PHEP Interim Progress Report

Centers for Disease Control and Prevention (CDC)
Procurement and Grants Office
Instructions for Preparing an Interim Progress Report
Catalog of Federal Domestic Assistance (CFDA) Number:
93.074 – National Bioterrorism Hospital Preparedness Program
and Public Health Emergency Preparedness Program
Funding Opportunity Announcement (FOA) Number: CDC-RFA-TP12-120102CONT13
Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness
(PHEP) Cooperative Agreements
Assistant Secretary for Preparedness and Response/National Healthcare Preparedness Programs
Centers for Disease Control and Prevention/Office of Public Health Preparedness and Response

Table of Contents
Eligibility and Available Funding ................................................................................................................. 2
Budget Period 2 Introduction ........................................................................................................................ 2
Program Requirements.................................................................................................................................. 4
Preparing and Submitting Budget Period 2 Interim Progress Reports/Funding Applications .................... 15
Accessing Required Application Package .............................................................................................. 15
Checklist of Required Application Contents .......................................................................................... 15
HPP and PHEP Submission Requirements ................................................................................................. 16
Project Narrative ..................................................................................................................................... 16
Work Plan: Capabilities Plan; Subawardee Contracts Plan.................................................................... 19
Budget .................................................................................................................................................... 22
Use of Budget Period 2 Funds for Response .............................................................................................. 26
Funding Formula......................................................................................................................................... 27
Cost Sharing or Matching ........................................................................................................................... 27
Maintenance of Funding (MOF) ................................................................................................................. 27
Maximum Amount of Carry-over Funds .................................................................................................... 28
Reporting Requirements ............................................................................................................................. 28
Audit Requirements .................................................................................................................................... 30
Appendix 1: HPP Budget Period 2 ............................................................................................................. 30
Appendix 2: PHEP Budget Period 2 Funding............................................................................................. 33
Appendix 3: Cities Readiness Initiative (CRI) Funding ............................................................................. 35
Appendix 4: HPP Budget Period 2 Benchmarks ........................................................................................ 38
Appendix 5: PHEP Budget Period 2 Benchmarks ...................................................................................... 39
Appendix 6: Guidance for Classifying Members of Healthcare Coalitions................................................ 44
Appendix 7: Training and Exercise Evaluation Requirements ................................................................... 49
Appendix 8: Emergency System for Advance Registration of Volunteer Health Professionals (ESARVHP) Compliance Requirements ........................................................................................... 53
Appendix 9: HPP-PHEP Budget Period 2 Requirements for Territories and Freely Associated States ..... 57
Appendix 10: Awardee Resources .............................................................................................................. 63

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Eligibility and Available Funding
This award will be a continuation of funds intended only for awardees previously awarded under
CDC-RFA-TP12-1201: Hospital Preparedness Program (HPP) and Public Health Emergency
Preparedness (PHEP) Cooperative Agreements. A total of $928,796,000 is currently available for
Budget Period 2, which begins July 1, 2013, and ends June 30, 2014. The funding amounts
available are shown in Appendices 1, 2, and 3. These numbers are for planning purposes only and
will be revised based on the final fiscal year 2013 budget.
The U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for
Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC)
require awardees to submit their interim progress reports through www.Grants.gov. Awardees
that encounter any difficulties submitting their interim progress reports through www.Grants.gov
should contact CDC’s Technical Information Management Section at (770) 488-2700 prior to the
submission deadline. For further information regarding the application process, contact Glynnis
Taylor at (770) 488-2752. For HPP-specific information, contact R. Scott Dugas at (202) 2450732; for PHEP information, contact Sharon Sharpe at (404) 639-0817.
Reports must be submitted by 5 p.m. Wednesday, May 1, 2013. Late or incomplete reports could result
in a delay in the award, a reduction in funds, or other action. ASPR and CDC will accept requests for a
deadline extension on rare occasions and after adequate justification has been provided.

Budget Period 2 Introduction
This guidance document is designed to assist awardees with developing a comprehensive Budget
Period 2 funding application and to act as a reference guide for fiscal, programmatic, and
administrative requirements of the Hospital Preparedness Program (HPP) and the Public Health
Emergency Preparedness (PHEP) cooperative agreements.
Awardees should refer to the CDC-RFA-TP12-1201 funding opportunity announcement
(http://www.cdc.gov/phpr/documents/cdc-rfa-tp12-1201_4_17_12_FINAL.pdf ) for the HPP and
PHEP cooperative agreements for overarching guidance on the description, background, program
implementation, and recipient activities. The purpose of the 2012-2017 HPP-PHEP cooperative
agreement programs is to provide technical assistance and resources that support state, local,
territorial, and tribal public health departments and healthcare systems/organizations in
demonstrating measurable and sustainable progress toward achieving public health and
healthcare preparedness capabilities that promote prepared and resilient communities.
Budget Period 2 should serve as a continuation of activities designed to develop, sustain, and
demonstrate progress toward achieving the public health and healthcare preparedness
capabilities. This capabilities-based model assists state and local planners in identifying gaps in
preparedness, determining specific jurisdictional priorities, and developing plans for building and
sustaining specific public health and healthcare capabilities. More information on the capabilities
can be found at
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http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf and
http://www.cdc.gov/phpr/capabilities/DSLR_capabilities_July.pdf .
Awardees should continue to improve collaborative efforts to ensure that public health and healthcare
system planning and response are coordinated and integrated. Awardees can use HPP and PHEP
cooperative agreement funding for activities and infrastructure that support this collaboration.
In addition to greater HPP and PHEP alignment, Budget Period 2 will focus on collaboration with the
U.S. Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA) and
other federal emergency preparedness programs. This collaboration will better support public health,
healthcare preparedness, homeland security, and emergency management coordination. Budget Period 2
funding applications should describe engagement among the following stakeholders in the public and
private sectors, as applicable: emergency management, public health, healthcare, law enforcement,
transportation, and other entities that distribute grant funds and/or provide technical assistance and
national strategies in support of preparedness activities.
Presidential Policy Directive (PPD) 8: National Preparedness, issued in March 2011, strengthens the
country’s security and resilience by systematically preparing for the threats that pose the greatest risk to
the nation’s security. PPD 8 directed the development of a National Preparedness Goal (NPG), which
defines the core capabilities necessary to strategically prepare for the specific types of incidents that pose
the greatest risk to the nation’s security. The core capabilities establish a common framework in which
agencies can work together to improve national preparedness.
The core capabilities are designed to ensure that preparedness, response, and recovery operations are
comprehensive, synchronized, and mutually supportive. Of the 31 NPG core capabilities, one focuses
specifically on public health and medical components; however, many of the other core capabilities
contain public health and medical components necessary for successful implementation of the NPG.
ASPR’s Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness
and CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning
inform state and local activities that operationally support these public health and medical components of
the core capabilities.
For instance, two public health and healthcare capabilities support the public information and warning
core capability to deliver coordinated, prompt, reliable, and actionable information to the whole
community. Public health agencies are responsible for disseminating critical health and safety information
to alert the media, public, and other stakeholders to potential health risks and reduce the risk of exposure
to ongoing and potential hazards, while hospitals and healthcare coalitions are responsible for assessing
an incident’s impact on healthcare delivery to determine immediate healthcare organization resource
needs to assist with developing processes for notification and information exchange between relevant
response partners, stakeholders, and healthcare organization.
HPP and PHEP projects must be conducted in a coordinated manner with FEMA and other preparedness
agencies, and HPP-PHEP funding applications should describe operational and complementary
engagement among emergency management, public health, health care, law enforcement, transportation,
and other preparedness programs as applicable. For example, in the NPG’s prevention mission area,
conducting biosurveillance is one of the critical tasks of the Screening, Search, and Detection core
capability. This critical task is led collaboratively by DHS, HHS, and the U.S. Department of Justice
(DOJ). Funding and planned activities should be coordinated among these lead federal departments to
capitalize on common interests and avoid redundancy.
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HPP-specific changes for Budget Period 2 better align HPP priorities with those of the PHEP program
and other federal partners, resulting in fewer HPP stand-alone requirements and reducing the awardee
reporting burden. For example, HPP training and exercise plans are more closely coordinated with PHEP
plans, and the HPP-PHEP risk assessment requirements are aligned with FEMA’s Threat and Hazard
Identification and Risk Assessment (THIRA) process. Routine progress reports are now due exclusively
during the application, mid-year, or end-of-year reporting cycles, and, to simplify reporting, the HPP
application budget remains focused on the function level. In Budget Period 2, HPP and PHEP work plans
now must address capability goals, objectives, and planned activities.
PHEP-specific changes for Budget Period 2 include modifications to medical countermeasure planning
and reporting processes. CDC will no longer use the medical countermeasure distribution and dispensing
(MCMDD) composite measure as a collective indicator of preparedness and operational capability within
local/planning jurisdictions, CRI areas, states, directly funded cities, territories, and freely associated
states. CDC will continue to conduct annual technical assistance reviews (TARs) of all 62 PHEP
awardees but will implement in Budget Period 2 a progress report format in lieu of the standard TAR.
This will allow CDC to maintain accountability in Budget Period 2 for medical countermeasure planning
while redesigning the TAR tool for Budget Period 3. This change also provides more time for awardees to
focus on the recommendations and operational gaps identified in prior TAR assessments.
Lastly, ASPR and CDC recognize the unique infrastructure and geographic challenges faced by the U.S.
territories and freely associated states that receive limited HPP and PHEP cooperative agreement funding.
These jurisdictions include the territories of American Samoa, Commonwealth of the Northern Mariana
Islands, Guam, and U.S. Virgin Islands and the freely associated states including Federated States of
Micronesia, Republic of the Marshall Islands, and Republic of Palau. Consequently, ASPR and CDC
have responded by modifying the HPP and PHEP requirements that these awardees can realistically
achieve in Budget Period 2. More details can be found in Appendix 9.

Program Requirements
For HPP-PHEP Budget Period 2, awardees must address and comply with joint program requirements, as
well as specific HPP and PHEP requirements. See Appendix 9 for modified requirements for American
Samoa, Commonwealth of the Northern Mariana Islands, Guam, and U.S. Virgin Islands and the freely
associated states including Federated States of Micronesia, Republic of the Marshall Islands, and
Republic of Palau.
Joint HPP-PHEP Requirements

1. Cross-Discipline Coordination


Foster greater HPP and PHEP program alignment and collaboration with other federal
preparedness programs. Awardees must continue to coordinate public health and
healthcare preparedness program activities. Awardees can use HPP and PHEP funding to
support coordination activities and must track accomplishments.
HHS strongly encourages awardees to work collaboratively with other federal health and
preparedness programs in their jurisdictions to maximize resources and prevent duplicative
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efforts. Specifically, the DHS Homeland Security Grant Program grants provide preparedness
funding to build the 31 NPG core capabilities, many of which have public health and healthcare
system activities. In addition, although no longer funded by DHS as a stand-alone grant program,
many activities and objectives associated with the Metropolitan Medical Response System
(MMRS) grant program may be considered allowable costs for HPP and PHEP programs as well
as the DHS Homeland Security Grant Program and will be considered on a case-by-case basis.
Public health department and the healthcare sector awardees must actively participate with their
emergency management and public safety partners in FEMA’s annual State Preparedness Report
(SPR), which is a self-assessment of preparedness capabilities in comparison with target
capabilities established in the state THIRA. The Post-Katrina Emergency Management Reform
Act of 2006 (PKEMRA), at 6 U.S.C. § 752, requires an SPR from any state or territory receiving
federal preparedness assistance administered by DHS. Those jurisdictions submit an annual SPR
to FEMA. Awardees should contact their jurisdiction’s state administrative agency to identify the
appropriate SPR point of contact. This will ensure that the state report reflects the full range of
preparedness activities occurring in each jurisdiction.
Additionally, as the daily delivery of public health and healthcare (e.g. Accountable Care
Organizations, Health Information Exchanges, etc.) impacts both public health and healthcare
preparedness and response, awardees are to consider linkages with programs and activities that
would improve the ability to execute the public health or healthcare preparedness capabilities.



Conduct jurisdictional risk assessments. Awardees are required to conduct jurisdictional
risk assessments (JRA) to identify potential hazards, vulnerabilities, and risks within the
community, including interjurisdictional (e.g., cross-border) risks as appropriate, that
relate to the public health, medical, and mental/behavioral systems and the functional
needs of at-risk individuals. Findings from the jurisdictional risk assessments should
inform capability-based planning, prioritize preparedness investments, and serve as a
basis for coordinating with emergency management.
HPP and PHEP awardees must coordinate activities with their emergency management and
homeland security counterparts. ASPR and CDC recognize that independently administered
public health and healthcare system JRAs and their planning priorities may differ from
emergency management and homeland security risk assessment findings. However, risk
assessments must be coordinated with relevant emergency management and homeland security
programs to account for specific factors that affect the community. Active coordination supports
“whole community” planning, informs the comprehensive jurisdictional THIRA process, and
contributes to overall preparedness and response planning efforts, including Homeland Security
Grant Program and Emergency Management Performance Grant funding opportunity
announcement requirements. More specific THIRA information is available at
http://www.fema.gov/plan.



Establish senior advisory committees. Awardees must establish and maintain advisory
committees of senior officials from governmental and nongovernmental organizations
involved in homeland security, healthcare, public health, and behavioral health to help
integrate preparedness efforts across jurisdictions and to maximize funding streams. This
will enable HPP and PHEP programs to better coordinate with relevant public health,
healthcare, and preparedness programs.
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The senior advisory committee must include regional officials directly responsible for
administering DHS preparedness grants and ASPR and CDC preparedness cooperative
agreements. These include:
o State administrative agency (SAA),
o Jurisdictional HPP director, principal investigator, or coordinator,
o Jurisdictional PHEP director or principal investigator,
o Jurisdictional emergency management agency representative,
o Jurisdictional emergency medical services representative,
o Jurisdictional medical examiner, and
o Jurisdictional hospital representative.
In addition, awardees are strongly encouraged to include healthcare coalition representatives as
applicable, as well as representatives from additional disciplines (e.g., legal, Medicare, Medicaid,
private insurance), local jurisdictions and associations, regional working groups, and other whole
community partners.



Obtain public comment and input on public health emergency preparedness and response
plans and their implementation using existing advisory committees or a similar
mechanism to ensure continuous input from other state, local, and tribal stakeholders and
the general public including those with an understanding of at-risk individuals and their
needs.



Comply with SAFECOM requirements. Awardees and subawardees that use federal
preparedness grant funds to support emergency communications activities must comply
with the fiscal year 2013 SAFECOM Guidance for Emergency Communications Grants.
The guidance provides recommendations to awardees seeking federal grant funding for
interoperable emergency communications projects; grants management best practices for
administering emergency communications grants; and information on standards that
ensure greater interoperability. The guidance is intended to ensure that federally funded
investments are compatible and support national goals and objectives for improving
nationwide interoperability. SAFECOM guidance is available at
http://www.safecomprogram.gov.

2. Administrative Preparedness


Continue to develop and implement administrative preparedness strategies. Awardees
should work with their local public health jurisdictions to strengthen administrative
preparedness planning. Such planning should address, among other things, emergency
use authorizations and public health and law enforcement collaboration. See Appendix 10
for resources to guide these efforts.



Monitor subawardee activities. As required by 45 CFR Part 92.40, awardees must
monitor activities supported by grants and subgrants to ensure compliance with
applicable federal requirements and that the performance goals are being met. See
Appendix 10 for resources to guide these efforts.
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3. Capabilities Development
Awardees must address and comply with the following Budget Period 2 requirements.


Achieve progress on capability development. In Budget Period 2, HPP and PHEP
cooperative agreement funds will be used to build and sustain capability development at
the state and local levels through associated planning, personnel, equipment, training,
exercises, and healthcare coalition development. Funded activities, including sustainment
activities to preserve current capabilities, should demonstrate measurable and sustainable
progress toward achieving public health and healthcare preparedness capabilities that
promote prepared and resilient communities.



Develop short-term capability goals and objectives. Awardees must develop short-term
goals, supporting objectives, and planned activities for the capabilities they are
addressing in Budget Period 2. For both programs, these short-term goals, objectives, and
planned activities should support the long-term goals to achieve each program’s
capabilities over the five-year project period. Capability short-term goals, supporting
objectives, and planned activities must have measurable outputs linked to program
activities and outcomes.
HPP awardees must continue to address capability required resource elements in the
capabilities plan component of the Budget Period 2 work plan, outlining the status of
completion or progression from the Budget Period 1 capabilities plan. Also, HPP budget
allocations will continue to be focused at the function level. In addition to these
requirements, and before funding additional activities based on the prioritization process,
specific capability components must be fully addressed as described below.



Comply with application and reporting requirements. Awardees must complete and
submit all required funding application components, including project narratives, work
plans, and budgets, with an emphasis on short-term (Budget Period 2) and long-term
(project period) plans to address the Healthcare Preparedness Capabilities: National
Guidance for Healthcare System Preparedness and the Public Health Preparedness
Capabilities: National Standards for State and Local Planning. In addition, awardees
must report during the mid-year and end-of-year reporting cycles on the status of planned
activities described in the work plans submitted as part of the funding applications.



Continue to develop healthcare coalitions. Awardees are expected to continue to develop
or refine healthcare coalitions as outlined in ASPR’s Healthcare Preparedness
Capabilities: National Guidance for Healthcare System Preparedness, Capability 1:
Healthcare System Preparedness, Function 1: Develop, refine, and sustain healthcare
coalitions; and in Capability 10: Medical Surge, Function 1: The healthcare coalition
assists with the coordination of the healthcare response during incidents that require
medical surge. PHEP awardees should strongly encourage and promote local health
department participation in healthcare coalitions to the maximum extent possible.
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Healthcare coalitions are expected to develop throughout the five-year project period
following a staged approach. The development of a coalition is based on the assessment
of functionality associated with Capability 1: Healthcare System Preparedness.
Awardees and their project officers will collaborate on the timeline for the development
of the coalition. A coalition development rating system will be released in concert with
the HPP performance measures.


Coordinate HPP-PHEP Training and Exercise Programs. Training and exercise activities
must support jurisdictional priorities. These priorities are generally informed by risk
assessments and operational gaps identified during self-assessments, exercises, and actual
response/recovery operations. Preparedness exercises must be conducted according to the
Homeland Security Exercise and Evaluation Program (HSEEP).
For Budget Period 2, awardees must submit an updated multiyear training and exercise
plan (MYTEP). PHEP awardees must conduct at least one PHEP annual exercise during
Budget Period 2; HPP awardees must submit a Budget Period 2 gap-based training
schedule and also perform and evaluate required exercises within the five-year project
period. Additionally, all awardees must conduct one joint, full-scale exercise (FSE)
during the five-year project period and must submit exercise documentation according to
the established evaluation and progress reporting requirements contained in Appendix 7.
In addition, there must be evidence in the Budget Period 2 work plans, budget
justifications, and technical assistance plans that all training is purposefully designed to
close operational gaps and sustain jurisdictionally required preparedness competencies.
For HPP awardees this includes National Incident Management System (NIMS)
documentation requirements outlined in Appendix 7. Awardees must report on
preparedness training conducted during Budget Period 2 in their annual progress reports,
describing the impact that training had on the jurisdictions.
Other federally funded preparedness programs have similar exercise and training
requirements which could provide collaborative opportunities. Exercise and training
activities should be coordinated across the jurisdiction(s) to the maximum extent possible
with the purpose of including the whole jurisdictional community. Exercises conducted
by other preparedness grant programs with similar exercise requirements may be used to
fulfill the annual HPP-PHEP exercise requirements if HHS preparedness capabilities are
tested and evaluated. Awardees are encouraged to invite participation from
representatives/planners involved with other federally mandated or private exercise
activities. At a minimum, ASPR and CDC encourage HPP and PHEP awardees to share
their MYTEP schedules with those departments, agencies, and organizations included in
their plans.



Meet Emergency System for Advance Registration of Volunteer Health Professionals
(ESAR-VHP) compliance requirements. The ESAR-VHP compliance requirements
identify capabilities and procedures that state ESAR-VHP programs must have in place to
ensure effective management and interjurisdictional movement of volunteer health
personnel in emergencies. Awardees must coordinate with volunteer health professional
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entities and are encouraged to collaborate with the Medical Reserve Corps (MRC) to
facilitate the integration of MRC units with the local, state, and regional infrastructure to
help ensure an efficient response to a public health emergency. More information about
the MRC program can be found at www.medicalreservecorps.gov or
[email protected].


Engage in technical assistance planning. Awardees must actively work with ASPR and
CDC project officers to update existing awardee technical assistance plans quarterly or
more frequently if needed to include Budget Period 2 activities. The consolidated HPPPHEP technical assistance plans will include awardee-identified and project officeridentified technical assistance needs and a joint strategy for addressing those needs. The
updated technical assistance plans following the quarter ending December 31, 2013,
satisfy mid-year technical assistance reporting requirements.



Plan and conduct joint site visits. Awardees should be actively involved in the planning
and execution of routine site visits conducted by ASPR and CDC project officers to
assess the activities, progress, and challenges of awardees. Awardees shall maintain all
program documentation that substantiates achievement of capabilities, performance
measures, and other programmatic requirements, including all-hazards public health
emergency preparedness and response plans, and make those documents available to
ASPR and CDC staff, as requested, during site visits or through other requests. Awardees
should plan to host site visits every 12 to 18 months.



Participate in mandatory meetings and training. The following Budget Period 2 meetings
are considered mandatory, and annual travel budgets should include travel funds for the
following HPP and PHEP staff:
o
Program director or coordinator to participate in the annual Public Health
Preparedness Summit sponsored by NACCHO
o
Two designated staff members to participate in the Directors of Public Health
Preparedness annual meeting sponsored by ASTHO
In addition, awardees must participate in other mandatory training sessions that may be
conducted via webinar or other remote meeting venues. Examples include:
o
HPP performance measurement refinement processes (e.g. webinars, surveys, etc.)
o
HPP 2013 performance measurement introductory training
o
HPP/HPP-PHEP training on new information technology system for electronic
reporting of performance measurement data

4. Meet National Incident Management System (NIMS) compliance requirements. Awardees
must meet NIMS requirements and adhere to national guidance and policies set forth in
publications such as the National Response Framework, Presidential Policy Directive 8:
National Preparedness, the National Preparedness Goal, and the National Preparedness
System. In addition, awardee jurisdictions must conduct operations in accordance with the
Incident Command System and applicable Hospital Incident Command Systems. HPP
awardees must update NIMS information submitted during Budget Period 1 with applicable
changes. See Appendix 7 for more detailed information.
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5. Engage the state office on aging or equivalent office in addressing the public health
emergency preparedness, response, and recovery needs of older adults. Awardees must
provide evidence that this state office or equivalent is engaged in the jurisdictional planning
process.
6. Develop preparedness and response strategies and capabilities that address the public health,
mental/behavioral health, and medical needs of at-risk individuals in the event of a public
health emergency. Awardees must have structures or processes in place, including the use of
functional needs assessments, to ensure the needs of at-risk individuals are included in
response strategies and the needs are identified and addressed in operational plans. In
addition, awardees are encouraged to coordinate emergency preparedness planning with state
and local agencies that provide services for disabled populations, including pregnant women
and women of childbearing age, and those with functional disabilities. At risk-individuals
include children, senior citizens, and pregnant women. In addition, individuals in need of
additional response assistance may include those who have disabilities; live in
institutionalized settings; are from diverse cultures; have limited English proficiency or are
non-English speaking; are transportation disadvantaged; have chronic medical disorders; and
have pharmacological dependency.
7. Utilize Emergency Management Assistance Compact (EMAC) or other mutual aid
agreements for medical and public health mutual to support coordinated activities and to
share resources, facilities, services, and other potential support required when responding to
public health emergencies.
8. Submit influenza pandemic preparedness plans as required by Sections 319C-1 and 319C-2
of the Public Health Service Act and amended by the Pandemic and All-Hazards
Preparedness Act (PAHPA). ASPR and CDC have determined that awardees can satisfy the
2013 annual requirement through the required submission of other program data such as the
2013 capability self-assessment and Budget Period 2 application that provide ample evidence
on the status of state and local influenza pandemic response readiness as well as the barriers
and challenges to preparedness and operational readiness. ASPR and CDC will review these
data to develop summary reports on operational readiness for influenza pandemic response
and use these reports to enhance pandemic and all-hazards preparedness through individual
awardee technical assistance plans.
9. Provide performance measure data. Awardee performance reporting provides critical
information needed to evaluate how well HPP and PHEP funding has improved the nation’s
ability to prepare for and respond to public health emergencies. ASPR and CDC used the
performance measure data collected at Budget Period 1 mid-year to determine the need for
further refinements to the measures based on real-world experience and data.
ASPR and CDC expect to release Budget Period 2 performance measure guidance, including new
reporting requirements, by June 2013. Expected modifications to the performance measures changes
may include, but are not limited to, fewer performance measures and required data elements as well
as changes to select existing measures. The new guidance will supersede performance measure
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requirements outlined in the HPP and PHEP Budget Period 1 Performance Measures Specifications
and Implementation Guidance documents and Appendices 6 and 9 of the CDC-RFA-TP12-1201
funding opportunity announcement.
Performance measures considered provisional in Budget Period 1 and retained for Budget Period 2
will no longer be considered provisional and will be subject to public dissemination by ASPR and
CDC. Any new measures introduced in Budget Period 2 may be considered provisional with the
public release of these data restricted to the extent allowable by law. All other measures may be
subject to public dissemination.
To reduce reliance on performance measurement and overall reporting burden, ASPR and CDC
intend to explore other methods of evaluating awardee capability and performance. Examples may
include site visits by evaluation staff, analysis of after-action reports and similar documents,
measurement based on local, regional, or statewide responses, and other forms of evaluation.
Awardees are encouraged to consider future requests by ASPR or CDC to conduct these activities in
their jurisdictions.
PHEP-specific Provisions
To reduce reporting burden on the majority of island jurisdictions, the following PHEP awardees will
not be required to report PHEP performance measures data in Budget Period 2: American Samoa,
Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of
the Marshall Islands, Republic of Palau, and U.S. Virgin Islands. However, these awardees will be
required to submit data on newly developed performance goals specifically designed to assess
fundamental aspects of preparedness in these jurisdictions (see Appendix 9). In addition, these
awardees will be required to submit data for the two HPP-PHEP performance measures (currently 6.1
and 15.1) related to the information sharing and volunteer management capabilities.
In addition, the PHEP program, in collaboration with CDC’s Epidemiology and Laboratory Capacity
program as well as CDC’s Office of Surveillance, Epidemiology and Laboratory Services (OSELS),
intends to pilot performance measures related to electronic laboratory reporting (ELR). Further
guidance and reporting requirements will be released in Budget Period 2.
Performance Measure Reporting Requirements
For planning purposes, including contract negotiation with subawardees, HPP and PHEP awardees
should adhere to reporting requirements as stated in these programs’ respective performance
measures guidance documents. ASPR’s Fiscal Year 2012 Hospital Preparedness Program (HPP)
Performance Measure Manual Guidance for Using the New HPP Performance Measures can be found
at http://www.phe.gov/Preparedness/planning/evaluation/Documents/fy2012-hpp-082212.pdf.
CDC’s PHEP Budget Period 1 Performance Measure Specifications and Implementation Guidance is
available at
http://www.cdc.gov/phpr/documents/PHEP+BP1+PM+Specifications+and+Implementation+Guidanc
e_v1_1.pdf.. The updated HPP and PHEP performance measure guidance documents to be released
by ASPR and CDC by June 2013 will include detailed reporting requirements for Budget Period 2.
ASPR and CDC recommend that awardees reflect performance measure requirements, including
contingencies for possible changes to these requirements, in contracts, memoranda of understanding,
and other binding documents with subawardees.
HPP and PHEP awardees are required to report Budget Period 2 performance measure and related
evaluation and assessment data to ASPR and CDC. Budget Period 2 performance measures include
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those that are specific to HPP, specific to PHEP, and a subset of performance measures jointly
developed by ASPR and CDC used to satisfy the requirements of both programs. Supporting data
related to the HPP and HPP-PHEP performance measures may be solicited from HPP and PHEP
awardees during both the mid-year (January 31, 2014) and the end-of-year (September 30, 2014)
reporting cycles for Budget Period 2. ASPR and CDC may reach out to awardees and other partners
to gain insight and feedback on existing measures as well as suggestions for improvement.

10. Meet evidence-based benchmarks. ASPR and CDC have specified a subset of measures and
select program requirements as benchmarks as mandated by Sections 319C-1 and 319C-2 of
the PHS Act as amended by PAHPA. Awardees must document, or demonstrate, that they
have met or substantially met a benchmark by providing complete and accurate information
describing how the benchmark was met. ASPR and CDC expect awardees to achieve,
maintain, and report on benchmarks throughout the five-year project period. Data for select
HPP and PHEP benchmarks are required to be submitted no later than January 31, 2014, as
part of the mid-year progress report, or as otherwise indicated by ASPR or CDC (. e.g.,
Laboratory Response Network proficiency testing, etc.). Note that a key benchmark for both
programs, “demonstrated adherence to application and reporting deadlines,” requires timely
submission of applicable information throughout Budget Period 2 – not just at mid-year.
HPP and PHEP benchmarks can be found in Appendices 4 and 5.
Awardees should review funding opportunity announcement CDC-RFA-TP12-1201 for information
on PAHPA accountability provisions and enforcement actions and disputes, as well as withholding
and repayment guidance.
HPP Requirements

1. Comply with HAvBED (National Hospital Available Beds for Emergencies and Disasters)
standards. While this requirement is no longer an HPP benchmark, awardees still are required
to maintain and refine an operational bed tracking, accountability/ availability system
compatible with the HAvBED data standards and definitions. Systems must be maintained,
refined, and adhere to all requirements and definitions included in the CDC-RFA-TP121201funding opportunity announcement, with the ongoing ability to submit required data to
the HHS Secretary’s Operations Center (HHS SOC) using either the HAvBED Web portal or
the HAvBED EDXL Communication Schema (found at https://havbedws.hhs.gov).
Information and technical assistance will be provided to awardees on both options. The
HAvBED Web portal is available at https://havbed.hhs.gov.
2. Identify existing healthcare coalitions. Awardees must update the following basic
information about the healthcare coalitions that exist within their states in their annual
progress reports.
o For each coalition, identify the:
•
•

Coalition name;
Coalition members by type (see Appendix 6), name, and national provider identification
(NPI) number;
12

o

• Coalition stage of development;
• Coalition point of contact (POC) name;
• POC telephone number;
• POC street address;
• POC e-mail address; and
• Coalition Web site address (if one exists)
An updated coalition map that delineates the geographic boundaries of all the coalitions
within the state.

In partnership with each HPP awardee, all identified coalitions may be asked to complete a
questionnaire to describe their characteristics and functions. ASPR will use this data to update
information on existing coalitions. Results will be shared with the awardees.
PHEP Requirements
1. Seek local health department and tribal concurrence (applicable to decentralized state health

departments and those with federally recognized tribes). Awardees must consult with local
public health departments, American Indian/Alaska Native tribes, or other subdivisions
within the jurisdiction to reach consensus, approval, or concurrence on the overall strategies,
approaches, and priorities described in their work plans. Awardees who are unable to gain
100% concurrence, must address the reasons for lack of concurrence.
2. Coordinate with cross-cutting public health preparedness partners. PHEP program
components as a whole should complement and be coordinated with other public health,
healthcare, and emergency management programs as applicable. For example, some public
health laboratory, surveillance and epidemiological investigation, and information sharing
capability functions may mutually support activities described within CDC’s Epidemiology
and Laboratory Capacity (ELC) for Infectious Diseases cooperative agreement. PHEP
awardees also should work with immunization programs and partners on syndromic
surveillance and other activities to assure preparedness for vaccine-preventable diseases,
influenza pandemics, and other events requiring a response. In addition, preparedness
planning across jurisdictions (e.g., cross-border) and multiple disciplines, to include U.S.
border health preparedness and response activities for the states sharing an international
boundary with Canada and Mexico, will better prepare awardees to assess, notify, and
respond to natural, accidental, or deliberate public health events.
3. Assure compliance with the following requirements. Unless otherwise noted, no specific
narrative response or attachment is necessary as CDC’s Procurement and Grants Office
(PGO) considers that acceptance of the Budget Period 2 funding awards constitutes assurance
of compliance with these requirements.
■
Maintain a current all-hazards public health emergency preparedness and response plan
and submit to CDC when requested and make available for review during site visits.
■
Submit required program progress reports and financial data, including progress in
achieving evidence-based benchmarks and objective standards; performance measures
data including data from local health departments as applicable; the outcomes of annual
preparedness exercises including strengths, weaknesses and associated corrective actions;
13

■

■
■
■

accomplishments highlighting the impact and value of the PHEP program in their
jurisdictions; and descriptions of incidents requiring activation of the emergency
operations center and Incident Command System. Reports must describe:
o preparedness activities that were conducted with PHEP funds;
o purposes for which PHEP funds were spent and the recipients of the funds;
o the extent to which stated goals and objectives as outlined in awardee work plans
have been met; and
o the extent to which funds were expended consistent with the awardee funding
applications.
In coordination with the Hospital Preparedness Program, inform and educate hospitals
and healthcare coalitions within the jurisdiction on their role in public health emergency
preparedness and response. (Capability 10: Medical Surge, Function 1: Assess the nature
and scope of the incident.)
Submit an independent audit report of PHEP expenditures every two years to the Federal
Audit Clearinghouse within 30 days of receipt of the report.
Have in place fiscal and programmatic systems to document accountability and
improvement.
Provide CDC with situational awareness data generated through interoperable networks
of electronic data systems. (Capability 6: Information Sharing.)

Please note the following two annual requirements apply only to those awardees funded for these
activities.

4. Comply with Cities Readiness Initiative (CRI) guidelines. To align with the PHEP
cooperative agreement’s capabilities-based approach, CRI requirements support Capability 8:
Medical Countermeasure Dispensing and Capability 9: Medical Materiel Management and
Distribution. As described in those capabilities, CRI supports medical countermeasure
distribution and dispensing (MCMDD) for all-hazards events. In Budget Period 2, CDC will
no longer use the MCMDD composite measure as an indicator of MCMDD preparedness and
operational capability within local/planning jurisdictions, CRI areas, states, directly funded
localities, territories, and freely associated states. Instead, Budget Period 2 CRI requirements
include a minimum TAR local progress report score of 69 (average of all CRI jurisdictional
local TAR scores in a single state). Each local planning jurisdiction within the 72 CRI
metropolitan statistical areas, including the four directly funded localities, must conduct three
different drills during Budget Period 2. The results of the drill data submissions and
compliance with dispensing and distribution standards will be reviewed during site visits to
evaluate local MCMDD preparedness.
5. Continue Level 1 chemical laboratory surge capacity activities. The 10 awardees must
address objectives related to chemical emergency response surge capacity as outlined in
Capability 12: Public Health Laboratory Testing, including staffing and equipping the lab,
maintaining critical instrumentation in a state of readiness, training and proficiency testing
for staff, and participating in local, state, and national exercises. In addition, awardees must
describe how they plan to increase their laboratory capabilities and capacities consistent with
the Laboratory Response Network for chemical terrorism program objectives, including the
14

addition of new high-throughput sample preparation and analysis techniques and analytical
capability for new threat agents.

Preparing and Submitting Budget Period 2 Interim Progress Reports/Funding
Applications
Funding applications are due 60 calendar days after the Budget Period 2 continuation guidance is posted
on www.grants.gov. Awardees must download the SF-424 application package associated with this
continuation guidance from www.grants.gov.

Accessing Required Application Package
■

■

Go to: www.Grants.gov
Select: “Apply for Grants”
Select: “Step 1: Download a Grant Application”
Insert the Funding Announcement Number only, formatted as:

■

Download application package and complete all sections.

■
■

o CDC-RFA-TP12-1201-2CONT13

Checklist of Required Application Contents
The mandatory application package associated with this funding opportunity includes:








Application for Federal Domestic Assistance-Short Organizational Form (SF424)
SF-424A Budget Information for Non-Construction Programs
Budget Justification
Indirect Cost Rate Agreement
Project Narrative Attachment Form
Other Attachments Forms (1 each unless otherwise noted)
o Attachment A:
Additional SF-424A
o Attachment B:
Budget Justification
o Attachment C:
Budget Detail
o Attachment D:
Budget Association to Work Plan
o Attachment E:
Additional Indirect Cost Rate Agreement
o Attachment F:
Additional Project Narrative
o Attachment G:
Work Plan (Capabilities Plan - one each for HPP and
PHEP)
o Attachment H:
Local Concurrence Letters (applicable PHEP awardees) or
documentation of negotiation process
o Attachment I:
Tribal Concurrence Letters (applicable PHEP awardees
only) or negotiation documentation of process
o Attachment J:
Standard Operating Procedures for Subawardee Monitoring
(optional if SOPs fully addressed in project narrative)
o Attachment K:
Subawardee Contracts Plan (optional)
o Attachment L:
Budget Change Report (optional carry-over request)
15

Application for Federal Domestic Assistance-Short Organizational Form
Complete all sections.
■
In addition to inserting the legal name of your organization in Block #5a, insert the HPPPHEP Award Number provided in the CDC Notice of Award. Failure to provide the
award number could cause delay in processing the application.
■
Please insert awardee’s business official information in Block #8.
Note: SF-424A Budget Information for Non-Construction Programs, Budget Justification and Indirect
Cost Rate Agreement should be attached to the application through the “Mandatory Documents” section
of the “Grant Application” page. Select “Other Attachments Form” and attach as a PDF file.

HPP and PHEP Submission Requirements
The HPP-PHEP funding application requires submission of a joint application containing the following
information via www.grants.gov:
■
■
■

Project narrative (one each must be submitted for HPP and PHEP, but it can be the same
narrative)
Work plan (one each for HPP and PHEP)
Itemized budget (one each for HPP and PHEP)

Project Narrative
The project narrative should summarize the overall preparedness strategy for the remainder of the fiveyear project period highlighting significant successes and challenges encountered in Budget Period 1.
The project narrative must be uploaded in a PDF file format when submitting via www.grants.gov. The
narrative must be submitted in the following format:
■
Maximum number of pages: 15. If the narrative exceeds the page limit, only the first 15 pages
will be reviewed.
■
Narrative must be prepared in English.
■
Font size: 12 point unreduced, Times New Roman
■
Single spaced.
■
Page margin size: 1 inch.
■
Number all narrative pages; not to exceed the maximum number of pages.
■
Application attachments must be in PDF format.
Awardees are strongly encouraged to use the Budget Period 2 project narrative template to ensure all
required aspects of the project narrative are submitted. The project narrative consists of the following
major components.
1. Five-year Forecast Update.
The five-year forecast should be based on the operational needs of the jurisdiction, preparedness
program gaps, overarching guidance of the public health and healthcare preparedness capabilities, and
other operational considerations as appropriate. It should summarize the overall preparedness strategy
for the remainder of the project period and represent a phased plan for completing the preparedness
program work associated with the capabilities. The forecast should contain the following elements:
16






Jurisdictional Prioritization. Based on the jurisdiction’s operational needs, awardees should
prioritize the capabilities they need to work on during Budget Periods 2-5. This prioritization
should focus on closing the most important program gaps first, represent a phased approach to
achieving the capabilities during the five-year project period, and include plans for working with
local and tribal health departments or healthcare coalitions as appropriate. Specifically, the
capability prioritization must include detailed plans for capabilities being addressed in Budget
Period 2, a rationale for choosing those capabilities, and an indication when work on the
remaining capabilities will be conducted. For example, if the fatality management capability will
not be addressed until Budget Period 4, that should be reflected in the phased plan.
Budget Period 1 Challenges. Describe any challenges or barriers encountered in Budget Period 1
that hindered progress on the capabilities and any anticipated challenges or barriers that may
affect the ability to complete or make progress on the capabilities in Budget Period 2.
Budget Period 1 Successes. Identify and describe any completed capability activities from HPP
and PHEP investments in Budget Period 1 that resulted in measureable changes or improved
outcomes. If these were submitted as part of the Budget Period 1 mid-year progress report,
awardees can refer to that report to avoid repeating the same information in this application.

2. Administrative Preparedness Strategies
Administrative preparedness plans should be incorporated into all-hazards preparedness plans. As
applicable, awardees should describe any updates, changes, and enhancements to administrative
preparedness plans submitted in Budget Period 1 including responses to the following questions:
■
Did you implement all or part of the administrative preparedness plan that was submitted as
part of the Budget Period 1 requirement?
■
If yes, describe any lessons learned.
■
If no, did you review the plan to see if it was still viable? Describe the review process and
any changes that were included as part of your revised plan.
■
Do you have emergency legal authorities, including, but not limited to:
o Receiving, allocating, and spending emergency funds
o Waivers or similar legal processes to minimize the potential conflicts between emergency
use authorizations (EUA) and state-based pharmaceutical, prescribing, labeling, and other
drug-related laws
o Formal memoranda of understanding or agreement (MOU/MOA) for conducting joint
law enforcement and epidemiological investigations
o Protection of volunteers against tort liability and workers’ compensation claims
3. Subawardee Monitoring
Awardees must describe or, if available, submit copies of their standard operating procedures (SOPs)
for subawardee monitoring. As required by 45 CFR Part 92.40, awardees must monitor activities
supported by grants and subgrants to ensure compliance with applicable federal requirements and that
the performance goals are being met. The SOP should include:
■
Type of monitoring such as:
o Site visits
o Reporting (program and financial)
o Voucher submission and review
■
Procedures for documenting and verifying program activities, such as:
o Progress on capabilities
o Participation in training and exercises
o Focus on emergency use authorizations (EUA) to ensure local jurisdictions understand
how EUAs may affect local response planning
17

Ensuring adequate policies and procedures are in place for conducting joint law
enforcement and epidemiological investigations
Procedures for documenting and verifying expenses, such as:
o A-133 audit compliance and resolutions of any findings
o Matching funds
o Allowable costs
o

■

See Appendix 10 for more information and tools to assist with subawardee monitoring.
4. Advisory Committee Activities
Awardees must describe plans for maintaining a senior advisory committee or an equivalent entity in
Budget Period 2 to provide input on preparedness strategies, plans to address operational gaps, and
potential preparedness investments. Comprised of senior officials (from governmental and
nongovernment organizations), the advisory committee should enhance the integration of disciplines
involved in homeland security, healthcare, public health, behavioral health, emergency management
and emergency medical services; include representatives of at-risk individual groups; improve
coordination of preparedness efforts across the jurisdiction; and leverage funding streams. Awardees
should also describe whether their advisory committees include citizen representation to obtain public
input and comment on emergency preparedness planning.
5. Local Health Department Concurrence (PHEP awardees only)
Awardees must describe, as applicable, the process used to consult with local public health
departments to reach consensus, approval, or concurrence on overall strategies, approaches, and
priorities outlined in their work plans. The narrative should explain whether concurrence was
obtained, issues that were encountered, and plans to address any concerns. In addition, awardees must
provide documented evidence that at least a majority, if not all, of local health departments within
their jurisdictions approves or concurs with the strategies, approaches, and priorities described in the
awardee work plans. State applicants will be required to provide signed letters of concurrence on
official agency letterhead from local health departments or representative entities upon request.
Awardees who are unable to gain 100% concurrence, despite good-faith efforts to do so, should
submit a PDF document with their applications describing the reasons for lack of concurrence and the
steps taken to address them.
6. Tribal Concurrence (PHEP awardees only)
As applicable, awardees must describe the process used to consult with American Indian/Alaska
Native tribes to reach consensus, approval, or concurrence on overall strategies, approaches, and
priorities outlined in their work plans. The narrative should explain whether concurrence was
obtained, issues that were encountered, and plans to address any concerns. In addition, awardees must
provide documented evidence that a majority, if not all, of American Indian/Alaska Native tribes
within their jurisdictions approves or concurs with the approaches and priorities described in the
awardee funding applications. State applicants will be required to provide signed letters of
concurrence on official agency letterhead from tribal health departments or representative entities
upon request. Awardees who are unable to gain 100% concurrence, despite good-faith efforts to do
so, should submit a PDF document with their applications describing the reasons for lack of
concurrence and the steps taken to address them.
7. Engagement with State Office on Aging
Awardees must describe the process or approach used to engage the state office on aging or
equivalent office in addressing the public health emergency preparedness, response, and recovery
18

needs of older adults. This description also should include the specific capabilities the awardee plans
on addressing with this entity.
8. National Incident Management System (NIMS) Compliance
Awardees must indicate whether they have met NIMS requirements as outlined in Appendix 7.
9. At-risk Individuals
Awardees must describe in general terms the structures or processes in place to ensure the needs of atrisk individuals are included in response strategies and are identified and addressed in operational
work plans. In addition, awardees should describe any plans to coordinate emergency preparedness
planning with state and local agencies that provide services for disabled populations, including
pregnant women and women of childbearing age, and those with functional disabilities.
10. Emergency Management Assistance Compact (EMAC)
Awardees must describe EMAC agreement or other mutual aid agreement processes in place for use
during emergency response and recovery operations or in other surge situations where additional
assistance is required.
11. Coordination with Cross-cutting Public Health Preparedness Partners (PHEP awardees only)
Awardees should describe how their PHEP program components are coordinated with other public
health, healthcare, and emergency management programs as applicable. For example, awardees
should outline any PHEP activities that mutually support activities within CDC’s Epidemiology and
Laboratory Capacity (ELC) for Infectious Diseases cooperative agreement. The project narrative also
should include how PHEP awardees work with immunization programs and related partners on
syndromic surveillance and other activities to assure preparedness for vaccine-preventable diseases,
influenza pandemics, and other events requiring a response.

Work Plan: Capabilities Plan; Subawardee Contracts Plan
Work plan
The work plan describes awardees’ short-term goals, objectives, and planned activities for Budget Period
2 and consists of two components:
 Capabilities plan (required)
 Subawardee contracts plan (optional)
Capabilities Plan
The capabilities plan must describe the goals, objectives, and planned activities associated with each
capability the awardees are making investments in or otherwise working on during Budget Period 2.
HPP awardees must continue to address all eight healthcare preparedness capabilities for successful
completion over the project period. In Budget Period 2, awardees must describe goals, objectives, and
planned activities that support their capability-based five-year strategy. To adequately address these
capabilities, HPP awardees must address the funded functions and required resource elements within the
narrative of their short-term goal, objectives, or planned activity submissions for Budget Period 2. The
19

goals, objectives, and planned activities should be related to the capabilities and their associated function
and resource element guidelines.
PHEP awardees are expected to achieve the 15 preparedness capabilities by the end of the five-year
project period and are granted the flexibility to choose the specific capabilities they work on in a single
budget period. For those capabilities awardees plan to work on during Budget Period 2, awardees must
describe the goals, objectives, and planned activities to support the planned activity type (build, sustain,
or scale back). Applications cannot be submitted if one or more capabilities are missing a short-term goal,
an objective, planned activities for an objective, or a rationale why there are no planned activities for a
capability.
HPP and PHEP awardees must provide updates to their capabilities plans in the form of outcome and
output descriptions in the Budget Period 2 mid-year progress report (January 31, 2014) and in the Budget
Period 2 annual progress report (September 30, 2014). These updates must thoroughly describe what HPP
and PHEP programs achieved in Budget Period 2. Awardees are encouraged to keep these reporting
requirements in mind as they design their capability short-term goals, objectives, and planned activities
for the Budget Period 2 application submission.
A complete Budget Period 2 capabilities plan includes the following elements:
1. A chosen planned activity type for each capability, using one of the following options:
■
Build
■
Sustain
■
Scale back
■
No planned activities this budget period
If “sustain” is selected, the awardee must identify in the short-term goal to what level or target
sustainment is desired during this budget period.
If there are no planned activities, the awardee must:
Identify any challenges or barriers that may have led to having no planned activities this budget
period from the drop-down menu in the application module.
■
Indicate and describe, if applicable, any self-identified technical assistance needs for the
capability.
■

2. Short-term goal. Awardees’ short-term goal descriptions must directly link to the capability’s
functions, tasks, or resource elements and answer the question: “Based on the jurisdictional needs,
what aspects of the capability does the awardee need to address in Budget Period 2 and to what
degree?” Both parts of the short-term goal are important and the description must identify the
specific, quantifiable changes or desired outcomes awardees need to achieve for each capability or to
what degree the capability needs to be sustained. The goal can span multiple functions, tasks, or
resource elements for each capability.
Each capability’s short term goal must identify the desired outcomes or changes for that capability. If
met, each short-term goal reported in the application submission will be linked to achieved
“outcomes” that are reported as part of mid-year and annual progress reports.
3. If awardees have planned activities for a capability they must select one of the following types of
funding for that capability:
■
HPP
20

■
■
■

PHEP
HPP and PHEP
Other funding source (state, local, DHS, other)

For HPP awardees, any capability with objectives that have associated functions that are supported by
HPP funding must have at least one budget line item associated to that function in the budget.
For PHEP awardees, any capability with objectives that are supported by PHEP funding must have at
least one budget line item associated to that capability in the budget.
4. Objectives. Awardees must provide at least one objective that directly supports the short-term goal for
a specific capability. Similar to the short-term goal, the objective descriptions must also be specific,
measurable, and directly support or contribute to the achievement of the short-term goal.
5. Planned Activities. Awardees must provide at least one planned activity for each objective that
describes the necessary deliverables, products, or outputs required to meet the objective. If met, each
planned activity reported in the application submission will be linked to achieved “outputs” that are
reported as part of the mid-year and annual progress reports. Planned activities must indicate which
aspects of the functions and resource elements will be built or sustained during Budget Period 2 and
should contain the following elements:
■
■

Defined deliverables, products, or outputs the planned activities are expected to produce; and
Milestones that are specific, measureable, realistic, and refer to what is being built or sustained.

6. Function Associations. Awardees must associate objectives to functions for a specific capability
through a functions drop-down menu.
7. Technical Assistance. Awardees should describe, if applicable, any self-identified technical assistance
needs for the objective.

Subawardee Contracts Plan
Awardees who propose contracts in their budget with local or tribal health departments/entities,
healthcare coalitions, or healthcare organizations may submit an optional subawardee contracts plan
describing the contractual arrangements. The plan is most beneficial for identical contracts that apply to
multiple subawardees as in the case of many state relationships with local health departments and
healthcare coalitions. Each subawardee still requires a separate budget line item, but the justification can
simply refer to the subawardee contracts plan instead of rewriting or copying and pasting the justification
numerous times. The plan should describe the full scope of work expected from the subawardees and the
specific capabilities to be addressed.
For each separate contract entered into the subawardee contracts plan, the following information must be
submitted:
■
■
■

A unique contract name for the subawardee contract;
An indication of the type of subawardee or jurisdiction the plan is written for;
An indication of which capabilities or other work plan associations this contract will
be supporting; and
21

■

A narrative that describes the scope of work, planned activities, and desired outcomes
of the contract per capability. It is important to include this narrative for every
capability included in the subawardee contracts plan.

Contracts not intended for multiple subawardees should be listed separately in the budget and should not
be included in the subawardee contracts plan. For example, contracts to single entities, such as academic
institutions or information management vendors should not be submitted as part of a subawardee
contracts plan. For these individual contracts, all of the required contract information should be included
in the budget justification.

Budget
SF-424A Budget Justification
A.
Download the form from www.grants.gov.
B.
Complete all applicable sections.
C.
Estimated unobligated funds
1. Provide an estimate of anticipated unobligated funds at the end of
the current budget period.
2. If use of estimated unobligated funds is requested in addition to
funding for the next year, complete all columns in Section A of 424A and submit an
interim Federal Financial Report (FFR), Standard Form-425, available at
http://grants.nih.gov/grants/forms.htm#closeout.
D.
The estimated unobligated balance should be realistic to be consistent with the annual
Federal Financial Report (FFR) to be submitted following the end of the budget period.
E.
Based on the current rate of obligation, if it appears there will be un-obligated funds at
the end of the current budget period, provide detailed actions that will be taken to obligate
this amount.
F.
If it appears there will be insufficient funds, (1) provide detailed justification of the
shortfall; and (2) list the actions taken to bring the obligations in line with the authorized
funding level.
G.
The proposed budget should be based on the federal funding level stated in the HPPPHEP Budget Period 2 guidance.
H.
In a separate narrative, provide a detailed, line-item budget justification of the funding
amount requested to support the activities to be carried out with those funds. Attach in the
“Mandatory Documents” box under “Budget Narrative Attachment Form.” Document needs
to be in the PDF format.
I.
The budget justification must be prepared in the general form, format, and to the level of
detail as described in the CDC Budget Guidance. The sample budget guidance is provided at:
http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm.
J.
For all contracts not included in the subawardee contracts plan, both newly requested and
existing, must contain the following information requirements. If these contract elements are
not available at application the contract budget line item could be restricted.
i. Name(s) of contractor(s)
ii. Scope of work
iii. Method of selection (competitive or sole source); procurement by noncompetitive
proposals may be used only when the award of a contract is infeasible under
small purchase procedures, sealed bids or competitive proposals and is justified
under criteria in 45 Code of Federal Regulations Part 92.36.
iv. Period of performance
22

v. Method of accountability
vi. Itemized budget with narrative justification
K.
For nonfederal Matching requirement, provide a line-item list of non-federal
contributions including source, amount, and/or value of third- party contributions proposed to
meet a matching requirement. (For further information, see “Cost Sharing or Matching”
section on page 26.)
L.
For Maintenance of Funding requirements, provide documentation ensuring that
expenditures for public health security are maintained at a level not less than the average of
such expenditures for the previous two years. (For further information, see “Maintenance of
Funding (MOF)1 section on page 26.)
Indirect Cost Rate Agreement
(This is not applicable to awardees subject to OMB Guidance A-21 – Educational Institutions. The rates
stay the same as the first-year award.)
■
If indirect costs are requested, include a copy of the current negotiated federal indirect cost rate
agreement or a cost allocation plan approval letter for those awardees under such a plan.
■
Clearly describe the method used to calculate indirect costs. Make sure the method is consistent
with the Indirect Cost Rate Agreement.
■
To be entitled to use indirect cost rates, a rate agreement must be in effect at the start of the
budget period.
■
If an Indirect Cost Rate Agreement is not in effect, indirect costs may be charged as direct if (1)
this practice is consist with the awardee’s/applicant’s approved accounting practices; and (2) if
the costs are adequately supported and justified. Please see the CDC Budget Guidance
(http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm) for additional information.
■
If applicable, attach in the “Mandatory Documents” box under “Other Attachments Form.”
Name document “Indirect Cost Rate.”
■

If awardees requests indirect costs in the budget, a copy of the current indirect cost rate
agreement is required. If the indirect cost rate is a provisional rate, the agreement should
have an effective date no more than 12 months prior to the application due date. The
indirect cost rate agreement should be uploaded as a PDF file attachment when
submitting via Grants.gov.

Awardees should consider the following in development of their budgets (SF-424A) and budget
justification narratives.
■
The itemized budget for conducting the project and the corresponding justification is allowable under
ASPR and CDC programs, is reasonable and consistent with public health and healthcare
preparedness program capabilities, and is consistent with stated objectives and planned program
activities.
■
Direct Assistance: PHEP awardees may request direct assistance (DA) for personnel (e.g., public
health advisors, Career Epidemiology Field Officers, Career Informatics Field Officers, or other
technical consultants), provided the work is within scope of the cooperative agreements and is
financially justified. PHEP awardees planning to request DA for personnel in lieu of financial
assistance should complete and submit the DA request form no later than March 15, 2013. DA may
also be requested for any Statistical Analysis Software (SAS) licenses desired for future budget
periods. DA requests for SAS licenses should be submitted no later than November 15, 2013.
Additional budget preparation guidance is available at:
http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm; and

http://www.cdc.gov/od/pgo/funding/budgetguide.htm
23

Funding Restrictions
Restrictions, which apply to both awardees and their subrecipients, must be taken into account while
writing the budget. Restrictions are as follows:
■
Recipients may not use funds for fund raising activities or lobbying.
■
Recipients may not use funds for research.
■
Recipients may not use funds for construction or major renovations.
■
Recipients may not use funds for clinical care.
■
Recipients may not use funds to purchase vehicles to be used as means of transportation for
carrying people or goods, e.g., passenger cars or trucks, electrical or gas-driven motorized carts.
■
PHEP-only recipients may (with prior approval) use funds to purchase industrial or warehouseuse trucks to be used to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles
must be of a type not licensed to travel on public roads.
■
Recipients may not use funds for reimbursement of pre-award costs.
■
Recipients may supplement but not supplant existing state or federal funds for activities described
in the budget.
■
The direct and primary recipient in a cooperative agreement program must perform a substantial
role in carrying out project objectives and not merely serve as a conduit for an award to another
party or provider who is ineligible.
■

Payment or reimbursement of backfilling costs for staff is not allowed.

■

None of the funds awarded to these programs may be used to pay the salary of an individual at a
rate in excess of Executive Level II or $179,700 per year

Joint Application Review Criteria
Applications will be initially reviewed for completeness by the CDC Procurement and Grants Office staff.
In addition, applications will be jointly reviewed for responsiveness to program requirements and
technical acceptability by project officers from ASPR and CDC’s Division of State and Local Readiness
(DSLR) and subject matter experts (SMEs). Eligible applications must meet all requirements defined in
this continuation guidance and associated funding opportunity announcement. Specifically, eligible
applications will be evaluated against the following criteria:
■

■
■

■

■
■

Evidence that HPP and PHEP program activities are well coordinated with each other, emergency
management agencies (EMA), and other community or state partners. Activities reflect sustained or
strengthened coordination between public health, healthcare, EMA, and other partners.
A jurisdictional risk assessment (JRA) has been completed or there are plans to complete the JRA in
Budget Period 2.
Senior advisory processes are in place and described. If there are no changes from prior year
structures or activities, awardees must simply verify the advisory board and associated processes are
still active.
Sufficient administrative preparedness plans are in place to meet the needs of the jurisdiction during
surge requirements or there is evidence of Budget Period 2 planned activities to close gaps in
administrative preparedness plans. Administrative preparedness plans include the ability to effectively
receive, obligate, and account for HPP and PHEP funds including the ability to move funding to the
local level in a timely manner.
There is evidence in the application narratives and budget justifications that training is designed to
close operational gaps or meet recurring training requirements.
There is evidence the State Office of Aging and groups representing at-risk populations are part of
HPP and PHEP program engagement, and the planning considerations surrounding these groups are
part of operational plans.
24

■
■

All elements required in the project narrative are present, comply with the guidance, and collectively
describe how the jurisdiction plans to build and sustain capabilities in Budget Period 2.
Project narrative and work plan review:
o
Awardees’ work plan narrative descriptions, the project narrative, technical assistance
descriptions, budget justifications, and five-year forecasts have reasonable relationships,
correlation, and continuity with each other and describe how the jurisdiction is building,
sustaining, or scaling back the public health and healthcare preparedness capabilities. Since this is
continuation guidance, the narrative descriptions should also be consistent with narratives
provided in Budget Period 1 or describe why there is significant variance between budget periods.
o
Awardees have adequate planned activities to monitor and demonstrate HPP and PHEP
defined performance measures and PAHPA benchmarks.
o
Awardee work plans and budgets are clearly and adequately linked through budget
associations to the capabilities or function and resource element level.
o
Budget line items contain sufficiently detailed justifications and cost calculations,
specifically for contract line items.
o
Short-term goals are at the capability level and describe the overall target or desired
outcomes for that capability in Budget Period 2.
o
Objectives directly link to and support the short-term goal for each capability and are
measurable and achievable descriptions of how a capability will be built, sustained, or scaled
back.
o
Planned activity descriptions define desired products or outputs and have measurable
milestones. They must also relate to the short-term goal and directly support the objectives.

HPP-specific Application Review Criteria
■
Awardees comply with HAvBED standards.
PHEP-specific Application Review Criteria
There are processes in place to engage local health departments and federally recognized American
Indian/Alaska Native Tribes and have resulted in documented evidence showing local or tribal
concurrence, as applicable, with the PHEP strategy and work plan approach to Budget Period 2.
Acceptable evidence includes a copy of written consensus on official letterhead of a majority of local
or tribal health officials whose jurisdictions encompass a majority of the state’s population or a
written recommendation of the SACCHO or Tribal Health Board or equivalent.
■
Medical countermeasure planned activities are sufficient to meet the PAHPA benchmarks for Budget
Period 2.
■
Sufficient descriptions exist that outline Level 1 chemical laboratory operations and processes, as
applicable.
■

Budget Period 2 applications that do not substantially meet these review criteria must be resubmitted
within 30 days after receipt of the Notice of Award (NOA) from CDC’s Procurement and Grants Office.
At the awardee’s request, HPP and PHEP program staff will provide technical assistance to help the
awardee with deficiencies noted during the application review.

25

Use of Budget Period 2 Funds for Response
HPP
Section 319C-2 of the PHS Act authorizes the HHS Secretary to award grants in the form of cooperative
agreements to enable eligible entities to improve surge capacity and enhance community and hospital
preparedness for public health emergencies. As awardees expend funds to meet the applicable goals
outlined in section 2802(b) of the PHS Act, in general, HPP funds are to be used only for activities which
prepare for public health emergencies and improve surge capacity – consistent with approved spend
plans. Awardees, nevertheless, may be able to expend HPP funds for response activities, subject to
approval by ASPR, provided the activities meet statutory and administrative requirements. Following are
examples of response activities that may be considered for approval.
Situation 1: HPP Staff Conducting Activities Consistent with Approved Project Goals
Awardees may use HPP funds to support positions performing preparedness-related activities consistent
with the awardee’s project goals and may utilize those positions within any phase of the disaster cycle,
provided that the staff members in those positions continue to do work within statutory limitations, the
notice of award, and the approved spending plan. For example, an employee's salary may be permissible
for response activities if that employee is carrying out the same responsibilities he or she would carry out
as part of his or her preparedness responsibilities.
Situation 2: Using an Emergency as a Training Exercise
Under certain conditions, HPP funds may, on a limited, case-by-case basis, be reallocated to support
response activities to the extent they are used for the purposes provided for in Section 319C-2 of the PHS
Act (the program's authorizing statute), applicable cost principles, the funding opportunity announcement,
and the awardee’s application (including the jurisdiction’s all-hazards plan). Awardees should contact
their assigned HPP project officers and grants management specialists for guidance on the process to
make such a change. ASPR encourages awardees to develop criteria such as costs versus benefits for
determining when to request a scope-of-work change to use a real incident as a required exercise.
The request to use an actual response as a required exercise and to pay salaries with HPP funds will be
considered for approval under these conditions:
■
■
■

A state or local declaration of an emergency, disaster, or public health emergency is in
effect.
No other funds are available for the cost.
The awardee agrees to submit within 60 days (of the conclusion of the disaster or public
health emergency) an after-action report, a corrective action plan, and other
documentation that support the actual dollar amount spent.

PHEP
Use of PHEP funds during response operations has not changed since Budget Period 1. PHEP cooperative
agreement funding is intended primarily to support preparedness activities that help ensure state and local
public health departments are prepared to prevent, detect, respond to, mitigate, and recover from a variety
of public health threats. The PHEP cooperative agreement provides technical assistance and resources that
strengthen public health preparedness and enhance the capabilities of state and local governments to
respond to these threats. PHEP funds may, on a limited, case-by-case basis, be reallocated to support
response activities to the extent they are used for the purposes provided for in Section 319C-1 of the PHS
Act (the program's authorizing statute), applicable cost principles, the funding opportunity announcement,
26

and the awardee’s application (including the jurisdiction’s all-hazards plan). Awardees must receive
approval from CDC to use PHEP funds during response for new activities not previously approved as part
of their annual funding applications or subsequent budget change requests.

Funding Formula
The distribution of HPP and PHEP funds is calculated using a formula established by the HHS Secretary
that includes a base amount for each awardee plus population-based funding. More information on how
the funding formula is calculated is available in the CDC-RFA-TP12-1201 funding opportunity
announcement.

Cost Sharing or Matching
Cost sharing or matching requirements remain in effect for Budget Period 2, with states required to make
available nonfederal contributions in the amount of 10% ($1 for each $10 of federal funds provided in the
cooperative agreement) of the award. Please refer to 45 CFR § 92.24 for match requirements, including
descriptions of acceptable match resources. Documentation of match, including methods and sources,
must be included in the Budget Period 2 application for funds, follow procedures for generally accepted
accounting practices, and meet audit requirements.
Exceptions to Matching Funds Requirement
 The match requirement does not apply to the political subdivisions of New York City, Los
Angeles County, or Chicago.
 Pursuant to department grants policy implementing 48 U.S.C. 1469a(d), any required matching
(including in-kind contributions) of less than $200,000 is waived with respect to cooperative
agreements to the governments of American Samoa, Guam, the Virgin Islands, or the Northern
Mariana Islands (other than those consolidated under other provisions of 48 U.S.C. 1469). For
instance, if 10% (the match requirement) of the award is less than $200,000, then the entire match
requirement is waived. If 10% of the award is greater than $200,000, then the first $200,000 is
waived, and the entity must meet the match requirements for the balance.

Maintenance of Funding (MOF) 1
Maintenance of funding requirements remain in effect for Budget Period 2. Awardees must maintain
expenditures for healthcare preparedness and public health security at a level that is not less than the
average level of such expenditures maintained by the awardee for the preceding two-year period. For
more information, refer to the CDC-RFA-TP12-1201 funding opportunity announcement.

1

This funding opportunity announcement uses one term that applies to both maintenance of funding (MOF) and
maintaining state funding (MSF). Section 319C-1 requires PHEP awardees to maintain expenditures for public
health security. Section 319C-2 requires HPP awardees to maintain expenditures for healthcare preparedness. This
provision addresses both requirements.

27

Maximum Amount of Carry-over Funds
Awardees may request to carry over unobligated funds. The carry-over request must present a
justifiable reason for not executing a spend plan on schedule (e.g., a jurisdictional hiring freeze).
The awardee must immediately communicate with ASPR and CDC any events occurring during
the performance period that have a significant impact upon timely execution of the spend plan.
The Pandemic and All-Hazards Act (PAHPA) of 2006 requires the HHS Secretary to determine
the maximum amount of unobligated funds that can be carried over into each succeeding budget
period. Awardees must repay any funds that exceed the maximum percentage of an award that
may be carried over to the succeeding fiscal year. The carry-over maximum percentage varies for
the HPP and PHEP programs; however, ASPR and CDC review all awardee requests on a caseby-case basis to determine appropriateness.
■

■

HPP awardees may carry over a maximum of 15 percent of Budget Period 1 funds into
Budget Period 2. Awardees must submit a waiver request to carry over funds that exceed
the 15 percent limit.
PHEP awardees may request to carry over up to 100 percent of Budget Period 1 funds
into Budget Period 2.

ASPR and CDC reserve the right to restrict carry-over amounts for awardees that maintain high
balances of unobligated funds.
HPP and PHEP awardees may request carry-over funds as part of their Budget Period 2 applications
based on the interim Federal Financial Reports (FFR) submitted with their Budget Period 2 applications.
(See the Budget section above - use of estimated unobligated funds.) These budget change requests are
submitted as an attachment to the application and must include a separate, revised work plan and budget
identifying the following elements:





Description of a bona fide need for permission to use an unobligated balance,
List of proposed activities,
Itemized budget, and
Narrative justification of those activities.

The grants management officer retains the right to determine how much of the estimated unobligated
balance may be processed as carry-over funds. If funds are authorized for carry-over, the awarding office
may add the funds to the full amount otherwise approved for the noncompeting continuation award for
Budget Period 2, the budget period into which the funds are carried, and allow them to be used for the
purpose(s) for which they were originally authorized or other purposes within the scope of the application
as originally approved (the approved budget is modified and/or increased accordingly). ASPR and CDC
will provide additional guidance on submitting carry-over requests.

Reporting Requirements
■

Pandemic influenza plans: Section 319C-1 of the PHS Act, as amended by PAHPA, currently
requires that HPP and PHEP awardees annually submit influenza pandemic plans. ASPR and
CDC have determined that awardees can satisfy the 2013 annual requirement through the
28

■

■

required submission of other program data such as the 2013 self-assessment and Budget
Period 2 application that provide ample evidence on the status of state and local influenza
pandemic response readiness as well as the barriers and challenges to preparedness and
operational readiness. No further awardee action will be required in Budget Period 2.
Awardees must document and submit annually data on their current preparedness status and
self-identified gaps based on the public health and healthcare preparedness capabilities as
they relate to overall jurisdictional needs. Further guidance and templates will be provided
separately.
Federal Funding Accountability And Transparency Act of 2006 (FFATA): Public Law 109282, the Federal Funding Accountability and Transparency Act of 2006 as amended
(FFATA), requires full disclosure of all entities and organizations receiving federal funds
including grants, contracts, loans and other assistance and payments through a single publicly
accessible Web site, www.USASpending.gov. The Web site includes information on each
federal financial assistance award and contract over $25,000, including such information as:
1. The name of the entity receiving the award;
2. The amount of the award;
3. Information on the award including transaction type, funding agency, etc.;
4. The location of the entity receiving the award;
5. A unique identifier of the entity receiving the award; and
6. Names and compensation of highly compensated officers (as applicable).
Compliance with this law is primarily the responsibility of the federal agency. However, two
elements of the law require information to be collected and reported by recipients: 1)
information on executive compensation when not already reported through the Central
Contractor Registry; and 2) similar information on all sub-awards/subcontracts/consortiums
over $25,000.

■

■

■

For the full text of the requirements under the Federal Funding Accountability and
Transparency Act of 2006, please review the following Web site:
http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=109_cong_bills&docid=f:s2590enr.txt.pdf
Updated Federal Financial Report cash transaction reports (FFR SF-425) must be filed in the
Payment Management System (PMS) within 30 days of the end of each quarter (i.e., no later
than October 30, 2013; January 30, 2014; and May 30, 2014). The FFR 425 form and
instructions are available at:
o http://www.whitehouse.gov/sites/default/files/omb/grants/standard_forms/ff_report.p
df
o http://www.nea.gov/manageaward/FFR-Instructions.pdf
Each funded awardee must provide an annual Interim Progress Report submitted via
www.grants.gov. The interim progress report will serve as the noncompeting continuation
application.
Additionally, funded awardees must provide an original plus two hard copies of the
following reports for Budget Period 2:
29

A mid-year progress report due 30 days after the first six months of the budget
period. This report should include work plan updates; status updates on applicable
PAHPA benchmarks, applicable performance measure data, and technical assistance
plans; and estimated HPP and PHEP financial reports.
o
An annual progress report due 90 days after the end of the budget period. This
report should include updates on work plan activities including local contracts and
progress on implementation of technical assistance plans; PAHPA benchmark data;
performance measure data and supporting information; training updates; preparedness
accomplishments, success stories, and program impact statements; healthcare
coalition assessments (HPP only); and updated healthcare coalition information (HPP
only); NIMS compliance activities, and ESAR-VHP requirements (HPP only).
o
Separate HPP and PHEP Federal Financial Reports (FFR) SF-425) no later than
90 days after the end of the budget period.
o A combined HPP and PHEP Federal Financial Report (FFR) SF-425 submitted via
the electronic FFR system in eRA Commons no later than 90 days after the end of the
budget period.
o

Audit Requirements
HPP and PHEP awardees are required to comply with audit requirements from the Office of
Management and Budget (OMB) Circular A-133. Awardees that expend $500,000 or more in
federal funds per year are required to complete an audit under this requirement. Information on
the scope, frequency, and other aspects of the audits can be found at
http://www.whitehouse.gov/omb/circulars.
In addition, HPP and PHEP awardees shall, not less often than once every two years, audit their
expenditures from amounts received under these awards. Such audits shall be conducted by an
entity independent of the agency administering a program funded, in accordance with the
Comptroller General’s standards for auditing governmental organizations, programs, activities,
and functions and using generally accepted auditing standards. Awardees may choose to include
HPP and PHEP as major programs in their required A-133 audit process to fulfill the PAHPArequired biennial audit. However, if awardees choose not to include HPP and PHEP expenditures
as part of their required A-133 audit process, a separate audit must be performed to fulfill the
PAHPA-required biennial audit.
The A-133 audit is submitted to the Federal Audit Clearinghouse, Bureau of the Census, Web
site: http://harvester.census.gov/fac/collect/ddeindex.html. For other audits conducted for HPP,
copies must be submitted to [email protected].
Audits that indicate funds have not been spent in accordance with section 319C-1 or 319C-2 of the PHS
Act may result in a disallowance decision requiring repayment or future withholding or offset of awards.

30

Appe ndix 1: HPP Budget Peri od 2

Appendix 1: HPP Budget Period 2
(Fiscal Year 2013) Funding*
Awardee
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Chicago
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Los Angeles
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Micronesia
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
New York City
North Carolina
North Dakota

FY 2013 Total
Funding Available
$5,378,598
$1,224,921
$317,806
$7,024,227
$3,476,230
$28,502,812
$3,251,353
$5,633,218
$4,148,022
$1,416,506
$1,114,169
$19,690,188
$10,388,028
$434,606
$1,888,437
$2,100,005
$10,844,663
$7,117,910
$3,609,364
$3,412,131
$4,929,121
$10,521,689
$5,127,138
$1,855,836
$317,221
$6,392,970
$7,183,057
$10,588,069
$359,370
$5,913,629
$3,528,671
$6,612,799
$1,509,880
$2,364,116
$3,256,408
$1,843,699
$9,473,742
$2,601,770
$11,934,686
$8,844,224
$10,232,711
$1,186,503
31

Awardee
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total FY 2013 HPP
Funding*

FY 2013 Total
Funding Available
$299,316
$12,275,120
$4,328,942
$4,410,314
$271,311
$13,465,110
$4,302,852
$1,574,338
$5,221,033
$1,331,020
$6,977,365
$26,165,661
$3,321,052
$1,138,684
$362,020
$8,666,514
$7,363,627
$2,391,321
$6,304,613
$1,075,284
$348,796,000

* Funding amounts are planning numbers subject to change based on the final FY 2013 budget.

32

Appe ndix 2: PHEP Budget Period 2 Funding

Appendix 2: Public Health Emergency Preparedness (PHEP)
Budget Period 2 (Fiscal Year 2013) Funding*

Awardee
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Chicago
Colorado
Connecticut
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Los Angeles County
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Micronesia
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
New York City

FY 2013
Total
Base plus
Population
Funding
$8,253,305
$3,780,600
$373,014
$10,025,328
$6,204,823
$33,153,601
$7,965,109
$8,527,481
$6,928,213
$3,986,900
$23,664,113
$13,647,490
$498,785
$4,495,077
$4,722,896
$14,139,197
$10,126,207
$6,348,183
$6,135,800
$7,769,305
$15,800,288
$7,982,531
$4,459,973
$372,384
$9,345,586
$10,196,358
$13,862,895
$417,771
$8,829,430
$6,261,292
$9,582,300
$4,087,445
$5,007,292
$5,968,117
$4,446,904
$12,662,981
$5,263,199
$15,312,942
$13,992,498

FY 2013
Cities
Readiness
Initiative
Funding
$297,200
$169,600
$0
$1,104,674
$197,771
$5,159,220
$1,577,831
$670,116
$546,650
$311,470
$2,761,704
$1,388,154
$0
$251,136
$162,442
$1,907,058
$736,647
$202,044
$387,136
$383,765
$3,151,142
$519,089
$169,600
$0
$1,347,741
$1,233,622
$1,131,906
$0
$846,633
$232,320
$870,731
$169,600
$195,544
$514,089
$279,824
$2,221,450
$233,713
$1,633,375
$3,742,763

FY 2013
Level 1
Chemical
Laboratory
Funding
$0
$0
$0
$0
$0
$993,604
$0
$0
$0
$0
$763,718
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$903,414
$887,768
$0
$915,450
$0
$0
$0
$0
$0
$0
$0
$918,754
$1,524,067
$0

FY 2013
Total
Funding
Available
$8,550,505
$3,950,200
$373,014
$11,130,002
$6,402,594
$39,306,425
$9,542,940
$9,197,597
$7,474,863
$4,298,370
$27,189,535
$15,035,644
$498,785
$4,746,213
$4,885,338
$16,046,255
$10,862,854
$6,550,227
$6,522,936
$8,153,070
$18,951,430
$8,501,620
$4,629,573
$372,384
$10,693,327
$12,333,394
$15,882,569
$417,771
$10,591,513
$6,493,612
$10,453,031
$4,257,045
$5,202,836
$6,482,206
$4,726,728
$14,884,431
$6,415,666
$18,470,384
$17,735,261
33

Awardee
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
TOTAL FY 2013
PHEP Funding*

FY 2013
Total
Base plus
Population
Funding
$13,480,244
$3,770,198
$353,104
$15,679,523
$7,123,029
$7,210,651
$322,948
$16,960,911
$7,094,934
$4,156,854
$8,083,638
$3,894,848
$9,974,867
$30,636,943
$6,037,726
$3,770,198
$420,624
$11,793,753
$10,390,797
$5,661,341
$5,036,586
$9,250,444
$3,770,198

FY 2013
Cities
Readiness
Initiative
Funding
$409,821
$169,600
$0
$1,459,374
$330,117
$471,490
$0
$1,692,135
$0
$277,313
$261,796
$169,600
$689,504
$3,809,972
$296,185
$169,600
$0
$1,456,814
$1,021,249
$609,113
$183,695
$486,802
$169,600

FY 2013
Level 1
Chemical
Laboratory
Funding
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$838,072
$0
$0
$0
$0
$0
$0
$792,661
$0
$0
$0
$1,148,980
$0

FY 2013
Total
Funding
Available
$13,890,065
$3,939,798
$353,104
$17,138,897
$7,453,146
$7,682,141
$322,948
$18,653,046
$7,094,934
$4,434,167
$9,183,506
$4,064,448
$10,664,371
$34,446,915
$6,333,911
$3,939,798
$420,624
$14,043,228
$11,412,046
$6,270,454
$5,220,281
$10,886,226
$3,939,798

$519,471,972

$50,841,540

$9,686,488

$580,000,000

* Funding amounts are planning numbers subject to change based on the final FY 2013 budget.

34

Appendix 3: Cities Readiness Initiative (C RI) Funding

Appendix 3: Cities Readiness Initiative (CRI)
Budget Period 2 (Fiscal Year 2013) Funding*
Awardee
Alabama

CRI City
Birmingham

Alaska
Arizona
Arkansas
Arkansas
California
California
California
California
California
California

Anchorage
Phoenix
Little Rock
Memphis
Los Angeles
Riverside
Sacramento
San Diego
San Francisco
San Jose

California

Fresno

Chicago
Colorado
Connecticut
Connecticut
Delaware
Delaware
Florida
Florida
Florida
Georgia
Hawaii
Idaho
Illinois
Illinois
Illinois
Indiana
Indiana
Indiana
Indiana
Iowa
Iowa

Chicago
Denver
Hartford
New Haven
Philadelphia
Dover
Miami
Orlando
Tampa
Atlanta
Honolulu
Boise
Chicago
St Louis
Peoria
Chicago
Indianapolis
Cincinnati
Louisville
Des Moines
Omaha

2010 Census Population
1,128,047

FY 2013 Awardee Total
$297,200

380,821
4,192,887
699,757
50,902
3,010,232
4,224,851
2,149,127
3,095,313
4,335,391
1,836,911

$169,600
$1,104,674
$197,771

$5,159,220

930,450
2,695,598
2,543,482
1,212,381
862,477
538,479
162,310
5,564,635
2,134,411
2,783,243
5,268,860
953,207
616,561
5,891,011
703,664
379,186
708,070
1,756,241
79,262
252,436
569,633
123,145

$1,577,831
$670,116
$546,650
$311,470

$2,761,704
$1,388,154
$251,136
$162,442
$1,907,058

$736,647

$202,044
35

Awardee
Kansas
Kansas
Kentucky
Kentucky
Los Angeles County
Louisiana
Louisiana
Maine
Maryland
Maryland
Maryland
Massachusetts
Massachusetts
Michigan
Minnesota
Minnesota
Mississippi
Mississippi
Missouri
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Hampshire
New Jersey
New Jersey
New Jersey
New Mexico
New York
New York
New York
New York City
North Carolina
North Carolina
North Dakota
Ohio

CRI City
Wichita
Kansas City
Louisville
Cincinnati
Los Angeles
Baton Rouge
New Orleans
Portland
Baltimore
Washington D.C
Philadelphia
Boston
Providence
Detroit
Fargo
Minneapolis
Jackson
Memphis
St. Louis
Kansas City
Billings
Omaha
Las Vegas
Boston
Manchester
New York City
Philadelphia
Trenton
Albuquerque
Albany
Buffalo
New York City
New York City
Charlotte
Virginia Beach
Fargo
Cincinnati

2010 Census Population
623,061
846,346
1,031,130
425,483
9,818,605
802,484
1,167,764
514,098
2,710,489
2,303,870
101,108
4,134,036
548,285
4,296,250
58,999
3,154,469
539,057
238,060
2,115,946
1,188,988
158,050
742,205
1,951,269
418,366
400,721
6,471,215
1,316,762
366,513
887,077
870,716
1,135,509
4,193,392
8,175,133
1,531,965
23,547
149,778
1,625,406

FY 2013 Awardee Total
$387,136
$383,765
$3,151,142
$519,089
$169,600
$1,347,741

$1,233,622
$1,131,906
$846,633
$232,320
$870,731
$169,600
$195,544
$514,089
$279,824

$2,221,450
$233,713
$1,633,375
$3,742,763
$409,821
$169,600
$1,459,374
36

Awardee

CRI City
Ohio
Cleveland
Ohio
Columbus
Oklahoma
Oklahoma City
Oregon
Portland
Pennsylvania
Philadelphia
Pennsylvania
Pittsburgh
Pennsylvania
New York City
Rhode Island
Providence
South Carolina
Columbia
South Carolina
Charlotte
South Dakota
Sioux Falls
Tennessee
Nashville
Tennessee
Memphis
Texas
Dallas
Texas
Houston
Texas
San Antonio
Utah
Salt Lake City
Vermont
Burlington
Virginia
Richmond
Virginia
Virginia Beach
Virginia
Washington D.C
Washington
Seattle
Washington
Portland
Washington D.C
Washington D.C
West Virginia
Charleston
West Virginia
Washington D.C
Wisconsin
Chicago
Wisconsin
Milwaukee
Wisconsin
Minneapolis
Wyoming
Cheyenne
Total FY 2013
Cities Readiness Initiative Funding*

2010 Census Population
2,077,240
1,836,536
1,252,987
1,789,580
4,008,994
2,356,285
57,369
1,052,567
767,598
226,073
228,261
1,589,934
1,027,138
6,371,773
5,946,800
2,142,508
1,124,197
211,261
1,258,251
1,648,136
2,623,079
3,439,809
436,429
601,723
304,284
53,498
166,426
1,555,908
125,364
91,738

FY 2013 Awardee Total

175,240,879

$50,841,540

$330,117
$471,490
$1,692,135
$277,313
$261,796
$169,600
$689,504

$3,809,972
$296,185
$169,600
$1,456,814

$1,021,249
$609,113
$183,695

$486,802
$169,600

* Funding amounts are planning numbers subject to change based on the final FY 2013 budget.

37

Appendix 4: HPP Budget Period 2 Benchmarks
Hospital Preparedness Program BP2 (Fiscal Year 2013)
Evidence-Based Benchmarks Subject to Withholding
PAHPA Benchmark
PAHPA1
PAHPA2
PAHPA3

PAHPA4

Awardees will submit timely and complete data for the mid-year progress report, the
end-of-year annual progress report, and the final Federal Financial Report (FFR).
Awardees will assure that all healthcare coalitions within their jurisdictions are within
Stage 1 of development.
Awardees shall develop and submit in accordance with Budget Period 2 guidance
requirements exercise plans that must include a proposed exercise schedule and a
discussion of the plans for healthcare entity exercise development, conduct,
evaluation, and improvement planning. This exercise plan must demonstrate
participation by healthcare coalitions and the participating hospitals to include the
participating organizations and anticipated capabilities to be tested.
Awardees will submit in accordance with Budget Period 2 guidance requirements a
comprehensive inventory that lists each of its participating hospitals by name and by
national provider identifier (NPI) (formerly known as HIPAA ID); identifies each of
the 11 National Incident Management System (NIMS) implementation activities that
have been achieved; and identifies each activity still in progress. This must also
include the plans to address the gaps for the identified hospitals that are not 100%
compliant with NIMS requirements.

38

Appendix 5: PHEP Budget Period 2 Benchmarks
Public Health Emergency Preparedness BP2 (Fiscal Year 2013)
Evidence-Based Benchmarks Subject to Withholding
CDC has identified the following fiscal year 2013 benchmarks for Budget Period 2 to be used as a basis
for withholding of fiscal year 2014 funding for PHEP awardees. As mandated by PAHPA, awardees that
fail to “substantially meet” the benchmarks are subject to withholding of funds penalties to be applied the
following fiscal year. Awardees that demonstrate achievement of these requirements are not subject to
withholding of funds.
1. Demonstrated adherence to all PHEP application and reporting deadlines. Failure to submit required
PHEP program data and reports by the stated deadlines will constitute a benchmark failure. A failure
to timely report key program data hinders CDC’s ability to analyze data and submit accountability
reports as required and jeopardizes CDC’s ability to accurately reflect PHEP program achievements
and barriers to success. This benchmark applies to all 62 awardees. Required data and reports include:
■
PHEP Budget Period 2 funding application due 60 calendar days following initial publication of
the continuation guidance and interim progress reports/noncompeting continuation funding
applications for subsequent PHEP budget periods are due no less than 90 days before the end of
the budget period;
•
PHEP Budget Period 2 mid-year progress reports, due 30 days after the first six months
of the budget period, including work plan updates; status updates on applicable PAHPA
benchmarks, applicable performance measure data, and technical assistance plans; and estimated
HPP and PHEP financial reports status.
■
Annual PHEP Budget Period 2 progress report, due 90 days after the end of the budget period, to
include updates on work plan activities including local contracts and progress on implementation
of technical assistance plans; PAHPA benchmark data; performance measure data and supporting
information; training updates; preparedness accomplishments, success stories, and program
impact statements; healthcare coalition assessments (HPP only); and updated healthcare coalition
information (HPP only); NIMS compliance activities, and ESAR-VHP requirements (HPP only).
■
PHEP Budget Period 2 financial report, no later than 90 days after the end of the budget
period.
2. Demonstrated capability to receive, stage, store, distribute, and dispense material during a public
health emergency. As part of their response to public health emergencies, public health departments
must be able to provide countermeasures to 100% of their identified population within 48 hours after
the federal decision to do so. To achieve this standard, public health departments must maintain the
capability to plan and execute the receipt, staging, storage, distribution, and dispensing of material
during a public health emergency.
In Budget Period 2, CDC will evaluate medical countermeasure distribution and dispensing
(MCMDD readiness using a modified version of the standard technical assistance review (TAR)
process. A progress report format will allow CDC to maintain accountability in Budget Period 2 for
medical countermeasure planning while redesigning the TAR tool for Budget Period 3. This change
also provides more time for awardees to focus on the recommendations and operational gaps
identified in prior TAR assessments.
39

To demonstrate the current capacity and degree of advancement in emergency response capabilities
during Budget Period 2, public health departments must comply with the following requirements and
submit all required supporting documentation by May 1, 2014.
■

The 50 states must meet a minimum overall TAR progress report benchmark of 89 for Budget
Period 2.



All CRI jurisdictions within a state must meet a minimum average TAR progress report
benchmark of 69 for Budget Period 2
o When there are multiple planning/local jurisdictions within a Cities Readiness Initiative
(CRI) metropolitan statistical area (MSA), CDC is responsible for performing TAR progress
report reviews for a minimum of 25% of the CRI jurisdictions, and the state is responsible for
performing TAR progress report reviews for 75% of the CRI jurisdictions.

■

The four directly funded localities must meet a minimum overall TAR progress report benchmark
of 89 for Budget Period 2. Directly funded locality scores will be derived from a local TAR
progress report review conducted during Budget Period 2. CDC is responsible for performing
TAR progress report reviews for the directly funded localities.

■

American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of
Micronesia, Guam, Puerto Rico, Republic of the Marshall Islands, Republic of Palau, and the
U.S. Virgin Islands must meet a minimum overall TAR progress report benchmark of 60 for
Budget Period 2. An island TAR progress report review must be conducted during Budget Period
2. CDC is responsible for conducting all island TAR progress report reviews.

3. Demonstrated ability to pass laboratory proficiency testing and/or exercises for biological and
chemical agents.
■
Awardees must ensure that Laboratory Response Network biological (LRN-B) laboratories
pass proficiency testing. CDC proficiency tests are composed of a number of unknown samples
that are tested to evaluate the abilities of LRN reference and/or national biological laboratories to
receive, test, and report on one or more suspected biological agents. To demonstrate this
capability, the LRN-B laboratory must successfully pass CDC proficiency tests for all LRN
agents/assays for which they have requested access to LRN-B reagents from CDC during each
budget period. Preliminary funding withholding tables will be calculated with data received by
April 30, 2014, to determine the awardees “at risk” of failing to reach the PAPHA benchmark.
1. Successfully passed is defined as:
a. The agent is detected or not detected in all samples as expected
b. The lab follows the appropriate algorithm for testing samples and
interpreting results
c. The lab submits data to CDC within the prescribed deadline
2. Using the definition as described above, CDC will use the following elements to
calculate if the laboratory passed:
a. Number of LRN-B proficiency tests successfully passed by the LRN-B
laboratory during first attempt (numerator)
b. Number of LRN-B proficiency tests participated in by the LRN-B laboratory
(denominator)
3. The minimum performance for each year of the PHEP project period is:
a. Budget Period 1: Laboratory cannot miss more than two PT challenges
b. Budget Periods 2-5: Laboratory cannot miss more than one PT challenge
40

In Budget Period 2, the LRN-B proficiency testing (PT) benchmark is applicable to each of the 50
state public health laboratories () plus the LRN-B laboratories in Los Angeles County, New York
City, and Washington, D.C. Although a lab that fails a challenge may retest (i.e., undergo
remediation) for purposes of being able to continue to test for that agent, retests will not apply to
the numerator for this benchmark.
■

Awardees must ensure that at least one LRN chemical (LRN-C) laboratory in their
jurisdictions passes the LRN-C Specimen packaging, and shipping (SPaS) exercise.
This annual exercise evaluates the ability of a laboratory to collect relevant samples for
clinical chemical analysis and ship those samples in compliance with International Air
Transport Association regulations. This benchmark applies to the 50 states; the directly
funded localities of Los Angeles County, New York City, and Washington, D.C.; and
Puerto Rico. These awardees must ensure at least one LRN-C laboratory passes CDC’s
SPaS exercise. If a laboratory fails the exercise on its first attempt but passes on the
second attempt, then the awardee will meet the benchmark. If a PHEP awardee has
multiple laboratories, at least one laboratory must participate and pass.



Awardees must ensure that LRN-C laboratories pass proficiency testing in core and
additional analysis methods. This benchmark applies to the 10 awardees with Level 1
laboratories (California, Florida, Massachusetts, Michigan, Minnesota, New Mexico, New York,
South Carolina, Virginia, and Wisconsin). Although this PAHPA benchmark does not apply to
awardees with Level 2 laboratories during Budget Period 2, awardees with Level 2 laboratories
must report on LRN-C proficiency testing performance measures as specified in PHEP
performance measure guidance. Proficiency testing data must be received by April, 30, 2014, to
determine awardees potentially at risk for failure to meet the PAHPA benchmark.

LRN methods can help determine how widespread an incident is, identify who does/does not
need long-term medical treatment, assist with nonemergency medical guidance, and help
law
enforcement officials determine the origin of the agent. Proficiency testing is the
most effective
method for evaluating laboratory performance, and participation is required, where possible, by the
Clinical Laboratory Improvements Amendment of 1988.
The LRN-C conducts proficiency testing
for all Level 1 and Level 2 chemical
laboratories to support meeting the regulatory
requirements for the reporting of patient
results as part of an emergency response program. Each
high complexity test is
proficiency tested three times per year (budget period) and each
laboratory is evaluated
on the ability to report accurate and timely results through secure
electronic reporting mechanisms.
CDC has identified nine core methods and four additional methods for detecting and
measuring these agents and conducts testing to determine a laboratory’s proficiency in these
methods. The core methods are 1) arsenic in urine by DRC ICP-MS; 2)
cadmium/lead/mercury
in blood by ICP-MS; 3) cyanide in blood by headspace GC-MS;
4) volatile organic chemicals
(VOCs) in blood by SPME GC-MS; 5) nerve agent metabolites in urine by LC-MS/MS; 6) toxic
elements (barium, beryllium, cadmium,
lead, uranium, and thallium) in urine by ICP-MS; 7)
tetramine in urine by GC-MS; 8)
metabolic toxins in urine by LC/MS/MS; and 9) plant toxins in
urine by LC-MS/MS.
Additional methods are 1) sulfur mustard metabolite in urine by LCMS/MS; 2) Lewisite
metabolite in urine by LC-ICP-MS; 3) nitrogen mustard metabolites in
urine by LCMS/MS; and 4) tetranitromethane biomarker in urine by LC-MS/MS.
Influenza Pandemic Plans
41

Section 319C-1 of the PHS Act, as amended by PAHPA, currently requires that PHEP awardees annually
submit influenza pandemic plans. CDC has determined that awardees can satisfy the 2013 annual
requirement through the required submission of other program data such as the 2013 capability selfassessment and Budget Period 2 application and performance measure data that provide ample evidence
on the status of state and local influenza pandemic response readiness as well as the barriers and
challenges to preparedness and operational readiness. Section 319C-1 also requires withholding of
funding from PHEP awardees that fail to submit acceptable pandemic influenza operations plans each
fiscal year.

42

Table 1: Criteria to Determine Potential Withholding of PHEP Fiscal Year 2014 Funds

Benchmark Measure

Yes

No

Possible %
Withholding

Did the awardee (all awardees) meet all
1 application and reporting deadlines?

Did the awardee (all awardees) demonstrate
2 capability to receive, stage, store, distribute, and
dispense material during a public health
emergency?

10%

Did the applicable awardee demonstrate
3 proficiency in public health laboratory testing
and/or exercises for biological and chemical
agents?

Did the awardee (all awardees) meet the 2013
Pandemic Influenza Plan (Public Health
4
Component Meets Standards) requirement?

Total Potential Withholding Percentage

10.0%

20.0%

Scoring Criteria
The first three benchmarks are weighted the same, so failure to substantially meet any one of the three
benchmarks will count as one failure and result in withholding of 10% of the fiscal year 2014 PHEP base
award. Failure to submit the 2013 influenza pandemic plan as required may result in withholding of 10%
of the fiscal year 2013 PHEP base award.
More information on withholding and repayment is available in the CDC-RFA-TP12-1201 funding
opportunity announcement posted at http://www.cdc.gov/phpr/documents/cdc-rfa-tp121201_4_17_12_FINAL.pdf.

43

Appendix 6: Guidance for Classifying Members of Healthcare Coalitions
Coalition Member Types
Member Type for
Dropdown Listing

Description

Criteria for this Coalition Member Classification
Do NOT Include:
ONLY Include:

Examples of Eligible Coalition Members

For purposes of creating national data consistency, awardees with a coalition member that corresponds to an example listed in Column 5 should classify their member using the member type in Column 1

Inpatient
Hospitals

24/7 nonfederal,
inpatient acute care
hospitals

Trauma Centers

24/7, nonfederal,
trauma centers

Long-term Care

24/7, nonfederal, subacute and long term
care inpatient
providers

• Freestanding psychiatric
hospitals
• Hospitals operated by the
federal government
• Hospitals that qualify as
Level 1-3 trauma centers
• Subacute care facilities
• Freestanding emergency
departments
• Hospitals operated by the
federal government
• Freestanding psychiatric
hospitals
• Psychiatric residential
treatment facilities (PRTFs
• Halfway houses
• Any type of 24/7 inpatient
provider agency operated by
the federal government
• Hospitals that operate 24/7,
even if they include swing
beds

• Hospitals that operate 24/7

•
•
•
•
•

General hospitals
Children’s hospitals
Rehabilitation hospitals
Long-term care hospitals
Community access hospitals (CAHs)

•
•
•
•
•
•

Nursing homes(NHs)
Skilled nursing facilities(SNFs)
Subacute care facilities
Rehabilitation facilities
Long-term care facilities (LTCFs)
Intermediate care facilities for persons with mental
retardation (ICFs/MR)
PACE facilities
Hospice
Religious nonmedical healthcare institutions
Alternative living facilities (ALFs)or alternative
residential facilities (ARFs)
Group homes

• Trauma centers classified as
Levels 1-3
• Long-term care facilities that
are licensed by the state
• Inpatient facilities that
operate 24/7

•
•
•
•
•

Community
Health Centers

Nonfederal,
community health
centers

• Any type of CHC or FQHC
operated by the federal
government
• Inpatient facilities that
operate 24/7
• Community mental or
behavioral health centers or
substance abuse clinics

• Community health centers
• Federally qualified health
centers (FQHCs)

44

Appendix 6: Guidance for Classifying Members of Healthcare Coalitions
Coalition Member Types
Member Type for
Dropdown Listing

Description

Criteria for this Coalition Member Classification
Do NOT Include:
ONLY Include:

Examples of Eligible Coalition Members

For purposes of creating national data consistency, awardees with a coalition member that corresponds to an example listed in Column 5 should classify their member using the member type in Column 1

Other Outpatient
or In-Home
Providers

Individual
Physicians Primary Care

Individual
Physicians Specialists

Other nonfederal
outpatient or in-home
healthcare providers

Individual (hospitalbased or private
practice) allopathic,
osteopathic, and
podiatric physicians primary care

Individual (hospitalbased or private
practice) allopathic,
osteopathic, and
podiatric physicians specialists

• Any community health center
or FQHC
• Any type of outpatient or inhouse provider agency
operated by the
federalgovernment
• Inpatient facilities that
operate 24/7
• Community mental or
behavioral health centers or
substance abuse clinics
• Any private practice
physician office groups or
hospital-based clinics
• Physicians that are
specialists as per examples
under “Individual
Physicians - Specialists”
• Nurse practitioners, or
physician assistants who
provide primary care
• Psychiatrists
• Physicians that are
specialists as per examples
under “Individual
Physicians - Primary care”
• Nurse practitioners, or
Physician Assistants who
provide anesthesia or other
specialty medicine
• Other specialists who are
NOT physicians
• Psychiatrists

• Outpatient or in-home
healthcare providers that are
NOT community health
centers or FQHCs

• Ambulatory surgical centers
• Home health agencies
• Comprehensive outpatient rehabilitation facilities
(CORF)
• Organ procurement organizations
• Rural health clinics
• End-stage dialysis facilities

• Allopathic, osteopathic, or
podiatric physicians
• Physicians that are in private
practice or are part of a
hospital-based group
• Primary care physicians
• Licensed practitioners

•
•
•
•
•
•

• Allopathic, osteopathic, or
podiatric physicians
• Physicians that are in private
practice or are part of a
hospital-based group
• Licensed practitioners

•
•
•
•
•
•
•

Family practice
Geriatrics,
Gerontology
General pediatrics
General practice
General internal medicine

General surgery
Allergy/immunology
Otolaryngology
Anesthesiology
Cardiology
Dermatology
Intervention pain
management
• Neurology
• Oncology
• Obstetrics/gynecology

• Orthopedics
• Pathology
• Plastic and
reconstructive surgery
• Physical medicine and
rehabilitation
• Proctology
• Pulmonary, diagnostic
radiology
• Urology
• Nuclear medicine

45

Appendix 6: Guidance for Classifying Members of Healthcare Coalitions
Coalition Member Types
Member Type for
Dropdown Listing

Description

Criteria for this Coalition Member Classification
Do NOT Include:
ONLY Include:

Examples of Eligible Coalition Members

For purposes of creating national data consistency, awardees with a coalition member that corresponds to an example listed in Column 5 should classify their member using the member type in Column 1

• Ophthalmology,
• Oral surgery

Other NonPhysician
Specialists

Other individual
healthcare providers
who are not
physicians

Behavioral Health

Nonfederal
behavioral health
(inpatient or
outpatient)

Healthcare
Support Suppliers

Nonfederal providers
or suppliers of
healthcare support
services

• Any physician that is a
licensed practitioner of
allopathic, osteopathic, or
podiatric medicine
• Clinical psychologists or
psychiatric social workers
• Specialty outpatient
institutions or in home
providers, as per the
examples listed above

• Specialists that are in private
practice or are part of a
hospital-based group
• Licensed, certified, or
registered, as required by
state law

• Any type of inpatient,
outpatient or individual
specialist provider group
operated by the federal
government
• Psychiatric services provided
as part of a general acute
care hospital program
• General healthcare services
that do not include
behavioral health
• Self-help groups that do not
operate under a plan of care
developed in accordance
with licensure requirements
• Any type of provider or
supplier agency operated by
the federal government
• Suppliers of healthcare
support that are employed by

• Mental health, behavioral
health, or substance abuse
providers licensed, certified,
or registered, as required by
law
• Institutional, inpatient, or
outpatient-based behavioral
health services that are
provided under a plan of
care developed in
accordance with licensure
requirements

• Suppliers that are licensed,
certified, or registered, as
required by state law

•
•
•
•
•
•
•
•
•
•
•

Infectious diseases
Emergency medicine
Gastroenterology
Hand therapists
Dentists
Oral surgeons
Speech therapists
Recreation therapists
Music therapists
Art therapists
Massage therapists

• Dietitians
• Chiropractors
• Certified nursemidwives
• Optometrists
• Specialty nurses
• Physician assistants
• Physical therapists
• Occupational therapists
• Respiratory therapists
• Freestanding psychiatric hospitals
• Psychiatric residential treatment centers(PRTFs)
• Community mental health centers and clinics
• Substance abuse clinics
• Halfway houses
• Group homes for the mentally ill
• Family therapists
• Psychotherapists
• Psychiatrists
• Clinical psychologists
• Psychiatric social workers
• Psychiatrists
• Clinical psychologists
•
•
•
•
•

Blood banks
Pharmacies
Poison control centers
Laboratories
Mammography centers

46

Appendix 6: Guidance for Classifying Members of Healthcare Coalitions
Coalition Member Types
Member Type for
Dropdown Listing

Criteria for this Coalition Member Classification
Do NOT Include:
ONLY Include:

Description

Examples of Eligible Coalition Members

For purposes of creating national data consistency, awardees with a coalition member that corresponds to an example listed in Column 5 should classify their member using the member type in Column 1

•
•

Federal Hospitals

24-hour federal
hospitals

Other Federal
Healthcare
Providers

Other federal
healthcare (not
hospital-based)
providers

Other Federal
Entities

Other federal
representatives that
are NOT healthcare
entities

Emergency
Medical Services
(EMS)
Public Health
Public Safety

•

•
•

or operate under the license
of another overarching
healthcare providers, such as
hospitals, nursing homes,
community health centers
Tribal clinics
Inpatient long term care
facilities even though
operated by the federal
government
Outpatient health centers,
clinics ,or other outpatient
healthcare services even
though operated by the
federal government
Tribal clinics
Any hospital or trauma
center that is owned and /or
operated by the federal
government

• Any federal agencyproviding behavioral or
general healthcare program
or services

• X-ray providers
• Durable medical equipment (DME) supply centers

• Any hospital or trauma
center that is owned and /or
operated by the federal
government
• Inpatient hospital providers
that operate 24/7

• Veterans Administration (VA) hospitals
• Department of Defense (DOD) hospitals
• Indian Health Service (IHS) hospitals

• Other inpatient healthcare
facilities operated by the
federal government
• Outpatient health centers,
clinics ,or other outpatient
healthcare services operated
by the federal government
• Employees, representatives
or grantors from U.S.
government agencies and
who are members of
healthcare coalitions

•
•
•
•

VA nursing homes
DOD nursing homes
VA clinics
IHS clinics

• FEMA representatives
• CDC representatives
• U.S. Navy

Emergency medical
services (EMS)
Public health
Public safety

• Police
• Fire

47

Appendix 6: Guidance for Classifying Members of Healthcare Coalitions
Coalition Member Types
Member Type for
Dropdown Listing

Description

Criteria for this Coalition Member Classification
Do NOT Include:
ONLY Include:

Examples of Eligible Coalition Members

For purposes of creating national data consistency, awardees with a coalition member that corresponds to an example listed in Column 5 should classify their member using the member type in Column 1

• Law enforcement
• National Guard

Emergency
Management
Medical Reserve
Corps
Academia

Emergency
management
Medical Reserve
Corps
• Universities
• Colleges
• Schools
• Research facilities

Academia

Airport /
Transportation

Airport/
transportation

Communication
Groups

Communications

Grassroot/
Volunteer/
nonprofit
Advocacy or
Service
Organizations

Grassroots, volunteer
organizations, and
other nonprofit
advocacy or service
organizations

Trade
Organizations

Healthcare provider
or healthcare
consumer trade
organizations

Other State and
Local Entities

Other state and local
government services
(that have not
otherwise been listed)

Private Business

Private business

• Ham radio operators
• Internet providers
• Volunteer agencies or
organizations that are not
MRC

•
•
•
•
•

American Red Cross
Disability organizations
Children’s advocacy groups
Child care providers
Public libraries

National, state, and local healthcare provider
associations
AARP

e.g., Walmart

48

Appendix 7: Training and Exercise Evaluation Requirements
Training and Exercise Overview
Training and exercise activities must support jurisdictional priorities. These priorities are generally
informed by risk assessments and operational gaps identified during self-assessments, exercises and
actual response/recovery operations. HPP and PHEP training and exercise requirements vary in Budget
Period 2, but awardees are encouraged to plan and execute these requirements with inclusion from both
the HPP and the PHEP programs, emergency management agencies, and community partners at the state
and local levels.
HPP Training Requirements
1. National Incident Management System (NIMS) Documentation
HPP awardees will assess and report annually which participating hospitals currently have adopted all
NIMS implementation activities and which are still in the process of implementing the 11 activities.
For any participating hospital still working to implement NIMS activities, funds must be prioritized
and made available during HPP Budget Period 2 to ensure the full implementation and maintenance
of all activities during the five-year project period.
The Budget Period 2 application must include a hospital status update that identifies each of the 11
NIMS implementation activities that have been achieved, including each activity still in progress.
2. Training Schedule
HPP awardees must specifically identify gap-based training on a schedule detailed in the HPPprovided template, which can be found in the PERFORMS Resource Library. The completed
schedule is due September 30, 2013.
Joint HPP-PHEP Training Requirements
1. Multiyear Training and Exercise Plan (MYTEP)
Each year, awardees must conduct, or participate, in a training and exercise planning workshop
(TEPW) and submit a MYTEP. Awardees must submit the MYTEP no later than September 30,
2013, as an uploaded attachment in PERFORMS. A template for the MYTEP can be found
PERFORMS Resource Library.
2. Exercise Schedule and Narrative
In addition to the MYTEP, awardees must specifically identify required exercises and include a
narrative that describes Homeland Security Exercise and Evaluation Program compliance, community
participation, the five-year exercise strategy, and joint exercises. The exercise schedule and narrative
must be completed as outlined in the templates located in the PERFORMS Resource Library. The
exercise schedule and narrative must be submitted by September 30, 2013, as an uploaded attachment
in PERFORMS.
3. Joint Training Report
As part of the Budget Period 2 annual progress report due September 30, 2014, awardees must report
on preparedness training conducted during Budget Period 2 and describe the impact the training had
on the jurisdiction. The template for this report can be found in the PERFORMS Resource Library.
49

Budget Period 2 Exercise Requirements
Awardees must conduct preparedness exercises in accordance with the Homeland Security Exercise and
Evaluation Program (HSEEP). Further information on these guidelines and exercise policy can be found
at https://hseep.dhs.gov/pages/1001_HSEEP7.aspx
HPP-specific Requirements
Within the five-year project period, awardees must perform and evaluate required exercises. ASPR and
CDC will monitor documentation through mid-year and annual progress reports and during technical
assistance visits. Awardees must meet these requirements during the remainder of the five-year period:
 Each identified healthcare coalition must participate in at least one required exercise. This may be
at the substate regional level or the statewide level.
 All HPP participating hospitals (and if possible other healthcare organizations) must participate in
a required exercise. This should be in conjunction with their respective healthcare coalitions’
participation.
 There must be participation in a joint full-scale exercise (FSE). This requirement is for the
healthcare coalition(s) within the associated Cities Readiness Initiative metropolitan statistical
area.
Note: A real incident may be substituted for a required exercise; however the after-action report
(AAR) must document healthcare coalition involvement as outlined in the exercise reporting section
below.
To qualify as an acceptable exercise, each HPP exercise must meet the following criteria:
 Exercises must be a substate regional or statewide functional or full-scale exercise.
 HPP exercises must test the capabilities of the participants from a single healthcare coalition
or multiple healthcare coalitions and demonstrate the following:
o Resource and information management as outlined in Capability 3: Emergency
Operations Coordination and Capability 6: Information Sharing.
o Components of Capability 10: Medical Surge to include at a minimum implementation of
prehospital coordination and surge capacity and capability operations as outlined in
Capability 10: Medical Surge, Functions 2 and 3.
• Note: This demonstration does not require every component of Capability 10:
Medical Surge, Functions 2 and 3 to be tested. However, the associated
performance measure (e.g. PM 10.1), must be tested.
• Note: If the primary risk for the healthcare coalition requires full-scale
evacuation and shelter-in-place operations to occur, the components of Capability
10: Medical Surge, Function 5: Medical Evacuation/Shelter-in-Place operations
may be considered as the medical surge demonstration.
o Each exercise must demonstrate, in some capacity, the continuation of essential
healthcare services as outlined in Capability 1: Healthcare System Preparedness,
Function 3. This describes planning for essential healthcare delivery services and the
ability of the healthcare system to implement essential continuity services (e.g., business
operations, power, water, information management, heating, ventilation, and air
conditioning (HVAC) redundancies).
o Demonstrations for Capability 2: Healthcare System Recovery, Capability 5: Fatality
Management, Capability 14: Responder Safety and Health, and Capability 15: Volunteer
Management may be achieved through allowable drills or functional or full-scale
exercises. However, awardees must demonstrate that the capability has been tested
within their jurisdictions.
50



Over the five-year project period, ASPR encourages coalitions to test each of the healthcare
preparedness capabilities but recognizes certain capabilities such as Capability 2: Healthcare
System Recovery, Capability 5: Fatality Management, Capability 14: Responder Safety and
Health, and Capability 15: Volunteer Management may be demonstrated at a statewide only or at
a singular (one substate region) level.
 A rotational strategy is highly recommended for awardees with a large number of healthcare
coalitions and must be forecasted in the five-year exercise schedule, with the realization that
the forecast may change.
 Awardees are expected to work with relevant state and local officials to provide information
for the National Exercise Schedule (NEXS), so that exercises can be coordinated across
levels of government and healthcare entities. Additionally, at-risk populations and/or those
who represent them must be engaged in preparedness planning and exercise activities.

HPP Allowable Costs
Activities for funding consideration under this requirement include:
 Costs associated with planning, developing, executing, and evaluating exercises.
o During Budget Period 1 and beyond HPP allows grant funding for functional or full-scale
exercise development and execution using the HSEEP methodology. Grants can be used
to fund workshops, drills, tabletop exercises, and other HSEEP planning meetings (e.g.,
concepts and objectives, initial planning conferences, mid-planning conferences, etc.),
only to the extent these funded elements, in line with the HSEEP building block approach
for exercise development and execution, dovetail with a functional or full-scale exercise
during the five-year project period.
o Allowable drills as described above to meet specific performance measure requirements
for Capability 2: Healthcare System Recovery, Capability 5: Fatality Management,
Capability 14: Responder Safety and Health, and Capability 15: Volunteer Management
may also be funded for activities that test these capabilities for an entire healthcare sector
(e.g. long-term care facilities, community health centers, and Medical Reserve Corps,
etc.). Awardees should discuss these drilling strategies with their field project officers.
o Individual facility exercises are not allowable.
 Costs associated with enhancement and upgrade of emergency operations plans based on
exercise evaluation and improvement plans (including those from the previous budget
period).
 Costs associated with release time for healthcare workers to attend exercises.
Note: Salaries for backfilling are not allowable costs under this funding announcement.
PHEP-specific Exercise Requirements
The Public Health Service Act, Section 319C-1, requires each PHEP-funded awardee to conduct at least
one annual exercise to test preparedness and response capabilities including submission of an after-action
report (AAR) and improvement plan (IP). The HSEEP building block approach could be an acceptable
model leading up to a jurisdiction’s full-scale exercise. This annual exercise could include tabletop,
functional or full-scale exercises that test public health preparedness and response capabilities. The
AAR/IPs for each exercise are due as part of the PHEP Budget Period 2 annual progress report due on
September 30, 2014.
Awardee response and recovery operations supporting real incidents could meet the criteria for this
annual exercise requirement if the response was sufficient in scope and the AAR/IPs adequately detail
which public health preparedness capabilities were tested and evaluated.
51

Medical countermeasure-related (MCM) drills, by themselves, are very narrowly focused and are no
longer sufficient to meet this annual exercise requirement, which should be focused more broadly to
address multiple operational gaps and developmental areas for the jurisdiction. Annual PHEP exercises
must be jointly planned and executed with as many healthcare sector, emergency management agency,
and community partners as are available.
Joint Exercise Requirement: Conduct one joint full-scale exercise during the five year project period
Within the five-year project period, awardees and Cities Readiness Initiative (CRI) planning jurisdictions
must participate in one joint full-scale exercise that includes MCM distribution and dispensing elements
outlined in the Performs Resource Library. This requirement applies to the healthcare coalition(s) and all
public health departments encompassed by the associated CRI metropolitan statistical areas (MSA).
Several PHEP awardees performed the requirements for a joint full scale-exercise in which preparedness
capabilities were tested and validated by an acceptable AAR/IP during an actual response and recovery
operation, or during a validated full-scale exercise, during Budget Period 11 (August 10, 2011, through
August 9, 2012). These awardees are required to conduct another joint full-scale exercise no later than
Budget Period 5 in accordance with the HSEEP cycle. In addition, several HPP and PHEP awardees
performed the requirements for a joint full scale-exercise in which preparedness capabilities were tested
and validated by an acceptable AAR/IP during an actual response and recovery operation, or during a
validated full-scale exercise, during Budget Period 1 (July 1, 2012, through June 30, 2013). These
awardees have met the full-scale exercise requirement for the project period.
Awardees must submit the joint full-scale exercise AAR/IP documentation in accordance with established
evaluation and progress reporting requirements.
During the five-year project period, distribution full-scale exercises are required for the 50 states and four
directly funded localities. Dispensing full-scale exercises are required for the 72 CRI MSAs and each
local planning jurisdiction within the 72 CRI areas and four directly funded localities. This requirement
applies to the healthcare coalition(s) and all public health departments encompassed by the associated
CRI MSAs. HPP and PHEP programs encourage awardees to include the distribution and dispensing
requirements as part of broader full-scale exercises. Distribution and dispensing full-scale exercises are
optional for the eight U.S. territories and freely associated states.
Exercise Requirement Reporting
All HPP and PHEP AAR/IPs are due by September 30, 2014, and must be submitted based on the
exercise reporting template located in the Performs Resource library. AAR/IPs must be posted on the
CDC/DSLR secure channel on www.llis.gov.

52

Appendix 8: Emergency System for Advance Registration of Volunteer
Health Professionals (ESAR-VHP) Compliance Requirements
The ESAR-VHP compliance requirements identify capabilities and procedures that state 2 ESAR-VHP
programs must have in place to ensure effective management and interjurisdictional movement of
volunteer health personnel in emergencies. Each state must meet all of the compliance requirements.
ESAR-VHP Electronic System Requirements

1. Each state is required to develop an electronic registration system for recording and managing
volunteer information based on the data definitions presented in the ESAR-VHP Interim Technical
and Policy Guidelines, Standards and Definitions (Guidelines).
These systems must:
a. Offer Internet-based registration. Information must be controlled and managed by authorized
personnel who are responsible for the data.
b. Ensure that volunteer information is collected, assembled, maintained and utilized in a
manner consistent with all federal, state, and local laws governing security and
confidentiality.
c. Identify volunteers via queries of variables as defined by the requester.
d. Ensure that each state ESAR-VHP system is both backed up on a regular basis and that the
backup is not co-located.
2. Each electronic system must be able to register and collect the credentials and qualifications of health
professionals that are then verified with the issuing entity or appropriate authority identified in the
ESAR-VHP Guidelines.
a. Each state must collect and verify the credentials and qualifications of the following health
professional occupations. Beyond this list of occupations, a state may register volunteers
from any other occupation it chooses. The standards and requirements for including
additional occupations are left to the states.
1) Physicians (allopathic and osteopathic)

2

For purpose of this document, state refers to the 50 states, the District of Columbia, the three metropolitan areas of
Chicago, New York City, Los Angeles County, the Commonwealths of Puerto Rico and the Northern Mariana
Islands, the territories of American Samoa, Guam and the United States Virgin Islands, the Federated States of
Micronesia, and the Republics of Palau and the Marshall Islands.

53

2) Registered nurses
3) Advanced practice registered nurses (APRNs) including nurse practitioners, certified
nurse anesthetists, certified nurse-midwives, and clinical nurse specialists
4) Pharmacists
5) Psychologists
6) Clinical social workers
7) Mental health counselors
8) Radiologic technologists and technicians
9) Respiratory therapists
10) Medical and clinical laboratory technologists
11) Medical and clinical laboratory technicians
12) Licensed practical nurses and licensed vocational nurses
13) Dentists
14) Marriage and family therapists
15) Physician assistants
16) Veterinarians
17) Cardiovascular technologists and technicians
18) Diagnostic medical sonographers
19) Emergency medical technicians and paramedics
20) Medical records and health information technicians
b. States must add additional professions to their systems as they are added to future versions of
the ESAR-VHP Guidelines.
c. To increase ESAR-VHP functionality immediately after a disaster or public health
emergency, states are encouraged to develop expedited ESAR-VHP registration and
credential verification processes to facilitate the health response.
3. Each electronic system must be able to assign volunteers to one of four ESAR-VHP credential levels.
Assignment will be based on the credentials and qualifications that the state has collected and verified
with the issuing entity or appropriate authority.
4. Each electronic system must be able to record all volunteer health professional/emergency
preparedness affiliations of an individual, including local, state, and federal entities. The purpose of
this requirement is to avoid the potential confusion that may arise from having a volunteer appear in
multiple registration systems, e.g., Medical Reserve Corps (MRC), National Disaster Medical System
(NDMS), etc.
5. Each electronic system must be able to identify volunteers willing to participate in a federally
coordinated emergency response.
a. Each electronic system must query volunteers upon initial registration and/or re-verification
of credentials about their willingness to participate in emergency responses coordinated by
the federal government. Responses to this question, posed in advance of an emergency, will
provide the federal government with an estimate of the potential volunteer pool that may be
available from the states upon request.
b. If a volunteer responds “Yes” to the federal question, states may be required to collect
additional information (e.g., training, physical and medical status, etc.).
54

6. Each state must be able to update volunteer information and reverify credentials annually. (Note:
ASPR will review this requirement regularly for possible adjustments based on industry standards
and the experience of the states.)
ESAR-VHP Operational Requirements
7. Upon receipt of a request for volunteers from any governmental agency or recognized emergency
response entity, all states should: 1) within 2 hours query the electronic system to generate a list of
potential volunteer health professionals to contact; 2) contact potential volunteers; and 3) within 24
hours provide the requester with a verified list of available volunteer health professionals that
includes the names, qualifications, credentials, and credential levels of volunteers.
8. Each state must develop a plan to recruit and retain volunteers.
9. Each state must develop a plan for coordinating with all volunteer health professional/emergency
preparedness entities to ensure an efficient response to an emergency, including but not limited to
MRC units, NDMS teams, and the Federal Emergency Management Agency (FEMA) Citizen Corps.
10. Each state must develop protocols for deploying and tracking volunteers during an emergency
(Mobilization Protocols):
a. Each state is required to develop written protocols that govern the internal activation,
operation, and timeframes of the ESAR-VHP system in response to an emergency. Included
in these protocols must be plans to track volunteers during an emergency and for
maintaining a history of volunteer deployments. ASPR may ask for copies of these protocols
as a means of documenting compliance.
b. Each state ESAR-VHP program is required to establish a working relationship with external
partners, such as the local and/or state emergency management agency and develop
protocols outlining the required actions for deploying volunteers during an emergency.
These protocols should ensure continuous (24/7) operability of the ESAR-VHP system.
There are three areas of focus:
1) Intrastate deployment: States must develop protocols that coordinate the use of
ESAR-VHP volunteers with those from other organizations, such as the Medical
Reserve Corps (MRC).
2) Interstate deployment: States must develop protocols outlining the steps needed to
respond to requests for volunteers received from another state. States that have
provisions for making volunteers employees or agents of the state must also develop
protocols for the deployment of volunteers to other states through the state
emergency management agency via the Emergency Management Assistance
Compact (EMAC).
Each state must have a process for receiving and maintaining the security of
volunteers’ personal information sent to them from another state and procedures for
destroying the information when it is no longer needed.
3) Federal deployment: Each state must develop protocols necessary to respond to
requests for volunteers that are received from the federal government. Further, each
55

state must adhere to the protocol developed by the federal government that governs
the process for receiving requests for volunteers, identifying available volunteers, and
providing each volunteer’s credentials to the federal government.
ESAR-VHP Evaluation and Reporting Requirements
11. Each state must test its ESAR-VHP system through drills and exercises. These exercises must be
consistent with the ASPR Hospital Preparedness Program (HPP), Centers for Disease Control and
Prevention’s (CDC) Public Health Emergency Preparedness (PHEP) program, and ASPR ESARVHP program requirements for drills and exercises.
12. Each state must develop a plan for reporting program performance and capabilities.
Each state will be required to report program performance and capabilities data as specified by the
ASPR Hospital Preparedness Program (HPP), CDC Public Health Emergency Preparedness (PHEP)
program, and/or the ASPR ESAR-VHP program.

56

Appendix 9: HPP-PHEP Budget Period 2 Requirements for Territories
and Freely Associated States
ASPR and CDC recognize the unique infrastructure and geographic challenges faced by the U.S.
territories and freely associated states that receive limited HPP and PHEP cooperative agreement funding.
These jurisdictions include the territories of American Samoa, Commonwealth of the Northern Mariana
Islands, Guam, and U.S. Virgin Islands and the freely associated states including Federated States of
Micronesia, Republic of the Marshall Islands, and Republic of Palau.
ASPR and CDC have responded by modifying the HPP and PHEP requirements that these awardees can
realistically achieve in Budget Period 2. These requirements will incrementally increase over the
remaining project period. This appendix serves as a guide to help these seven territorial and freely
associated state awardees achieve a level of preparedness that will assure appropriate public health and
healthcare response and mitigation strategies. The modified requirements do not apply to the territory of
Puerto Rico.
Background and Rationale
Public health preparedness efforts and challenges in the territories and freely associated states differ from
the U.S. mainland. The geographical isolation and distinctive infrastructures present unique challenges
that result in equally unique strategies for achieving preparedness. HPP and PHEP funds have been used
to promote public health preparedness understanding and awareness within the health departments,
ministries, and communities in these areas but have been and currently are being used primarily for
building and maintaining basic public health capacities.
Awardees are expected to use their cooperative agreement funding to build and sustain the public health
and healthcare preparedness capabilities, ensuring that federal preparedness funds are directed to priority
areas within their jurisdictions as identified through their strategic planning efforts.
HPP and PHEP Requirements for Territories and Freely Associated States
Following are 22 Budget Period 2 requirements, including performance goals, for the seven territories and
freely associated states of American Samoa, Commonwealth of the Northern Mariana Islands, Guam,
Federated States of Micronesia, Republic of the Marshall Islands, Republic of Palau, and U.S. Virgin
Islands.
11.

Complete and submit all required Budget Period 2 application components and reports.*
Project Narrative: The narrative should summarize the overall preparedness strategy for the project
period, as well as describe specific plans for capabilities to be addressed during Budget Period 2. The
project narrative may briefly address cross-cutting activities and plans for addressing any challenges
or barriers that may impede progress. Examples include:
 Leadership capacity and organizational stability
 Technical capacity in information technology infrastructure and use
 Budget and accounting system as it relates to administrative preparedness
 Staff retention for maintaining project continuity
 Collaboration between partners, hospitals, department of health programs, local grants
management staff
 Delays in awarding subcontracts, which impinge on ability to carry out public health and
healthcare preparedness projects in a timely manner
 Manual collection of public health surveillance records
57

Awardees should review the Budget Period 1 project narrative and revise if necessary. If no revisions
are needed, the Budget Period 1 project narrative should be renamed and submitted as the Budget
Period 2 project narrative.
Capabilities Work Plan and Budget: The Budget Period 2 capabilities work plan and budget should
address the Public Health Preparedness Capabilities: National Standards for State and Local
Planning and the Healthcare Preparedness Capabilities: National Guidance for Healthcare System
Preparedness and take into consideration the results from the jurisdictional risk assessment conducted
in Budget Period 1. In the capabilities work plan, awardees must describe plans and related objectives
to build, sustain, or scale back each of the 15 capabilities in Budget Period 2.
Budget Period 2 Submission Requirements:
 Interim progress reports/funding applications are due 60 calendar days following initial
publication of the Budget Period 2 continuation guidance on www.grants.gov.

Mid-year progress reports are due 30 days after the first six months of the budget period
and must include work plan updates; status updates on applicable PAHPA benchmarks,
applicable performance measure data, and technical assistance plans; and estimated HPP and
PHEP financial reports.

Annual progress reports are due 90 days after the end of the budget period and will
include updates on work plan activities, progress on implementation of technical assistance
plans; preparedness accomplishments; success stories; and final financial reports.
12. Foster greater PHEP and HPP program alignment.
Upon request, awardees must show documented progress in coordinating public health and healthcare
preparedness program activities to include leveraging of funding to support those activities and
tracking alignment accomplishments.
13.

Conduct multiyear training and exercise planning.
Awardees must update their Budget Period 1 multiyear training and exercise plans to include planned
training sessions for public health and healthcare preparedness capabilities. Plans should include
goals and objectives for each exercise and training activity. Updated plans must be submitted as part
of the funding applications.
During the project period, awardees should conduct one joint, full-scale exercise. Joint exercises
should meet multiple program requirements, including HPP, PHEP, and medical countermeasure
planning requirements. HSEEP-compliant after-action reports and improvement plans based on
results of exercises or real events should be submitted within 90 days of the exercise/event at ad hoc
attachments in PERFORMS.

14. Engage with HPP and PHEP project officers.
Awardees must actively collaborate with their project officers to maintain individualized technical
assistance plans. The technical assistance plans will include awardee-identified and project officeridentified needs and a joint strategy for addressing those needs.
Awardees should be actively involved with HPP and PHEP project officers in planning and executing
routine site visits to assess the activities, progress, and challenges of awardees and provide/coordinate
technical assistance. Awardees should plan on hosting site visits from HPP and PHEP project officers
once every 12 to 18 months.
58

15. Submit pandemic influenza plans annually as required by Section 319C-1 and 319C-2 of the PHS Act
and amended by PAHPA.* †
ASPR and CDC have determined that awardees can satisfy the 2013 annual requirement through the
required submission of other program data that provide ample evidence on the status of state and local
influenza pandemic response readiness as well as the barriers and challenges to preparedness and
operational readiness.
16. Assure compliance with the following requirements. Unless otherwise noted, no specific narrative
response or attachment is necessary as CDC’s Procurement and Grants Office (PGO) considers that
acceptance of the Budget Period 2 funding awards constitutes assurance of compliance with these
requirements.
■
Maintain a current all-hazards public health emergency preparedness and response plan and
submit to CDC when requested and make available for review during site visits.
■
Submit required progress reports and program and financial data.
■
Submit an independent audit report every two years to the Federal Audit Clearinghouse
within 30 days of receipt of the report.
 Have in place fiscal and programmatic systems to document accountability and improvement.
 Provide CDC, as feasible, with situational awareness data.
17. Mandatory attendance at meetings.
At least one representative from each jurisdiction is required to attend the annual Public Health
Preparedness Summit once every two years. Information on dates and location for the 2014 summit
will be provided to awardees when they are finalized.
Budget Period 2 Performance Goals
The performance goals below are a set of achievable measures to gauge preparedness progress across
each of the 15 public health preparedness and eight healthcare preparedness capabilities. The HPP and
PHEP project officers will conduct an evidence-based analysis of these performance goals during site
visits and provide technical assistance as needed.
Overall
18. Performance Goal: Awardees conduct at least semi-annual (preferably quarterly) reconciliation of
the program’s financial records with the Payment Management System draw-down records to ensure
accurate accounting and timely expenditures of funds.*
Demonstration: Provide notes from meeting with local jurisdictional fiscal staff to include any
discrepancies noted.
Capability 1: Community /Healthcare System Preparedness
19. Performance Goal: Public health emergency operations plans address preparedness and response
strategies that address the public health and medical needs of at-risk individuals and the elderly in the
event of a public health emergency. †
Demonstration: Provide excerpt from the public health emergency operations plans that address atrisk and elderly individuals.
20. Performance Goal: A committee comprised of senior advisors from partner governmental and
nongovernmental organizations and representatives from the general public is developed to provide
input on the public health preparedness and response activities. † In addition, a healthcare coalition
should be established to collaborate on roles and responsibilities for healthcare preparedness and
59

response. Jurisdictions may elect to combine these two functions into one joint committee to address
the needs for both the public health senior advisory committee (PHEP) and healthcare coalition
(HPP).
Demonstration: Documented minutes of regular advisory committee/coalition meetings, to include
participants, decisions made, and actions implemented, should be available upon request.
Capability 2: Community/Healthcare System Recovery
No performance goals for Budget Period 2.
Capability 3: Emergency Operations Coordination
21. Performance Goal: An Emergency Management Assistance Compact (EMAC) or other mutual aid
agreements for medical and public health mutual aid is in force. This requirement applies only to
Guam and U.S. Virgin Islands (PL 104-321). †
Demonstration: Provide copy of EMAC and/or current mutual aid agreements.
22. Performance Goal: A role-based activation list with the names and phone numbers of responders is
maintained with current data and exercised at least semi-annually.
Demonstration: Provide copy of two unannounced call down drills or real incidents which
documents the ability to contact responders to activate the emergency operations center.
Capability 4: Emergency Public Information and Warning
23. Performance Goal: Emergency operations plans include the process to alert the public to a
potential health hazard.
Demonstration: Evidence of the development and dissemination of a health alert to the general
public in response to a real incident or as a drill.
Capability 5: Fatality Management
No performance goals for Budget Period 2.
Capability 6: Information Sharing
No performance goals for Budget Period 2.
Capability 7: Mass Care
24. Performance Goal: An electronic database for determining hospital bed availability throughout the
jurisdiction is in place.
Demonstration: Provide information on hospital bed availability to HPP staff when requested.
Capability 8: Medical Countermeasure Dispensing
25. Performance Goal: Achieve a score of 60 or higher on the Budget Period 2 island technical
assistance review (ITAR) progress report. **
Demonstration: The ITAR score received in Budget Period 1 will extend into Budget Period 2.
Awardees may improve their scores by providing updates to elements of the ITAR with
documentation to demonstrate the jurisdiction’s competencies in medical countermeasure distribution
and dispensing.
Capability 9: Medical Materiel Management and Distribution
26. Performance Goal: Conduct three (3) operational drills from the PHEP cooperative agreement
online Data, Collection and Reporting Suite.
60

Demonstration: Utilize the online reporting template found at
http://ophprsurveys.cdc.gov./mrlWeb/mrlWeb.dll?1.Project=DCARSMenu_BP1&1.user1=drills to
conduct and report the observed data on any three different drills during Budget Period 2.
Capability 10: Medical Surge
No performance goals for Budget Period 2.
Capability 11: Non-Pharmaceutical Interventions
No performance goals for Budget Period 2.
Capability 12: Public Health Laboratory Testing
27. Performance Goal: Laboratory staff members are trained and certified to package and ship
laboratory specimens.
Demonstration: Provide copies of International Air Transport Association (IATA) certification for
at least three laboratory staff members.
28. Performance Goal: Standard operating procedures are in place for packaging and shipping
specimens.
Demonstration: Provide documentation of standard procedures for packaging and shipping
specimens.
Capability 13: Public Health Surveillance and Epidemiological Investigation
29. Performance Goal: Collect syndromic surveillance data from healthcare facilities, schools, and large
businesses.
Demonstration: Written standard operating procedures for collecting and analyzing syndromic
surveillance data.
30. Performance Goal: Develop a team of specialists who analyze health indicator and syndromic
surveillance data weekly.
Demonstration: Provide documentation of weekly analysis conducted by surveillance team.
Capability 14: Responder Safety and Health
31. Performance Goal: Meet National Incident Management System (NIMS) compliance requirement. †
Information on NIMS is located at http://www.fema.gov/emergency/nims/.
Demonstration: Document certification of training completion by public health response staff. If
trainees are not U.S. citizens, other documentation of training completion is acceptable.
Capability 15: Volunteer Management
32. Performance Goal: Meet Emergency System for Advance Registration of Volunteer Health
Professionals (ESAR-VHP) guidelines. †
Demonstration: Describe the system utilized to coordinate hospital and public health volunteers to
meet the intent of the ESAR-VHP requirement.

* Failure to meet this requirement may be grounds for withholding funds in future years.
Pandemic and All-Hazards Preparedness Act (PAHPA) requirement

†

61

HPP-PHEP Budget Period 2
Summary of Requirements for Territories and Freely Associated States
Requirement
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

*

Submit Budget Period 2 application and required reports
Foster HPP and PHEP alignment
Develop multiyear training and exercise plan
Engage with project officers
Submit influenza pandemic plans*†
Comply with PGO assurances†
Attend annual Public Health Preparedness Summit
Reconcile financial records†
Include plans for at-risk and elderly populations†
Develop senior advisory committee/healthcare coalition†
Develop mutual aid agreements or EMAC (Guam & USVI only) †
Conduct call down drills
Disseminate public information
Collect and report on hospital bed availability*
Achieve a score of 60 or higher on the ITAR*
Conduct three (3) medical countermeasure dispensing drills
Maintain IATA certification for laboratory staff
Develop procedures for specimen shipping*
Collect syndromic surveillance data
Analyze syndromic surveillance data
Meet NIMS compliance†
Address volunteer management†

PHEP

HPP

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Yes
No
No
No
No
No
No
Yes
Yes

* Failure to meet this requirement may be grounds for withholding funds in future years.
†
Pandemic and All-Hazards Preparedness Act (PAHPA) requirement

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Appendix 10: Awardee Resources
Administrative Preparedness
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
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Emergency Use Authorization (EUA) toolkit - Outlines key concepts of how federal and state
emergency declarations initiate various response authorities and liability protections.
http://www.astho.org/EUAToolkit/?terms=legal+toolkit
Food and Drug Administration main EUA site http://www.fda.gov/EmergencyPreparedness/Counterterrorism/ucm182568.htm
Emergency Authority and Immunity (EAI) toolkit - Outlines key concepts of how federal and state
emergency declarations initiate various response authorities and liability protections.
http://www.astho.org/EAIToolkit/?terms=legal+toolkit
Memoranda of Understanding (MOU) with the Federal Bureau of Investigation - To promote
collaboration between the disciplines of public health and law enforcement, CDC and the U.S.
Federal Bureau of Investigation (FBI) developed a Joint Criminal and Epidemiological Investigations
Workshop for public health and law enforcement personnel. Awardees can obtain details for
scheduling this free workshop by contacting their nearest FBI field office WMD coordinator or by
contacting their HPP or PHEP project officers. Additional resources to advance jurisdictional
planning include:
o Criminal and Epidemiological Investigation Handbook (2011 - This handbook facilitates the use
of resources and to maximize communication and interaction among law enforcement and public
health officials in an effort to minimize potential barriers to communication and information
sharing during a bioterrorism incident. http://www.fbi.gov/aboutus/investigate/terrorism/wmd/criminal-and-epidemiological-investigation-handbook
o Radiological/Nuclear Law Enforcement and Public Health Investigation Handbook – This
handbook provides an introduction to radiological/nuclear law enforcement and public health
investigations so personnel have a better understanding of each other’s information requirements
and investigative procedures.
http://emergency.cdc.gov/radiation/pdf/Radiological%20Nuclear%20handbook%2009%2001%20
11.pdf
o Joint Public Health – Law Enforcement Investigations: Model Memorandum of Understanding
(MOU) - Also referenced within Public Health Preparedness Capabilities: National Standards
for State and Local Planning, this document provides factors and provisions for consideration for
adoption by state, tribal, local, and other jurisdictions when developing methods for coordinating
joint public health and law enforcement investigations of bioterrorism, suspected bioterrorism, or
other public health concerns possibly resulting from deliberate, criminal actions.
http://www.nasemso.org/Projects/DomesticPreparedness/documents/JIMOUFinal.pdf

Capabilities
Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf.
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Public Health Preparedness Capabilities: National Standards for State and Local Planning http://www.cdc.gov/phpr/capabilities/DSLR_capabilities_July.pdf
■

ESF#8
■
Emergency Support Function #8 (ESF #8) – Public Health and Medical Services Annex
http://www.fema.gov/emergency/nrf/
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Executive Directives
Presidential Policy Directive 8: National Preparedness http://www.dhs.gov/xabout/laws/gc_1215444247124.shtm
■
Strategic National Risk Assessment in Support of PPD 8: A Comprehensive Risk-Based Approach
toward a Secure and Resilient Nation - http://www.dhs.gov/xlibrary/assets/rma-strategic-nationalrisk-assessment-ppd8.pdf
■
National Health Security Strategy http://www.phe.gov/preparedness/planning/authority/nhss/Pages/default.aspx
■

Exercise and Evaluations
■
Homeland Security Exercise and Evaluation Program Guidance https://hseep.dhs.gov/pages/1001_HSEEP7.aspx
HAvBED
■
HAvBED EDXL Communication Schema - https://havbedws.hhs.gov
■
HAvBED Web Portal - https://havbed.hhs.gov
HHS Office of the Assistant Secretary for Preparedness and Response
■
http://www.phe.gov/preparedness/pages/default.aspx
HHS Centers for Disease Control and Prevention
■
Office of Public Health Preparedness and Response http://www.cdc.gov/phpr/
■
Funding, Guidance, and Technical Assistance http://www.cdc.gov/phpr/coopagreement.htm
■
Division of Strategic National Stockpile –
http://www.cdc.gov/phpr/stockpile/stockpile.htm
HHS National Healthcare Preparedness Programs Healthcare Systems Evaluation Branch
■
Public Health and Healthcare Systems Evaluation Branch Web page http://www.phe.gov/Preparedness/planning/evaluation/Pages/default.aspx
■
Fiscal year 2012/Budget Period 1Hospital Preparedness Program (HPP) Performance Measure
Manual Guidance for Using the New HPP Performance Measures http://www.phe.gov/Preparedness/planning/evaluation/Documents/fy2012-hpp-082212.pdf
■
Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program
and Priorities Going Forward - http://www.upmcbiosecurity.org/website/resources/publications/2009/pdf/2009-04-16-hppreport.pdf
■
Healthcare Facilities Partnership Program and Emergency Care Partnership Program Evaluation
Report - http://www.upmc-biosecurity.org/website/resources/publications/2010/pdf/2010-01-29hfpp_eval_rpt.pdf
■
The Next Challenge in Healthcare Preparedness: Catastrophic Health Events - http://www.upmcbiosecurity.org/website/resources/publications/2010/pdf/2010-01-29-prepreport.pdf
■
Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report http://www.iom.edu/Reports/2009/DisasterCareStandards.aspx
■
Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response http://www8.nationalacademies.org/cp/projectview.aspx?key=49130
■
Allocation of Scarce Resources During Mass Casualty Events (MCEs) http://www.ahrq.gov/clinic/tp/scarcerestp.htm
64

■

Home Health Care During an Influenza Pandemic: Issues and Resources http://www.flu.gov/professional/hospital/homehealth.html.

Pandemic and All-Hazards Preparedness Act (PAHPA)
■
PAHPA Overview - http://www.phe.gov/preparedness/legal/pahpa/pages/default.aspx
■
PAHPA Full Text - http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=109_cong_public_laws&docid=f:publ417.109.pdf
Preparedness Reports
■
CDC State Preparedness Reports - http://www.cdc.gov/phpr/pubs-links/pubslinks.htm
■
From Hospitals to Healthcare Coalitions: Transforming Health Preparedness & Response in Our
Communities - http://www.phe.gov/Preparedness/planning/hpp/Documents/hpp-healthcarecoalitions.pdf
Research Activities
■
Distinguishing Public Health Research and Public Health Non-Research http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-researchnonresearch.pdf
Subawardee Monitoring
These tools from the Association of Government Auditors (AGA) have been reviewed by the HHS Office
of the Inspector General as relevant tools for administering and monitoring grant programs.
■
AGA’s Risk Assessment Monitoring Tool http://www.agacgfm.org/AGA/Documents/Performance%20%26%20Programs/riskassessmentmonito
ringtool.pdf
■
AGA’s Financial and Administrative Monitoring Tool http://www.agacgfm.org/AGA/Documents/Performance%20%26%20Programs/financialadministrativ
emonitoringtool.pdf
■
AGA’s Fraud Prevention Toolkit - http://www2.agacgfm.org/tools/FraudPrevention/.

65