[Federal Register Volume 60, Number 20 (Tuesday, January 31, 1995)]
[Notices]
[Pages 5935-5940]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-2273]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement 522]
State and Community-Based Childhood Lead Poisoning Prevention
Program and Surveillance of Elevated Blood Lead Levels in Children,
Notice of Availability of Funds for Fiscal Year 1995
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of funds in fiscal year (FY) 1995 for new and competing
continuation State and community-based childhood lead poisoning
prevention programs, and to build statewide capacity to conduct
surveillance of elevated blood lead levels in children.
State and community-based programs must (1) assure that children in
communities with demonstrated high-risk for lead poisoning are
screened, (2) identify those children with elevated blood lead levels,
(3) identify possible sources of lead exposure, (4) monitor medical and
environmental management of lead poisoned children, (5) provide
information on childhood lead poisoning and its prevention and
management to the public, health professionals, and policy- and
decision-makers, (6) encourage and support community-based programs
directed to the goal of eliminating childhood lead poisoning, and (7)
build capacity for conducting surveillance of elevated blood lead (PbB)
levels in children.
Surveillance grants are to develop and implement complete
surveillance systems for blood lead levels in children to ensure
appropriate targeting of interventions and track progress in the
elimination of childhood lead poisoning.
Applicants may apply for either a prevention program grant or a
surveillance grant. Applicants applying for prevention grant funds must
address surveillance issues in their application.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
2000, a PHS-led national activity to reduce morbidity and mortality and
improve the quality of life. This announcement is related to the
priority area of Environmental Health. (To order a copy of Healthy
People 2000, see the section WHERE TO OBTAIN ADDITIONAL INFORMATION.)
[[Page 5936]]
Authority
This program is authorized under sections 301(a) (42 U.S.C. 241(a))
and 317A (42 U.S.C. 247b-1) of the Public Health Service Act, as
amended. Program regulations are set forth in Title 42, Code of Federal
Regulations, Part 51b.
Smoke-Free Workplace
The Public Health Service 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.
Environmental Justice Initiative
Activities conducted under this announcement should be consistent
with the Federal Executive Order No. 12898 entitled, ``Federal Actions
to Address Environmental Justice in Minority Populations and Low-Income
Populations.'' Grantees, to the greatest extent practicable and
permitted by law, shall make achieving environmental justice part of
its program's mission by identifying and addressing, as appropriate,
disproportionately high and adverse human health and environmental
effects of lead on minority populations and low-income populations.
Eligible Applicants
Eligible applicants for State childhood lead poisoning prevention
programs and surveillance programs are State health departments or
other State health agencies or departments deemed most appropriate by
the State to direct and coordinate the State's childhood lead poisoning
prevention program, and agencies or units of local government that
serve jurisdictional populations greater than 500,000. This eligibility
includes health departments or other official organizational authority
(agency or instrumentality) of the District of Columbia, the
Commonwealth of Puerto Rico, and any territory or possession of the
United States. Also eligible are federally recognized Indian tribal
governments.
Applicants from eligible units of local jurisdiction must elect to
either apply directly to CDC as a grantee, or to apply as part of a
statewide grant application. You cannot submit applications
simultaneously through both mechanisms.
For Surveillance Funds only: Eligible applicants must have
regulations for reporting of PbB levels by both public and private
laboratories or provide assurances that such regulations will be in
place within six months of awarding the grant. This program is intended
to initiate and build capacity for surveillance of childhood PbB
levels. Therefore, any applicant that already has in place a PbB level
surveillance activity must demonstrate how these grant funds will be
used to enhance, expand or improve the current activity, in order to
remain eligible for funding. CDC funds should be added to blood-lead
surveillance funding from other sources, if such funding exists. Funds
for these programs may not be used in place of any existing funding for
surveillance of PbB levels. Applicants other than State health
departments must apply in conjunction with their State or territorial
health department.
If a State agency applying for grant funds is other than the
official State health department, written concurrence by the State
health department must be provided.
Applicants that currently have Childhood Lead Prevention Grants may
submit supplements for the surveillance component. These supplements
must meet all the above eligibility and will be evaluated as a part of
the surveillance objective review.
Special Consideration
In order to help empower distressed communities--those that are
designated as ``Empowerment Zones'' or ``Enterprise Communities'' (EZ/
EC) under the Community Empowerment Initiative [Public Law 103-66-
August 10, 1993], or those that meet the characteristics of those
areas--special consideration will be given to qualified applicants for
comprehensive program activities in communities that:
1. Are characterized by a high incidence of children with elevated
blood lead levels;
2. Have high rates of poverty and other indicators of socio-
economic distress, such as high levels of unemployment, and significant
incidence of violence, gang activity, and crime; and
3. Provide evidence that their target community has prepared and
submitted an EZ/EC application to HHS for a ``comprehensive community-
based strategic plan for achieving both human and economic development
in an integrated manner.''
Applicants that meet both the program criteria and the EZ/EC
criteria outlined above, will be awarded points in the objective review
of their application.
Availability of Funds
State and Community-Based Prevention Funds: Approximately $8,000,000
will be available in FY 1995 to fund a selected number of new and
competing continuation childhood lead poisoning prevention programs.
The CDC anticipates that program awards for the first budget year will
range from $200,000 to $1,500,000.
Surveillance Funds: Approximately $200,000 will be available in FY
1995 to fund a selected number of new and competing continuation grants
to support the development of PbB surveillance activities. Surveillance
awards are expected to range from $60,000 to $75,000, with the average
award being approximately $70,000.
The new awards are expected to begin on or about July 1, 1995. New
awards are made for 12-month budget periods within project periods not
to exceed 3 years. Estimates outlined above are subject to change based
on the actual availability of funds and the scope and quality of
applications received. Continuation awards within the project period
will be made on the basis of satisfactory progress and availability of
funds.
These grants are intended to develop, expand, or improve prevention
programs in communities with demonstrated high-risk populations, and/or
develop statewide capacity for conducting surveillance of elevated
blood-lead levels. Grant awards cannot supplant existing funding for
childhood lead poisoning prevention programs or surveillance
activities. Grant funds should be used to increase the level of
expenditures from State, local, and other funding sources.
Awards will be made with the expectation that program activities
will continue when grant funds are terminated.
Note: Grant funds may not be expended for medical care and
treatment or for environmental remediation of lead sources. However,
the applicant must provide an acceptable plan to ensure that these
program activities are appropriately carried out.
Not more than 10 percent (exclusive of Direct
Assistance) of any grant may be obligated for administrative costs.
This 10 percent limitation is in lieu of, and replaces, the indirect
cost rate.
Purpose
Prevention Grant Program
State and community health agencies are the principal delivery
points for childhood lead screening and related medical and
environmental management activities; however, limited resources have
made it difficult for agencies to develop and maintain programs for the
elimination of this [[Page 5937]] totally preventable disease. The
purpose of this grant program is to provide impetus for the development
and operation of State and community-based childhood lead poisoning
prevention programs in high-risk areas, and build capacity for
conducting surveillance of elevated blood-lead levels in children.
Grant-supported programs are expected to serve as catalysts and models
for the development of non-grant-supported programs and activities in
other States and communities. Further, grant-supported programs should
create community awareness of the problem (e.g., among community and
business leaders, medical community, parents, educators, and property
owners). It is expected that State health agencies will play a lead
role in the development of community-based childhood lead poisoning
prevention programs, including ensuring coordination and integration
with maternal and child health programs; State Medicaid EPSDT programs;
community and migrant health centers; and community-based organizations
providing health and social services in or near public housing units,
as authorized under Section 340A of the PHS Act.
The prevention grant program will provide financial assistance and
support to State and community-based government agencies to:
1. Establish, expand, or improve services to assure that children
in communities with demonstrated high risk for lead poisoning are
screened. Screening should focus on (1) making certain children, not
currently served by existing health care services, are screened, and
(2) integrating screening efforts with maternal and child health
programs; State Medicaid programs, such as the Early Periodic
Screening, Diagnosis, and Treatment (EPSDT) programs; community and
migrant health centers; and community-based organizations providing
health and social services in or near public housing units, as
authorized under Section 340A of the PHS Act, and (3) guaranteeing that
high-risk children seen by private providers are screened.
2. Intensify case management efforts to ensure that children with
lead poisoning receive appropriate and timely follow-up services.
3. Establish, expand, or improve environmental investigations to
rapidly identify and reduce sources of lead exposure throughout a
community.
4. Develop infrastructure to implement the provisions of the CDC
Lead Statement, Preventing Lead Poisoning in Young Children (October
1991).
5. Develop and implement efficient information management/data
systems compatible with CDC guidelines for monitoring and evaluation.
6. Improve the actions of other appropriate agencies and
organizations to facilitate the rapid remediation of identified lead
hazards in high-risk communities.
7. Enhance knowledge and skills of program staff through training
and other methods.
8. Based upon program findings, provide information on childhood
lead poisoning to the public, policy-makers, the academic community,
and other interested parties.
Surveillance Grant Funds
The surveillance component of this announcement is intended to
assist State health departments or other appropriate agencies to
implement a complete surveillance activity for PbB levels in children.
Development of surveillance systems at the local, State and national
levels is essential for targeting interventions to high-risk
populations and for tracking progress in eliminating childhood lead
poisoning.
The childhood blood lead surveillance program has the following
five goals:
1. Increase the number of State health departments with
surveillance systems for elevated PbB levels;
2. Build the capacity of State- or territorial-based PbB level
surveillance systems;
3. Use data from these systems to conduct national surveillance of
elevated PbB levels;
4. Disseminate data on the occurrence of elevated PbB levels to
government agencies, researchers, employers, and medical care
providers; and
5. Direct intervention efforts to reduce environmental lead
exposure.
Program Requirements
Prevention Grant Program
The following are requirements for Childhood Lead Poisoning
Prevention Projects:
1. A full-time director/coordinator with authority and
responsibility to carry out the requirements of the program.
2. Ability to provide qualified staff, other resources, and
knowledge to implement the provisions of the program. Applicants
requesting grant supported positions must provide assurances that such
positions will be approved by the applicants' personnel system.
3. A data management component that supports the development,
implementation, and maintenance of an automated case management system
that provides timely and useful analysis and reporting of program data.
4. A plan to monitor and evaluate all major program activities and
services.
5. Demonstrated experience or access to professionals knowledgeable
in conducting and evaluating public health programs.
6. Ability to translate program findings to State and local public
health officials, policy and decision-makers, and to others seeking to
strengthen program efforts.
7. Provides information that describes why certain communities were
selected for program activities, including information on housing
conditions, income, other socioeconomic factors, and previous surveys
or activities for childhood lead poisoning prevention.
8. A comprehensive public and professional information and
education outreach plan directed specifically to high-risk populations,
health professionals and paraprofessionals and the public. The plan may
also address education and outreach activities directed to policy and
decision-makers, parents, educators, property owners, community and
business leaders, housing authorities and housing and rehabilitation
workers, and special interest groups. The plan should be based on a
needs assessment which: (a) determines the feasibility of a health
education program; (b) utilizes assessment data interpretations to
determine priorities for health education programming; and (c)
identifies the appropriate target population for the program.
9. Establishment and maintenance of a system to monitor the
notification and follow-up of children who are confirmed with elevated
blood lead levels and who are referred to local Public Housing
Authorities (PHAs).
10. Effective, well-defined working relationships within public
health agencies and with other agencies and organizations at national,
State, and community levels (e.g., housing authorities, environmental
agencies, maternal and child health programs, State Medicaid EPSDT
programs; or, community and migrant health centers; community-based
organizations providing health and social services in or near public
housing units, as authorized under Section 340A of the PHS Act, State
epidemiology programs, State and local housing rehabilitation offices,
schools of public health and medical schools, and environmental
interest groups) to appropriately address the needs and requirements of
programs (e.g., data management systems to [[Page 5938]] facilitate the
follow-up and tabulation of children reported with elevated blood lead
levels, training to ensure the safety of abatement workers) in the
implementation of proposed activities. This includes the establishment
of networks with other State and local agencies with expertise in
childhood lead poisoning prevention programming.
11. Activities, services, and educational materials provided by the
program must be culturally sensitive (i.e., programs and services
provided in a style and format respectful of cultural norms, values,
and traditions which are endorsed by community leaders and accepted by
the target population), developmentally appropriate (i.e., information
and services provided at a level of comprehension which is consistent
with learning skills of individuals to be served), linguistically-
specific (i.e., information is presented in dialect and terminology
consistent with the target population's native language and style of
communication), and educationally appropriate.
12. Assurances that income earned by the childhood lead poisoning
prevention program is returned to the lead program for use by the
program.
13. For awards to State agencies, there must be a demonstrated
commitment to provide technical, analytical, and program evaluation
assistance to local agencies interested in developing or strengthening
childhood lead poisoning prevention programs.
14. SPECIAL REQUIREMENT regarding Medicaid provider-status of
applicants: Pursuant to section 317A of the Public Health Service Act
(42 U.S.C. 247b-1) as amended by Sec. 303 of the ``Preventive Health
Amendments of 1992'' (Pub. L. 102-531), applicants AND current grantees
must meet the following requirements: For Childhood Lead Poisoning
Prevention Program services which are Medicaid-reimbursable in the
applicant's State:
Applicants who directly provide these services must be
enrolled with their State Medicaid agency as Medicaid providers.
Providers who enter into agreements with the applicant to
provide such services must be enrolled with their State Medicaid agency
as providers.
An exception to this requirement will be made for providers whose
services are provided free of charge and who accept no reimbursement
from any third-party payer. Such providers who accept voluntary
donations may still be exempted from this requirement.
15. For State Prevention Programs, a Surveillance component defined
as a process which: (1) systematically collects information over time
about children with elevated PbB levels using laboratory reports as the
data source; (2) provides for the follow-up of cases, including field
investigations when necessary; and (3) provides timely and useful
analysis and reporting of the accumulated data including an estimate of
the rate of elevated PbB levels among all children receiving blood
tests.
For Surveillance Grants
The following are requirements for surveillance only grant
projects:
1. A full-time director/coordinator with authority and
responsibility to carry out the requirements of surveillance program
activities.
2. Ability to provide qualified staff, other resources, and
knowledge to implement the provisions of this program. Applicants
requesting grant supported positions must provide assurances that such
positions will be approved by the applicants' personnel system.
3. Effective, well-defined working relationships with childhood
lead poisoning prevention programs within the applicants' State.
4. Revise, refine, and implement, in collaboration with CDC, the
methodology for surveillance as proposed in the respective program
application.
5. Collaborate with CDC in any interim and/or final evaluation of
the surveillance activity.
6. Monitor and evaluate all major program activities and services.
7. Demonstrated experience or access to professionals knowledgeable
in conducting and evaluating public health programs.
8. Ability to translate program findings to State and local public
health officials, policy and decision-makers, and to others seeking to
strengthen program efforts.
Evaluation Criteria
The review of applications will be conducted by an objective review
committee who will review the quality of the application based on the
strength and completeness of the plan submitted. The budget
justification will be used to assess how well the technical plan is
likely to be carried out using available resources. The maximum ratings
score of an application is 100 points.
A. The factors to be considered in the evaluation of prevention
program grant funds are:
1. Evidence of the Childhood Lead Poisoning Problem (35%) The
applicant's ability to identify populations and communities at high
risk, as defined by data from previous screening efforts, environmental
data, and/or demographic data. (Population-based data or estimates
should be compared to NHANES III data discussed in the Background and
Definition Section included in the application kit). Current screening
prevalence should also be discussed.
2. Technical Approach (30%) The quality of the technical approach
in carrying out the proposed activities including:
(a) Goals and Objectives: The extent to which the applicant has
included goals which are specific, measurable, and relevant to the
purpose of this proposal (10 points).
(b) Approach: The extent to which the applicant provides a detailed
description of the proposed activities which are likely to achieve each
objective for the budget period (10 points).
(c) Timeline: The extent to which the applicant provides a
reasonable schedule for implementation of the activities (5 points).
(d) Evaluation: The extent to which evaluation plans address the
achievement of each objective (5 points).
3. Applicant Capability (10%) Capability of the applicant to
initiate and carry out proposed program activities successfully within
the time frames set forth in the application. Proposed staff skills
must match the proposed program of work described. Elements to consider
include:
(a) Demonstrated knowledge and experience of the proposed project
director or manager and staff in planning and managing large and
complex interdisciplinary programs involving public health,
environmental management, and housing rehabilitation. The percentage of
time the project manager will devote to this project is a significant
factor, and must be indicated (5 points).
(b) Written assurances that proposed positions can and will be
filled as described in the application (3 points).
(c) Evidence of institutional capacity, demonstrated by the
experience and continuing capability of the jurisdiction, to initiate
and implement similar environmental and housing projects. The applicant
should describe these related efforts and the current capacity of its
agency (2 points).
4. Collaboration (20%)
(a) Extent to which the applicant demonstrates that proposed
activities are being conducted in conjunction with, or through,
organizations with known and established ties in the target
communities. Evidence of support and [[Page 5939]] participation from
appropriate community-based or neighborhood-based organizations in the
form of memoranda of understanding or other agreements of collaboration
(10 points).
(b) Extent to which the applicant documents established
collaboration with appropriate governmental agencies responding to
childhood lead poisoning prevention issues such as environmental
health, housing, medical management, etc., through specific commitments
for consultation, employment, or other activities, as evidenced by the
names and proposed roles of these participants and letters of
commitment. Absence of letters describing specific participation will
result in a reduced rating under this factor (10 points).
5. Special Consideration for EZ/EC (5%) Special consideration will
be given to applicants that target program activities in communities
that:
(a) Are characterized by a high incidence of children with elevated
blood lead levels;
(b) Have high rates of poverty and other indicators of socio-
economic distress, such as those with high levels of unemployment, and
significant incidence of violence, gang activity, and crime; and
(c) Are preparing or implementing a comprehensive community-based
strategic plan for achieving both human and economic development in an
integrated manner.
6. Budget Justification and Adequacy of Facilities (Not Scored) The
budget will be evaluated for the extent to which it is reasonable,
clearly justified, and consistent with the intended use of grant funds.
The adequacy of existing and proposed facilities to support program
activities also will be evaluated.
B. The factors to be considered in the evaluation of applications
for Surveillance Program Grant Funds only are:
1. Surveillance Activity (35%) The clarity, feasibility, and
scientific soundness of the surveillance approach. Also, the extent to
which a proposed schedule for accomplishing each activity and methods
for evaluating each activity are clearly defined and appropriate. The
following points will be specifically evaluated:
a. How laboratories report PbB levels.
b. How data will be collected and managed.
c. How data quality and completeness of reporting will be assured.
d. How and when data will be analyzed.
e. How summary data will be reported and disseminated.
f. Protocols for follow-up of individuals with elevated PbB levels.
g. Provisions to obtain denominator data.
2. Progress Toward Complete Blood-Lead Surveillance (30%) The
extent to which the proposed activities are likely to result in
substantial progress towards establishing a complete State-based PbB
surveillance activity (as defined in the ``PURPOSE'' section).
3. Project Sustainability (20%) The extent to which the proposed
activities are likely to result in the long-term maintenance of a
complete State-based PbB surveillance system. In particular, specific
activities that will be undertaken by the State during the project
period to ensure that the surveillance program continues after
completion of the project period.
4. Personnel (10%) The extent to which the qualifications and time
commitments of project personnel are clearly documented and appropriate
for implementing the proposal.
5. Use of Existing Resources (5%) The extent to which the proposal
would make effective use of existing resources and expertise within the
applicant agency or through collaboration with other agencies.
6. Budget (Not Scored) The extent to which the budget is
reasonable, clearly justified, and consistent with the intended use of
funds.
Executive Order 12372 Review
Applications are subject to Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. Applicants (other than federally recognized
Indian tribal governments) should contact their State Single Point of
Contact (SPOC) as early as possible to alert them to the prospective
applications and receive any necessary instructions on the State
process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC for each affected State. A
current list of SPOCs is included in the application kit. Indian tribes
are strongly encouraged to request tribal government review of the
proposed application. If SPOCs or tribal governments have any process
recommendations on applications submitted to CDC, they should send them
to Henry S. Cassell, III, Grants Management Officer, Grants Management
Branch, Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., Atlanta, GA 30305, no
later than 60 days after the application due date. The Program
Announcement Number and Program Title should be referenced on the
document. The granting agency does not guarantee to ``accommodate or
explain'' State process recommendations it receives after that date.
Public Health System Reporting Requirement
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance number is 93.197.
Other Requirements
Paperwork Reduction Act Projects that involve the collection of
information from ten or more individuals and funded by this grant will
be subject to review by the Office of Management and Budget (OMB) under
the Paperwork Reduction Act.
Application Submission and Deadline
The original and two copies of the application (PHS Form 5161-1,
OMB Number 0937-0189) must be submitted to Henry S. Cassell, III,
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, Atlanta, GA 30305, on or before
April 14, 1995.
1. Deadline:
Applications shall be considered as meeting the deadline if they
are either:
A. Received on or before the deadline date, or
B. Sent on or before the deadline date and received in time for
submission for the review process. 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 shall not be acceptable as proof of timely mailing.
2. Late Applications:
Applications which do not meet the criteria in 1.A. or 1.B., above
are considered late applications. Late applications will not be
considered in the current competition and will be returned to the
applicant.
A one-page, single-spaced, typed abstract must be submitted with
the application. The heading should include the title of the grant
program, project title, organization, name and address, project
director and telephone number. This abstract should be included in the
``Application Content'' section of the application. [[Page 5940]]
Where to Obtain Additional Information
A complete program description, information on application
procedures and an application package may be obtained from Lisa
Tamaroff, 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, Mailstop E-
13, Atlanta, GA 30305, telephone (404) 842-6796.
Please refer to Announcement Number 522 when requesting information
and submitting any application.
Technical assistance on prevention activities may be obtained from
David L. Forney, Chief, Program Services Section, Lead Poisoning
Prevention Branch, Division of Environmental Hazards and Health
Effects, National Center for Environmental Health, Centers for Disease
Control and Prevention (CDC), 4770 Buford Highway NE., Mailstop F-42,
Atlanta, GA 30341-3724, telephone (404) 488-7330.
Technical assistance on surveillance activities may be obtained
from Carol Pertowski, M.D., Medical Epidemiologist, Lead Poisoning
Prevention Branch, Division of Environmental Hazards and Health
Effects, National Center for Environmental Health, Centers for Disease
Control and Prevention (CDC), 4770 Buford Highway NE., Mailstop F-42,
Atlanta, GA 30341-3724, telephone (404) 488-7330.
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) 783-3238.
Dated: January 24, 1995.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 95-2273 Filed 1-30-95; 8:45 am]
BILLING CODE 4163-18-P
