STD Applicant Workplan Template - 1 year plan

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

Attachment D - Instrument 2- STD Applicant Work Plan Template_1 Year Pla....xlsm

STD Prevention and Control: Workplan Template Pilot

OMB: 0920-0879

Document [xlsx]
Download: xlsx | pdf

Overview

Home Page
Program Context & Partners
Chlamydia
Gonorrhea
Syphilis
Congenital Syphilis
Adverse Outcomes
Outbreak
Partner Services for Women
EPT
Partner Services for MSM
STD Specialty Care
Gonorrhea & Syphilis Tx
Priority Pop. Screening & Tx
Community Health Promotion
Provider Education & Reporting
Policy
Analysis, Translation, Dissemin
Data-Driven Planning


Sheet 1: Home Page




Form Approved
OMB No. 0920-0879
Expiration Date 01/31/2021






Strengthening STD Prevention and Control for Health Departments (STD PCHD)






Work Plan

PCHD 2019 Year 1






Project Area: [Choose your Project Area…]






Period of Performance: 1/1/2019 - 12/31/2019







Submission Date: Write the date you are submitting your application in the MM/DD/YYYY format (e.g., 07/16/2018) Submission Date:








Click the navigation bar or a tab at the bottom of the workbook to jump to the corresponding worksheet.

The following navigation bar is available on the top of all worksheets:












Instructions:




You may use this template to prepare a 2019 PCHD Year 1 Work Plan for DSTDP. Please refer to the supplemental guidance document for more information.



Complete each tab in this workbook. On the Program Context & Partners tab, you will be asked a series of questions that will allow you to reflect on some of the cross-cutting issues and partners related to your work plan activities during PCHD Year 1. On the Strategy work plan tabs, you will be asked to identify annual objectives, baseline measures and target goals, and activities that will support the achievement of the annual objective.

Applicants will complete and submit the PCHD work plan each year during the five year period of performance of the award.






If you need technical support at any time, please send an email with a detailed description of your need to the following address:

[email protected]



Notes on Data Entry:




All light yellow cells are available for user input. You can type your responses directly into the yellow cells, or copy and paste your responses from another document into the cells. Press ALT+Enter to write on a new line in the same Excel cell.

Boxes with a red corner have additional tips for data entry. Hover your cursor over them to view the tips. For optimal viewing, keep resolution to 100%.



Drop-down menus are included in the Program Context & Partners tab. Please respond to the questions on Strategy Area Partnerships table by selecting from one of the response options included in the drop-down menu.

Copying Information from Microsoft Word, PDF or Excel?
Step 1: Copy (Ctrl+C) the text you want to transfer and click in the yellow cell where you want to paste

Step 2: Click into the formula bar (fx) at the top of the screen, and paste (Ctrl+V) -OR- hit F2/double-click within the yellow cell to generate a flashing cursor, and then paste

**If the light yellow cell is no longer yellow after you paste, or anything else goes wrong, hit Ctrl+Z to undo your action**

Saving and Submitting Your Work:



Click "File" from the ribbon above and then "Save" from the menu. If this is your first time saving this document, you will be prompted to choose a location for where this file will be saved. Please save this file as "[ProjectAreaName]_WorkplanY1_yy-mm-dd" and as an .xlsm version. (Note: you will see a warning message reminding you that if you change the format of the document, you may lose some of the functionality. Click "Ok" and save the file in your preferred location.)

When you are finished with this document, there are two ways to package it for submission. Option 1 - click the button below, select a folder for where you would like the final file saved, and the file will be saved with an automatically-generated filename. You will no longer be able to edit any text, but you will be able to print out the work plan template.

Option 2 - click "File" from the ribbon above and then "Save As" from the menu or use the button below. Choose the .xls or .xlsx file type from the "Save as type" drop-down menu. You will see a warning sign that says "The following features cannot be saved in macro-free workbooks: VB project". Click "Yes" to save the file as a .xls or .xlsx file type. You will still be able to edit light yellow cells, but a few features from this workbook will no longer be available.






To submit this document, attach the file ending in .xls or .xlsx to your application for this NOFO in Grants.gov.






Relevant Links:








[insert link to NOFO award posting]



[insert link to NOFO technical notes]



[insert link to NOFO TA resources (PETT)]



[insert link to S.M.A.R.T. Objectives Builder]



[insert link to other guidance documents]



Microsoft Excel Basics













CDC estimates the average public reporting burden for this collection of information as 255 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

Sheet 2: Program Context & Partners






PCHD Year 1: Strategy Area Context and Partnerships


This page is an opportunity for you to describe some of the cross-cutting issues and partners related to your work plan activities during PCHD Year 1.
Surveillance








Strategy Area Point of Contact: Include the Point of Contact’s first and last name, title Strategy Area Point of Contact (if different from Principal Investigator)











Strategy Area Context: Be specific to objectives/activities proposed for this year (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Context



Use the space below to describe any contextual factors, cross-cutting issues, changes, or priorities that impact your PCHD 2019 Year 1 objectives for this strategy area.









Strategy Area Risks: Include issues that could jeopardize implementation or the timeline (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Risks



Use the space below to describe any major risks associated with implementation of the objectives under this strategy area for PCHD 2019 Year 1.









Strategy Area Partnerships: Consider partners who are critical to accomplishing your program objectives in this Strategy Area for the year (no need to list every stakeholder) Strategy Area Partnerships



What partners (funded and unfunded) are key and essential to meeting the strategies and activities proposed in this area?

Partner Type: If your partner type is not listed, select “Other” and briefly describe the partnership in the space to the right Partner Type Brief Partner Details: Briefly describe this partner, such as its organizational name and number of partner organizations in the group (E.g., “Local health departments in X, Y, and Z counties”). (No need to list proper names of all organizations) Brief Partner Details New Partnership: Select Yes (Y) if this will be a new partner for the STD program, or if this partner is an existing partner that will play a new role in your work. Select No (N) otherwise Is this a New Partnership for Your Program?






























Disease Investigation and Intervention
Back to Top ^






Strategy Area Point of Contact: Include the Point of Contact’s first and last name, title Strategy Area Point of Contact (if different from Principal Investigator)











Strategy Area Context: Be specific to objectives/activities proposed for this year (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Context



Use the space below to describe any contextual factors, cross-cutting issues, changes, or priorities that impact your PCHD 2019 Year 1 objectives for this strategy area.









Strategy Area Risks: Include issues that could jeopardize implementation or the timeline (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Risks



Use the space below to describe any major risks associated with implementation of the objectives under this strategy area for PCHD 2019 Year 1.









Strategy Area Partnerships: Consider partners who are critical to accomplishing your program objectives in this Strategy Area for the year (no need to list every stakeholder) Strategy Area Partnerships



What partners (funded and unfunded) are key and essential to meeting the strategies and activities proposed in this area?

Partner Type: If your partner type is not listed, select “Other” and briefly describe the partnership in the space to the right Partner Type Brief Partner Details: Briefly describe this partner, such as its organizational name and number of partner organizations in the group (E.g., “Local health departments in X, Y, and Z counties”). (No need to list proper names of all organizations) Brief Partner Details New Partnership: Select Yes (Y) if this will be a new partner for the STD program, or if this partner is an existing partner that will play a new role in your work. Select No (N) otherwise Is this a New Partnership for Your Program?






























Screening, Diagnosis, and Treatment
Back to Top ^






Strategy Area Point of Contact: Include the Point of Contact’s first and last name, title Strategy Area Point of Contact (if different from Principal Investigator)











Strategy Area Context: Be specific to objectives/activities proposed for this year (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Context



Use the space below to describe any contextual factors, cross-cutting issues, changes, or priorities that impact your PCHD 2019 Year 1 objectives for this strategy area.









Strategy Area Risks: Include issues that could jeopardize implementation or the timeline (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Risks



Use the space below to describe any major risks associated with implementation of the objectives under this strategy area for PCHD 2019 Year 1.









Strategy Area Partnerships: Consider partners who are critical to accomplishing your program objectives in this Strategy Area for the year (no need to list every stakeholder) Strategy Area Partnerships



What partners (funded and unfunded) are key and essential to meeting the strategies and activities proposed in this area?

Partner Type: If your partner type is not listed, select “Other” and briefly describe the partnership in the space to the right Partner Type Brief Partner Details: Briefly describe this partner, such as its organizational name and number of partner organizations in the group (E.g., “Local health departments in X, Y, and Z counties”). (No need to list proper names of all organizations) Brief Partner Details New Partnership: Select Yes (Y) if this will be a new partner for the STD program, or if this partner is an existing partner that will play a new role in your work. Select No (N) otherwise Is this a New Partnership for Your Program?






























Prevention and Policy
Back to Top ^






Strategy Area Point of Contact: Include the Point of Contact’s first and last name, title Strategy Area Point of Contact (if different from Principal Investigator)











Strategy Area Context: Be specific to objectives/activities proposed for this year (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Context



Use the space below to describe any contextual factors, cross-cutting issues, changes, or priorities that impact your PCHD 2019 Year 1 objectives for this strategy area.










Strategy Area Risks: Include issues that could jeopardize implementation or the timeline (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Risks



Use the space below to describe any major risks associated with implementation of the objectives under this strategy area for PCHD 2019 Year 1.









Strategy Area Partnerships: Consider partners who are critical to accomplishing your program objectives in this Strategy Area for the year (no need to list every stakeholder) Strategy Area Partnerships



What partners (funded and unfunded) are key and essential to meeting the strategies and activities proposed in this area?

Partner Type: If your partner type is not listed, select “Other” and briefly describe the partnership in the space to the right Partner Type Brief Partner Details: Briefly describe this partner, such as its organizational name and number of partner organizations in the group (E.g., “Local health departments in X, Y, and Z counties”). (No need to list proper names of all organizations) Brief Partner Details New Partnership: Select Yes (Y) if this will be a new partner for the STD program, or if this partner is an existing partner that will play a new role in your work. Select No (N) otherwise Is this a New Partnership for Your Program?






























Data Use and Utilization
Back to Top ^




Strategy Area Point of Contact: Include the Point of Contact’s first and last name, title Strategy Area Point of Contact (if different from Principal Investigator)








Strategy Area Context: Be specific to objectives/activities proposed for this year (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Context


Use the space below to describe any contextual factors, cross-cutting issues, changes, or priorities that impact your PCHD 2019 Year 1 objectives for this strategy area.






Strategy Area Risks: Include issues that could jeopardize implementation or the timeline (No need to repeat what you wrote in your narrative or 5 Year Plan) Strategy Area Risks


Use the space below to describe any major risks associated with implementation of the objectives under this strategy area for PCHD 2019 Year 1.






Strategy Area Partnerships: Consider partners who are critical to accomplishing your program objectives in this Strategy Area for the year (no need to list every stakeholder) Strategy Area Partnerships


What partners (funded and unfunded) are key and essential to meeting the strategies and activities proposed in this area?
Partner Type: If your partner type is not listed, select “Other” and briefly describe the partnership in the space to the right Partner Type Brief Partner Details: Briefly describe this partner, such as its organizational name and number of partner organizations in the group (E.g., “Local health departments in X, Y, and Z counties”). (No need to list proper names of all organizations) Brief Partner Details New Partnership: Select Yes (Y) if this will be a new partner for the STD program, or if this partner is an existing partner that will play a new role in your work. Select No (N) otherwise Is this a New Partnership for Your Program?





















Sheet 3: Chlamydia





PCHD Year 1: Work Plan



Conduct Surveillance



Strategy 1: Conduct Chlamydia (CT) surveillance
1A: Collect, manage, analyze, interpret and disseminate data on identified cases of chlamydia, ensuring timely capture of core epidemiological variables available on laboratory reports: age, sex, county, diagnosing facility type, specimen collection date, and anatomic site(s) of infection
Objective 1A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 4: Gonorrhea







PCHD Year 1: Work Plan




Conduct Surveillance




Strategy 2: Conduct Gonorrhea (GC) surveillance

2A: Collect, manage, analyze, interpret and disseminate data on identified cases of gonorrhea, ensuring timely capture of core epidemiological variables available on laboratory reports: age, sex, county, diagnosing facility type, specimen collection date, and anatomic site(s) of infection

Objective 2A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed









_x000D_
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2B: To better understand GC epidemiology, conduct provider follow-up and, if needed, brief patient interviews of a random sample of GC cases from a well-defined high morbidity area or the project area as a whole. Ensure timely and quality capture of core epidemiological variables including, but not limited to: age, sex, county, diagnosing facility type, specimen collection date, anatomic site(s) of infection, race/ethnicity, gender identity/sexual orientation, sex of sex partner(s), clinical signs/symptoms, pregnancy status, HIV status, partner treatment (i.e., EPT provision), gonorrhea-related sequelae (i.e., presence of pelvic inflammatory disease (PID), disseminated gonococcal infection (DGI), etc.), substance use, date of diagnosis, treatment received (including names and doses of treatment), date of treatment, co-infection with other STDs, and history of GC infection

Objective 2B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 5: Syphilis







PCHD Year 1: Work Plan




Conduct Surveillance




Strategy 3: Conduct syphilis surveillance

3A: Collect, manage, analyze, interpret and disseminate data on identified cases of syphilis, ensuring timely capture of core epidemiological variables available on laboratory reports: age, sex, county, diagnosing facility type, and specimen collection date

Objective 3A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed









_x000D_
_x000D_
_x000D_
3B: To better understand primary and secondary (P&S) syphilis epidemiology, conduct provider follow-up and, if needed, brief patient interviews of all cases of P&S syphilis. Ensure timely and quality capture of core epidemiological variables including, but not limited to: age, sex, county, diagnosing facility type, specimen collection date, race/ethnicity, gender identity/sexual orientation, sex of sex partner(s), pregnancy status, clinical signs/symptoms, HIV status, substance use, treatment received, date of treatment, and history of syphilis

Objective 3B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 6: Congenital Syphilis







PCHD Year 1: Work Plan




Conduct Surveillance




Strategy 4: Conduct congenital syphilis (CS) surveillance
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4A: To better understand CS epidemiology, conduct provider and mother follow-up and review medical records of all reported CS cases. Based on information collected, manage, analyze, and disseminate data on reported cases of CS, ensuring timely and quality capture of epidemiological core maternal, fetal, and neonatal variables including, but not limited to: mother's age, race/ethnicity, county, stage of syphilis diagnosed during pregnancy, date(s) of 1st prenatal visit, syphilis testing (and corresponding titers), treatment(s) and delivery; HIV status of mother, substance use, clinical settings of diagnosis and care; and fetal and neonatal information such as ultrasound findings, physical and laboratory findings, and HIV status of infant at birth

Objective 4A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










4B: For applicants with 10 or more cases of congenital syphilis in the previous calendar year: Improve methods to match vital statistics birth and mortality data with syphilis surveillance data to review syphilis testing practices among women who delivered a stillborn baby, identify missed cases of syphilis-related stillbirth, and strengthen CS case report data

Objective 4B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










4C: For applicants with 10 or more cases of congenital syphilis in the previous calendar year: Strengthen CS morbidity and mortality case review boards at the local and/or state level to help identify causes of CS and develop interventions to address causes

Objective 4C-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 7: Adverse Outcomes





PCHD Year 1: Work Plan



Conduct Surveillance



Strategy 5: Conduct surveillance of adverse outcomes of STDs
5A: Conduct active surveillance of adverse outcomes of adult syphilis including neurosyphilis and otic and ocular syphilis through sentinel approaches, collecting variables including, but not limited to: neurological manifestations, ocular manifestations, otic manifestations, and late clinical manifestations. These are in addition to the stage of syphilis and the core epidemiologic variables listed for P&S syphilis in Strategy 3B
Objective 5A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Sheet 8: Outbreak





PCHD Year 1: Work Plan



Conduct Disease Investigation and Intervention



Strategy 6: Respond to STD-related outbreaks
6A: Review STD surveillance data by the core epidemiologic variables at regular intervals to identify outbreaks and other significant changes in STD epidemiology
Objective 6A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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6B: Develop and maintain an outbreak capacity plan to respond to significant changes in STD epidemiology. Ensure that staff are trained and ready to implement the outbreak capacity plan
Objective 6B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Sheet 9: Partner Services for Women







PCHD Year 1: Work Plan




Conduct Disease Investigation and Intervention




Strategy 7: Conduct health department disease investigation for pregnant women and other reproductive-age women with syphilis

7A: Prioritize for investigation all reported cases among females of reproductive age and reactive serology, including provider follow-up to confirm stage, treatment and pregnancy status

Objective 7A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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_x000D_
_x000D_
_x000D_
7B: Regardless of pregnancy status, conduct follow-up on new syphilis cases among women of reproductive age, to obtain more information, if needed, on treatment and other information needed to ensure linkage to related STD, MCH, and HIV prevention and other services. For those who are pregnant, investigation should also include follow-up with the pregnant female, prenatal care providers, birthing centers, and neonatal care providers as needed to ensure adequate maternal follow up and stillbirth and neonatal evaluations per clinical guidelines

Objective 7B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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7C: Provide timely partner services to all pregnant women who are diagnosed with syphilis and all other women of reproductive age who are diagnosed with early syphilis

Objective 7C-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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Sheet 10: EPT





PCHD Year 1: Work Plan



Conduct Disease Investigation and Intervention



Strategy 8: Promote Expedited Partner Therapy (EPT) (where permissible) to partners of chlamydia and/or gonorrhea cases
8A: Assess EPT practices to identify and prioritize providers and organizations or areas to target for promotion and improvement. Provide technical assistance and education to promote EPT to providers and organizations who frequently report cases of chlamydia and/or gonorrhea including cases of repeat infections
Objective 8A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Sheet 11: Partner Services for MSM







PCHD Year 1: Work Plan




Conduct Disease Investigation and Intervention




Strategy 9: Conduct health department syphilis disease investigation and intervention for men with syphilis

9A: Conduct follow-up on primary and secondary syphilis cases among men, to obtain more information, if needed, on treatment, sex of sex partners, HIV serostatus, HIV care status, PrEP use, and other information to ensure linkage to appropriate STD and HIV related prevention services

Objective 9A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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9B: Provide timely and comprehensive partner services to men with primary and secondary syphilis who report pregnant or other female partners of reproductive age

Objective 9B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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_x000D_
_x000D_
_x000D_
9C: Use program and epidemiologic data to identify which subgroups of MSM with primary and secondary syphilis and factors associated with transmission to target for partner services to yield high numbers of all partners treated in a timely fashion and for whom consequence of transmission is the greatest. As resources permit, provide timely partner services including comprehensive STD and HIV testing and linkage to care and needed prevention services to those subgroups of MSM with primary and secondary syphilis

Objective 9C-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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Sheet 12: STD Specialty Care





PCHD Year 1: Work Plan



Promote CDC-Recommended Screening, Diagnosis, and Treatment



Strategy 10: Promote quality STD specialty care services
10A: Identify all STD specialty clinics in the project area
Objective 10A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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10B: Promote quality STD care in those settings based on clinical guidelines and recommendations and promote strategies for expanding access to care in those settings
Objective 10B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Sheet 13: Gonorrhea & Syphilis Tx





PCHD Year 1: Work Plan



Promote CDC-Recommended Screening, Diagnosis, and Treatment



Strategy 11: Promote CDC-recommended treatment for gonorrhea and syphilis
11A: Assess GC treatment practices to identify and prioritize providers, organizations, and areas to target for promotion and improvement. Provide education and technical assistance to providers and organizations who prescribe non-recommended treatment for gonorrhea
Objective 11A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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[+] Create objective



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11B: Assess syphilis treatment practices to identify and prioritize providers, organizations, and areas to target for promotion and improvement. Provide education and technical assistance to providers and organizations who prescribe non-recommended treatment for syphilis
Objective 11B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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11C: Implement a Benzathine penicillin G forecasting inventory management system to monitor supply, and have a plan to address shortages in the applicant's project area. Assist providers and organizations who are unable to provide timely, recommended treatment for syphilis in getting access to medication or dispensing the treatment to the patient, as needed
Objective 11C-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Sheet 14: Priority Pop. Screening & Tx







PCHD Year 1: Work Plan




Promote CDC-Recommended Screening, Diagnosis, and Treatment




Strategy 12: Promote CDC-recommended screening for, and treatment of, STDs among priority populations

12A: For pregnant women: Assess screening and treatment practices to identify and prioritize providers, organizations, and areas to target for promotion and improvement. Provide education and technical assistance, for prenatal-care providers and organizations who do not regularly screen for syphilis as recommended

Objective 12A-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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12B: For young adults and adolescents, particularly those seen in family planning clinics, adolescent health clinics, and primary care settings: Assess screening and treatment practices to identify and prioritize providers, organizations, and areas to target for promotion and improvement. Provide education and technical assistance to targeted providers and organizations to promote recommended screening and treatment

Objective 12B-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed









_x000D_
_x000D_
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12C: For MSM, particularly those seen in lesbian, gay, bisexual, transgender and queer (LGBTQ) health centers, HRSA-funded HIV care settings, primary care settings, and clinics providing HIV PrEP: Assess screening and treatment practices to identify and prioritize providers, organizations, and areas to target for promotion and improvement. Provide education and technical assistance to targeted providers and organizations, to promote recommended screening and treatment

Objective 12C-1




Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective



Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target













Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To































[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed










[+] Create objective




Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 15: Community Health Promotion





PCHD Year 1: Work Plan



Promote STD Prevention and Policy



Strategy 13: Promote STD prevention to the public
13A: Provide audience-appropriate, 508-compliant, STD-prevention information online, including answers to common STD questions (e.g., symptoms, testing methods, treatment) and places where testing and treatment are available
Objective 13A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 16: Provider Education & Reporting





PCHD Year 1: Work Plan



Promote STD Prevention and Policy



Strategy 14: Promote STD prevention and reporting to provider community
14A: Notify local providers and organizations about important or timely STD-related issues, such as outbreaks, emerging diseases, recommended treatment changes, biomedical advances, and reporting requirements
Objective 14A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 17: Policy





PCHD Year 1: Work Plan



Promote STD Prevention and Policy



Strategy 15: Monitor STD-related policies and policy development
15A: Work with the CDC, the NNECS recipient, and other partners to identify STD-related policies of interest. Monitor proposed and actual changes in policies that may affect STD prevention programs
Objective 15A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








15B: Work with local policy liaisons and with partner organizations on the development of policies that enhance the work of the STD prevention program
Objective 15B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 18: Analysis, Translation, Dissemin





PCHD Year 1: Work Plan



Analyze and Use Data for Program Improvement



Strategy 16: Conduct epidemiologic analysis, translation and dissemination
16A: Conduct regular analyses of trends in, geographic distribution of, and factors associated with reported cases using core epidemiologic variables
Objective 16A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








16B: Disseminate, interpret, and discuss data and findings with internal and external stakeholders
Objective 16B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








16C: Assist local jurisdictions with analyzing their data on a regular basis, including analyses of trends, epidemiologic factors, and geographic distribution of cases, and help local areas identify outbreaks, gaps in services, or disparities in the burden of disease that should drive resource allocation
Objective 16C-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed




Sheet 19: Data-Driven Planning





PCHD Year 1: Work Plan



Analyze and Use Data for Program Improvement



Strategy 17: Conduct data-driven planning, analysis, monitoring and evaluation for program improvement
17A: Routinely analyze, synthesize and interpret surveillance, epidemiologic, program, and other data to strengthen the program's understanding of local STD epidemiology and program context. Evaluate progress, using scientific methods, program data, performance data, and cost data, and adjust program plans accordingly
Objective 17A-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








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Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








17B: Use findings from those analyses to identify the program's STD prevention and control priorities, populations, and geographic areas, to develop program plans, and to allocate staffing and other resources accordingly
Objective 17B-1



Annual Objective: You may list up to 3 objectives per strategy; Focus on the highest priority work on this strategy in the upcoming year. For help creating SMART objectives, refer to the resource link available on the Home Page. Annual Objective: Describe one objective for this strategy, using the S.M.A.R.T. objectives format
Description: Briefly describe the baseline and target measures of your objective


Baseline: This should be the baseline measure in your SMART objective. Baseline should be from the prior calendar/fiscal year, if possible. If the baseline data point is from a different year, please note in this text box, next to the baseline number provided (e.g., 75% (2016)). If you have multiple baselines (e.g., for specific counties), list them here, instead of creating separate objectives for each. Baseline Target: This should be the target measure in your SMART objective. Target










Activity Description: Describe up to four planned activities you will conduct in order to achieve your Objective; Prioritize and include only the most critical activities, milestones, or tasks. Activity Description Activity Timeframe: Indicate the timeframe when each Activity will happen or occur (e.g., March-October 2019, Monthly, Ongoing, As Needed). Do not just provide a completion date. Activity Timeframe Output Indicator: Describe the output or deliverable that will signify achievement of the Activity. This may be numeric (e.g., 10 workgroup meetings held) or narrative (e.g., New protocol approved). Output Indicator Assigned To: Include the staff person or group primarily responsible for this Activity. If a staff person, provide his/her name and title. Assigned To

























[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed








[+] Create objective



Applicants can submit up to three objectives for each sub-strategy; click again to hide if not needed



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