[Federal Register Volume 62, Number 29 (Wednesday, February 12, 1997)]
[Notices]
[Pages 6540-6546]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-3473]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement 716]
Traumatic Brain Injury Surveillance Program Notice of
Availability of Funds for Fiscal Year 1997
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1997 funds for a cooperative agreement
program for population-based data systems for Traumatic Brain Injury
(TBI). The intent of the program is to further develop a multi-state,
population-based surveillance system for TBI that began in FY 1995. The
development of population-based surveillance for TBI fulfills, in part,
activities mandated in Public Law 104-166, The Traumatic Brain Injury
Act, enacted in 1996. This program will serve two purposes:
Part I--To enhance existing State or territory surveillance systems
for TBI, to ensure they are population-based and provide high quality,
useful data.
Part II--To develop TBI surveillance systems in States or
territories that have not received past funding from CDC for this
purpose and have legal authority to collect TBI data but have little or
no surveillance infrastructure. 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 to
improve the quality of life. This announcement is related to the
priority areas of Unintentional Injury, Violent and Abusive Behavior,
and Surveillance and Data Systems. (For ordering a copy of ``Healthy
People 2000,'' see the section ``WHERE TO OBTAIN ADDITIONAL
INFORMATION.'')
Authority
This program is authorized under sections 301, 317, 391, and 392,
of the Public Health Service Act (42 U.S.C. 241, 247b, 280b, and 280b-
1) as amended, including Pub. L. 104-166.
Smoke-Free Workplace
CDC strongly encourages all grant recipients to provide a smoke-
free workplace and to promote the non-use of all tobacco products, and
Pub. L. 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
Eligible applicants are the official State public health agencies
or other State agencies or departments. This includes the District of
Columbia, American Samoa, the Commonwealth of Puerto Rico, the Virgin
Islands, the Federated States of Micronesia, Guam, the Northern Mariana
Islands, the Republic of the Marshall Islands, and the Republic of
Palau.
State agencies applying under this announcement that are other than
the official State health department must provide written concurrence
for the application from the official State health agency.
Only one application from each State may enter the review process
and be considered for an award under this program. Applicants may apply
for either Part I or Part II funding as most appropriate, but not both.
For Part I, applicants who are funded under Announcement 526 are
not eligible for this program.
For Part II, applicants who have received past funding for TBI
Surveillance from CDC (from the National Center for Injury Prevention
and Control (NCIPC) or the National Center for Environmental Health
(NCEH)) are not eligible for this program.
Availability of Funds
Approximately $1,550,000 is available in FY 1997 to fund up to
eleven awards under Parts I and II of this announcement:
Part I--Approximately $1,200,000 is available in FY 1997 to fund
six to eight awards to enhance existing State surveillance systems for
TBI. It is expected that the average award will be $150,000, ranging
from $125,000 to $175,000.
Part II--Approximately $350,000 is available in FY 1997 to fund two
to three awards to assist in planning TBI surveillance systems. It is
expected that the average award will be $115,000, ranging from $90,000
to $125,000.
Projects are expected to begin on or about August 1, 1997, and will
be made for a 12-month budget period within a project period of up to 3
years. Funding estimates may vary and are subject to change.
Funds may be used for personnel services, supplies, equipment,
travel, subcontracts, and services directly related to project
activities. Project funds cannot be used to supplant other existing
funds for surveillance or registry activities, for construction costs,
or to lease or purchase facilities or space.
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Continuation awards within the project period will be made on the
basis of satisfactory progress and the availability of funds.
Funding Preferences: During the selection process CDC will make
every effort to ensure a balanced geographic distribution.
Use of Funds
Prohibition on use of CDC funds for certain gun control activities:
The Departments of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 1997 specifies that: ``None of the
funds made available for injury prevention and control at the Centers
for Disease Control and Prevention may be used to advocate or promote
gun control.''
Anti-Lobbying Act requirements prohibit lobbying Congress with
appropriated Federal monies. Specifically, this Act prohibits the use
of Federal funds for direct or indirect communications intended or
designed to influence a Member of Congress with regard to specific
Federal legislation. This prohibition includes the funding and
assistance of public grassroots campaigns intended or designed to
influence Members of Congress with regard to specific legislation or
appropriation by Congress.
In addition to the restrictions in the Anti-Lobbying Act, CDC
interprets the new language in the CDC's 1997 Appropriations Act to
mean that CDC's funds may not be spent on political action or other
activities designed to affect the passage of specific Federal, State,
or local legislation intended to restrict or control the purchase or
use of firearms.
Background and Definitions
Background
Among all types of injury, traumatic brain injury is most likely to
result in death or permanent disability. The incidence and prevalence,
severity, and cost indicate that these injuries are important public
health problems. TBI is also preventable.
Some estimates and studies of incidence have indicated
that traumatic brain injuries may result in 260,000 hospitalizations
and 52,000 deaths each year.
The severity of the nonfatal injuries is shown by
estimates that each year 70,000 to 90,000 people sustain TBI resulting
in permanent disability.
The costs of TBI--acute care, rehabilitation, chronic
care, and indirect costs--are unknown but certainly enormous. One
estimate suggests that head injuries impose an annual economic burden
of $37 billion in direct and indirect costs. These estimates of cost
fail to account for the extraordinary losses experienced by the
families and friends of those who have died or sustained disability
from TBI.
Injuries are largely preventable. The leading causes of
TBI are motor-vehicle crashes, falls, and violence.
Despite the magnitude of the problem of TBI, surveillance systems
in only a few U.S. jurisdictions are adequately monitoring its impact.
In the past, most of the data on TBIs have been collected in: (1)
Hospital-based clinical case series, (2) epidemiological studies
restricted to particular times and locales, (3) registries maintained
by government agencies responsible for providing services for persons
with these injuries, and (4) state-based public health surveillance
systems for TBI.
Hospital-based clinical case series. Data collected at hospitals
treating persons with Central Nervous System (CNS) injuries have been
used mainly to assess clinical course, treatment efficacy and quality
of care. Usually these data are not collected from all the hospitals
serving a geographic area; instead these data include only persons who
present at a particular hospital or group of hospitals for treatment.
Thus, the data may be unrepresentative of injury occurrence in the
entire population of the geographic area. They provide no information
on persons in the area who fail to receive treatment at the hospitals
collecting the data, persons whose characteristics may differ
substantially from those who do receive treatment at these hospitals.
Epidemiological Studies. Although epidemiological studies designed
to estimate the incidence of TBI have been useful, published studies
have been limited to certain geographic areas and to earlier time
periods. These studies, although valuable in defining the size of the
problem and describing etiologies of injury, have not been ongoing.
Therefore, they have not provided sufficient data to define patterns in
TBI over time, to assess changes in such patterns, and to evaluate the
effectiveness of current prevention programs. Furthermore, in
specialized studies, investigators have used varying definitions of TBI
and inclusion criteria, making comparison across studies (and therefore
across jurisdictions) difficult. Studies of these injuries have
produced a broad range of incidence estimates.
Service-based registries. Until recently, TBI case reports were
often collected in registries developed to plan and provide for patient
and family services. These were often collected by agencies of State
government not involved in traditional public health prevention
activities (e.g., mental health, vocational rehabilitation, and other
rehabilitation services). Because of the service delivery focus of
registries, little information was collected on the etiologies of
injuries, limiting the usefulness of these data for prevention program
planning. These data are seldom used for public health program
planning.
State-based Surveillance. Over the past several years, many States
have responded to the need for better TBI data by developing public
health surveillance systems--some efforts growing out of previous
registry efforts. These data systems are just beginning to provide
ongoing population-based incidence and etiologic information that is
useful to plan and evaluate public health programs. Building on these
efforts, in 1995, CDC funded four States to conduct ongoing population-
based surveillance for TBI. Methods of data collection vary among these
surveillance systems, some employing legal reporting requirements for
CNS injuries similar to reporting requirements for certain communicable
diseases, some using existing hospital discharge data systems or trauma
registries, and some relying on a combination of these methods.
Definitions
Traumatic Brain Injury (TBI) and essential data elements for TBI
surveillance are fully defined in CDC's ``Guidelines for Surveillance
of Central Nervous System Injury.'' For ordering a copy of the
Guidelines, see the sections ``WHERE TO OBTAIN ADDITIONAL INFORMATION''
and ``TRAUMATIC BRAIN INJURY SURVEILLANCE REFERENCES.''
Surveillance is the ongoing, systematic collection, analysis, and
interpretation of health data necessary for designing, implementing,
and evaluating public health programs.
Hospital discharge data (HDD) are summary data compiled by
hospitals for all patients admitted and discharged. These data, which
are usually entered in a computer data base maintained by each
hospital, include information on patient age, sex, residence, diagnoses
coded according to the International Classification of Diseases, 9th
Revision, Clinical Modification (ICD-9-CM codes), services provided,
service charges, and dates of hospital admission and discharge. In some
jurisdictions, hospital discharge data are compiled from all patients
in all hospitals and are maintained in a centralized, population-based,
data collection system. In other
[[Page 6542]]
jurisdictions, these data are only separately maintained by each
hospital.
Purpose
The purpose of this program is to improve the quality and
availability of TBI data:
Part I--To enhance existing TBI surveillance systems in order to
develop a multi-state surveillance system which will use common case
definitions and data base. This surveillance system will better define
the magnitude of TBI at a national level, define the spectrum of
severity of injury, better define populations at high risk, and define
the distribution of external causes of injury in order to plan injury
control programs addressing prevention and service provision. CDC's
Guidelines for Central Nervous System Injury Surveillance will be the
standards used.
Part II--To develop new TBI surveillance systems in States or
territories with authority to collect TBI data but which have had no
prior funding from CDC to develop TBI surveillance and which have
little or no TBI surveillance infrastructure. These State-based
surveillance systems will also become part of the multi-state
surveillance system described under Part I by the end of the project
period. CDC's Guidelines for Central Nervous System Injury Surveillance
will be the standards used.
Program Requirements
Part I--The applicant must:
1. Demonstrate the existence of a statewide (or territory-wide)
population-based TBI surveillance system or a population-based TBI
surveillance system in a geo-political jurisdiction of 1.5 million
people or more.
2. Document that legislation and/or regulations are in place which
support current collection of TBI data, and protect the confidentiality
of this data.
3. Demonstrate the availability of at least one year of TBI data
from the TBI surveillance system (from calendar year 1993, 1994, or
1995).
Part II--The applicant must: Document that legislation and/or
regulations are in place which support current collection of TBI data,
and protect the confidentiality of this data.
Both Part I and Part II applicants are to provide a 1 page Summary
which includes:
1. Type of Federal assistance requested: Part I or Part II.
2. A succinct, but informative, response to each application
program requirement.
An affirmative response to each requirement is required to qualify
for the full objective review. This page should be included as the
first page of the application and titled ``Program Requirements.''
Cooperative Activities
In conducting activities to achieve the purposes of this program,
the recipient will be responsible for the activities under A.
(Recipient Activities), and CDC will be responsible for the activities
listed under B. (CDC Activities).
Part I
Recipients of awards under Part I of this announcement will develop
an enhanced statewide (or territory-wide) population-based TBI
surveillance or population-based TBI surveillance within a geo-
political jurisdiction of 1.5 million or more.
A. Recipient Activities include but will not be limited to:
1. Conduct surveillance for TBI using the definitions and variables
as defined in the CDC Guidelines for Central Nervous System Injury
Surveillance. Recipients will collect information addressing
demographics, etiology, severity and outcome.
2. Access and use mortality data and hospital patient data, using
vital records (death certificates and/or multiple-cause-of-death data)
and linking them to hospital discharge data to produce a non-
duplicative data base for the population under surveillance.
3. Evaluate the surveillance system for completeness and validity
of data collected using methods described in ``Guidelines for
Evaluating Surveillance Systems.''
4. Develop and submit an annual report of the analysis of
surveillance data.
5. Compile and submit timely case-level surveillance data yearly
(in each budget period) to CDC for use in a multi-state TBI
surveillance data base formatted per CDC Guidelines for Central Nervous
System Injury Surveillance.
6. Develop a yearly work plan which includes measurable objectives
with appropriate time lines and associated activities.
B. CDC Activities:
1. Provide technical assistance for effective surveillance program
planning and management and for application of the CDC Guidelines for
Central Nervous System Injury Surveillance.
2. Provide technical assistance to evaluate the surveillance system
for completeness and validity.
3. Maintain multi-state data base to develop TBI rates and other
information for reports and other publications, when appropriate.
Standard practices for co-authorship and publication among CDC and
participating recipients will be followed according to the Manual
Guide--General Administration No. CDC-69, Authorship of CDC or ATSDR
Publications (12/1/95).
Part II
Recipients of awards under Part II of this announcement will
develop statewide (or territory-wide) population-based TBI surveillance
or population-based TBI surveillance within a geo-political
jurisdiction of 1.5 million or more.
A. Recipient Activities include but are not limited to:
1. Develop and implement a 3-year plan to conduct TBI surveillance
using the CDC Guidelines for Central Nervous System Injury
Surveillance. Recipients will be expected to collect information
addressing demographics, etiology, severity and outcome.
2. Use mortality data and hospital patient data, using vital
records (death certificates and/or multiple-cause-of-death data) and
linking them to hospital discharge data to produce a non-duplicative
data base for the population under surveillance.
3. Develop and submit an annual report on progress of the
developing TBI surveillance system.
4. Compile and submit case-level surveillance data to CDC in a
timely manner for use in a multi-state TBI surveillance data base
formatted per CDC Guidelines for Central Nervous System Injury
Surveillance.
5. Where applicable, evaluate the surveillance system for
completeness and validity of data collected using methods described in
``Guidelines for Evaluating Surveillance Systems.''
6. Develop a yearly work plan which includes measurable objectives
with appropriate time lines and associated activities.
B. CDC Activities:
1. Provide technical assistance for effective surveillance program
planning and management and for application of the CDC Guidelines for
Central Nervous System Injury Surveillance.
2. Provide technical assistance for data management and analysis.
3. Maintain multi-state data base to develop TBI rates and other
information for reports and other publications, when appropriate.
Standard practices for co-authorship and publication among CDC and
participating recipients will be followed according to the Manual
Guide--General Administration No. CDC-69, Authorship of CDC or ATSDR
Publications (12/1/95).
[[Page 6543]]
Technical Reporting Requirements
An original and two copies of semi-annual progress reports are
required of all awardees. Time lines for the semi-annual reports will
be established at the time of award. Final financial status and
performance reports are required no later than 90 days after the end of
the project period. All reports are submitted to the Grants Management
Branch, Procurement and Grants Office, CDC.
Semi-annual progress reports should include:
A. A brief program description.
B. A listing of program goals and objectives, accompanied by a
comparison of the actual accomplishments related to the goals and
objectives established for the period.
C. If established goals and objectives were not accomplished or
were delayed, describe both the reason for the deviation and
anticipated corrective action or deletion of the activity from the
project.
D. Other pertinent information, including the status of
completeness, timeliness and quality of data, published annual reports
from surveillance efforts, as well as other materials published related
to the surveillance system.
For Part II, any other information about the progress of
surveillance system development should be included.
Application Content
The entire application, including appendices, should not exceed 60
pages and the Proposal Narrative section contained therein should not
exceed 25 pages. The first page of the application should contain the
response to the Program Requirements section and be marked ``Program
Requirements.'' Pages should be clearly numbered and a complete index
to the application and any appendices included. The project narrative
section must be double-spaced. The original and each copy of the
application must be submitted unstapled and unbound. All materials must
be typewritten, double-spaced, with unreduced type (font size 10 point
or greater) on 8\1/2\'' by 11'' paper, with at least 1'' margins,
headers and footers, and printed on one side only.
The applicant should provide a detailed description of first-year
activities and briefly describe future-year objectives and activities.
Part I--Application Content
A. Provide a 1 page Abstract which includes:
1. Existing resources for the program.
2. Major objectives and components for the proposed program.
B. Proposal Narrative (not to exceed 25 double-space pages
excluding the budget narrative and appendices): This section should
include:
1. A brief description of the needs for TBI surveillance within the
jurisdiction applying for assistance.
2. A description of the existing TBI surveillance program within
the jurisdiction, including the following:
a. Existing staff and brief summary of their qualifications.
b. Methods of case ascertainment and data collection, including:
(1) Case definition.
(2) Data elements collected.
(3) Sources of data used to ascertain cases.
(4) Other sources of data used to provide additional information on
cases.
c. A brief summary of any data analyses completed.
d. A brief summary of any evaluations of surveillance data quality
or timeliness.
3. A description of goals and specific, measurable, and time-linked
objectives for the proposed surveillance program. Any proposed
enhancements of the program should be noted. A schedule of attainment
should be included.
4. A description of methods to achieve the proposed surveillance
program objectives. This must include at least the following:
a. Proposed staff and qualifications. If staff are to be hired,
assurances from the agency that position(s) are available and can be
filled in a timely manner must be included.
b. Proposed methods of case ascertainment and data collection,
including:
(1) The TBI case definition and its consistency with the CDC case
definition.
(2) A listing of data elements proposed to be collected. This
should include (but need not be limited to) data elements contained in
the core variables of the CDC Guidelines for Central Nervous System
Injury Surveillance. Data element formats must be consistent with the
CDC Guidelines. At a minimum, data elements collected for every case
should include birth date, age, sex, county (or zip code) of residence,
ICD-9 or ICD-9-CM diagnostic codes, dates of hospital admission and
discharge (if applicable) or dates of injury and death (if applicable),
and type of hospital discharge disposition (if applicable). It is also
expected that in at least a representative sample of reported cases,
additional data elements will be collected describing injury cause
(using either E-codes or CDC etiology codes), severity, and outcome, as
described in the CDC Guidelines. Other data elements may be collected
electively (e.g., medical service charges).
(3) All sources of data that would be used to ascertain cases. At a
minimum this should include vital records (death certificates and/or
multiple-cause-of-death data) and hospital discharge data. Hospital
discharge data may be obtained from state-wide hospital discharge data
systems, or may be obtained directly from all individual hospitals
within the jurisdiction that provide acute care for brain injuries.
(4) All other sources of data that would be used to provide
additional information on cases. At a minimum this should include
hospital medical records, which may be reviewed in a representative
sample of cases. Other, optional sources of data might include, for
example, police reports or medical examiner records.
(5) A brief description of the sampling strategy proposed to obtain
additional case information from medical records and other data sources
(see previous section). This is important to validate case reports and
collect additional data concerning injury risk factors, causes,
severity, and outcome. Because of the time required to abstract such
records and the large number of reported cases, it is not expected that
all reported cases be abstracted. Sampling strategies should ensure
representativeness of the sample, but may involve more intensive
sampling of some strata with fewer reported cases (e.g., moderate and
severe cases). The qualifications of data abstractors and quality
control of this data collection should be addressed.
c. Evidence of legal authority to conduct all aspects of
surveillance, including authority that gives the applicant access to
and authority to collect all necessary vital records data, hospital
discharge data, and medical records within the jurisdiction and protect
the confidentiality of this data. A letter from the official State
public health agency or other State agency or department or from the
Attorney General's Office assuring that appropriate State authorities
exist should be provided, which cites relevant language from State laws
and/or regulations. Appropriate State authorities at a minimum must
provide proof of the ability to collect and protect the confidentiality
of essential data from State death certificates, hospital discharge
data, and hospital medical records for all cases of traumatic brain
injury occurring in the State.
d. A description of the applicant's capability for the entry,
management,
[[Page 6544]]
processing and analysis of data, including a description of computer
hardware and software resources; a description of methods and timeline
to ensure timely delivery of edited case-level data to CDC.
e. Appropriate letters of commitment, such as letters from agencies
that will provide the project with essential data or access to data.
f. A brief description of the proposed use of data for injury
prevention programs.
5. A description of plans to evaluate the attainment of proposed
objectives, including plans to evaluate the sensitivity and predictive
value positive of case ascertainment and the completeness and quality
of data.
6. A detailed first-year budget and narrative justification with
future annual projections. Budgets should include costs for travel for
two project staff to attend one meeting in Atlanta with CDC staff.
Part II--Application Content
A. Provide a 1 page Abstract which includes:
1. Existing resources for the program.
2. Major objectives and components for the proposed program.
B. Proposal Narrative (not to exceed 25 double-space pages
excluding the budget narrative and appendices). This Section should
include:
1. A brief description of the needs for TBI surveillance within the
jurisdiction applying for assistance.
2. A description of the existing TBI surveillance resources within
the jurisdiction, including the following:
a. Existing staff and brief summary of their qualifications.
b. Available TBI data, including:
(1) Case definition (s).
(2) Data elements collected.
(3) Sources of data used to ascertain cases.
c. A brief summary of any available analyses of TBI data.
3. A description of goals and specific, measurable, and time-linked
objectives for the development of TBI surveillance. A schedule of
attainment should be included.
4. A description of planned activities to address the objectives to
develop TBI surveillance. This must include at least the following:
a. Proposed staff and qualifications. If staff are to be hired,
assurances from the agency that position(s) are available and can be
filled in a timely manner must be included.
b. Proposed methods of case ascertainment and data collection,
including:
(1) The TBI case definition, consistent with the CDC case
definition.
(2) A listing of data elements proposed to be collected. This
should include (but need not be limited to) data elements contained in
the core variables of the CDC Guidelines for Central Nervous System
Injury Surveillance. When data are submitted to CDC, they must be in a
format consistent with the CDC Guidelines.
(a) At a minimum, data elements collected for every case should
include birth date, age, sex, county (or zip code) of residence, ICD-9
or ICD-9-CM diagnostic codes, dates of hospital admission and discharge
(if applicable) or dates of injury and death (if applicable), and type
of hospital discharge disposition (if applicable). It is expected that
population-based data including these variables, obtained by linking
hospital discharge data with vital records data, will be compiled and
submitted in a timely manner, but no later than the end of the project
period.
(b) It is also expected that in at least a representative sample of
reported cases, including morbidity and mortality, additional data
elements will be collected describing injury cause (using either E-
codes or CDC etiology codes), severity, and outcome, as described in
the CDC Guidelines.
(3) All sources of data that would be used to ascertain cases. At a
minimum this should include vital records (death certificates or
multiple-cause-of-death data) and hospital discharge data. Hospital
discharge data may be obtained from state-wide hospital discharge data
systems, or may be obtained directly from all individual hospitals
within the jurisdiction that provide acute care for head injuries.
(4) All other sources of data that would be used to provide
additional information on cases. At a minimum this should include
hospital medical records, which may be reviewed in a representative
sample of cases. Other, optional sources of data might include police
reports or medical examiner records.
(5) A brief description of plans to develop a sampling strategy to
obtain additional case information from medical records and other data
sources (see previous section).
c. Evidence of legal authority to conduct all aspects of
surveillance, including authority that gives the applicant access to
and authority to collect all necessary vital records data, hospital
discharge data, and medical records within the jurisdiction and protect
the confidentiality of this data. A letter from the official State
public health agency or other State agency or department or from the
Attorney General's Office assuring that appropriate State authorities
exist should be provided, which cites relevant language from State laws
and/or regulations. Appropriate State authorities at a minimum must
provide proof of the ability to collect and protect the confidentiality
of essential data from State death certificates, hospital discharge
data, and hospital medical records for all cases of traumatic brain
injury occurring in the State.
d. A description of the applicant's plans to develop capability for
the entry, management, processing and analysis of data, including a
description of computer hardware and software resources; a description
of methods and timeline to ensure timely delivery of edited case-level
data to CDC.
e. Appropriate letters of commitment, such as letters from agencies
that will provide the project with essential data or access to data.
f. A description of the proposed use of data for injury prevention
programs.
5. A description of plans for a process evaluation of the
attainment of proposed objectives.
6. A detailed first-year budget and narrative justification with
future annual projections. Budgets should include costs for travel for
two project staff to attend one meeting in Atlanta with CDC staff.
Evaluation Criteria
Upon receipt, applications for Part I and Part II will be reviewed
by CDC staff for completeness and affirmative responses as outlined
under the previous heading, ``PROGRAM REQUIREMENTS.'' Incomplete
applications and applications that are not responsive will be returned
to the applicant without further consideration.
An Objective Review of applications that are successful in the
preliminary review will then be conducted according to the following
criteria:
Part I--Evaluation Criteria
1. Needs Assessment (5 points)
The extent to which the applicant describes the impact of TBI in
the applicant's jurisdiction and the need for TBI data for public
health programs.
2. Existing Surveillance Program and Resources (25 points)
The current status of the applicant's existing TBI surveillance
program, and the degree to which it can be adapted to serve the
requirements and purposes of this cooperative agreement. Important
issues include access to critical data sources (vital records, hospital
discharge data, and medical records); established relationships between
the applicant and data providers (including
[[Page 6545]]
letters of support); legal authority to obtain and protect the
confidentiality of data; currentness of existing TBI morbidity and
mortality data analyzed by age, sex, and cause; ability to characterize
the external cause, severity, and outcome of TBI (e.g., by abstracting
data from medical records in a representative sample of reported
cases); and established relationships with TBI advocacy and prevention
organizations and programs.
3. Goals and Objectives (10 points)
The extent to which objectives are specific, achievable, practical,
measurable, time-linked, and consistent with the overall purposes
described in this announcement.
4. Methods and Activities (30 points)
The extent that the proposed methods and activities can achieve the
proposed objectives, consistent with the purposes of this announcement.
The extent to which clear explanations of appropriate methods
addressing case ascertainment and data collection, TBI case
definition(s), data elements, sources and availability of data,
sampling methods, legal authority for surveillance activities and to
protect confidentiality, and data processing and analysis are provided.
5. Project Management and Staffing (20 points)
The extent to which proposed staffing, organizational structure,
staff experience and background, identified training needs or plan, and
job descriptions and curricula vitae for both proposed and current
staff indicate ability to carry out the objectives of the program.
Assurances that proposed positions are available and can be filled in a
timely manner.
6. Evaluation (10 points)
The degree to which the applicant includes adequate plans to
evaluate the attainment of proposed objectives, including plans to
evaluate the sensitivity and predictive value positive of case
ascertainment and the completeness and quality of data.
7. Budget (not scored)
The extent to which the budget is reasonable, clearly justified,
and consistent with stated objectives and proposed activities.
Part II--Evaluation Criteria
1. Needs Assessment (10 points)
The extent to which the applicant describes the impact of TBI in
the applicant's jurisdiction and the need for TBI data for public
health programs.
2. Existing Surveillance Resources (20 points)
The potential of the applicant's existing TBI surveillance
activities and resources to serve the requirements and purposes of this
cooperative agreement. Critical issues include availability of and
access to critical data sources (vital records, hospital discharge
data, and medical records), and legal authority to obtain and protect
the confidentiality of data.
3. Goals and Objectives (15 points)
The extent to which objectives are specific, achievable, practical,
measurable, time-linked, and consistent with the overall purposes
described in this announcement.
4. Methods and Activities (30 points)
The extent that the proposed plans and activities can achieve the
proposed objectives for surveillance, consistent with the purposes of
this announcement. The extent to which clear explanations of
appropriate methods addressing case ascertainment and data collection,
TBI case definition(s), data elements, sources and availability of data
(including letters of support), legal authority for surveillance
activities and to protect confidentiality, and data processing and
analysis are provided.
5. Project Management and Staffing (15 points)
The extent to which proposed staffing, organizational structure,
staff experience and background, identified training needs or plan, and
job descriptions and curricula vitae for both proposed and current
staff indicate ability to carry out the objectives of the program.
Proposed staffing should include epidemiologic and data management
capacity. Assurances that proposed positions are available and can be
filled in a timely manner.
6. Evaluation (10 points)
The degree to which the applicant includes adequate plans for a
process evaluation of the attainment of proposed objectives.
7. Budget (not scored)
The extent to which the budget is reasonable, clearly justified,
and consistent with stated objectives and proposed activities.
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 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. If SPOCs have
any State process recommendations on applications submitted to CDC,
they should send them to Ron S. Van Duyne, 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, Mailstop E-13, Atlanta, GA 30305, no later than 60 days after
the application deadline. The Program Announcement Number and Program
Title should be referenced on the document. The granting agency does
not guarantee to ``accommodate or explain'' the State process
recommendations it receives after that date.
Public Health System Reporting Requirements
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 93.136.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by the cooperative agreement 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
(Revised 7/92, OMB Number 0937-0189) must be submitted to Joanne A.
Wojcik, 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, on or before April 16, 1997.
1. Deadline: Applications shall be considered as meeting the
deadline if they are either;
a. Received on or before the deadline date; or
[[Page 6546]]
b. Sent on or before the deadline date and received in time for
submission to the objective review group. (Applicants must request a
legibly dated U.S. Postal Service postmark or obtain a legibly dated
receipt from a commercial carrier or the U.S. Postal Service. Private
metered postmarks will not be acceptable as proof of timely mailing.)
2. Late Applications:
Applications that 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.
Where To Obtain Additional Information
To receive additional written information call (404) 332-4561. You
will be asked to leave your name, address, and telephone number and
will need to reference to Announcement 716. You will receive a complete
program description, information on application procedures, and
applications forms.
If you have questions after reviewing the contents of all the
documents, business management business management technical assistance
may be obtained from Joanne Wojcik, Grants Management Specialist,
Grants Management Branch, Procurement and Grants Office, Centers for
Disease Control and Prevention (CDC), 255 East Paces Ferry Road, NE.,
Mailstop E-13, Atlanta, GA 30305, telephone (404) 842-6535 or internet
address jcw6@cdc.gov>.
Programmatic technical assistance may be obtained from David J.
Thurman, M.D., M.P.H., Division of Acute Care, Rehabilitation Research,
and Disability Prevention, National Center for Injury Prevention and
Control, Centers for Disease Control and Prevention (CDC), 4770 Buford
Highway, NE., Mailstop F-41, Atlanta, GA 30341-3724, telephone (770)
488-4031 or internet address dxt9@cdc.gov>.
This and other CDC announcements are available through the CDC
homepage on the Internet. The address for the CDC homepage is http://
www.cdc.gov>.
CDC will not send application kits by facsimile or express mail.
Please refer to Announcement 716 when requesting information and
submitting an application.
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) referenced in the
``INTRODUCTION'' through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325, telephone (202) 512-1800.
Dated: February 6, 1997.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
Traumatic Brain Injury Surveillance References
Methods and Key Resources
Thurman DJ, Sniezek JE, Johnson D, Greenspan A, Smith SM. Guidelines
for Surveillance of Central Nervous System Injury. Atlanta: Centers for
Disease Control and Prevention, 1995.
Klaucke DN, Buehler JW, Thacker SB, et al. Guidelines for evaluating
surveillance systems. MMWR 1988;37(s-5):1-18.
Health Care Financing Administration. International Classification of
Diseases, 9th Revision, Clinical Modification, Third Edition.
Washington, DC: U.S. Department of Health and Human Services, 1989.
Epidemiologic Studies and Reviews
Kraus, JF. Epidemiology of head injury. In Cooper, PR, ed., Head
Injury, Third Edition. Baltimore: Williams and Wilkins, 1993; 1-25.
Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with
traumatic brain injury, 1979 through 1992. JAMA 1995; 273:1778.
Published epidemiologic studies of TBI are also reviewed in the
article ``Epidemiology of Traumatic Brain Injury in the United States''
located at the Internet website of the National Center for Injury
Prevention and Control http://www.cdc.gov/ncipc/dacrrdp/tbi.htm>.
Centers for Disease Control and Prevention. Traumatic Brain Injury--
Colorado, Missouri, Oklahoma, and Utah, 1990-93. MMWR 1997; 46(1):8-11.
How to Obtain a Copy of the CDC Guidelines for Surveillance of
Central Nervous System Injury:
A copy of these Guidelines can be obtained either by calling 770-
488-4031, by submitting the ``NCIPC Publications Order Form'' through
the Internet website of the National
Center for Injury Prevention and Control http://www.cdc.gov/ncipc/
pub-res/pubsav.htm>, or by writing to the Division of Acute Care,
Rehabilitation Research, and Disability Prevention, National Center for
Injury Prevention and Control, Centers for Disease Control and
Prevention (CDC), 4770 Buford Highway, NE., Mailstop F-41, Atlanta, GA
30341-3724.
[FR Doc. 97-3473 Filed 2-11-97; 8:45 am]
BILLING CODE 4163-18-P
