the face page of the application (SF 424);

B. A summary of the project that should be titled ``Public Health

System Impact Statement (PHSIS)'', not to exceed one page, and include

the following:

1. A description of the population to be served;

2. A summary of the services to be provided; and

3. A description of the coordination plans with the appropriate

State and/or local health agencies.

Catalog of Federal Domestic Assistance Number

The Catalog of Federal Domestic Assistance Number is 93.939, HIV

Prevention Activities--Non-Governmental Organization Based.

Other Requirements

A. HIV Program Review Panel

Recipients must comply with the terms and conditions included in

the document titled Content of HIV/AIDS-Related Written Materials,

Pictorials, Audiovisuals, Questionnaires, Survey Instruments, and

Educational Sessions in Centers for Disease Control and Prevention

(CDC) Assistance Programs (June 1992), a copy of which is included in

the application kit. In complying with the program review panel

requirements contained in this document, recipients are encouraged to

use a current program review panel such as the one created by the State

health department's HIV/AIDS Prevention Program. If the recipient forms

its own program review panel, at least one member must also be an

employee or a designated representative of a State or local health

department. The names of review panel members must be listed on the

Assurance of Compliance Form, CDC 0.1113.

B. Accounting System

The services of a certified public accountant licensed by the State

Board of Accountancy or equivalent must be retained throughout the

budget period as a part of the recipient's staff or as a consultant to

the recipient's accounting personnel. These services may include the

design, implementation, and maintenance of an accounting system that

will record receipts and expenditures of Federal funds in accordance

with accounting principles, Federal regulations, and terms of the

cooperative agreement.

C. Audits

Funds claimed for reimbursement under this cooperative agreement

must be audited annually by an independent certified public accountant

(separate and independent of the consultant referenced above or

recipient's staff certified public accountant). This audit must be

performed within 60 days after the end of the budget period, or at the

close of an organization's fiscal year. The audit must be performed in

accordance with generally accepted auditing standards (established by

the American Institute of Certified Public Accountants (AICPA)),

governmental auditing standards (established by the General Accounting

Office (GAO)), and Office of Management and Budget (OMB) Circular A-

133.

D. Human Subjects

If the proposed project involves research on human subjects, the

applicant must comply with the Department of Health and Human Services

Regulations (45 CFR Part 46) regarding the protection of human

subjects. Assurance must be provided (in accordance with the

appropriate guidelines and form provided in the application kit) to

demonstrate that the project will be subject to initial and continuing

review by an appropriate institutional review committee.

E. Paperwork Reduction Act

OMB clearance for the data collection initiated under this

cooperative agreement is pending approval by the Office of Management

and Budget.

Application Submission and Deadline

The original and two copies of the application (PHS Form 5161-1,

OMB Number 0937-0189) must be submitted to Mr. Van Malone, Grants

Management Officer, Grants Management Branch, Procurement and Grants

Office, Centers for Disease Control and Prevention (CDC), 255 East

Paces Ferry Road, NE., Room 300, Mail Stop E-15, Atlanta, GA 30305, on

or before October 15, 1996. Faxed copies will NOT be accepted. In

addition, CDC strongly recommends that all applicants, simultaneously

submit a copy of the application to their State HIV/AIDS Directors.

Deadline: Applications will meet the deadline if they are either

received on or before the deadline date, or sent on or before the

deadline date and received in time for submission to the review group.

(Applicants must request a legibly dated U.S. Postal Service postmark

or obtain a legibly dated receipt from a commercial carrier or U.S.

Postal Service. Private metered postmarks will not be acceptable proof

of timely mailing.)

Applications that do not meet these criteria will be considered

late and will not be considered in the current funding cycle. Late

applications will be returned to the applicant.

Where to Obtain Additional Information

To receive the application kit, call (404) 332-4561. You will be

asked to leave your name, address, and telephone number; and you must

refer to Announcement Number 704. You will then receive program

announcement 704, required application forms and attachments, a current

list of SPOCs, a summary of HIV related objectives, a list of the State

health department points of contact, and the HE/RR guidelines. The

announcement is also available through the CDC home page on the

Internet. The address for the CDC home page is http://www.cdc.gov.

If you have questions after reviewing the contents of the

documents, business management technical assistance may be obtained

from Maggie Slay, Grants Management Specialist, Grants Management

Branch, Procurement and Grants Office, Centers for Disease Control and

Prevention (CDC), 255 East Paces Ferry Road, NE., Room 300, Mail Stop

E-15, Atlanta, GA 30305, telephone (404) 842-6797, or INTERNET address,

[email protected].

Announcement Number 704, ``Cooperative Agreements for Minority

Community-Based Human Immunodeficiency Virus (HIV) Prevention

Projects'' must be referenced in all requests for information

pertaining to these projects.

Programmatic technical assistance may be obtained by calling Norm

Fikes

[[Page 42628]]

in the Division of HIV/AIDS Prevention, National Center for HIV, STD,

and TB Prevention, Centers for Disease Control and Prevention (CDC),

Mail Stop E-58, Atlanta, GA 30333, telephone (404) 639-8317. (Technical

assistance may also be obtained from your respective State/local health

departments.)

Preapplication Workshops will be held in October and November 1996.

Prospective applicants are encouraged to attend a workshop in their

area. The purpose of these workshops is to assist prospective

applicants in understanding CDC application requirements and program

priorities. During the workshops, information will be presented on this

application guidance, programmatic priorities, HIV prevention community

planning, CDC business management requirements, and how to access

additional preapplication resources relevant to application

development. For additional information concerning workshops in your

area, please contact your State or local health department or a project

officer in the Division of HIV/AIDS Prevention, National Center for

HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

(CDC), Mail Stop E-58, Atlanta, GA 30333, telephone (404) 639-8317.

Potential applicants may obtain a copy of ``Healthy People 2000''

(Full Report; Stock No. 017-001-00474-0) or ``Healthy People 2000''

(Summary Report; Stock No. 017-001-00473-1) through the Superintendent

of Documents, Government Printing Office, Washington, DC 20402-9325,

telephone (202) 512-1800.

Dated: August 12, 1996.

Joseph R. Carter,

Acting Associate Director for Management and Operations, Centers for

Disease Control and Prevention.

[FR Doc. 96-20897 Filed 8-15-96; 8:45 am]

BILLING CODE 4163-18-P