Foa

2017-2022 Hospital Preparedness Program (HPP) - Public Health
Emergency Preparedness (PHEP) Cooperative Agreement
CDC-RFA-TP17-1701

March 17, 2017 Amendments
Pages 10 and 92
Clarifying the Exceptions to Matching Funds Requirement
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The match requirement does not apply to the political subdivisions of New York City, Los
Angeles County, or Chicago.
Pursuant to department grants policy implementing 48 U.S.C. 1469a(d), any required matching
(including in-kind contributions) of less than $200,000 is waived with respect to cooperative
agreements to the governments of American Samoa, Guam, the U.S. Virgin Islands, or the
Northern Mariana Islands (other than those consolidated under other provisions of 48 U.S.C.
1469). For instance, if 10% (the match requirement) of the award is less than $200,000, then the
entire match requirement is waived. If 10% of the award is greater than $200,000, then the first
$200,000 is waived, and the rest must be paid as match.
The match requirement is also waived for the freely associated states, including the Republic of
Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands.
Matching does not apply to future contingent emergency response awards that may be authorized
under 311, 317(a), and 317(d) of the Public Health Service (PHS) Act unless such a requirement
were imposed by statute or administrative process at the time.

Pages 28, 60, 69, 119
Senior health official changed to state health official
Page 33
Domain 2 Strategy: Strengthen Incident Management, Activity 4: Ensure HCC Integration and Collaboration with
Emergency Support Fuction-8 (ESF-8).

HPP Awardee Recovery Plan
Each awardee must develop a health care system recovery plan and submit the plan to ASPR by the
end of Budget Period 2 4 with annual progress reports.
Page 44
MCM Operational Readiness Reviews
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State awardees must conduct operational reviews for all CRI planning jurisdictions within a two-year
period, reviewing 50% of the CRI planning jurisdictions every other year.
Page 52
Domain 5 Strategy: Strengthen Surge Management/Management of Public Health Surge

Activity 3: Coordinate Volunteers

PHEP Requirements/Recommendations
Conduct Activities Based on State Plans to Manage Public Health Surge
Implement Plans that support the Emergency System for Advance
Registration of Volunteer Health Professionals (ESAR-VHP)
Page 95
b. Application Deadline
April 4, 2017, 5 p.m. U.S. Eastern Time, at www.grants.gov. If Grants.gov is inoperable and cannot
receive applications, and circumstances preclude advance notification of an extension, then applications
must be submitted by the first business day on which grants.gov operations resume.
Page 103 Funding Restrictions – added one item
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HPP awardees cannot spend HPP funds on training courses, exercises, and planning resources when
similar offerings are available at no cost.

Page 119

Application Attachments – deleted two items and add one item
Following is a list of acceptable attachments awardees can upload as PDF files as part of their
applications at www.grants.gov. Awardees may not attach documents other than those listed; if other
documents are attached, applications will not be reviewed.
• Table of Contents for Entire Submission
• HPP Project Abstract
• PHEP Project Abstract
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HPP Project Narrative
PHEP Project Narrative
HPP Work Plan (high-level plan)
HPP Domain Work Plan
PHEP Work Plan (high-level plan)
PHEP Domain Work Plan
HPP Budget Narrative
HPP Application for Federal Assistance (SF-424)
HPP Budget Information for Non-Construction Programs (SF-424A)
HPP Indirect Cost Rate Agreement
PHEP Budget Narrative
PHEP Application for Federal Assistance (SF-424)
PHEP Budget Information for Non-Construction Programs (SF-424A)
PHEP Indirect Cost Rate Agreement
MYTEP – joint HPP-PHEP plan
CDC Assurances and Certifications (PHS-5161)
Senior Health Official (SHO) Letter (PHEP only)
Local Concurrence Letters (PHEP only)
Tribal Input Letters (PHEP only)
EMSC support letters (HPP only)
HPP Organizational Chart
PHEP Organizational Chart
Disclosure of Lobbying Activities (SF-LLL)

Optional attachments:
 Memorandum of Agreement (MOA)
 Memorandum of Understanding (MOU)
 Bona Fide Agent status documentation, if applicable

Contents
Part I. Overview ..........................................................................................................................................................8
A. Federal Agency Names: ......................................................................................................................................8
B. Funding Opportunity Title: .................................................................................................................................8
C. Announcement Type: New - Type 1 ...................................................................................................................8
D. Agency Funding Opportunity Number: ..............................................................................................................8
E. Catalog of Federal Domestic Assistance (CFDA) Number: .................................................................................8
F. Dates ...................................................................................................................................................................8
1. Due Date for Letter of Intent (LOI): ................................................................................................................8
2. Due Date for Applications: .............................................................................................................................8
3. Due Date for Informational Conference Call: .................................................................................................8
G. Executive Summary ............................................................................................................................................9
1. Summary Paragraph .......................................................................................................................................9
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a. Eligible Applicants: ......................................................................................................................................9
b. FOA Type: ...................................................................................................................................................9
c. Approximate Number of Awards: ...............................................................................................................9
d. Total Project Period Funding: .....................................................................................................................9
e. Average One-Year Award Amount: ......................................................................................................... 10
f. Total Project Period Length: ..................................................................................................................... 10
g. Estimated Award Date: ............................................................................................................................ 10
h. Cost Sharing and / or Matching Requirements: ...................................................................................... 10
Part II. Full Text ........................................................................................................................................................ 11
A. Funding Opportunity Description.................................................................................................................... 11
1. Background .................................................................................................................................................. 11
a. Overview .................................................................................................................................................. 11
b. Statutory Authorities ............................................................................................................................... 12
c. Healthy People 2020 ................................................................................................................................ 12
d. Other National Public Health Priorities and Strategies ........................................................................... 12
e. Relevant Work ......................................................................................................................................... 13
2. ASPR-CDC Project Description ..................................................................................................................... 13
a. Approach.................................................................................................................................................. 13
i. Purpose ................................................................................................................................................. 14
ii. Outcomes ............................................................................................................................................. 14
iii. Strategies and Activities...................................................................................................................... 16
1. Collaborations.................................................................................................................................. 68
a. With other ASPR and CDC programs and ASPR- and CDC-funded organizations:....................... 68
b. With organizations not funded by ASPR or CDC: ........................................................................ 69
2. Target Populations........................................................................................................................... 70
a. Health Disparities......................................................................................................................... 70
iv. Funding Strategy ................................................................................................................................. 71
b. Evaluation and Performance Measurement ........................................................................................... 71
i. ASPR and CDC Evaluation and Performance Measurement Strategy .................................................. 71
ii. Applicant Evaluation and Performance Measurement Plan ............................................................... 83
c. Organizational Capacity of Awardees to Implement the Approach ........................................................ 84
d. Work Plan ................................................................................................................................................ 84
e. ASPR and CDC Monitoring and Accountability Approach ....................................................................... 87
f. ASPR and CDC Program Support to Awardees ......................................................................................... 88
B. Award Information .......................................................................................................................................... 89
1. Funding Instrument Type: ........................................................................................................................... 89
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2. Award Mechanism: ...................................................................................................................................... 89
3. Fiscal Year: ................................................................................................................................................... 89
4. Approximate Total Fiscal Year Funding: ...................................................................................................... 89
5. Approximate Project Period Funding: ......................................................................................................... 89
6. Total Project Period Length: ........................................................................................................................ 89
7. Expected Number of Awards: ...................................................................................................................... 89
8. Approximate Average Award: ..................................................................................................................... 90
9. Award Ceiling: .............................................................................................................................................. 90
10. Award Floor: .............................................................................................................................................. 90
11. Estimated Award Date: .............................................................................................................................. 90
12. Budget Period Length: ............................................................................................................................... 90
13. Direct Assistance ....................................................................................................................................... 90
C. Eligibility Information ...................................................................................................................................... 91
1. Eligible Applicants ........................................................................................................................................ 91
2. Additional Information on Eligibility............................................................................................................ 91
3. Justification for Less than Maximum Competition ...................................................................................... 91
4. Cost Sharing or Matching ............................................................................................................................ 91
5. Maintenance of Effort ................................................................................................................................. 92
D. Application and Submission Information ........................................................................................................ 93
1. Required Registrations ................................................................................................................................ 93
a. Data Universal Numbering System: ......................................................................................................... 93
b. System for Award Management (SAM): .................................................................................................. 93
c. Grants.gov: ............................................................................................................................................... 93
2. Request Application Package ...................................................................................................................... 95
3. Application Package..................................................................................................................................... 95
4. Submission Dates and Times ....................................................................................................................... 95
a. Letter of Intent Deadline (must be emailed or postmarked by) ............................................................. 95
b. Application Deadline ............................................................................................................................... 95
5. CDC Assurances and Certifications .............................................................................................................. 95
6. Content and Form of Application Submission ............................................................................................. 96
7. Letter of Intent ............................................................................................................................................ 96
8. Table of Contents ........................................................................................................................................ 96
9. Project Abstract Summary ........................................................................................................................... 96
10. Project Narrative ....................................................................................................................................... 96
a. Background .............................................................................................................................................. 96
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b. Approach ................................................................................................................................................. 96
i. Purpose ................................................................................................................................................. 96
ii. Outcomes ............................................................................................................................................. 97
iii. Strategies and Activities...................................................................................................................... 97
1. Collaborations.................................................................................................................................. 97
2. Target Populations and Health Disparities ...................................................................................... 97
c. Applicant Evaluation and Performance Measurement Plan.................................................................... 97
d. Organizational Capacity of Applicants to Implement the Approach ....................................................... 97
11. Work Plan .................................................................................................................................................. 98
12. Budget Narrative ....................................................................................................................................... 98
13. Funds Tracking ......................................................................................................................................... 100
14. Intergovernmental Review ...................................................................................................................... 100
15. Pilot Program for Enhancement of Employee Whistleblower Protections ............................................. 100
16. Copyright Interests Provisions ................................................................................................................. 100
17. Funding Restrictions ................................................................................................................................ 101
18. Data Management Plan ........................................................................................................................... 107
19. Other Submission Requirements ............................................................................................................. 107
a. Electronic Submission: ........................................................................................................................... 107
b. Tracking Number: .................................................................................................................................. 107
c. Validation Process:................................................................................................................................. 107
d. Technical Difficulties:............................................................................................................................. 108
e. Paper Submission: ................................................................................................................................. 108
E. Review and Selection Process ....................................................................................................................... 108
1. Review and Selection Process: Applications will be reviewed in three phases .................................... 108
a. Phase 1 Review ...................................................................................................................................... 108
b. Phase II Review ...................................................................................................................................... 109
c. Phase III Review ..................................................................................................................................... 110
2. Announcement and Anticipated Award Dates .......................................................................................... 111
F. Award Administration Information ............................................................................................................... 111
1. Award Notices ........................................................................................................................................... 111
2. Administrative and National Policy Requirements.................................................................................... 111
3. Reporting ................................................................................................................................................... 112
a. Awardee Evaluation and Performance Measurement Plan (required) ................................................. 113
b. Annual Performance Report (APR) (required)....................................................................................... 114
c. Federal Financial Reporting (FFR) (required) ......................................................................................... 115
d. Final Performance and Financial Report (required) .............................................................................. 116
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4. Federal Funding Accountability and Transparency Act of 2006 (FFATA) .................................................. 116
5. Reporting of Foreign Taxes (International/Foreign projects only) ............................................................ 116
G. Agency Contacts ............................................................................................................................................ 117
H. Other Information ......................................................................................................................................... 119
I. Glossary .......................................................................................................................................................... 127

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Part I. Overview
Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the
"Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFATP17-1701. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of
changes.

A. Federal Agency Names:
Office of the Assistant Secretary for Preparedness and Response (ASPR) and Centers for Disease
Control and Prevention (CDC) / Agency for Toxic Substance and Disease Registry (ATSDR)

B. Funding Opportunity Title:
Hospital Preparedness Program (HPP) - Public Health Emergency Preparedness (PHEP) Cooperative
Agreement.

C. Announcement Type: New - Type 1
This announcement is only for non-research activities supported by ASPR and CDC. If research is
proposed, the application will not be considered. For this purpose, research is defined at
https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.
Guidance on how CDC interprets the definition of research in the context of public health can be found
at http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-researchnonresearch.pdf.

D. Agency Funding Opportunity Number:
CDC-RFA-TP17-1701

E. Catalog of Federal Domestic Assistance (CFDA) Number:
93.074

F. Dates
1. Due Date for Letter of Intent (LOI):

N/A
2. Due Date for Applications:

04/04/2017
Applications must be electronically submitted no later than 5 p.m. EST on the application due date.
3. Due Date for Informational Conference Call:

Wednesday, February 8, 1:30 p.m. to 3 p.m. EST
Monday, February 13, 1:30 p.m. to 3 p.m. EST

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G. Executive Summary
1. Summary Paragraph

This FOA is for the continued purpose of strengthening and enhancing the capabilities of state, local,
and territorial public health and health care systems to respond effectively (mitigate the loss of life and
reduce the threats to the community’s health and safety) to evolving threats and other emergencies
within the United States and territories and freely associated states. This announcement provides clear
expectations and priorities for awardees and health care coalitions (HCCs) to strengthen and enhance
the readiness of the public health and the health care delivery system to save lives during emergencies
that exceed the day-to-day capacity and capability of the public health and medical emergency
response systems. This announcement provides funds to ensure that HPP awardees focus on activities
that advance progress toward meeting the goals of the 2017-2022 Health Care Preparedness and
Response Capabilities and document progress in establishing or maintaining ready health care systems
through strong HCCs and to ensure that PHEP awardees continue to advance development of effective
public health emergency management and response programs as outlined in the Public Health
Preparedness Capabilities: National Standards for State and Local Planning. Awardees must develop
strategies and activities based on the HPP-PHEP Logic Model and use findings from their jurisdictional
risk assessments, capability self-assessments, National Health Security Preparedness Index, and
incident after-action reports to inform their strategic priorities and preparedness investments.
a. Eligible Applicants:

Government Organizations:
 States
 Local governments or their bona fide agents: Chicago, Los Angeles County, New York City,
and Washington, D.C.
 Territorial governments or their bona fide agents and freely associated states: American
Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia,
Guam, Puerto Rico, Republic of the Marshall Islands, Republic of Palau, and U.S. Virgin
Islands
b. FOA Type:

Cooperative Agreement
c. Approximate Number of Awards:

62
d. Total Project Period Funding:

$4,201,250,000
Subject to availability of funds
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e. Average One-Year Award Amount:

HPP: $5.7 million
PHEP: $10 million
f. Total Project Period Length:

5 years
g. Estimated Award Date:

July 1, 2017
h. Cost Sharing and / or Matching Requirements:

Yes.
ASPR and CDC may not award a cooperative agreement to a state or consortium of states under these
programs unless the awardee agrees that, with respect to the amount of the cooperative agreements
awarded by ASPR and CDC, the state will make available nonfederal contributions in the amount of
10% ($1 for each $10 of federal funds provided in the cooperative agreement) of the award. Match
may be provided directly or through donations from public or private entities and may be in cash or in
kind, fairly evaluated, including plant, equipment or services. Amounts provided by the federal
government or services assisted or subsidized to any significant extent by the federal government may
not be included in determining the amount of such nonfederal contributions.
Please refer to 45 CFR § 75.306 for match requirements, including descriptions of acceptable match
resources. Documentation of match, including methods and sources, must be included in the Budget
Period 1 application for funds, follow procedures for generally accepted accounting practices, and
meet audit requirements.
Exceptions to Matching Funds Requirement
 The match requirement does not apply to the political subdivisions of New York City, Los
Angeles County, or Chicago.
 Pursuant to department grants policy implementing 48 U.S.C. 1469a(d), any required matching
(including in-kind contributions) of less than $200,000 is waived with respect to cooperative
agreements to the governments of American Samoa, Guam, the U.S. Virgin Islands, or the
Northern Mariana Islands (other than those consolidated under other provisions of 48 U.S.C.
1469). For instance, if 10% (the match requirement) of the award is less than $200,000, then
the entire match requirement is waived. If 10% of the award is greater than $200,000, then the
first $200,000 is waived, and the rest must be paid as match.
 The match requirement is also waived for the freely associated states, including the Republic of
Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands.

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

Matching does not apply to future contingent emergency response awards that may be
authorized under 311, 317(a), and 317(d) of the Public Health Service (PHS) Act unless such a
requirement were imposed by statute or administrative process at the time.

Part II. Full Text
A. Funding Opportunity Description
1. Background
a. Overview

Recent public health threats of potentially catastrophic proportion underscore the importance of
effective planning and response capabilities that can be applied to all hazards. As new threats,
including novel infectious diseases, emerge, ASPR and CDC programs must ensure that both medical
and public health systems are not only integral parts of emergency response activities but also part of
emergency preparedness planning with all relevant partners. Increased cooperation among
responders, including state and local public health officials, emergency medical services (EMS), health
care coalitions (HCCs), and private health care organizations, ensure the nation is better prepared to
respond to all hazards. Governmental public health departments and the mostly private sector health
care delivery systems are now recognized as essential partners in emergency response, increasing their
ability to identify and mitigate potential threats to the public’s health. During the 2012-2017 project
period, the aligned HPP-PHEP cooperative agreement provided technical assistance and resources to
support state, local, and territorial public health departments, along with HCCs and health care
organizations, to show measurable and sustainable progress toward achieving the preparedness and
response capabilities that promote prepared and resilient communities. Alignment of these two
distinct federal preparedness programs continues through this FOA. Although each program focuses on
readiness for two discrete sectors, the public health enterprise for PHEP and the mostly private health
care and medical systems for HPP, alignment offers opportunities for these sectors to coordinate and
collaborate. This facilitates improved community preparedness and response nationwide, reduces
awardee burden, and increases federal efficiency.
This 2017-2022 funding opportunity provides funds to continue those efforts. Awardees must increase
or maintain their levels of effectiveness across six key preparedness domains: community resilience,
incident management, information management, countermeasures and mitigation, surge
management, and biosurveillance. These domains build on the efforts to strengthen the public health
and health care capabilities from the previous project period. Addressing these domains allows
awardees and local and tribal public health and health care subawardees to focus efforts on
strengthening their preparedness capabilities and preventing or reducing morbidity and mortality from
public health incidents whose scale, rapid onset, or unpredictability stresses the public health and
health care systems. Additionally, this funding opportunity supports efforts to establish and maintain
capacities to detect, assess, report and respond to domestic public health incidents as obligated by the
International Health Regulations (2005) [IHR(2005)}.This will ensure the earliest possible recovery and
return of the public health and health care systems to pre-incident levels or improved functioning.

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Improved planning and response coordination across all levels will present new opportunities to
leverage resources while maximizing effort, resulting in increased efficiency. While cooperative
agreement funding to the contiguous United States and its territories and freely associated states will
continue to build and sustain core public health and health care preparedness capabilities, awardees
must demonstrate measurable and sustainable progress toward achieving effectiveness across the
preparedness and response capabilities.
Subject to the availability of funding, ASPR and CDC may introduce a future project that supports
advanced development of key public health and health care preparedness capabilities in high
population cities during the 2017-2022 project period funding cycle. This future project will support
these cities with identifying gaps and strengthening radiological laboratory and other preparedness
capabilities
b. Statutory Authorities

Hospital Preparedness Program (HPP): section 319C-2 of the Public Health Service (PHS) Act (42 USC §
247d-3b), as amended.
Contingent Emergency Response Funding (HPP only): section 311 of the PHS Act ((42 USC § 243)),
subject to available funding and other requirements and limitations.
Public Health Emergency Preparedness (PHEP): section 319C-1 of the PHS Act (47 USC § 247d-3a), as
amended.
Contingent Emergency Response Funding (PHEP Only): 317(a) and 317(d) of the PHS Act [42 USC §
247b(a) and (d)], subject to available funding and other requirements and limitations.
c. Healthy People 2020
This FOA addresses the “Healthy People 2020” focus area of Preparedness:

https://www.healthypeople.gov/2020/topics-objectives/topic/preparedness
Preparedness objectives for HP 2020: https://www.healthypeople.gov/2020/topicsobjectives/topic/preparedness/objectives
d. Other National Public Health Priorities and Strategies

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2017-2022 Health Care Preparedness and Response Capabilities
2017 HPP and PHEP Performance Measures Guidance
2017-2022 HPP-PHEP Supplemental Guidelines
Public Health Preparedness Capabilities: National Standards for State and Local Planning
Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for
Preparedness, Version 11
Sections 319C-1 and 319C-2 of the PHS Act
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HHS Pandemic Influenza Plan
Homeland Security Presidential Directives (HSPD) 5 and 21;
PPD 8

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HSEEP
International Health Regulation Monitoring and Evaluation Framework
National Incident Management System

NHSS

CMS-3178-F

e. Relevant Work
This FOA builds upon relevant current and emergent ASPR- and CDC-supported programmatic priorities, goals,
guidance, and recommendations. For a detailed listing of relevant work, please visit
http://www.cdc.gov/phpr/coopagreement.htm.

2. ASPR-CDC Project Description
a. Approach

The HPP-PHEP Cooperative Agreement logic model is an organizing framework that guides the use of
inputs, production of outputs, and specifies intended outcomes. It should be used to identify program
boundaries and responsibilities. Through the implementation of the logic model, short-term or system
outcomes will be achieved through strategies that strengthen community resilience, surveillance,
epidemiological investigations, laboratory testing, countermeasures and mitigation activities, surge
management for public health and health care services, information management targeting the public
and partners, and coordination of system responses through effective incident management.
The following section describes the detail of each domain strategy, domain activity, and subsequent
awardee requirements. Awardees should focus HPP and PHEP program implementation activities on
program requirements within each of the domains. At the time of application, awardees must
summarize how they will address program requirements within each of the six domains. In addition to
meeting joint and program-specific requirements, all 2017-2022 HPP-PHEP Cooperative Agreement
awardees are expected to work with their local and other pertinent partners to develop and
strengthen the six domains. For additional information regarding the HPP program requirements,
please refer to the 2017-2022 Health Care Preparedness and Response Capabilities and the 2017-2022
HPP-PHEP Supplemental Guidelines. For additional information regarding the PHEP program
requirements, recommendations, and guidelines, please refer to the Public Health Preparedness
Capabilities: National Standards for State and Local Planning and the 2017-2022 HPP-PHEP
Supplemental Guidelines.

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CDC-RFA-TP17-1701 Logic Model: HPP-PHEP Cooperative Agreement
Bold indicates project period outcome

i. Purpose

The purpose of 2017-2022 HPP-PHEP cooperative agreement is to strengthen and enhance the
capabilities of the public health and health care systems to respond to evolving threats and other
emergencies. Effective responses will enable jurisdictions to prevent or reduce morbidity and mortality
from public health incidents whose scale, rapid onset, or unpredictability stresses the public health and
health care systems and to ensure the earliest possible recovery and return of the public health and
health care systems to pre-incident levels or improved functioning.
ii. Outcomes

ASPR and CDC will monitor and evaluate progress across all six domains. ASPR and CDC expect
awardees to demonstrate and improve response outcomes during exercises and real incidents.
By the end of the project period, ASPR expects HPP awardees to strengthen and enhance the readiness
of the health care system for activities that advance and document progress toward meeting the goals
of the four capabilities detailed in the 2017-2022 Health Care Preparedness and Response Capabilities.
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ASPR also expects awardees to document progress across five key domains in establishing or
maintaining ready health care systems through strong health care coalitions.
HPP awardee strategies, activities, and related outputs indicated in the logic model will lead to
achieving these response and program outcomes during the project period:
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Timely assessment and earliest possible sharing of essential elements of information,
Earliest possible identification and investigation of an incident,
Earliest possible implementation of intervention and control measures,
Earliest possible communication of situational awareness and risk information,
Continuity of emergency operations management throughout the surge of an emergency or
incident,
 Timely and situationally appropriate coordination and support of response activities with
partners, and
 Continuous learning and improvements are systematic.
ASPR will monitor process outputs and performance measures to determine each awardees level of
performance.
By the end of the project period, PHEP awardees should build or maintain the necessary elements
identified in the Public Health Preparedness Capabilities: National Standards for State and Local
Planning to achieve substantial, measurable progress in each of the funded public health preparedness
capabilities across the six domains. To achieve this goal, the Strategies and Activities section of the
logic model focuses on 1) areas for which improvement has been identified in drills, exercises, and
incident responses across each of the public health preparedness capabilities and medical
countermeasure (MCM) technical assistance action plans and 2) program requirements for the project
period, both of which are described in more detail in the Strategies and Activities section.
PHEP awardee strategies, activities, and related outputs indicated in the logic model will lead to
progress in the development and maintenance of established (CDC’s expected level of effectiveness)
state, local, and territorial public health emergency management and response programs during the
project period. Ultimately, CDC expects awardees to achieve the following response and program
outcomes.
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


Timely assessment and sharing of essential elements of information,
Earliest possible identification and investigation of an incident with public health impact,
Timely implementation of intervention and control measures,
Timely communication of situational awareness and risk information,
Continuity of emergency operations management throughout the surge of an emergency or
incident,
Timely coordination and support of response activities with partners, and
Continuous learning and improvements are systematic.
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iii. Strategies and Activities

HPP enables the health care delivery system to decrease morbidity and mortality during emergencies
and disaster events that exceed the day-to-day capacity and capability of existing health and
emergency response systems. HPP prepares the health care delivery system to save lives, in part,
through the development of HCCs that incentivize diverse and often competitive health care
organizations with differing priorities and objectives to work together. The purpose of HPP funds is to
ensure that HPP awardees focus on activities that advance progress toward meeting the goals of the
four capabilities detailed in the 2017-2022 Health Care Preparedness and Response Capabilities and
document progress in establishing or maintaining ready health care systems through strong HCCs.
The goal of the PHEP program is to develop effective public health emergency management and
response programs nationwide. By the end of the project period, awardees should build or maintain
the necessary elements identified in the Public Health Preparedness Capabilities: National Standards
for State and Local Planning to achieve substantial, measurable progress in each of the funded public
health preparedness capabilities across the six domains. To achieve this goal, the PHEP strategies and
activities focus on 1) areas for which improvement has been identified in drills, exercises, and incident
responses across each of the public health preparedness capabilities and medical countermeasure
(MCM) technical assistance action plans and 2) program requirements for the project period.
For the 2017-2022 project period, HPP and PHEP awardees must address and comply with joint, HPPspecific, and PHEP-specific programmatic requirements for the strategies and activities listed below, as
well as other requirements associated with statute and HHS grant guidance. In completing the program
requirements segment of the funding application, awardees must provide updates on joint, HPPspecific, and PHEP- specific requirements.
Joint requirements apply to all HPP and PHEP awardees, including territories and freely associated
states. However, ASPR and CDC will provide additional guidance and technical assistance that describe
modified requirements for American Samoa, the Commonwealth of the Northern Mariana Islands,
Guam, the U.S. Virgin Islands, and the freely associated states including the Federated States of
Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Please refer to the 20172022 HPP-PHEP Supplemental Guidelines for these modified requirements as well as specific
assurances, program, and administrative requirements for the HPP and PHEP programs.
Awardees are expected to develop and strengthen six domains through the implementation of the
following strategies and activities during the project period.

Domain 1 Strategy: Strengthen Community Resilience
Resilient communities develop, maintain, and leverage collaborative relationships among government,
community organizations, and individual households that enable them to more effectively respond to
and recover from disasters and emergencies. Awardees must conduct the following activities that
sustain or expand community resilience. These activities must be actionable, realistic, and support the
achievement of readiness outputs and intended outcomes.
16

 Partner with stakeholders by developing and maturing health care coalitions
 Characterize the probable risks to the jurisdiction and the HCC
 Characterize populations at risk
 Engage communities and health care systems
 Operationalize response plans.

Activity 1: Partner with Stakeholders by Developing and Maturing Health Care
Coalitions
HPP Requirements
Establish a Health Care Coalition
For the purposes of this FOA, ASPR defines a health care coalition (HCC) as a coordinating body that
incentivizes diverse and often competitive health care organizations and other community partners
with differing priorities and objectives and reach to community members to work together to prepare
for, respond to, and recover from emergencies and other incidents that impact the public’s health.
HCCs should coordinate with their HCC members to facilitate:


Strategic planning



Identification of gaps and mitigation strategies



Operational planning and response



Information sharing for improved situational awareness



Resource coordination and management.

All awardees must develop and/or mature their HCCs by the end of Budget Period 1. With funding
provided, HPP expects awardees to refine and/or sustain HCCs through the end of the five-year project
period. Further, awardees must work collaboratively with each HCC and its members including by
defining all HCC boundaries in their jurisdictions by the end of Budget Period 1. The following are
Budget Period 1 requirements.


When defining the HCC boundaries, awardees and HCCs must consider daily health care delivery
patterns, corporate health systems, and defined catchment areas, such as regional emergency
medical services (EMS) councils, trauma regions, accountable care organizations, emergency
management regions, etc.



Awardees must ensure partnership and engagement with their local health departments within
identified HCC boundaries.



Awardees must ensure that there are no geographic gaps in HCC coverage and that all interested
health care facilities, including independent facilities, are able to join an HCC, if desired.

17

Following are additional factors that awardees and their HCCs should consider when defining HCC
boundaries for Budget Period 1 and the entire project period.


HCC boundaries may span several jurisdictional or political boundaries. Please note that due to
cooperative agreement restriction, funding must be limited HCCs within awardees’ jurisdictional
boundary.



HCC boundaries should encompass more than one of each member type, such as hospitals and
EMS, to enable coordination and enhance the HCC’s ability to share the load during an emergency
(see also HCC member requirements below).

Once boundaries are established, HCCs must coordinate with all ESF-8 lead agencies within those
defined boundaries. HCCs serve as multiagency coordination groups that should support and integrate
with ESF-8 activities.
Coordination between the HCC and the ESF-8 lead agency can occur in a number of ways. Some HCCs
serve as the ESF-8 lead agency for their jurisdiction(s). Others integrate with their ESF-8 lead agency
through an identified designee at the jurisdiction’s emergency operations center (EOC) who represents
HCC issues and needs and provides timely, efficient, and bidirectional information flow to support
situational awareness.
More information about defining HCC boundaries can be found in Capability 1, Objective 1, Activity 1
of the 2017-2022 Health Care Preparedness and Response Capabilities.

Identify HCC Members
ASPR defines an HCC member as an entity within the HCC’s defined boundaries that contributes to HCC
strategic planning, identification of gaps and mitigation strategies, operational planning and response,
information sharing, and resource coordination and management.
HCCs must collaborate with a variety of stakeholders to ensure the community has the necessary
medical equipment and supplies, real-time information, communication systems, and trained and
educated health care personnel to respond to an emergency. These stakeholders include core HCC
members and additional HCC members. HCCs should include a diverse membership to ensure a
successful whole community response.
HCCs must ensure the following core membership.


Hospitals (a minimum of two acute care hospitals)



EMS (including interfacility and other non-EMS patient transport systems)



Emergency management organizations



Public health agencies.

Further, awardees are not permitted to use HPP funds to make subawards to any HCC that does not
meet the core membership requirements. ASPR understands that urban and rural HCCs may have
18

different membership compositions based on population characteristics, geography, and types of
hazards, but each funded HCC must include, at least, the core members.
Awardees and HCCs should expand HCC membership to include additional types of members. In cases
where there are multiple entities of an HCC member type, there may be a subcommittee structure that
establishes a lead entity to communicate common interests to the HCC. The awardee must make
available a listing or provide access to a listing of additional coalition members as defined in the 20172022 Health Care Preparedness and Response Capabilities. HCC membership does not begin or end
with attending meetings (see also HCC governance requirements below).
HCCs also should include specialty patient referral centers such as pediatric, burn, trauma, and
psychiatric centers, as HCC members within its geographic boundaries. They may also serve as referral
centers to other HCCs where that specialty care does not exist.
More information about identifying HCC membership can be found in Capability 1, Objective 1, Activity
2 of the 2017-2022 Health Care Preparedness and Response Capabilities.

Establish HCC Governance
Each HCC funded by the awardee must define and implement a governance structure and necessary
processes to execute activities related to health care delivery system readiness and coordination by the
end of Budget Period 1. HCC governance should include organizational structures, roles and
responsibilities, mechanisms to provide guidance and direction, and processes to ensure integration
with the ESF-8 lead agency.
The HCC must document the following information related to its governance and must be prepared to
submit the documentation to an HPP field project officer (FPO) upon request:


HCC membership



An organizational structure to support HCC activities



Member guidelines for participation and engagement



Policies and procedures



Integration within existing state, local, and member-specific incident management structures and
specifies roles.

Information about using HPP funds to establish a HCC legal entity can be found ASPR Grant Directive02(A). “Use of Grant Funds for Setting up a HCC as a Separate Legal Entity” is available in the HPP-PHEP
Supplemental Guidelines More information about establishing HCC governance can be found in
Capability 1, Objective 1, Activity 3 of the 2017-2022 Health Care Preparedness and Response
Capabilities.
ASPR will implement an HPP-provided tool that the HCC, in coordination with their awardee and HCC
members, must use to self-assess its progress toward meeting program requirements and the 20172022 Health Care Preparedness and Response Capabilities. The tool will allow HCCs and their members
19

to better plan and prioritize activities, help awardee and HCC leadership identify risks and issues
earlier, and enable HPP to provide more targeted assistance.

Develop a Preparedness Plan for Each HCC
Each HCC funded by the awardee must develop a preparedness plan and submit the plan to ASPR by
the end of Budget Period 1 with the annual progress report (APR). The HCC must develop its
preparedness plan to include core HCC members and additional HCC members so that, at a minimum,
hospitals, EMS, emergency management organizations, and public health agencies are represented.
The HCC preparedness plan must emphasize strategies and tactics that promote communications,
information sharing, resource coordination, and operational response planning with HCC members and
other stakeholders.
HCC members should approve the initial preparedness plan and maintain involvement in no less than
annual reviews. The final preparedness plan must be approved by all its core member organizations.
The review should include identifying gaps in the preparedness plan and working with HCC members to
define strategies to address the gaps. Following reviews, the HCC must update the plan as necessary
after exercises and real incidents. All of the HCC’s additional member organizations must be given an
opportunity to provide input into the preparedness plan, and all member organizations must receive a
final copy of the plan.
Each preparedness plan can be presented in various formats, including a subset of strategic
documents, annexes, or a portion of the HCC’s concept of operations (CONOPS) plans; however, at a
minimum the HCC preparedness plan must:


Incorporate the HCC’s and its associated members’ priorities for planning and coordination based
on regional needs and gaps. Priorities will depend on multiple factors including perceived risk,
emergencies occurring in the region, available funds, applicable laws and regulations, supporting
personnel, HCC member facilities and organizations involved, and time constraints



Leverage HCC members’ existing facility preparedness plans as required by the CMS Emergency
Preparedness Rule: Medicare and Medicaid Programs; Emergency Preparedness Requirements for
Medicare and Medicaid Participating Providers and Suppliers



Be developed by HCC leadership with broad input from HCC members and other stakeholders



Outline strategic and operational objectives for the HCC as a whole and for each HCC member



Include short-term – within the year – and longer-term – three- to five-year – objectives



Include a recurring objective to develop and review the HCC response plan, which details the
responsibilities and roles of the HCC and its members, including how they share information,
coordinate activities and resources during an emergency, and plan for recovery



Inform training, exercise, and resource and supply management activities during the year

20



Include a checklist of each HCC member’s proposed activities, methods for members to report
progress to the HCC, and processes to promote accountability and completion.

More information about the HCC Preparedness Plan can be found in Capability 1, Objective 3 of the
2017-2022 Health Care Preparedness and Response Capabilities.

Activity 2: Characterize the Probable Risks to the Jurisdiction and the HCC
Joint Requirements
Jurisdictional Risk Assessments
All HPP and PHEP awardees must participate in or complete a jurisdictional risk assessment (JRA) at
least once every five years. The five-year period can extend from one project period to the next, but
ASPR and CDC require awardees conduct at least one JRA in this project period. For instance, if a JRA
was conducted in Budget Period 4 during the previous project period, one is not necessary until Budget
Period 4 of this project period. HPP and PHEP awardees should coordinate risk assessment activities
with each other and with relevant emergency management and homeland security programs in their
jurisdictions. In addition, risk assessment activities must be coordinated as possible with relevant
emergency management and homeland security programs to support jurisdictional Threat and Hazard
Identification and Risk Assessment (THIRA) efforts.
HPP and PHEP awardees should use the JRA to identify the potential hazards, vulnerabilities, and risks
facing their jurisdiction and their HCCs. Awardees should incorporate the impact from incidents that
may have occurred since the last JRA. Awardees must ensure that all their funded HCCs have the
opportunity to provide input into the JRA for this project period. Further, awardees must provide their
HCCs with the date the JRA was completed or is projected to be completed.
ASPR and CDC recommend more frequent analyses of hazards and vulnerabilities to maintain progress
toward improving community resilience. Awardees should incorporate impact from incidents that may
have occurred since the last JRA for which public health or health care had a lead role in mitigating
identified disaster health risks. If a JRA or equivalent was conducted less than five years before an
incident, awardees should review risks and develop brief narratives describing how they have
continued to engage critical partners to address vulnerable populations.
In addition, ASPR and CDC recommend awardees review current findings of the National Health
Security Preparedness Index (NHSPI) and their respective State Preparedness Reports (SPR) to help
gauge risks and gaps. NHSPI is intended to help guide efforts to improve state and local public health
systems and achieve a higher level of health security preparedness. HPP and PHEP awardees should
use NHSPI results to help them assess their jurisdictional strengths and weaknesses. The results should
be analyzed, along with other data sources such as the HHS Capabilities Planning Guide, jurisdictional
risk assessments, incident after-action reports and improvement plans, site visit observations, and
other jurisdictional priorities and strategies, to help determine their strategic priorities, identify

21

program gaps, and, ultimately, prioritize preparedness investments. More information on the NHSPI
can be found at http://www.nhspi.org/.

HPP Requirements
Assess Hazard Vulnerabilities and Risks
Each awardee-funded HCC must complete an annual hazard vulnerability analysis (HVA) to identify and
plan for risks, in collaboration with the awardee. These assessments can determine resource needs and
gaps, identify individuals who may require additional assistance before, during, and after an
emergency, and highlight applicable regulatory and compliance issues. The HCC and its members
should use the information about these risks and needs to inform training and exercises and prioritize
strategies to close or mitigate preparedness and response gaps within their boundaries. The HCC must
be prepared to submit documentation about its HVA to the HPP FPO upon request.
General principles for the HCC HVA process include, but are not limited to, the following.


The HVA process should be coordinated with state and local emergency management organization
assessments, such as THIRA, and any public health hazard assessments, including a jurisdictional
risk assessment. The intent is to ensure completion, share risk assessment results, and minimize
duplication of effort.



The assessment components should include regional characteristics, such as risks for natural or
manmade disasters, geography, and critical infrastructure.



The assessment components should address population characteristics, including demographics,
and consider those individuals who might require additional help in an emergency including
children, pregnant women, seniors, and individuals with access and functional needs, including
people with disabilities and others with unique needs.



The HCC should regularly review and share the HVA with all members.

Assess Regional Health Care Resources
Each HCC funded by awardees must complete a resource assessment to identify health care resources and
services at the jurisdictional and regional levels that could be coordinated and shared. This information is vital
for continuity of health care delivery during and after an emergency. Further, this information is critical to
uncovering resource vulnerabilities relative to the HCC’s HVA that could impede the delivery of medical care and
health care services during an emergency. To meet the community’s clinical care needs during an emergency,
HPP awardees must ensure that each HCC maintains visibility into their members’ resources and resource
needs, such as personnel, facilities, equipment, and supplies. HCCs must be capable of tracking this information
and sharing it with all of their members by the end of Budget Period 2.
The HCC must be prepared to submit documentation about its resource assessment to the HPP FPO upon
request.

Additionally, the HCC, in collaboration with its HCC members, should compare available resources and
current HVA(s) to identify gaps and help prioritize HCC and HCC member activities. The HCC should
22

focus its time and resource investments on closing those gaps that will improve the care of acutely ill
and injured patients.
More information about identifying risks and needs, assessing hazard vulnerabilities, assessing regional
health care resources, and prioritizing resource gaps and mitigation strategies can be found in
Capability 1, Objective 2, Activities 1, 2, and 3 of the 2017-2022 Health Care Preparedness and
Response Capabilities.

Activity 3: Characterize Populations at Risk
Joint Requirements
Certain individuals may require additional assistance before, during, and after an emergency. HPP and
PHEP awardees must conduct inclusive risk planning for the whole community, including for children;
pregnant women; senior citizens; individuals with access and functional needs, including people with
disabilities; individuals with pre-existing, serious behavioral health conditions; and others with unique
needs throughout the five year project period. In conducting this risk planning, HPP and PHEP
awardees must involve each HPP-funded HCC and its HCC members. In addition, HPP and PHEP
awardees are encouraged to involve experts in non-infectious diseases (chronic conditions and
maternal and child health experts) in risk planning.
HPP and PHEP awardees must describe the structure or processes in place to integrate the access and
functional needs of at-risk individuals. Recommended strategies involve inclusion in public health,
health care, and behavioral health response activities; furthermore, these strategies should be
identified and addressed in operational work plans. ASPR and CDC encourage HPP and PHEP awardees,
subawardees, and HCCs to identify community partners with established relationships with diverse atrisk populations, such as social services organizations and Federally Qualified Health Centers.

HPP Requirements
HPP awardees and HCCs must obtain de-identified data from the U.S. Department of Health and
Human Services emPOWER map every six months to identify populations with unique health care
needs, such as dialysis and those with electricity-dependent medical and assistive equipment, such as
ventilators and wheel chairs. ASPR strongly recommends that HPP awardees also use the Agency for
Toxic Substances and Disease Registry (ATSDR)’s Social Vulnerability Index, which helps identify risk
factors and at-risk populations by geographic area. Other demographic tools, such as the U.S.
Census/American Community Survey, may help awardees, subawardees, and HCCs to better anticipate
the potential access and functional needs of at-risk community members before, during, and after an
emergency.
As part of inclusive planning for populations at risk conducted by HPP awardees, HPP-funded HCCs
must:


Support public health agencies with situational awareness and information technology (IT) tools
already in use that can help identify children, seniors, pregnant women, people with disabilities,
and others with unique needs
23



Support public health agencies in developing or augmenting existing response plans for these
populations, including mechanisms for family reunification



Identify potential health care delivery system support for these populations (pre- and post-event)
that can prevent stress on hospitals during an emergency



Assess needs and contribute to medical planning that may enable individuals to remain in their
residences during certain emergencies. When that is not possible, coordinate with the ESF-8 lead
agency to support the ESF-6 (Mass Care, Emergency Assistance, Housing, and Human Services) lead
agency with inclusion of medical care at shelter sites



Coordinate with the ESF-8 lead agency to assess medical transport needs for these populations.

Resources to facilitate this work can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.
More information for HPP awardees and HCCs about assessing community planning for populations at
risk can be found in Capability 1, Objective 2, Activity 4 of the 2017-2022 Health Care Preparedness and
Response Capabilities.

PHEP Requirements/Recommendations
In addition to the JRA assessment requirements, PHEP awardees must work with HCCs to meet the
needs of those in the community with unique healthcare needs or those that have electricitydependent medical devices. PHEP awardees should also have processes in place for identifying
individuals with disabilities and others with access and functional needs that might require special
assistance from the emergency management system. PHEP awardees must address the unique needs
of these at-risk populations in their plans, exercises, and responses. CDC will provide PHEP awardees
with specific tools, resources, and guidance documents for addressing the unique needs of at-risk
populations. One planning resource is CDC’s Public Health Workbook to Define, Locate, and Reach
Special, Vulnerable, and At-risk Populations in an Emergency. Available at
http://emergency.cdc.gov/workbook/pdf/ph_workbookfinal.pdf, the workbook identifies five
categories that should be considered in planning:


Economic Disadvantage (using poverty as a criteria may help reach a large number of people)



Language and Literacy (includes people who have limited ability to read, speak, write or understand
English or their native language)



Medical Issues and/or Disability (Persons with any impairment that substantially limits a major life
activity or physical, mental, cognitive, or sensory issues)



Isolation (cultural, geographic, or social)



Older adults (with chronic health issues or other impeding factors)



Infants and children 18 years or younger can also be at risk, particularly if they are separated from their
parents or guardians.
24

To address the needs of infants and children, awardees should collaborate with child-serving
institutions such as schools and daycare centers to assure crisis preparedness plans are in place. In
addition, CDC recommends awardees consider family reunification plans for schools and day cares
centers, either as part of crisis preparedness plans or separate plans for reunification. CDC also strongly
recommends that PHEP awardees use the Agency for Toxic Substances and Disease Registry (ATSDR)’s
Social Vulnerability Index, which helps identify risk factors and at-risk populations by geographic area.

Community Assessment for Public Health Emergency Response (CASPER)
The Community Assessment for Public Health Emergency Response (CASPER) is a rapid needs
assessment methodology designed to quickly gather household-based information from a community.
Although originally designed for disaster response, CASPER is now used by health departments for
preparedness activities such as assessments of chronic respiratory conditions, determining perceived
health impact of proposed coal gasification plants, knowledge of mosquito prevention, and projected
vaccination behaviors. As all jurisdictions are at risk for environmental emergencies, PHEP funding can
be used for CASPER training and for conducting CASPER assessments. Subject to jurisdictional priorities
and training availability, CDC recommends that PHEP awardees should either attend in-person CASPER
trainings conducted by CDC subject matter experts (SME) or conduct a CASPER with technical
assistance from CDC SMEs. Awardees can find more detailed information and resources at
https://www.cdc.gov/nceh/hsb/disaster/casper/training.htm and in the 2017-2022 HPP-PHEP
Supplemental Guidelines.

Environmental Public Health Tracking
PHEP awardees may use PHEP funds to collaborate with the state and local environmental tracking programs to
support activities related to environmental public health tracking. Potential areas for collaboration between the
PHEP program and environmental health programs include:


Identifying and providing essential data (health and environmental), information, and tools and
methodologies to help conduct environmental health surveillance, spatial temporal analysis, and data
visualization to help key state and local emergency response partners facilitate situational awareness
and mitigate negative environmental health effects before, during, and after an emergency response.



Improving awareness of local environmental impacts on health among community members and
responders before, during, and after an event.



Identifying population groups at highest risk for natural, chemical, and radiological events to target
preparedness strategies and monitor response and recovery impacts.

More information is available at http://www.cdc.gov/nceh/tracking/. Awardees can also find more detailed

information and resources in the 2017-20122 HPP-PHEP Supplemental Guidelines.

Response Plans for Chemical, Biological, Radiological, Nuclear, and Explosive
Threats
25

PHEP awardees must develop response plans for chemical, biological, radiological, nuclear, and
explosive (CBRNE) threats. This includes conducting biosurveillance activities to develop or update
response plans as necessary to meet preparedness goals with respect to CBRNE threats, whether
naturally occurring, unintentional, or deliberate. Awardees should also consider active shooter and
other threats. CDC encourages awardees to design response plans that focus on assessing medical
surge needs and to work with HPP awardees and health care systems to coordinate activities and to
provide surge support as needed. Plans should highlight the importance of using a “systems” approach
to manage scarce resources, including limited medical countermeasures, decontamination and
contamination control, staff, and medical resources.

Activity 4: Engage Communities and Health Care Systems
Joint Requirements
HPP and PHEP awardees must continue to build and sustain community partnerships to support health
care preparedness and response to ensure that activities have the widest possible reach with the
strongest possible ties to the community.
Awardees must describe the structure or processes in place to integrate the access and functional
needs of at-risk individuals. Recommended strategies to integrate the access and functional needs of
at-risk individuals involve inclusion in public health, healthcare, and behavioral health response
strategies within work plans. ASPR and CDC recommend awardees, subawardees, and HCCs identify
community partners with established relationships with diverse at-risk populations, such as social
services organizations, and use available tools to better anticipate the potential access and functional
needs of at-risk community members before, during, and after an emergency. Helpful tools include the
CDC Public Health Workbook To Define, Locate, and Reach Special, Vulnerable, and At-risk Populations
in an Emergency and ATSDR’s Social Vulnerability Index (https://svi.cdc.gov/), which helps identify risk
factors and at-risk populations by geographic area. Numerous additional resources to facilitate this
work can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Local Health Department Participation in HCCs
HPP and PHEP awardees must ensure that local health departments participate in HCCs in their
jurisdictions. PHEP awardees should also ensure partnership and engagement with fusion centers,
poison control centers, and other community-based organizations. Additional guidance on
recommendations can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

HPP Requirements
Sustainability and HCC Value
Sustainability planning is a critical component in HCC development. Strong governance mechanisms,
constant regional stakeholder engagement, and sound financial planning help form the foundation to
continue HCC activities well into the future.

26

There are a variety of ways to promote greater community effectiveness and organizational and
financial sustainability. Full investment in readiness includes in-kind donation of time, resources,
support, and continued engagement with HCC members and the community. Financial strategies,
including cost-sharing techniques and other funding options, enhance stability and sustainment. The
HCC should:


Offer HCC members technical assistance or consultative services in meeting the CMS Emergency
Preparedness Rule: Medicare and Medicaid Programs; Emergency Preparedness Requirements for
Medicare and Medicaid Participating Providers and Suppliers



Develop materials that identify and articulate the benefits of HCC activities to its members and
additional stakeholders and promote HCC preparedness efforts to health care executives, clinicians,
community leaders, and other key audiences



Explore ways to meet individual member’s requirements for tax exemption through community
benefit



Analyze critical functions to preserve and identify financial opportunities beyond federal funding,
such as foundations and private funding, dues, and training fees to support or expand HCC
functions



Develop a financing structure, and document the funding models that support HCC activities



Determine ways to cost share, such as coordinating required exercises with public health agencies,
emergency management organizations, and other organizations with similar requirements)



Incorporate leadership succession planning into the HCC governance and structure



Leverage group buying power to obtain consistent equipment across a region and allow for sharing
or emergency allocation of equipment

Executive, Clinician, and Community Leader Engagement
Health care executives can promote coordination and buy-in across all health care facility and
organization types, clinical departments, and nonclinical support services. To that end, the HCC should
communicate the direct and indirect benefits of HCC membership to health care executives to advance
their engagement in preparedness and response and to contribute to their understanding of other dayto-day benefits HCC membership offers.
Health care executives should provide input, acknowledgement, and approval regarding HCC strategic
and operational planning. The HCC should regularly inform health care executives of HCC activities and
initiatives through reports and regular invitations to participate in meetings, trainings, and exercises. At
a minimum, the HCC must engage its members’ health care executives in debriefs (“hot washes”)
related to exercises, planned events, and real incidents (See HPP 2017-2022 Performance Measures
Implementation Guide).

27

Further, ASPR encourages HCCs to engage health care delivery system clinical leaders to provide input,
acknowledgement, and approval regarding strategic and operational planning. Clinicians from a wide
range of specialties should be included in HCC activities on a regular basis to validate medical surge
plans and to provide subject matter expertise to ensure realistic training and exercises. Clinicians with
relevant expertise should lead health care provider training for assessing and treating various types of
illnesses and injuries. Clinicians should be engaged in strategic and operational planning, contribute to
committees and advisory boards, and participate in training and education sessions. Additional
engagement can include active participation in planning, exercise, and response activities.
More information about engaging health care executives and clinicians can be found in Capability 1,
Objective 5, Activities 2 and 3 of the 2017-2022 Health Care Preparedness and Response Capabilities.
Consistent with a whole community approach to preparedness, the HCC should actively work with and
engage community leaders outside of its members. The HCC should identify and engage community
members, businesses, charitable organizations, and the media in health care preparedness planning
and exercises to promote the resilience of the entire community. Community engagement creates
greater awareness of the HCC’s role and emergency preparedness activities.
More information about engaging community leaders can be found in Capability 1, Objective 5, Activity
4 of the 2017-2022 Health Care Preparedness and Response Capabilities.
More information about sustainability planning and promoting the value of health care coalitions can
be found in Capability 1, Objective 5, Activities 1 and 5 of the 2017-2022 Health Care Preparedness and
Response Capabilities.

PHEP Requirements
Tribal Populations
PHEP awardees must describe how they obtain programmatic input from tribes, as applicable,
regarding the content and implementation of jurisdictional public health emergency preparedness and
response plans. CDC recommends PHEP awardees leverage existing advisory committees or similar
organizational approaches to ensure tribal input is obtained.
Awardees with federally recognized tribes within their jurisdictions must provide a letter signed by the
jurisdiction’s state health official or preparedness director on official agency letterhead confirming
those tribes approve or have provided input on the approaches and priorities described in PHEP
applications. Awardees unable to gain 100% input, despite good-faith efforts to do so, must submit a
separate attachment with their applications describing the reasons why and the steps taken to address
tribal input. CDC will work with awardees to help resolve issues as necessary. Additional guidance for
working with tribes can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

28

Activity 5: Operationalize Response Plans
Joint Requirements
HPP and PHEP awardees and each HCC, as part of a coordinated statewide effort, must conduct a joint
statewide exercise (functional or full-scale exercise) once during the project period to test progress
toward achieving the capabilities outlined in the 2017-2022 Health Care Preparedness and Response
Capabilities and the Public Health Preparedness Capabilities: National Standards for State and Local
Planning, and in collaboration with cross-border metropolitan statistical area (MSA)/Cities Readiness
Initiative (CRI) regions. Exercise requirement details are provided in the 2017-2022 HPP-PHEP
Supplemental Guidelines.

Domain 2 Strategy: Strengthen Incident Management
HPP and PHEP awardees must conduct the following activities to strengthen emergency operations
management throughout all phases of an incident.


Coordinate emergency operations



Standardize the incident command structure (ICS) for public health



Establish incident command structures for health care organizations and HCCs



Ensure HCC integration and collaboration with ESF-8



Expedite fiscal and administrative preparedness procedures

Activity 1. Coordinate Emergency Operations
Joint Requirements
All-hazards Emergency Preparedness and Response Plan
HPP and PHEP awardees must maintain a current all-hazards public health and medical emergency
preparedness and response plan. Awardees must submit their plans to ASPR and CDC when requested
and make it available for review during site visits. Awardees must provide an opportunity for each HCC
in their jurisdictions to review and provide updates to their preparedness and response plans. In
addition, awardees must obtain public comment and input on public health and medical emergency
preparedness and response plans and their implementation using existing advisory committees or a
similar mechanism to ensure continuous input from other state, local, and tribal stakeholders, the
health care delivery system, and the general public, including members of at-risk populations and
those with an expertise integrating the access and functional needs of at-risk individuals.

Emergency Management Assistance Compact (EMAC)
Awardees must describe in their all-hazards public health and medical emergency preparedness and
response plans how they will use EMAC or other mutual aid agreements for medical and public health
mutual aid to support coordinated activities and to share resources, facilities, services, and other
potential support required when responding to emergencies that impact the public’s health. Awardees
should work with state emergency management organizations and other related agencies to
29

incorporate EMAC into training and exercises as a way to gain familiarity with processes for requesting
and deploying resources through the EMAC system.
Information regarding the ongoing development of public health mission ready packages (MRPs) can
be found in the 2017-20122 HPP-PHEP Supplemental Guidelines.

HPP Requirements
HCCs in Response
HCCs serve a communication and coordination role within their respective jurisdictions. This
coordination ensures the integration of health care delivery into the broader community’s incident
planning objectives and strategy development. It also ensures that resource needs that cannot be
managed within the HCC itself are rapidly passed along to the ESF-8 lead agency. HCC coordination
may occur at its own coordination center, the local EOC, or by virtual means – all of which are intended
to interface with the ESF-8 lead agency.
Coordination between the HCC and the ESF-8 lead agency can occur in a number of ways. Some HCCs
serve as the ESF-8 lead agency for their jurisdictions. Others integrate with their ESF-8 lead agency
through an identified designee at the jurisdiction’s EOC who represents HCC issues and needs and
provides timely, efficient, and bidirectional information flow to support situational awareness.
Regardless, HCCs connect the medical response elements and provide the coordination mechanism
among health care organizations, including hospitals and EMS, emergency management organizations,
and public health agencies.
HPP awardees must ensure by the end of Budget Period 2 that their HCCs are engaged when an
emergency with the potential to impact the public’s health occurs within their boundaries. The HCC
and its members must, at a minimum, define and share essential elements of information (EEIs) to
include elements of electronic health record and resource needs and availability. In particular,
awardees must ensure the HCC is engaged when one or more health care organizations have lost
capacity or ability to provide patient care or when a disruption to a health care organization requires
evacuation.
See also HPP requirements under Strategy 2, Activity 4: Ensure HCC Integration and Collaboration with
ESF-8.

PHEP Requirements/Recommendations
PHEP awardees must conduct training for incident command and support personnel and drill and
exercise the public health jurisdictional incident command structure. When possible, such training
should include emergency management partners. In addition, awardees must ensure that local
jurisdictions are involved in drills and exercises to improve implementation of the incident command
structure as it applies to responding to public health threats and emergencies.

Infectious Disease Response
30

CDC recommends that PHEP awardees develop and implement plans and protocols for rapid and
appropriate public health actions, such as controlled movement, isolation, quarantine, or public health
orders pursuant to applicable statutes and regulations. CDC also recommends that awardees
collaborate with designing, developing, and distributing coordinated laboratory guidance, plans and
protocols regarding laboratory biosafety during emergency responses to infectious diseases. This
includes the safe handling and containment of infectious microorganisms and hazardous biological
materials such as infectious waste. The 2017-2022 HPP-PHEP Supplemental Guidelines provides
additional information.

Activity 2: Standardize Incident Command Structure for Public Health
PHEP Requirements/Recommendations
PHEP awardees must develop and establish an incident management framework consistent with the
National Incident Management System (NIMS). Awardees must use the National Response Framework
(NRF) to guide governments at all levels including state, local, territorial, and tribal government
planning. All levels of government must be prepared under NRF to conduct an all-hazards incident
response. Emergency operations plans should use incident command to implement elements of the
NRF in scalable and flexible ways.
In addition, awardees must coordinate emergency operations with appropriate staff to address all
potential hazards. In addition to command staff and support function staff, PHEP awardees must have
available lists of staff who have been identified in advance for a medical or public health response.
Awardees must also have operational plans or annexes that address resource management;
communications and information management; emergency public warning and information; medical
surge and non-pharmaceutical interventions; and first responder and volunteer management.

Activity 3: Establish Incident Command Structures for Health Care Organizations
and HCCs
HPP Requirement
National Incident Management System Implementation
HPP awardees must ensure that HCCs assist their members with NIMS implementation throughout the
project period. HCCs must:


Ensure HCC leadership receives NIMS training based on evaluation of existing NIMS education levels and
need.



Promote NIMS implementation among HCC members, including training and exercises, to facilitate
operational coordination with public safety and emergency management organizations during an
emergency using an incident command structure (ICS)



Assist HCC members with incorporating NIMS components into their emergency operations plans

31

For those HCC members not bound by NIMS implementation, the HCC should consider training on
response planning techniques, organizational structure, and other incident management practices that
will prepare members for their roles during a response.
More information about NIMS implementation can be found in Capability 1, Objective 4, Activity 1 of
the 2017-2022 Health Care Preparedness and Response Capabilities.

Activity 4: Ensure HCC Integration and Collaboration with Emergency Support
Function-8 (ESF-8)
HCC Response Plan
Each HCC funded by the awardee must develop a response plan that is informed by its members’
individual emergency operations plans and submit the plan to ASPR by the end of Budget Period 2 with
annual progress reports. Each HCC’s response plan must describe the HCC’s operations that support
strategic planning, information sharing, and resource management. The plan must also describe the
integration of these functions with the ESF-8 lead agency to ensure information is provided to local
officials and to effectively communicate and address resource and other needs requiring ESF-8
assistance. In cases where the HCC serves as the ESF-8 lead agency, the HCC response plan may be the
same as the ESF-8 response plan.
The interests of all members and stakeholders should be considered in the response plan; however,
each HCC must coordinate the development of its response plan by involving core members and other
HCC members so that, at a minimum, hospitals, EMS, emergency management organizations, and
public health agencies are represented in the plan. Each HCC must review and update its response plan
regularly, and after exercises and real incidents.
The HCC response plan can be presented in various formats, including the placement of information
described below in a supporting annex. Regardless of the format, each HCC’s response plan must
clearly outline:


Individual HCC member organization and HCC contact information,



Locations that may be used for multiagency coordination,



Process for multiagency coordination if location is virtual,



A brief summary of each individual member’s resources and responsibilities,



Integration with appropriate ESF-8 lead agencies,



Emergency activation thresholds and processes



Alert and notification procedures,



EEIs agreed to be shared, including information format, such as bed reporting, resource requests
and allocation, and patient distribution, and tracking procedures,
32



Communication and IT platforms and redundancies for information sharing,



Support and mutual aid agreements,



Evacuation and relocation processes,



Additional HCC roles and responsibilities as determined by state or local plans and agreements
such as staff sharing, alternate care sites, and shelter support, and



Activation and notification processes for initiating and implementing medical surge response
coordination among HCC members and other topics related to medical surge, including:
o Strategies to implement if the emergency overwhelms regional capacity or specialty care
including trauma, burn, and pediatric capability,
o Strategies for patient tracking,
o Strategies for initial patient distribution (or redistribution) across the region,
o among local hospitals in the event a facility becomes overwhelmed, and
o Processes for joint decision making and engagement among the HCC, HCC members, state and
local public health agencies, and emergency management organizations to avoid crisis
conditions based on proactive decisions about resource utilization.

Each HCC should also monitor their members’ progress toward closing gaps in their own plans and
offer assistance to help close the gaps as appropriate.
More information about the HCC Response Plan can be found in Capability 2, Objective 1, Activity 2 of
the 2017-2022 Health Care Preparedness and Response Capabilities.

HPP Awardee Recovery Plan
Each awardee must develop a health care system recovery plan and submit the plan to ASPR by the
end of Budget Period 2 4 with annual progress reports. Recovery processes can be integrated into
awardees’ existing plans, such as an annex to the emergency operations plan, or developed as a
separate, standalone plan. The awardee must ensure the HCCs and their members participate in the
development of the state and local pre-emergency recovery planning activities as described in the
National Disaster Recovery Framework to leverage recovery resources, programs, projects, and
activities.
The health care system recovery plan must outline, at a minimum:


Goals and strategic priorities for the continued delivery of essential health care services, including
behavioral health, and opportunities for improvement after an emergency,



Flexible operational objectives and tactics to accommodate different recovery approaches,



Integration with pre-incident plans including community health improvement plans or
organizational capital improvement plans,
33



Critical infrastructure dependencies regarding public utilities, IT, transportation, etc., and



Workforce retention issues essential to operations, including access to child or adult dependent
care.

More information about planning, assessing and facilitating recovery for the health care system can be
found in Capability 3, Objective 7, Activities 1, 2, and 3 of the 2017-2022 Health Care Preparedness and
Response Capabilities.

HCC Continuity of Operations Plan
Each HCC funded by the awardee must develop an HCC continuity of operations (COOP) plan that is
informed by its members’ COOP plans and submit the plan to ASPR by the end of Budget Period 3 with
annual progress reports. HCC COOP plans may be an annex to the HCC’s response plan or may take
another form.
Each HCC’s COOP plan should include, at a minimum:


Activation and response functions,



Multiple points of contact for each HCC member,



Orders of succession and delegations of authority for leadership continuity,



Immediate actions and assessments to be performed in case of disruptions,



Safety assessment and resource inventory to determine whether or not the HCC can continue to
operate,



Redundant, replacement, or supplemental resources, including communication systems, and



Strategies and priorities for addressing disruptions to mission critical systems that include but not
limited to electricity, water, and medical gases.

Each HCC, in coordination with the awardee, should ensure that communication and coordination
systems that are used for incident management are adequately secured, backed up, and have
redundant power and server protections.
More information about COOP planning can be found in Capability 3, Objective 2, Activities 1 and 2 of
the 2017-2022 Health Care Preparedness and Response Capabilities.

Activity 5. Expedited Fiscal Procedures Are in Place for Ensuring Funding Reaches
Impacted Public Health Departments, HCCs, and their Members during an
Emergency Response
Joint Requirements
HPP and PHEP awardees must have expedited fiscal procedures that ensure the funding provided
through the HPP and PHEP funding mechanisms reach the impacted communities in an expedited
34

manner, especially during an emergency response. HPP and PHEP awardees must ensure that these
systems are routinely tested.
For the purposes of this FOA, fiscal preparedness is defined as the process of ensuring that fiscal and
administrative authorities and practices that govern funding, procurement, contracting, hiring, and
legal capabilities necessary to mitigate, respond to, and recover from public health emergencies can be
accelerated, modified, streamlined, and accountably managed at all levels of government. The ultimate
goal is to ensure that the funding reaches the impacted communities as quickly as possible to ensure
that it has the greatest potential for a positive public health and health care impact. HPP and PHEP
awardees must establish plans to effectively receive, obligate, and account for HPP and PHEP funds
that are consistent with the purpose of the HPP and PHEP cooperative agreement. Plans must include
the ability to move funding to the local level and to HCCs in a timely and effective manner.
It is critical that as awardees apply resources to achieve the public health and health care preparedness
and response capabilities, they also plan how they will address the additional fiscal and administrative
challenges they may face during a public health emergency. To ensure that these potential challenges
are addressed, response plans should include emergency authorities and expedited fiscal processes
that would likely differ from the awardees’ standard procedures. As applicable, awardees should
review incident action plans (IAPs), AARs/IPs, awardee capability self-assessment data, and JRAs when
considering the actions taken or planned to overcome challenges and barriers within the scope of fiscal
preparedness.
HPP and PHEP awardees must work with their local public health jurisdictions and HCCs to ensure that
fiscal processes are in place to move funds efficiently between awardees and local public health
departments and HCC fiscal entities (where they exist). ASPR has established a benchmark for
awardees to execute subaward for routine grants within 90 days of the beginning of the budget period
See ASPR-CDC Evaluation and Performance Measurement Strategy section.
At the time of application, HPP and PHEP awardees must identify whether their jurisdictions have:


Tested expedited procedures as identified in their plans for:
o receiving emergency funds during a real incident or exercise and
o reducing the cycle time for contracting and procurement during a real incident or exercise.



Implemented internal controls related to subrecipient monitoring and any negative audit findings
resulting from suboptimal internal controls.



Tested emergency authorities and mechanisms as identified in their plans to reduce time for hiring
or reassignment of staff (workforce surge). If they were tested, awardees must identify which
procedures were tested and describe the average times for recruitment and hiring of staff in
routine and emergency circumstances.

PHEP Requirements/Recommendations
35

PHEP awardees must document the time it takes to move funds from the state to local public health,
both during emergencies and during routine grant administration. In addition to the application project
narrative, which describes the standard fiscal operating procedures, PHEP awardees must develop and
submit plans to CDC no later than September 30, 2018, that address the following components.
Fiscal Planning: alignment of the HPP-PHEP administrative processes to describe how funds will be managed
between the two programs, including processes for:

 Streamlining and consolidating contracting procedures; and
 Tracking HPP and PHEP funds separately as, according to federal appropriations law and HHS grant
guidance, HPP and PHEP funds must maintain their unique identity and must be used for their
intended purposes.
Emergency Legal Authority: describe and provide awardee citations for emergency legal authorities
applicable to the Public Health Emergency Law Competency Model, including authorities addressing:


Procedures for the declaration of disasters or emergencies and accompanying emergency
authorities for designated officials;



Expedited procedures for receiving, allocating, and spending emergency funds, including the ability
to quickly move emergency funds from the state level to local governments;



Powers and procedures for the use of public health interventions including isolation, quarantine,
and the seizure and reallocation of supplies;



Suspensions (http://lawatlas.org/datasets/emergency-powers), waivers, or similar legal processes
that can be used to minimize the potential conflicts between federal authorities applicable to
medical countermeasures and state-based pharmaceutical, prescribing, labeling, and other drugrelated laws; if no waivers or similar legal processes exist, awardees must describe laws that may
potentially conflict with Emergency Use Authorizations (EUA)s, Emergency Use Instructions (EUI),
Investigational New Drug, and Investigational Device Exemption;



Formal memoranda of understanding or agreement (MOU/MOA) between health authorities and
other preparedness partners including law enforcement for implementation of public health
activities, such as joint investigations of intentional threats or incidents that impact the public’s
health, signed and executed between the appropriate Federal Bureau of Investigation field office
and state public health departments, including local public health departments where relevant
(such as in home rule states); and



Protection of volunteers against tort liability and licensure penalties, and the provision of Workers’
Compensation claims (excluding federal mechanisms such as the Public Readiness and Emergency
Preparedness Act). Awardees should distinguish between in-state and out-of-state volunteers and
indicate whether the state can use EMAC to send or receive volunteers.

Fiscal and Administrative Emergency Processes: describe expedited fiscal and other administrative processes
and identify procedures to test fiscal preparedness planning for such activities, including:
36



Emergency procurement and contracting authorities and processes and how they differ from dayto-day business processes;



Receiving emergency funds during a real incident or exercise, as well as reducing the cycle time for
contracting or procurement during a real incident or exercise;



Emergency hiring processes (workforce surge) and how they differ from customary hiring
processes;



Reporting/monitoring methodology to ensure payment efficiency and funding accountability;



Emergency procedures for allocating funds to local and tribal health departments and other
subawardees; and



Implemented internal controls related to subrecipient monitoring and any negative audit findings
resulting from suboptimal internal controls.

CDC encourages PHEP awardees to exercise their fiscal processes at least once during the five-year
project period. Awardees should identify priorities for exercising, considering examples such as:





Receiving emergency funds,
Reducing the cycle time for contracting and procurement,
Hiring, and
Financial reporting, budget management and administration systems, and regulations.

The 2017-2022 HPP-PHEP Supplemental Guidelines provide additional information.

Domain 3 Strategy: Strengthen Information Management
HPP and PHEP awardees must conduct the following activities to strengthen information sharing
among public health and medical preparedness and response partners and enhance emergency public
information and warning.
 Share situational awareness across the health care and public health systems


Share emergency information and warnings across disciplines, jurisdictions, and HCCs and their
members.



Conduct external communication with the public.

Activity 1. Share Situational Awareness across the Health Care and Public Health
Systems
Joint Requirements
Common Operating Picture
HPP and PHEP awardees must work together to establish a common operating picture, or situational
awareness tool, that facilitates coordinated information sharing among all public health, health care,
HCCs, and relevant stakeholders. This includes state, local and territorial public health agencies and
37

their respective preparedness programs, public health laboratories, communicable disease programs,
and programs addressing healthcare-acquired infections. Information sharing is the ability to share
real-time information related to the emergency, such as capacity, capability, and stress on health care
facilities and situational awareness across the various response organizations and levels of
government. Accomplishing these activities will enable the health care delivery systems, public health,
and other organizations that contribute to responses to coordinate efforts before, during, and after
emergencies; maintain situational awareness; and effectively communicate with the public.
Given the need to establish a common operating picture for effective response, HPP and PHEP
awardees and HCCs must provide situational awareness data, including data on bed availability, to
ASPR and CDC during emergency response operations and at other times, as requested.
Additionally, HPP and PHEP awardees, the HCCs, and their members must agree to participate in
current and future federal health care situational awareness initiatives for the duration of the five-year
project period.

HPP Requirements
Health Care Situational Awareness and Sharing
The development of information sharing procedures and the use of interoperable and redundant
platforms is critical to a successful response. In particular, information sharing allows for the tracking
of resource availability and needs and also allows HCC members, other stakeholders, and the ESF-8
lead agency to provide coordinated, accurate, and timely information to health care providers and the
public. Information sharing requirements exist for both HPP awardees and HCCs to help ensure proper
resource coordination and situational awareness.
HCCs also play an important role in sharing information with their HCC members, the ESF-8 lead
agency, and additional stakeholders. HPP awardees must ensure that each HCC is able to access and
collect timely, relevant, and actionable information about their members during emergencies.
HPP requires all funded HCCs to share pertinent emergency information with their HCC members, the
ESF-8 lead agency, and other stakeholders. Information sharing procedures must be documented in
each HCC’s response plan by the end of Budget Period 2. When documenting information sharing
procedures in response plans, HCCs should:


Define communication methods, frequency of information sharing, and the communication
systems and platforms available to share information during an emergency response and steady
state



Identify triggers that activate alert and notification processes



Define the EEIs that HCC members should report to the HCC, and coordinate with other HCC
members and with federal, state, local, and tribal response partners during an emergency to share
information, such as the number of patients, severity and types of illnesses or injuries, operating
status, resource needs and requests, and bed availability
38



Identify the platform and format for sharing each EEI to include elements of the EHR



Describe a process to validate health care organization status and requests during an emergency;
this includes situations where reports are received outside of HCC communication systems and
platform, such as media reports, no report when expected, rumors of distress, etc.

PHEP Requirements/Recommendations
Sustain or Enhance Public Health Information Systems
PHEP awardees using PHEP funding to sustain or enhance public health informatics must seek to
increase interoperability and functionality by ensuring that properly functioning public health
information systems are available. Such systems, whether they are internally managed or externally
hosted or shared platforms, must be capable of supporting syndromic surveillance, integrated
surveillance, public health registries, situational awareness dashboards, and other public health and
preparedness activities. See Domain 6 - Biosurveillance for more information.

Activity 2. Share Emergency Information and Warnings across Disciplines,
Jurisdictions, and HCCs and their Members
Joint Requirements
Coordinate Emergency Information Sharing between Public Health and Health Care
ASPR and CDC recognize and value the distinct roles and responsibilities of HPP and PHEP awardees,
HCCs, and their members, as well as emergency management and other response partners.
HPP and PHEP awardees must identify reliable, resilient, interoperable, and redundant information and
communication systems and platforms, including those for bed availability, EMS data, and patient
tracking, and provide access to HCC members and other stakeholders.
The following are factors that HCCs, in coordination with HPP and PHEP awardees and other public
health agency members, should consider when developing processes and procedures to rapidly
acquire and share clinical knowledge.


Processes and procedures should address a variety of emergencies such as chemical, biological,
radiological, nuclear, or explosive (CBRNE), trauma, burn, pediatrics, or highly infectious disease
outbreaks



Approaches to improve patient management, particularly at facilities that may not care for certain
types of patients regularly

Sharing accurate and timely information is critical during an emergency. Accordingly, by the end of the
five-year project period each HCC must assist its members with developing the ability to rapidly alert
and notify their employees, patients, and visitors. Alerts and notifications should update stakeholders
on the emergency situation, protect stakeholders’ health and safety, and facilitate provider-to-provider
communication.
39

By the end of the five-year project period, the HCC, in coordination with its public health agency
members and HPP and PHEP awardees, must also develop processes and procedures to rapidly acquire
and share clinical knowledge between health care providers and between health care organizations
during responses.
More information about sharing emergency information procedures and platforms can be found in
Capability 2, Objectives 2 and 3 of the 2017-2022 Health Care Preparedness and Response Capabilities.

HPP Requirements
HCC Redundant Communications Systems and Platforms
HCCs can use communication systems and platforms to assist in the collection and dissemination of
timely, relevant, and actionable information. Accordingly, HPP awardees must ensure that each HCC
has primary and redundant communications systems and platforms capable of sending EEIs by the end
of Budget Period 1. Additionally, by the end of Budget Period 1, each HCC must be able to demonstrate
its ability to use these systems to effectively coordinate information during emergencies, planned
events, and on a regular basis. As part of this requirement and to ensure the continuity of information
flow and coordination activities, multiple employees from each HCC member organization must
understand and have access to the HCC’s information sharing platforms.
More information about strengthening information management during an emergency can be found in
Capability 2, Objectives 2 and 3 of the 2017-2022 Health Care Preparedness and Response Capabilities

Activity 3: Conduct External Communication with the Public
Joint Requirements
Coordinate Public Messaging
Accurate and timely communication with the public is important during a response to a public health
emergency. Accordingly, by the end of Budget Period 2, each HCC and its members, in collaboration
with HPP and PHEP awardees, should agree upon and plan for the type of information that will be
disseminated by either the HCC or its individual members to the public during an emergency.
Additionally, by the end of the five year project period, the HCC, in collaboration with HPP and PHEP
awardees, should provide public information officer (PIO) training to those who are designated to act
in that capacity during an emergency for HCC members and are in need of such training. This training
should include health risk communication training.
Health care organizations, as well as HCCs and public health departments, should work with their
community’s Joint Information Center (JIC) to ensure information is accurate, consistent, linguistically
and culturally appropriate, and disseminated to the community using one voice during an emergency.
Additionally, ASPR and CDC recommend that HPP and PHEP awardees coordinate public messaging and
information sharing regarding monitoring and tracking of cases of persons under investigation during
40

infectious disease outbreaks with PIOs for various response partners to ensure maximum coordination
and consistency of messaging.
More information about communicating with the public during an emergency can be found in
Capability 2, Objective 3 of the 2017-2022 Health Care Preparedness and Response Capabilities.

PHEP Requirements/Recommendations
PHEP awardees must ensure information sharing systems are in place. These systems must include
redundant equipment, appropriately trained public health information officers (PIOs) and other
personnel, procedures for media notification, message development, and plans describing how the
public can contact the public health department for up-to-date information on incidents. This can
include call centers, help desks, and other available communication platforms.

Domain 4 Strategy: Strengthen Countermeasures and Mitigation
HPP and PHEP awardees should conduct the following activities that strengthen access to and administration of
medical and other countermeasures for pharmaceutical and non-pharmaceutical interventions and strengthen
mitigation strategies.





Manage access to and administration of pharmaceutical and non-pharmaceutical interventions
Ensure safety and health of responders
Operationalize response plans.

Activity 1: Manage Access to and Administration of Pharmaceutical and NonPharmaceutical Interventions
Joint Requirements
Following an emergency, effective care cannot be delivered without available staff and appropriate
countermeasures. Accordingly, managing access to and administration of countermeasures and
ensuring the safety and health of clinical and other personnel are important priorities for preparedness
and continuity of operations. While PHEP funding plays an important role in medical countermeasure
(MCM) planning and procuring and dispensing MCMs for the community, including at-risk populations,
HPP funding assists in planning for closed points of dispensing (POD) and ensuring that health care
workers and their families are protected during emergencies.

MCM Distribution and Dispensing Plans
A number of federally funded programs exist to enhance preparedness for and response to a public
health emergency, including CDC’s Strategic National Stockpile (SNS), CHEMPACK program, and Cities
Readiness Initiative (CRI). HPP and PHEP awardees, including HCCs and their members, must
understand their jurisdictional MCM distribution plans by the end of Budget Period 1, either through
participation in jurisdictional MCM operational readiness reviews or briefings provided by the
jurisdiction’s MCM coordinator.
41

Additionally, in jurisdictions participating in the CHEMPACK program, CRI, or other local and state plans
for maintaining treatment or prophylaxis caches, HPP and PHEP awardees and each HCC must be
engaged in the development, training, and exercising of these MCM distribution and dispensing plans
by the end of Budget Period 1. Additionally by the end of Budget Period 1, each HCC should collaborate
with local public health departments and PHEP awardees to assist its members with closed points of
dispensing (POD) plans. Local public health departments supported by PHEP funding are responsible
for general population POD planning with assistance from the state.

HPP Requirements
Assess Supply Chain Integrity
Conducting an assessment of the supply chain’s integrity is one strategy to help HPP awardees and
HCCs identify equipment and supply needs that will be in demand during an emergency and develop
strategies to address potential shortfalls. To ensure the ongoing delivery of patient care services
following an emergency, critical equipment and supplies must be made available for all populations.
For example, pharmaceuticals and medical materiel are needed for both emergency treatment and to
maintain the health of patients, providers, and first responders.
By the end of the five-year project period, HPP awardees and HCCs must conduct a supply chain
integrity assessment to evaluate equipment and supply needs that will be in demand during
emergencies and develop strategies to address potential shortfalls. Upon request, HPP awardees must
provide documentation of the assessment and corresponding mitigation strategies to an HPP FPO. As
part of this supply chain integrity assessment, each HCC and its members should:


Collaborate with manufacturers and distributors to collect information on access to critical
supplies, availability in regional systems, and potential alternate delivery options in the case that
access or infrastructure is compromised



Collaborate with the ESF-8 lead agency when using this information to effectively coordinate
equipment and supply needs within the region.

Completing a supply chain integrity assessment will likely highlight vulnerabilities in access to or
availability of critical supplies. Accordingly, HPP awardees, HCCs, and HCC members may purchase
pharmaceuticals and other medical materiel likely to be required during a patient surge. All HPP
awardees, HCCs, or HCC members purchasing pharmaceuticals and other medical materiel with HPP
funds must consider strategies for the acquisition, storage, rotation with day-to-day supplies to
diminish waste due to expiring supplies, use including policies relating to the activation and
deployment of their stockpile, and disposal. HPP awardees and HCCs must document such strategies
and provide documentation to the FPO upon request.
More information about resources to consider during a supply chain integrity assessment, mitigation
strategies, and acquisition of pharmaceuticals and medical materiel can be found in Capability 3,
Objective 3 of the 2017-2022 Health Care Preparedness and Response Capabilities.
42

PHEP Requirements/Recommendations
Public health departments coordinate medical material management and distribution when a public
health emergency overwhelms the routine community supply chain. Public health’s role includes:





Formalizing partnerships with private and public warehouse facilities and shipping companies
Planning for potential nonmedical and medical distribution, dispensing, and administration
Distributing and dispensing nonmedical and medical countermeasures
Ensuring availability of medical countermeasures to individuals at greatest risk of morbidity and
mortality from an influenza pandemic

These activities are described in more detail in CDC’s Public Health Preparedness Capabilities: National
Standards for State and Local Planning, specifically, Capability 8: Medical Countermeasure Dispensing
and Capability 9: Medical Materiel Management and Distribution.
As described in those capabilities, PHEP awardees must ensure they can support medical
countermeasure distribution and dispensing (MCMDD) for all-hazards events ranging from a terrorist
attack, an influenza pandemic, or an emerging infectious disease such as Ebola or Zika. CDC provides
the 50 states and the four directly funded localities of Chicago, Los Angeles County, New York City, and
Washington, D.C. with dedicated funding through CRI to ensure they have MCM distribution and
dispensing plans in place and can effectively execute those plans in response to public health
emergencies. Initially, CRI planning was specific to a large-scale biologic attack with anthrax as the
primary threat consideration, which requires the dispensing of life-saving antibiotics or other
countermeasures to affected populations within 48 hours. Current planning has evolved to encompass
improved MCM planning and operational readiness for all hazards. Successfully executing an MCM
mission is critical to ensuring the nation’s public health security during any large public health
emergency.
To improve all-hazards MCM distribution and dispensing planning and response capabilities, CDC
strongly encourages that PHEP awardees make 75% of their CRI funds available to CRI jurisdictions
within 90 days of the start of the budget period, beginning in Budget Period 2. CRI jurisdictions are
independent planning jurisdictions that include the counties and municipalities within the defined
metropolitan statistical area (MSA). CDC recognizes that this funding allocation may present challenges
to some awardees and will consider exceptions on a case-by-case basis.
To comply with PAHPRA and the priority resource planning and other elements specified in Capabilities
8 and 9, all 62 PHEP awardees must have plans in place for demonstrating operational readiness to
receive, stage, distribute, and dispense MCMs including medications and medical supplies received
from the SNS. PHEP awardees are required to complete the following MCM activities.

MCM Operational Readiness Reviews
43

In 2012-2016, with involvement from 19 awardee jurisdictions, national partners, and CDC SMEs, CDC
developed, piloted, and implemented a new MCM operational readiness review (ORR) process for
assessing state, local, and territorial ability to successfully execute a major public health response
requiring the rapid distribution and dispensing of life-saving MCMs. The MCM ORR is intended to
identify programmatic strengths and operational gaps for medical countermeasure response planning
and operational readiness. CDC has updated the MCM ORR tool based on feedback received during its
first full year of implementation in 2015-2016.
Beginning with Budget Period 1, CDC will conduct MCM ORRs on a two-year cycle, reviewing half of the
62 PHEP awardee jurisdictions every year. This process is designed to support and enhance state and
local public health departments across the nation in strengthening their MCM capacity. PHEP awardees
and local CRI jurisdictions must submit initial ORR self-assessment data in Budget Period 1 using the
updated ORR tool to assess their continued progress in advancing MCM capabilities.
State awardees must conduct operational reviews for all CRI planning jurisdictions within a two-year
period, reviewing 50% of the CRI planning jurisdictions every other year. State awardees must submit the
resulting MCM ORR data from their CRI reviews to CDC using a web-based data collection system. CDC’s
MCM regional field advisors will attend one MCM ORR per CRI MSA to observe and provide feedback.
As part of the operational readiness review process, awardees must provide CDC with supporting
documentation regarding their public health preparedness capabilities, exercises, performance measures,
program requirements, and other information relative to medical countermeasure distribution and
dispensing. CDC encourages awardees to provide CDC with access to relevant documentation using their
jurisdictions’ internal shared systems. By Budget Period 3, awardees must develop processes to enable CDC
to access jurisdictional documentation using shared systems.
MCM ORR data, including status levels for PHEP awardees and local CRI jurisdictions, may be publically
released.

During interim years, CDC and awardees will address identified improvement areas based on the most
recent MCM ORR findings. To help jurisdictions move toward “Established” status levels by June 30,
2022, CDC will work with all 62 PHEP awardees to complete the following activities designed to address
identified planning and operational opportunities for improvement.

MCM Technical Assistance Action Plans
All PHEP awardees must submit updated MCM action plans twice each budget period and participate
in quarterly conference calls with CDC to discuss action plan activities. The action plans focus on
activities designed to address prioritized MCM operational gaps identified during the awardees’ most
recent ORRs.
In addition, state awardees must develop MCM action plans for all of their CRI local planning
jurisdictions, conduct quarterly conference calls with the CRI jurisdictions, and submit updated MCM
action plans to CDC twice each budget period. Each action plan must summarize completed activities in
response to areas of improvement identified in the jurisdiction’s most recent MCM ORR.
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RSS Site Surveys
PHEP awardees must have updated receipt, stage, and store (RSS) site survey information available in
CDC’s Online Technical Resources Assistance Center (On-TRAC) data center. RSS site information is
required for the primary and back-up RSS sites (a minimum of at least two locations) and all potential
RSS sites in their jurisdictions. Awardees must update RSS site information each year, and the U.S.
Marshal Service and CDC must validate each RSS site at least once every three years.

Critical Contacts
PHEP awardees must have available online in CDC’s On-TRAC data center current operational
information that identifies points of contact to facilitate time-sensitive, accurate information sharing
before a public health emergency. Awardees must review and update the operational critical contact
information that is in CDC’s On-TRAC data center at least every six months or as changes occur.

Inventory Management Tracking System and Data Exchange Annual Tests
PHEP awardees must provide inventory counts to CDC during a public health emergency. Awardees
may use either CDC’s Inventory Management and Tracking System (IMATS) with the built-in reporting
functionality or configure their own inventory management system (IMS) using the Inventory Data
Exchange (IDE) Specification guide, enabling them to receive and respond to an inventory request from
CDC. PHEP awardees must participate in annual tests that provide MCM inventory counts to CDC to
ensure data reports of inventory levels are reliable. More specific details are provided in the 20172022 HPP-PHEP Supplemental Guidelines.

Non-Pharmaceutical Interventions
PHEP awardees should coordinate non-pharmaceutical interventions by developing and updating plans
that include documentation of the applicable jurisdictional, legal, and regulatory authorities necessary
for implementation in routing and incident-specific situations. Such plans must include necessary
authorization for interventions with the following elements: individuals, groups, facilities, animals,
food products, public works/utilities, and travel through ports of entry for state, local and territorial
jurisdictions as appropriate. Plans should include consideration of the legal and planning issues for
interventions such as isolation, quarantine, school and child care closures, workplace and community
organization/event closure, and restrictions on movement.

Activity 2: Ensure the Safety and Health of Responders
Joint Requirements
HPP and PHEP awardees, HCCs, and their members must equip, train, and provide resources necessary
to protect responders, employees, and their families from hazards during response and recovery
operations. Personal protective equipment (PPE), MCMs, workplace violence training, psychological
first aid training, and other interventions specific to an emergency are all necessary to protect
responders and health care workers from illness or injury and should be readily available to the health
care workforce.
45

Personal Protective Equipment
Awardees and HCCs should manage PPE resources, including stockpiling considerations, vendormanaged inventory, and the potential reuse of equipment; this includes consistent policies regarding
the type of PPE necessary for various infectious pathogens, and sharing information about PPE supplies
across HCCs, EMS, public health agencies, and other members.

HPP Requirements
Protecting the Health Care Workforce
The health care workforce needs readily available PPE, such as respirators, protective clothing, gloves,
and face shields, for protection from a wide range of threats including infectious diseases, radiation,
chemical exposure, and various physical hazards. Any HPP awardee, HCC, or HCC member purchasing
PPE with HPP funds must consider and document acquisition, storage, rotation, activation, use, and
disposal decisions and provide this documentation to the FPO upon request.
ASPR encourages, when possible, regional procurement of PPE. This procurement approach may offer
significant advantages in pricing and consistency for staff, especially when PPE is shared across health
care organizations in an emergency. Additionally, in circumstances where HCC members are part of a
larger corporate health system, a balance between corporate procurement and regional procurement
should be considered.

PHEP Requirements/Recommendations
PHEP awardees are responsible for ensuring the safety and health of public health department staff
who respond to an incident, including a large-scale incident that may require significant personnel
from outside the health department. More information is available in Capability 14: Responder Safety
and Health in the Public Health Preparedness Capabilities: National Standards for State and Local
Planning and in the 2017-2022 HPP-PHEP Supplemental Guidelines. Public health departments must
ensure the health and safety of responders through the following activities.






Distribute and dispense medical and nonmedical countermeasures to public health first
responders.
Purchase PPE, support fit testing, and maintain respiratory protection programs for public and
health care sector workforce.
Promote coordinated training and maintenance of competencies among public health first
responders, health care providers (including EMS), and others as appropriate, on the use of PPE and
environmental decontamination. Training should follow Occupational Safety and Health
Administration (OSHA) guidelines and state regulations.
Collaborate, develop, and implement strategies to ensure availability of effective supplies of PPE by
working with suppliers and coalitions to develop plans for caching or redistribution/sharing.

46



Public health agencies, health care organizations, and other HCC members should inform each
other and integrate plans for purchasing, caching, and distributing PPE.

Activity 3: Operationalize Response Plans
Joint Requirements
Implementing MCM response plans requires sufficient staffing to set up and sustain prolonged
dispensing operations, as well as security personnel to effectively secure assets, facilities, and
personnel through all phases of MCM planning and operations. In recognition of the staffing challenges
jurisdictions face as the public health workforce continues to shrink, awardees must consider other
staffing resources to effectively mobilize MCM dispensing operations.
Awardees must proactively integrate all components of their state and local governments in MCM
response planning and consider inclusion of the following strategies in their MCM plans.


Consider using the National Guard as a potential resource for MCM distribution and dispensing
operations and provide training for National Guard personnel designed to serve in this capacity;



Consider voluntary reassignment of state and local employees to participate in MCM mission areas;



In addition to state-funded personnel, the Pandemic and All-Hazards Preparedness Reauthorization
Act of 2013 (PAHPRA) provides the Secretary of the Department of Health and Human Services
(HHS) with discretion to authorize the temporary reassignment of federally funded state, tribal, and
local personnel during a declared federal public health emergency upon request by a state or tribal
organization; the temporary reassignment provision is applicable to state, tribal, and local public
health department or agency personnel whose positions are funded, in full or part, under PHS
programs and allows such personnel to immediately respond to the public health emergency in the
affected jurisdiction; and



Explore whether federal workers assigned to state or regional office may be eligible to serve
temporary details to staff state and local MCM dispensing operations in their jurisdictions.

PHEP Requirements/Recommendations
Community Reception Centers (Radiation Preparedness)
As an option for exercising, CDC encourages all awardees to consider developing or enhancing
Community Reception Center (CRC) plans/exercises for sheltering and monitoring those that were
potentially exposed to radioactive material. See https://emergency.cdc.gov/radiation/toolkits.asp for
more information. Awardees using PHEP funds to support CRC activities, must include these activities
in their work plans.

Domain 5 Strategy: Strengthen Surge Management
47

Following a public health incident, HPP and PHEP awardees should coordinate to assess the public
health and medical needs of the affected community, with PHEP awardees focusing on public health
surge needs and HPP awardees and their HCCs focusing on medical surge needs. While the two
programs may focus on different sectors within the community, HPP and PHEP awardees must
coordinate these activities jointly.
The following four activities are used to manage public health surge.





Address mass care needs, such as shelter monitoring
Address surge needs, including family reunification
Coordinate volunteers
Prevent or mitigate injuries and fatalities

The following four activities are used to manage medical surge.





Conduct health care facility evacuation planning and execute evacuations
Address emergency department and inpatient surge
Develop alternate care systems
Address specialty surge, including pediatrics, chemical, radiation, burn, trauma, behavioral health,
and highly infectious diseases.

Management of Public Health Surge
Activity 1: Address Mass Care Needs
Joint Requirements
Address Health Needs in Congregate Locations
PHEP awardees must coordinate with health care coalitions and their members to address the public
health, medical, and mental health needs of those impacted by an incident at congregate locations.
HPP awardees should serve as subject matter experts to PHEP awardees on the health care needs of
those impacted by an incident. For example, HPP awardees, HCCs, and HCC members should serve as a
planning resource to PHEP awardees and public health agencies as they develop mass shelters. In
particular, HPP awardees and HCCs should provide their expertise on the inclusion of medical care at
shelter sites.

Activity 2: Address Surge Needs
Joint Requirements
Family Reunification
During a public health incident or crisis, families are at risk for becoming disconnected. HPP awardees
and HCCs must serve as planning resources and subject matter experts to PHEP awardees and public
health agencies as they develop or augment existing response plans for affected populations, including
mechanisms for family reunification. These plans should give consideration to:
48



Information needed to facilitate reunification of families



Reunification considerations for children



Family notification and initiation of reunification processes.

Infectious Diseases
During an infectious disease outbreak, HPP and PHEP awardees, HCCs, and HCC members all have roles in
planning for and responding to outbreaks that stress either the capacity or the capability of the public health or
health care delivery systems. ASPR and CDC require that awardees and HCCs coordinate the following activities
to ensure the ability to surge to meet the demands during a highly infectious disease response.



Establish a common operating picture that facilitates coordinated infectious disease information
sharing among all HCC members and relevant stakeholders, including state, local, and territorial
public health agencies and their respective preparedness programs, state public health
laboratories, communicable disease programs, and health care-associated infections (HAI)
programs.
o PHEP awardees should ensure infectious disease response planning includes state and local
emergency management, partners responsible for airports and international points of entry
into the United States, including CDC quarantine stations of jurisdiction, public safety, and
other relevant agencies and community partners. Planning should include identification and
management of potentially infected interstate and international travelers and acquisition and
deployment of immunizations and prophylactic medication as appropriate.



Develop or update plans to describe how jurisdictional public health departments will:
o Monitor known cases or exposed persons including how surveillance will be shared,
o Conduct short- and long-term follow-up of known or suspected households, and
o Ensure the security of storage and retrieval of sensitive information.



Establish key indicators, critical information requirements, and EEI that will assist with timing of
notifications, alerting, and coordinating responses to emerging or re-emerging infectious disease
outbreaks of significant public health and health care importance, including novel or highconsequence pathogens.



Provide real-time information through coordinated information sharing systems (see Capability 2,
Objective 3, Activity 4 of the 2017-2022 Health Care Preparedness and Response Capabilities and
Capability 6: Public Health Preparedness Capabilities: National Standards for State and Local
Planning) and ensure that information is directed to the public and to the many disciplines that
comprise the responder community.



Coordinate public messaging and information sharing, including information related to monitoring
and tracking of persons under investigation (PUIs), among PIOs for jurisdictional public health
agencies, as well as PIOs at HCCs and health care organizations.



Ensure infectious disease response planning includes state and local emergency management,
transportation, public safety, and other relevant agencies and community partners.
49



Continue planning with health care organizations and other stakeholders such as mortuary, autopsy
personnel, and medical examiners, to coordinate the management of the deceased when bodies
are considered infectious, including addressing the provision of body bags and other supplies,
defining assistance, and developing relationships with crematoriums, funeral directors, and other
partners to effectively plan for managing the deceased when bodies are considered infectious.



Identify, leverage, and share leading practices to optimize infectious disease preparedness and
response activities.

ASPR and CDC also recommend the following joint activities.


HCCs and state HAI multidisciplinary advisory groups or similar infection control groups within the
state should partner to develop a statewide plan for improving infection control within health care
organizations.



Jurisdictional public health infection control and prevention programs including HAI programs and
HCC members should jointly develop infectious disease response plans for managing individual
cases and larger emerging infectious disease outbreaks.



HPP and PHEP awardees, HCCs, and their members should collaborate on informatics initiatives to
include but are not limited to electronic laboratory reporting, electronic test ordering, electronic
case reporting, electronic death reporting, and syndromic surveillance.



HPP and PHEP awardees and HCCs should engage with the community to improve understanding of
issues related to infection prevention measures, such as:
o Changes in hospital visitation policies,
o Social distancing, and
o Infection control practices in hospitals, such as:


PPE use,



Hand hygiene,



Source control, and



Isolation of patients.

 HPP and PHEP awardees, HCCs, and their members should promote coordinated training and
maintenance of competencies among public health first responders, health care providers, EMS,
and others as appropriate, on the use of PPE, environmental decontamination, and management of
infectious waste. Training should follow OSHA and state regulations.
 HPP and PHEP awardees, HCCs and their members should collaborate to develop and implement
strategies to ensure availability of effective supplies of PPE, including:
o Working with suppliers and coalitions to develop plans for caching or redistribution and
sharing and
o Informing each other and integrating plans for purchasing, caching, and distributing PPE.
50

 HPP and PHEP awardees, HCCs, and their members should sustain planning for the management of
PUIs to:
o Monitor health care personnel who may have had a risk exposure to a PUI by directly treating
or caring for a PUI in a health care setting and
o Clarify roles and responsibilities for key response activities related to the monitoring of PUIs,
to include:


Assisting or assessing readiness of health care organizations in the event of a PUI and



Conducting AARs and testing plans for PUI management to identify opportunities to
improve local, state, and national response activities.

More information about addressing specialty medical surge for infectious diseases can be found in
Capability 4, Objective 9 of the 2017-2022 Health Care Preparedness and Response Capabilities.

PHEP Requirements/Recommendations
Conduct Activities Based on State Plans to Manage Public Health Surge
CDC requires PHEP awardees to continuously assess and evaluate the medical and public health needs
of the affected community and identify areas where the response effort is not meeting the demands.
Awardees must then implement surge plans to address the gaps.

Activity 3: Coordinate Volunteers
Joint Requirements
HPP and PHEP awardees must coordinate the identification, recruitment, registration, training, and
engagement of volunteers to support the jurisdiction’s response to incidents. To develop competency
in implementing plans involving volunteers, awardees should ensure volunteers are included in
training, drills, and exercises throughout the five-year project period.
HPP awardees, including HCCs and their members, should work to manage volunteers in the hospital
or other health care setting. This includes:


Identifying situations that would require volunteers in hospitals. Leverage existing hospital
volunteer services and staffing resource mechanisms;



Identifying processes to assist with volunteer coordination, including protocols to handle walk-up
volunteers and others who cannot participate due to state regulations;



Estimating the anticipated number of volunteers and health professional roles based on identified
situations and resource needs of the facility;



Identifying and addressing volunteer liability, licensure, workers compensation, scope of practice,
and third-party reimbursement issues that may deter volunteer use;

51



Leveraging existing government and nongovernmental volunteer registration programs, such as
Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and
Medical Reserve Corps (MRC); and



Developing rapid credential verification processes to facilitate emergency response.

PHEP Requirements/Recommendations
Conduct Activities Based on State Plans to Manage Public Health Surge
Implement Plans that Support the Emergency System for Advance Registration of
Volunteer Health Professionals (ESAR-VHP)
It is critical that PHEP awardees coordinate identification, recruitment, registration, training and
engagement of volunteers to support the jurisdictional public health agency’s response to incidents.
Awardees must ensure volunteers are included in training, drills, and exercises to develop competency
at implementing plans as described in the Emergency System for Advance Registration of Volunteer
Health Professionals (ESAR-VHP) compliance requirements.
Awardees in jurisdictions that do not use spontaneous or other volunteers due to state regulations
must describe in their plans how they plan to handle those types of volunteers during an incident.

Activity 4: Prevent or Mitigate Injuries and Fatalities
PHEP Requirements/Recommendations
Community Partnerships for Coordination
With regard to fatalities, PHEP awardees must coordinate with HCCs and other community partners,
including law enforcement, emergency management, and medical examiners or coroners to ensure
proper tracking, transportation, handling, and storage of human remains and ensure access to mental
and behavioral health services for responders and families impacted by an incident.

Management of Medical Surge
Activity 1: Conduct Health Care Facility Evacuation Planning and Execute
Evacuations
HPP Requirements
By the end of Budget Period 1, HPP awardees, HCCs, and HCC members must ensure all health care
organizations, public health agencies, and emergency management organizations are included in
evacuation, transportation, and relocation planning and execution during exercises and real incidents.
Further, HPP awardees, HCCs, and HCC members must sustain or further develop their evacuation
planning and response activities throughout the remainder of the five-year project period.

Coalition Surge Test
52

To test the ability of the HCC to perform components of the 2017-2022 Health Care Preparedness and
Response Capabilities, each HCC must conduct an exercise using the Coalition Surge Test once each
budget period. Additional information on HPP exercise requirements and the Coalition Surge Test are
provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Activity 2: Address Emergency Department and Inpatient Surge
HPP Requirements
Crisis Care Strategies
HCCs and their members that coordinate during a medical surge response are more likely to effectively
manage the emergency without state or federal assets or employing crisis care strategies. However, it
is not possible to plan for all worst-case scenarios, and there may be times when the health care
delivery system is stressed beyond its maximum surge capacity. During those scenarios, crisis care
strategies may be employed and planned for well in advance. Planning for medical surge should follow
the medical surge capacity and capability (MSCC) tiered approach, where successive levels of
assistance are activated as the emergency evolves.
Accomplishing these activities will enable the health care delivery system and other organizations that
contribute to responses to coordinate efforts before, during, and after emergencies; continue
operations; and appropriately surge as necessary.

Immediate Bed Availability
Immediate bed availability (IBA) is defined as the ability of a hospital to provide at least 20 percent bed
availability of staffed beds within four hours of a disaster. IBA is built on three pillars: continuous
monitoring across the health system; off-loading of patients who are at low risk for untoward events
through reverse triage; and on-loading of patients from the disaster. While the goal of IBA is to create
capacity within hospitals, other health care partners including home care providers, skilled nursing
facilities, long-term care facilities, clinics, and community and tribal health centers, can meet the needs
of patients who are discharged early as part of the surge response.
HCCs and their members must plan and respond together to address emergency department and
inpatient surge with the goal of ensuring IBA throughout the five-year project period. In particular,
HCCs and their members should focus their hospital medical surge capability and IBA activities in these
areas:


Emergency department beds



General medical, general surgical, and monitored beds



Critical care beds



Surgical intervention units



Clinical laboratory and radiology services



Health care volunteer management
53



Equipment and supplies



Staffing



Coordination of ambulance transport with EMS System

Crisis Standards of Care
By the conclusion of the five-year project period, HPP awardees must document their processes to
oversee jurisdictional crisis standards of care (CSC) planning and to coordinate all local or regional
planning efforts. HPP awardees must be prepared to submit documentation to their FPOs and ASPR’s
Technical Resource, Assistance Center, and Information Exchange (TRACIE) detailing these processes
upon request. Further, HPP awardees must ensure the documentation includes:


Efforts undertaken to promote a uniform approach to establishing the ethical and legal
frameworks necessary for CSC planning and implementation, for example, liability protections and
specific rules and laws that might need modification or suspension to support CSC
implementation, such as to broaden scope of practice or relax interstate licensure requirements



Efforts undertaken to promote community engagement and discussion related to CSC planning



Evidence of jurisdictional support of crisis surge response, including specific methodologies to
allow for the expansion of health care service delivery, including establishment of alternate care
facilities, adjustment of prescribing practices, and amendment of EMS protocols



Efforts undertaken to socialize and describe CSC planning in a whole-of-government context,
including discussions with elected officials and other government leaders



The process used to ensure provision of consistent and uniform clinical guidance for scarce
resource conditions

HCCs also play a role in CSC planning. By the end of the five-year project period, each HPP-funded HCC
must document its plan for implementing CSC, integrating EMS, hospital, public health, and emergency
management policies related to situations in which the usual delivery of health care services is not
possible due to disaster conditions. HCCs must be prepared to submit the documentation regarding
this plan to an HPP FPO upon request. HCCs must include in the documentation:


The key stakeholders involved in the planning, including a description of how these stakeholders
integrate with each other to ensure a coordinated response to crisis conditions



Efforts undertaken to promote provider engagement in CSC planning



Activities to support the implementation of crisis care decision-making by EMS agencies, including
dispatch, transport, and treatment decisions



Activities to support the implementation of crisis care decision-making by hospitals and other
health care entities, especially as they relate to managing limited resources and the integration of
crisis strategies into surge capacity planning and incident management
54

More information about addressing emergency department and inpatient medical surge can be found
in Capability 4, Objective 2, Activity 1 of the 2017-2022 Health Care Preparedness and Response
Capabilities.

Activity 3: Develop Alternate Care Systems
HPP Requirements
Alternate Care Systems
An alternate care system, defined as the use of nontraditional settings and modalities for health care
delivery, may be required when demand overwhelms a region or the nation’s health care delivery
system for a prolonged period, or an emergency has significantly damaged infrastructure and limited
access to health care. HCCs should plan to provide support, including personnel and supplies, to public
health agencies and emergency management organizations that have leadership roles in selecting,
establishing, and operating alternative care sites.
Accordingly, HPP awardees and HCCs should plan for the development of alternate care systems, in
collaboration with state and local public health agencies and emergency management organizations,
prior to the conclusion of the five-year project period. However, the development of an alternate care
system does not begin and end with identification of alternate care sites. HPP awardees and HCCs are
encouraged to consider additional factors in their alternate care system activities prior to the
conclusion of the five-year project period:


Establishment of telemedicine or virtual medicine capabilities



Establishment of assessment and screening centers for early treatment



Provision of medical care at shelters



Assisting with the selection and operation of alternate care sites

More information about the development of alternate care systems can be found in Capability 4,
Objective 2, Activity 3 of the 2017-2022 Health Care Preparedness and Response Capabilities.

Activity 4: Address Specialty Surge
HPP Requirements
Pediatric Care
Each HCC should promote its members’ planning for pediatric medical emergencies and foster
relationships and initiatives with emergency departments that are able to stabilize and manage
pediatric medical emergencies.
HPP awardees must collaborate with the Emergency Medical Services for Children (EMSC) program
within its jurisdiction to better meet the needs of children receiving emergency medical care. The
Health Resources and Services Administration (HRSA) administers the EMSC program at the federal

55

level, and HRSA awardees may be state agencies or accredited schools of medicine. This program
works to ensure that critically ill and injured children receive optimal pediatric emergency care.
Following are specific areas of collaboration.


HPP awardees and the EMSC program awardees within their jurisdictions must provide a joint letter
of support indicating that EMSC and HPP are linked at the awardee level. HPP awardees must
provide the initial letter of support with their funding applications at the beginning of each budget
period throughout the five-year project period.



HPP awardees must work with HCCs and EMSC to ensure that all hospitals are prepared to receive,
stabilize, and manage pediatric patients. At the end of each budget period, HRSA will provide HPP
with data regarding each hospital’s capability to manage pediatric medical emergencies to assist
with this work.

EMSC awardee contact information is available in the PERFORMS Resource Library or via HPP FPOs.

Chemical or Radiation Emergency Incident
The health care system must be prepared to manage exposed or potentially exposed patients during a
chemical or radiation emergency. To ensure successful surge management during chemical or radiation
emergency events, HCCs and their members should complete the following activities prior to the
conclusion of the five-year project period.


Coordinate training for their members on the provision of wet and dry decontamination and
screening to differentiate exposed from unexposed patients (especially in radiation emergency
events)



Ensure involvement and coordination with regional HAZMAT resources (where available) including
EMS, fire service, health care organizations, and public health agencies (for public messaging)



Assist members with the distribution of available, including mobilization of CHEMPACKs when
necessary.



Consider participating in a joint community reception center exercise with public health partners.

Burn and Trauma Care
HPP awardees, their HCCs, and HCC members must plan to coordinate a response to large burn and
trauma emergencies in collaboration with all burn and trauma systems within their jurisdictions,
boundaries, or that may partner with them. This must be noted in the HCC response plan by the end of
Budget Period 2. HPP awardees must also be prepared to submit this documentation to an FPO upon
request.
Given the limited number of burn specialty hospitals and trauma centers, an emergency affecting large
numbers of burn or trauma patients will require HCC and awardee involvement to ensure those
patients that can benefit the most from burn and trauma services receive priority for transfer.
Additionally, HCCs can assist with patient distribution to coordinate the availability of critical trauma
56

and burn response resources, such as operating rooms, surgeons, anesthesiologists, operating room
nurses, and surgical equipment and supplies.

Behavioral Health Needs
Emergencies may cause severe emotional impacts on survivors, their families, and responders and may
additionally cause substantial destabilization of patients with existing behavioral health issues.
Consequently, by the conclusion of the five-year project period, ASPR encourages HPP awardees to:


Develop and use behavioral health support and strike teams to support affected populations



Plan for widespread information dissemination to help providers, patients, families, and the
community understand the symptoms and signs of acute stress responses and collaborate with
HCCs to communicate when and where individuals should seek treatment



Provide ongoing support to their inpatient and outpatient behavioral health members



Assist with the provision of psychological first aid to those impacted, including health care workers

Infectious Diseases
HPP awardees, HCCs, and their members have roles in planning for and responding to infectious
disease outbreaks that stress either the capacity or the capability of the health care delivery system.
Prior to the end of the five year project period:


Awardees, HCCs, and their members must expand existing Ebola concept of operations plans
(CONOPs) to enhance preparedness and response for all infectious disease emergencies that stress
the health care delivery system



HCCs must include HAI coordinators and quality improvement professionals at the health care
facility and jurisdictional levels in their activities, including planning, training, and exercises/drills;
also include HCC leaders in state HAI coordination work groups



HCCs should develop a uniform process of continuous screening for newly presenting, hospitalized,
and other patients and integrate information with electronic health records (EHRs) where possible,
throughout HCC member facilities and organizations



HCCs should coordinate visitor policies for infectious disease emergencies at member facilities to
ensure uniformity



HCCs should develop and exercise plans to coordinate patient distribution for highly pathogenic
respiratory viruses and other highly transmissible infections, including complicated and critically ill
infectious disease patients, when tertiary care facilities or designated facilities are not available

More information about addressing specialty surge can be found in Capability 4, Objectives 4 through 9
of the 2017-2022 Health Care Preparedness and Response Capabilities.

57

Domain 6 Strategy: Strengthen Biosurveillance (PHEP)
As defined by Homeland Security Presidential Directive 21 (HSPD-21), biosurveillance involves active
data-gathering with appropriate analysis and interpretation of biosphere data that might relate to
disease activity and threats to human or animal health — whether infectious, toxic, metabolic, or
otherwise, and regardless of intentional or natural origin — to achieve early warning of health threats,
early detection of health events, and overall situational awareness of disease activity. PHEP awardees
must ensure coordination among preparedness, laboratory, and epidemiology programs through the
following activities to strengthen biosurveillance.


Conduct epidemiological surveillance and investigation



Detect emerging threats and injuries



Conduct laboratory testing

Activity 1: Conduct Epidemiological Surveillance and Investigation
PHEP Requirements/Recommendations
PHEP awardees must continue to create, maintain, support, and strengthen routine surveillance and
detection systems and epidemiological processes. In addition, awardees must be able to surge these
systems and processes in response to incidents of public health significance.

Public Health Informatics (Surveillance and Investigation)
PHEP awardees should consider updating essential systems that strengthen epidemiological
surveillance and investigation capability with modern technological tools and make them more
versatile in meeting the demands for timely, population-specific, and geographically specific
surveillance information. To meet these expectations, CDC encourages PHEP awardees to consider two
key strategies:


Enhance the public health information system workforce: Prioritize implementation of targeted
cross-cutting workforce training and development opportunities to maintain functionality and
increase capacity of public health information systems, such as electronic death registration
systems.



Advance electronic information exchange: Public health informatics capacity includes specific
actions to both receive and transmit data electronically using standards-based messaging;
awardees should focus their efforts on improving information sharing and coordinate information
technology goals, investments, and work plans with input from state laboratory directors, state
epidemiologists, information technology or informatics directors, or specifically designated
individuals empowered by these authorities by:
o Participating in CDC’s National Notifiable Diseases Surveillance System (NNDSS) Modernization
to increase NNDSS case reports submitted electronically to CDC using HL7 messaging,

58

o Advancing ELR to improve overall surveillance, timeliness, and accuracy of case reporting,
confirmation to state and local public health, and subsequent information sharing with CDC,
o Participating in the National Syndromic Surveillance Program (NSSP) to increase the
proportion of emergency department visits monitored by jurisdictions,
o Implementing electronic test ordering (ETOR) to accept electronic test orders and to return
findings electronically, and
o Implementing electronic case reporting (eCR) consistent with national standards to accept and
process electronically transmitted reportable disease information from electronic health
records.
The 2017-2022 HPP-PHEP Supplemental Guidelines includes additional information related to public
health informatics.

Electronic Death Registration (EDR)
Awardees using PHEP funds for EDR must ensure they are developing or advancing state-based EDR
systems that can provide more timely public health mortality surveillance information to CDC’s
National Center for Health Statistics (NCHS) and state epidemiologists. Awardees using PHEP funds to
support existing EDR systems must prioritize goals and objectives in their work plans that advance the
use and geographic coverage of current death reporting systems. Awardees using PHEP funds to build
operational EDR systems must prioritize development of scalable plans designed to initially implement
an EDR system. More information is available in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Border Health Surveillance
PHEP awardees in jurisdictions located on the United States-Mexico border or the United StatesCanada border must conduct activities that enhance border health, particularly regarding disease
detection, identification, investigation, and preparedness and response activities related to emerging
diseases and infectious disease outbreaks whether naturally occurring or due to bioterrorism. This
focus on cross- border preparedness reinforces the U.S. public health and health system preparedness
whole-of- community approach which is essential for local-to-global threat risk management and
response to actual events regardless of source or origin.

Disaster Epidemiology Training
CDC recommends that PHEP awardees participate in disaster epidemiology training initiatives as
determined by jurisdictional priorities. Following are recommended activities and tools.


Rapid Response Registry (RRR): RRR is used to quickly register victims of disasters and provide
services, information, or long-term monitoring. The RRR toolkit and technical support from SMEs
with ATSDR are available to assist with implementation.



Emergency Responder Health Monitoring and Surveillance System (ERHMS): ERHMS is designed to
provide real-time data and recommendations on health and safety issues that arise among
59

responders involved in an emergency response. The system includes specific recommendations
and tools for all phases of a response (pre-deployment, deployment, and post-deployment).


Incorporate information from the ATSDR's Assessment of Chemical Exposures (ACE) into training
initiatives. ACE can be used to conduct epidemiological assessments after a chemical incident. The
ACE toolkit is a helpful resource to assist local authorities in responding to or preparing for a
chemical release and has been implemented in several recent disasters.

More detailed information and resources are available in the 2017-2022 HPP-PHEP Supplemental
Guidelines.

Collaborate with Poison Control Centers
CDC recommends that PHEP awardees implement processes for using poison control center data for
public health surveillance. Such data can be particularly helpful in 1) providing situational awareness
during a known public health threat, 2) identifying an emerging public health threat, 3) identifying
unmet public health communication needs following a public health threat, or 4) providing surveillance
for specific exposures or illnesses of concern to the health department. Detailed information and
resources can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

Activity 2: Detect Emerging Threats and Injuries
PHEP Requirements/Recommendations
Response Plans for Chemical, Biological, Radiological, Nuclear, and Explosive
Threats
Awardees can use PHEP funding to maintain personnel needed to address chemical, biological,
radiological, nuclear and explosive (CBRNE) threats through hiring, training, exercising, and otherwise
implementing response plans. In addition, awardees should describe in their MYTEPs specific plans to
address identified gaps during the project period, and collaborate with HPP awardees to coordinate
joint training and exercise opportunities.

State Health Official Input Letter
To ensure strong state systems for detection of threats and injuries, states must plan and coordinate
their allocated resources across several domains. PHEP awardees must submit an application letter
signed by the jurisdiction’s state health official on official agency letterhead confirming the PHEP
director, the epidemiology lead, and the public health laboratory director, or their designated
representatives, have provided input into plans, strategies, and investment priorities within
epidemiology, surveillance, and laboratory work plans. Awardees who are unable to obtain effective
input from these stakeholders must submit a separate attachment with their funding applications
describing the reasons why and the steps taken to address them. CDC will work with awardees to help
resolve issues as necessary. An optional letter template is available in the PERFORMS Resource Library.

Activity 3: Conducting Laboratory Testing
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PHEP Recommendations
Laboratory Response Network-Biological (LRN-B)
PHEP-funded LRN-B laboratories must adhere to the LRN-B requirements and maintain the tools and
resources necessary for LRN-B participation. PHEP-funded standard reference LRN-B laboratories must
meet requirements for:










staffing, training, and equipment;
proficiency testing;
partnerships, for example with law enforcement agencies;
attending national meetings;
meeting CDC benchmark requirements;
identifying and covering High Priority Areas;
meeting the LRN-B standard laboratory checklist requirements;
maintaining communications with sentinel laboratories; and
providing support for the detection of emerging infectious diseases. In addition, standard reference
laboratories must be able to perform multiple-agent screening on high-risk environmental samples.

Advanced reference laboratories are required to meet the standard reference level requirements, as
well as maintain Select Agent certification, and, if requested, support the LRN-B program with assay
development, evaluation of new technologies, proficiency testing remediation, and high throughput
surge capacity. Additional information is available by contacting the LRN-B program office at
[email protected]. Awardees must describe planned activities to meet the program and membership
requirements in their Budget Period 1 public health laboratory testing work plans and budgets.
Description of the program and membership requirements are included in the 2017-2022 HPP-PHEP
Supplemental Guidelines.

Laboratory Response Network-Chemical (LRN-C)
All PHEP-funded LRN-C Level 1, Level 2, and Level 3 laboratories must adhere to LRN-C requirements
and standards and maintain the tools and resources necessary for LRN-C participation. These include:








staffing, training, and equipment requirements;
submission of success stories;
proficiency testing;
CDC benchmark requirements;
emergency surge activities;
logistical support and administrative activities; and
meeting the LRN-C standard laboratory requirements.

The 10 awardees receiving dedicated Level 1 LRN-C funding must address objectives related to
chemical emergency response surge capacity as outlined in Capability 12: Public Health Laboratory
61

Testing, including staffing and equipping the lab, maintaining critical instrumentation in a state of
readiness, training and proficiency testing for staff, and participating in local, state, and national
exercises. In addition, awardees must describe how they plan to increase their laboratory capabilities
and capacities consistent with the LRN chemical terrorism program objectives, including the addition of
new high-throughput sample preparation and analysis techniques and analytical capability for new
threat agents.
Additional information is available by contacting the LRN-C technical program office at [email protected]. Awardees must describe planned activities to meet the program and
membership requirements in their Budget Period 1 public health laboratory testing work plans and
budgets. Description of the program and membership requirements are included in the 2017-2022
HPP-PHEP Supplemental Guidelines.

LRN- C Equipment Requirements (Level 1 and Level 2 Laboratories Only)
LRN-C Level 1 laboratories and Level 2 laboratories must replace the inductively coupled plasma mass
spectrometry (ICP-MS) equipment by 2018 and nerve agent metabolites (NAM) equipment by 2020 to
maintain the LRN-C membership requirements. Awardees must describe their equipment replacement
activities in their Budget Period 1 public health laboratory testing work plans and budgets in
partnership with their laboratory directors and chemical threat program coordinators to assure the
effective replacement of equipment.
In addition, laboratories must work with their project officers and grant management specialists as
necessary when obtaining quotes and making procurement decisions. Beginning in Budget Period 1, 21
Level 2 laboratories are receiving PHEP funds specifically for completing the replacement of ICP-MS
equipment. PHEP funds must be strictly used for equipment replacement. Level 1 labs will continue to
receive dedicated PHEP funding. Subject to the availability of funds throughout ensuing budget
periods, CDC expects to provide funds to support the LRN-C NAM equipment replacement
requirement. CDC will actively monitor and assess the progress of the equipment replacement
completion.

Federal Requirements
For the HPP-PHEP 2017-2022 project period, awardees must address and comply with other federal
requirements that include joint, HPP-specific, and PHEP-specific programmatic requirements and
assurances. In completing the Program Requirements segment of the funding application, awardees
must provide updates on these programmatic requirements and assurances. In addition, HPP and PHEP
awardees must summarize in their work plans how they will address the strategies and activities listed
within each of the six domains of the HPP-PHEP Logic Model.
Joint program requirements and assurances apply to all HPP and PHEP awardees, including territories
and freely associated states. However, ASPR and CDC will provide additional guidance and technical
assistance that describe modified requirements for U.S. territories and freely associated states of
62

American Samoa, The Commonwealth of Northern Mariana Islands, Guam, Puerto Rico, the U.S. Virgin
Islands, Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall
Islands. Please refer to the 2017-2022 HPP-PHEP Supplemental Guidelines for specific assurances,
program requirements, and any additional administrative requirements.
1. Coordinate exercise planning and implementation.
 Awardees must develop and update multiyear training and exercise plans (MYTEPs) to reflect
planned activities. Updated MYTEPs must be submitted at the time of application.
 Awardees must conduct one joint statewide or regional full-scale exercise within the five-year
project period to test public health and health care preparedness capabilities.
 Awardees must conduct an annual public health and medical preparedness exercise that
specifically addresses the needs of people with disabilities and other at-risk individuals or
populations (see www.phe.gov/Preparedness/planning/abc/Pages/atrisk.aspx) and report in
the following year’s funding application on the strengths and weaknesses identified and
corrective actions taken to address weaknesses. HPP awardees should consider the access and
functional needs of at-risk individuals and engage these populations as they plan the budget
period’s HCC-based exercises.
 Awardees must complete and submit AAR/IPs for all responses to real incidents and planned
events and for exercises conducted to demonstrate compliance with HPP and PHEP program
requirements. HPP and PHEP awardees should provide an AAR/IPs in accordance with
Homeland Security Exercise and Evaluation Program (HSEEP) guidelines for each qualifying
exercise within 120 days.
 Exercise requirements are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.
Below is a summary of the joint and program-specific exercise requirements.
Requirement
Annual Requirements

HPP

PHEP

Required and Optional Awardees

2 Redundant Communication Drills
At least two drills per health care coalition (HCC)
1 Coalition Surge Test:
http://www.phe.gov/Preparedness/planning/hpp
/Pages/coaltion-tool.aspx
Each HCC in states, directly funded localities,
Guam, and Puerto Rico must conduct 1 exercise; a
real incident/event will be considered.
1 Hospital Surge Test-:
http://www.phe.gov/preparedness/planning/hpp
/surge/Pages/default.aspx



Required: All 62 awardees



Required: States, directly funded localities,
Guam, and Puerto Rico.



After-action Report/Improvement Plan (AAR/IP)
Submission
1 Multiyear Training and Exercise Plan (MYTEP)
Submission (joint plan)





Required: American Samoa, Commonwealth
of Northern Mariana Islands, Federated
States of Micronesia, Republic of Palau,
Republic of the Marshall Islands, and U.S.
Virgin Islands
Required: All 62 awardees





Required: All 62 awardees

63

Requirement

HPP

3 MCM drills

PHEP

Required and Optional Awardees



U.S. territories and freely associated states
(excluding Puerto Rico) may use an Excel
spreadsheet rather than PERFORMS to
receive and respond to an inventory request
from CDC.
Required: All CRI local jurisdictions




Required: All 62 awardees
Required: All 62 awardees.

All CRI local jurisdictions must complete all 3 drills
annually: 1) staff notification and assembly; 2)
facility set-up; and 3) site activation. Throughput
estimation is now completed as part of the
dispensing full-scale exercise (FSE). However, if a
site does not participate in the dispensing FSE (for
example, participates in immunization FSE in lieu
of dispensing FSE), oral MCM throughput must be
measured and information submitted at least
once during the fiveyear period.
1 Exercise or Real Incident
1 Inventory Management and Tracking System
(IMATS) or Inventory Data Exchange (IDE) Test

However, to document compliance,
American Samoa, Commonwealth of
Northern Mariana Islands, Federated States
of Micronesia, Guam, Republic of Palau,
Republic of the Marshall Islands, and U.S.
Virgin Islands may submit an Excel
spreadsheet to respond to CDC inventory
request, as opposed to IMATS or IDE.
Project Period Requirements
1 Functional or Full-scale Exercise
Applies to states, directly funded localities, and
Puerto Rico, who must participate in a joint,
statewide exercise involving HPP/HCCs, PHEP, and
emergency management agency/organization
partners; a real incident/event will be considered

1 Fiscal Preparedness Tabletop Exercise
1 Medical Countermeasure (MCM) Distribution
Full-scale Exercise








Required: States, directly funded localities
and Puerto Rico
Optional: American Samoa, Commonwealth
of Northern Mariana Islands, Federated
States of Micronesia, Guam, Republic of
Palau, Republic of the Marshall Islands, and
U.S. Virgin Islands, who may focus exercise
on any event type and may test the
jurisdiction’s Zika response plan to fulfill this
requirement
Optional: All 62 Awardees
Required: States and directly funded
localities
Optional: CDC recommends all U.S.
territories and freely associated states
participate in HSEEP-based training for plan
and exercise development; with
implementation evaluated using the MCM
ORR tool. CDC will follow up with these

64

Requirement

HPP

1 MCM Dispensing Full-scale Exercise or 1 Mass
Vaccination Full-scale Exercise

AAR/IP Submission



PHEP

Required and Optional Awardees



awardees to determine specific exercise
requirements. The intent of these
requirements is to successfully conduct an
MCM-related full-scale exercise.
Required: All 62 awardees



1 POD in each CRI local planning jurisdiction
in each of the 72 MSAs and four directly
funded localities must be exercised.
Required: All 62 awardees

2. Submit pandemic influenza preparedness plans.
Awardees are required to have updated plans describing activities they will conduct with respect to
pandemic influenza as required by Sections 319C-1 and 319C-2 of the PHS Act.
 HPP awardees can satisfy the annual requirement through the submission of required program
data such as the capability self-assessment and program measures that provide information on
the status of state and local pandemic response readiness, barriers and challenges to
preparedness and operational readiness, and efforts to address the needs of at-risk individuals.
 PHEP awardees will meet this annual requirement through their participation in CDC’s MCM
operational readiness review process. CDC has incorporated pandemic influenza elements and
mass vaccination requirements into the ORR tool. In addition, awardees must address
pandemic influenza planning gaps as part of their medical countermeasure technical assistance
action plans.
3. Describe progress on capability development.
Awardees must:
 Describe their top jurisdictional strategic priorities for the project period.
 Develop strategies and activities based on the HPP-PHEP Logic Model
 Identify the data sources used to inform their strategic priorities. Sources include but are not
limited to jurisdictional risk assessments, capability self-assessments, NHSPI, and AAR/IPs.
 List challenges or barriers that are anticipated for the project period, including any budgetary
issues that might hinder the success or completion of the project as originally proposed and
approved.
4. Maintain a current all-hazards public health emergency preparedness and response plan and
submit to ASPR or CDC when requested and make available for review during site visits.
5. Establish and maintain senior advisory committees. Awardees must establish and maintain
advisory committees or similar mechanisms of senior officials from governmental and
nongovernmental organizations involved in homeland security, health care, public health, EMS, and
behavioral health to help integrate preparedness efforts across jurisdictions and to maximize
65

funding streams. This will enable HPP and PHEP programs to better coordinate with relevant public
health, health care, and preparedness programs.
6. Obtain public comment and input on public health emergency preparedness and response plans
and their implementation. Awardees must obtain public comment and input on public health
emergency preparedness and response plans and their implementation using existing advisory
committees or a similar mechanism to ensure continuous input from other state, local, and tribal
stakeholders and the general public, including members of at-risk populations and those with
expertise at integrating the access and functional needs of at-risk individuals..
7. Coordinate emergency public health and health care preparedness and response plans with
educational agencies and state child care lead agencies. Awardees must ensure emergency
preparedness and response coordination with designated educational agencies and lead child care
agencies in their jurisdictions.
8. Engage State Unit on Aging or Equivalent Office. HPP and PHEP awardees must engage the State
Unit on Aging, Area Agency on Aging, or an equivalent office in addressing the public health
emergency preparedness, response, and recovery needs of older adults. Awardees must provide
evidence that this state office is engaged in the jurisdictional planning process.
9. Meet Emergency System for Advance Registration of Volunteer Health Professionals (ESAR- VHP)
compliance requirements. The ESAR-VHP compliance requirements identify capabilities and
procedures that state ESAR-VHP programs must have in place to ensure effective management and
interjurisdictional movement of volunteer health personnel in emergencies. Awardees must
coordinate with volunteer health professional entities and are encouraged to collaborate with the
Medical Reserve Corps (MRC) to facilitate the integration of MRC units with the local, state, and
regional infrastructure to help ensure an efficient response to a public health emergency. More
information about the MRC program can be found at www.mrc.hhs.gov.
10. Ensure cross-discipline coordination. Awardees may use HPP and PHEP funding to support
coordination activities, such as local health departments planning with health care coalitions, but
must track accomplishments. Awardees should coordinate activities with state emergency
management agencies, EMS providers (including the State Office of Emergency Medical Services),
mental health agencies (including the State Mental Health Authority and the Disaster Behavioral
Health Coordinator), HCCs, and educational agencies and state child care lead agencies.
11. Comply with SAFECOM requirements. Awardees and subawardees that use federal preparedness
grant funds to support emergency communications activities must comply with current SAFECOM
guidance for emergency communications grants. SAFECOM guidance is available at
www.safecomprogram.gov.
66

12. Ensure compliance with the following cooperative agreement administrative requirements.


Submit required progress reports and program and financial data, including budgets and work
plans; progress in achieving evidence-based benchmarks and objective standards; performance
measures data including data from local health departments; outcomes of annual preparedness
exercises including strengths, weaknesses and associated corrective actions; and
accomplishments highlighting the impact and value of the HPP and PHEP programs in their
jurisdictions.



Inform and educate hospitals and health care coalitions within the jurisdiction on their role in
public health emergency preparedness and response.



Submit an independent audit report every two years to the Federal Audit Clearinghouse within
30 days of receipt of the report.



Provide situational awareness data during emergency response operations and other times as
requested.



Document Maintenance of Funding and Matching Funds.



Have in place fiscal and programmatic systems to document accountability and improvement.
The following are accountability processes designed to generate programmatic improvements:
o Plan and participate in joint site visits at least once every 12-24 months. In addition to
site visits, awardees are encouraged to invite HPP and PHEP project officers and senior
ASPR and CDC staff to attend or observe events such as scheduled exercises, regional
meetings, jurisdictional conferences, senior advisory committee meetings, and coalition
meetings supported by HPP and PHEP funding to gain insight on strengths and
challenges in preparedness planning.
o Participate in mandatory meetings and trainings. The following meetings are considered
mandatory, and awardees should budget travel funds accordingly:
 Annual preparedness summit sponsored by the National Association of County
and City Health Officials (NACCHO)
 Directors of public health preparedness annual meeting sponsored by the
Association of State and Territorial Health Officials
 Health care coalition preparedness conference as specified by ASPR
 Training for MCM coordinators sponsored by ASPR and CDC and other MCM
regional workshops
 Other mandatory training sessions that may be conducted via webinar or other
remote meeting venues
67

o Maintain all program documentation for purposes of data verification and validation.
ASPR and CDC strongly encourage awardees to develop internal electronic systems that
allow jurisdictions to share documentation with HPP and PHEP project officers, including
evidence of progress completing corrective actions for weaknesses identified during
exercises and drills. In Budget Period 1, ASPR and CDC will strengthen the emphasis on
verification and validation of requirements to identify strengths and potential gaps,
better review and evaluate progress, and provide technical assistance.
o Engage in technical assistance planning. Awardees must actively work with their HPP
and PHEP project officers to properly identify, manage, and update technical assistance
plans at least quarterly to assess TA progress. ASPR encourages HCCs, health care
organizations and other stakeholders supporting the provision of care during
emergencies to use ASPR’s TRACIE system. CDC encourages awardees to engage in
technical assistance planning and to submit specific requests through the use of CDC’s
On-TRAC portal.
13. Obtain local health department concurrence. PHEP Requirement only, applicable to
decentralized state health departments
PHEP awardees must consult with local public health departments or other subdivisions within
the jurisdiction to reach consensus, approval, or concurrence on the overall strategies,
approaches, and priorities described in their work plans and on the relative distribution of
funding as outlined in the budgets associated with the work plans. Awardees do not need to
obtain concurrence on the specific funding amounts but rather the process and formula used to
determine local health department amounts. Awardees must describe the process used to
obtain concurrence, including any nonconcurrence issues encountered, and plans to resolve
issues identified.
State awardees must provide signed letters of concurrence on official agency letterhead from
local health departments or representative entities upon request. Awardees who are unable to
gain 100% concurrence must submit a PDF document with their applications describing the
reasons for lack of concurrence and the steps taken to address them. CDC will investigate
instances where awardees are unable to gain concurrence and attempt to identify means to
resolve nonconcurrence issues.
1. Collaborations
a. With other ASPR and CDC programs and ASPR- and CDC-funded organizations:

Awardees must provide evidence of proposed or existing key collaborations. Memorandums of
agreement (MOA), memorandums of understanding (MOU), letters of commitment, or service
agreements may be used to formally document the scope of work, intensity, and duration of
collaborations with partners. Each document should thoroughly describe the proposed collaboration
68

and specific activities, which parties are responsible for what, and the intended outcomes and benefits
for the overall proposed program. PHEP awardees are required to collaborate with CDC's Division of
State and Local Readiness, Division of Healthcare Quality Promotion, and ELC and LRN program offices
to ensure that activities and funding are complementary and not duplicative. Awardees are
encouraged to collaborate with their jurisdictional laboratory, surveillance, and epidemiology leads,
maternal-child health programs, immunization programs, environmental health programs,
occupational health programs, legal counsel, health care providers, blood safety organizations, and
emergency management partners. In addition, awardees are encouraged to partner with other federal
programs. Letters from state health officials are required in some instances. The Strategies and
Activities section of this FOA outlines the anticipated collaborations for the implementation of the
cooperative agreement. For additional details, please see the 2017-2022 HPP-PHEP supplemental
Guidelines.
PHEP awardees must provide the following with their applications.
 Letters signed by their jurisdictional state health officials confirming the PHEP director, the
epidemiology lead, and the public health laboratory director, or their designated
representatives have provided input into plans, strategies, and investment priorities within
epidemiology, surveillance, and laboratory work plans.
 Letters signed by their jurisdictional state health officials or PHEP Directors confirming that
tribes approve or have provided input on the approaches and priorities described in PHEP
applications. (Applies to awardees with federally recognized tribes within their jurisdictions.)
 Letters of concurrence from local health departments or representative entities upon request.
(Applies to decentralized state health departments.)
b. With organizations not funded by ASPR or CDC:

Consistent with a whole community approach to preparedness, HPP awardees and HCCs should
actively work with and engage community leaders outside of its members. Community engagement
creates greater awareness of the HCC’s role and emergency preparedness activities, promotes
community resilience.
HPP awardees and the EMSC program awardees within their jurisdictions must provide a joint letter of
support indicating that EMSC and HPP are linked at the awardee level. HPP awardees must provide the
initial letter of support with their funding applications at the beginning of each budget period
throughout the five-year project period.
PHEP awardees are expected to establish, build, and sustain strategic and meaningful collaborative
partnerships. Toward the implementation of the plans, training, exercising, and technical assistance,
applicants should also consider working relationships with other federal agencies and key partners
such as educational entities; other state and local public health departments; community health care
centers; community- and faith-based organizations; stakeholders; law enforcement; national
organizations, such as the poison control centers; and other entities interested in promoting improved
public health emergency preparedness outcomes. Formal MOUs may be established as needed to help
formalize partnerships.
69

For additional details, please see the 2017-2022 HPP-PHEP Supplemental Guidelines. Please note: Funding
cannot be used for activities already covered by other federal grants or cooperative agreements.
Federal agencies participating in the Emergency Preparedness Grant Coordination process are working
to identify current preparedness activities and areas for collaboration across federal grants with public
health and healthcare preparedness components. The participating federal agencies include:
 Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and
Response (ASPR)
 Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA)
 HHS Centers for Disease Control and Prevention (CDC)
 HHS Health Resources and Services Administration (HRSA)
 Department of Transportation (DOT) National Highway Traffic Safety Administration (NHTSA)
Federal agencies are actively coordinating guidance and technical assistance and encourage all
recipients to actively coordinate preparedness activities for their jurisdictions. More information on
the Emergency Preparedness Grant Coordination process can be found at
http://www.phe.gov/Preparedness/planning/hpp/Pages/emergency-prep-grant.aspx.
2. Target Populations

This FOA targets, in broad terms, the entire U.S. population and the public health and health care
systems within the United States and its territories and freely associated states. Specifically, funds are
intended to support the needs of any community impacted by a public health emergency or disaster
and to ensure that the public health and health care systems are ready and capable of keeping their
communities safe and mitigating the impacts of any public health emergency. Additionally, there is a
special emphasis on ensuring the health needs of at-risk populations, including tribal entities, and to
ensure that plans and processes are in place pre-event and during an event to address the unique
needs of this population. Additionally, there is a special emphasis on integrating the access and
functional needs of at-risk populations that may interfere with their ability to access or receive medical
care before, during, or after a disaster or emergency.
a. Health Disparities
Awardees must show evidence that they are integrating the access and functional needs of at-risk and

vulnerable population(s) as indicated in their planning. Awardees must describe the structure or
processes in place to integrate the access and functional needs of at-risk individuals, including but not
limited to children, pregnant women, older adults, people with disabilities, and people with limited
English proficiency and non-English speaking populations. Strategies to integrate the access and
functional needs of at-risk individuals involve inclusion in public health, health care, and behavioral
health response strategies; furthermore, these strategies are identified and addressed in operational
work plans. Awardees, subawardees, and HCCs are encouraged to identify community partners with
established relationships with diverse at-risk populations, such as social services organizations, and to
use demographic tools such as the Social Vulnerability Index and the U.S. Census/American Community
70

Survey to better anticipate the potential access and functional needs of at-risk community members
before, during, and after an emergency. Applicants must also ensure inclusive planning with tribes.
Applicants must also ensure inclusive planning with tribes.
iv. Funding Strategy

The distribution of HPP and PHEP funds is calculated using a formula established under section 319C1(h) of the PHS Act, as amended. States and U.S. territories and freely associated states receive the
greater of a minimum amount prescribed by the formula or a base amount, as determined by the
Secretary, supplemented by a population-based formula, and possible additional funding based on
findings about significant unmet needs or high degree of risk. Eligible political subdivisions receive an
amount determined by the Secretary and possible additional funding based on findings about
significant unmet needs or high degree of risk.
b. Evaluation and Performance Measurement
i. ASPR and CDC Evaluation and Performance Measurement Strategy
Awardees must use both the health care preparedness and response capabilities and the public health
preparedness capabilities to guide the implementation of their strategic plans. Accordingly, the ASPR and CDC
strategy for monitoring and evaluating program and awardee performance will include several activities,
spanning both process and short-term outcome evaluation. Specific requirements and recommended activities
are detailed in the Strategies and Activities section of this FOA. For additional information regarding the health
care preparedness and response capabilities and domains, see 2017-2022 Health Care Preparedness and

Response Capabilities. For additional information regarding the public health preparedness capabilities, please
see Public Health Preparedness Capabilities: National Standards for State and Local Planning.

Performance measures are derived directly from ASPR’s 2017-2022 Health Care Preparedness and
Response Capabilities and CDC’s Public Health Preparedness Capabilities: National Standards for State
and Local Planning and the respective budget period’s performance measure specifications and
implementation guidance.
The HPP-PHEP evaluation and performance measure approach includes process measures and outputs
to track implementation of the strategies and outcome measures to monitor achievement of the
outcomes expected in the project period. Evaluation findings and performance measures will be
reviewed routinely to identify:



Areas for program improvement, and
Programs demonstrating substantial progress in specific program areas.

Evidence-based Benchmarks
ASPR and CDC have specified a subset of measures and select program requirements as benchmarks as
mandated by Sections 319C-1 and 319C-2 of the PHS Act as amended. Awardees must achieve,
71

maintain, and report on benchmarks throughout the five-year project period. Substantial failure to
meet the benchmarks may result in potential funding penalties. To substantially meet a benchmark,
awardees must provide complete and accurate information describing how the benchmark was met.
Accountability Provisions
Awardees that fail to “substantially meet” the benchmarks required by this funding opportunity
announcement are subject to withholding of a statutorily mandated percentage of the award if an
awardee fails substantially to meet established benchmarks for the immediately preceding fiscal
year or fails to submit a satisfactory pandemic influenza plan.
HHS is required to treat each failure to substantially meet all the benchmarks and each failure to
submit a satisfactory pandemic influenza plan as a separate withholding action. For example, an
awardee failing substantially to meet benchmarks AND who fails to submit a satisfactory pandemic
influenza plan could have 10% withheld for each failure for a total of 20% for the first year this
happens. If this situation remained unchanged, HHS would then be required to assess 15% for each
failure for a total of 30% for the second year this happens. Alternatively, if one of the two failures is
corrected in the second year but one remained, HHS is required to withhold 15% of the second year
funding.
HPP Evaluation and Performance Measurement Strategy
To measure and evaluate HPP performance, a variety of measures were developed at the input-,
activity-, output-, or outcome-level. The 2017-2022 HPP performance measures target output and
outcome measures to address the information needs of various stakeholders.
ASPR will review and evaluate HPP awardees based on a number of sources of information including
performance measure data, information gathered during site visits, produced AAR/IPs, and HCC
preparedness and response plans developed. This information will also be used to identify program
areas to be improved, program successes, and key areas of technical assistance to provide to awardees
and their HCCs. The HPP performance measures monitor implementation of the program, and are
intended to help assess an HCC’s readiness to respond in an emergency.
American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia,
Republic of the Marshall Islands, Republic of Palau, and the U.S. Virgin Islands will not be required to
respond to a subset of the first 22 listed performance measures due to differences in how they are
structured and function. In these cases, the measure is followed with “Does not apply to select U.S
Territories and Freely Associate States” or, in one instance, specifically “Does not apply to Federated
States of Micronesia, Republic of Palau, and Republic of the Marshall Islands only.” U.S. Territories and
Freely Associated States-specific requirements can be found in HPP 2017-2022 Supplemental Guidance
document. Additionally, performance measures 23 through 28 only apply to these awardees.
Following are the 22 HPP performance measures and the six measures (23-28) for select U.S. territories
and freely associated states.


Percent of funding each HCC receives from the awardee, other federal sources, and non-federal sources.
72



























Number of calendar days from start of budget period for awardees to execute subawards with each
HCC’s fiduciary agent. (Does not apply to select U.S. Territories and Freely Associated States).
Membership representation rate of HCC core (acute care Hospitals, EMS, Emergency Management,
Public Health) and additional member organizations by member type.
Percent of HCCs that have a complete and approved Preparedness Plan.
Percent of HCCs that have a complete and approved Response Plan.
Percent of awardees that obtain de-identified data from emPOWER at least once every six months to
identify numbers of individuals with electricity-dependent medical and assistive equipment for planning
purposes. (Does not apply to Federated States of Micronesia, Republic of Palau, and Republic of the
Marshall Islands.)
Percent of HCCs that obtain de-identified data from emPOWER at least once every six months to identify
numbers of individuals with electricity-dependent medical and assistive equipment for planning
purposes. (Does not apply to Federated States of Micronesia, Republic of Palau, and Republic of the
Marshall Islands.)
Percent of awardees that obtain data from the Social Vulnerability Index to estimate the populations
with a higher likelihood of having access and functional needs for planning purposes at least once per
year. (Does not apply to select U.S. Territories and Freely Associated States.)
Percent of HCCs that obtain data from the Social Vulnerability Index to estimate the populations with a
higher likelihood of having access and functional needs for planning purposes at least once per year.
(Does not apply to select U.S. Territories and Freely Associated States.)
Percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial, or
regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.
Percent of awardees that have provided an opportunity for each HCC to review and provide input to the
awardee’s ESF-8 preparedness and response plan.
Percent of HCCs engaged in their awardee’s jurisdictional risk assessment.
Percent of HCCs that have drilled their redundant communications plans and systems and platforms at
least once every six months.
Percent of HCC member organizations that responded during a redundant communications drill by
system and platform type used.
Percent of HCC core member organizations participating in Phase 1: Table Top Exercise with Functional
Elements and Facilitated Discussion of the Coalition Surge Test. (Does not apply to select U.S. Territories
and Freely Associated States.)
Percent of HCC core member organizations’ executives participating in Phase 2: After Action Review of
the Coalition Surge Test. (Does not apply to select U.S. Territories and Freely Associated States.)
Time [in minutes] for evacuating facilities in the HCC to report the total number of evacuating patients.
(Does not apply to select U.S. Territories and Freely Associated States.)
Time [in minutes] for receiving facilities in the HCC to report the total number of beds available to
receive patients. (Does not apply to select U.S. Territories and Freely Associated States.)
Time [in minutes] for the HCCs to identify an appropriate mode of transport for the last evacuating
patient. (Does not apply to select U.S. Territories and Freely Associated States.)
Percent of patients at the evacuating facilities that are identified as able to be: a) discharged safely to
home or b) evacuated to receiving facilities during Phase 1: Tabletop Exercise with Functional Elements
73
















and Facilitated Discussion of the Coalition Surge Test. (Does not apply to select U.S. territories and
Freely Associated States.)
Percent of evacuating patients with an appropriate bed identified at a receiving health care facility in 90
minutes. (Does not apply to select U.S. Territories and Freely Associated States.)
Percent of evacuating patients with acceptance for transfer to another facility that have an appropriate
mode of transport identified in 90 minutes. (Does not apply to select U.S. Territories and Freely
Associated States.)
Percent of HCCs where areas for improvement have been identified from HCC and member
organizations’ own exercises or real-world events and the HCCs’ preparedness and response plans have
been revised to reflect improvements.
Percent of awardees with a complete, jurisdiction-wide protocol that delineates a) the appropriate
allocation of scarce resources during crises and b) local and regional crisis standards of care (CSC)
planning and implementation efforts.
Percent of HCC core member organizations participating in the Command Center Tabletop and
Emergency Department Tabletop during the Hospital Surge Test. (Only applies to select U.S. Territories
and Freely Associated States.)
Percent of HCC core member organizations’ executives participating in the After Action Review of the
Hospital Surge Test. (Only applies to select U.S. Territories and Freely Associated States.)
Percentage of ICU beds made available during the Hospital Surge Test. (Only applies to select U.S.
Territories and Freely Associated States.)
Percentage of non-ICU beds made available during the Hospital Surge Test. (Only applies to select U.S.
Territories and Freely Associated States.)
Percentage of emergency department beds made available during the Hospital Surge Test. (Only applies
to select U.S. Territories and Freely Associated States.)
Percentage of patients with a bed identified in the emergency department during the Hospital Surge
Test. (Only applies to select U.S. Territories and Freely Associated States.)

74

HPP Budget Period 1 Benchmarks Subject to Withholding
Program Benchmarks
HPP Benchmarks
HPP - Program 1

Requirements
Awardees must execute subawards with each HCC within 90
calendar days from the start of each budget period.

HPP - Program 2

Awardees must submit quarterly Federal Financial Reports (FFRs)
within 30 calendar days of Notice of Award deadlines during each
budget period.
Awardees must submit a joint MYTEP with each budget period
application package.
Awardees must have a draft preparedness plan completed by April 1,
2018, and final plans submitted with the Budget Period 1 Annual
Progress Report.
HPP awardees must satisfy the annual requirement to submit a
pandemic influenza preparedness plan through the submission of
required program data such as the capability self-assessment and
program measures that provide information on the status of state
and local pandemic response readiness, barriers and challenges to
preparedness and operational readiness, and efforts to address the
needs of at-risk individuals.

HPP - Program 3
HPP - Program 4

HPP – Program 5

75

Criteria to Determine Potential Withholding of HPP Fiscal Year 2018 Funds

1.
2.

Benchmark Measure
Yes
Awardees must execute subawards with each HCC within 90
calendar days from the start of each budget period.

No

Possible %
Withholding

Awardees must submit quarterly Federal Financial Reports
(FFRs) within 30 calendar days of Notice of Award deadlines
during each budget period.
10%

3.

Awardees must submit a joint MYTEP with each budget
period application package.

4.

100% of awardee HCCs must have a draft preparedness plan
completed by April 1, 2018, and final plans submitted with
the Budget Period 1 Annual Progress Report.
100% of awardees must submit required program data such
as the capability self-assessment and program measures
that provide information on the status of state and local
pandemic response readiness, barriers and challenges to
preparedness and operational readiness, and efforts to
address the needs of at-risk individuals.
Total Potential Withholding Percentage

5.

10%

20%

Scoring Criteria
The four program benchmarks are weighted the same, so failure to substantially meet any one of the
benchmarks during each fiscal year will count as one failure and result in withholding of 10% of the
following fiscal year’s HPP award. Failure to submit the required program data outlined in the fifth
benchmark regarding the annual pandemic influenza preparedness plan requirement will count as one
failure and result in withholding of 10% of the following fiscal year’s HPP award. More information on
enforcement actions and disputes is available in the withholding and repayment guidance available in
the 2017-2022 HPP-PHEP Supplemental Guidelines.

PHEP Evaluation and Performance Measurement Strategy
CDC’s evaluation and performance monitoring strategy will assess progress made across the six
domains, and their related strategies, activities, and outcomes described in this announcement. CDC
will deploy several methods for assessing awardee performance throughout this five-year project
period, including collection of process measures, reports, and program and performance measures.

76

Process Measurement
CDC will measure PHEP awardee progress using a variety of standard reports and systematic
approaches. These include but are not be limited to the following elements.
1. Annual CPG status reports: Awardee self-assessments report three process measures for each
capability function:
 Function importance
 Function status
 Function challenges and barriers
2. MCM ORR data: Information will inform operational process measures related, but not limited, to:


Staffing
o Core staff plans, vacancies, and training
o First responder plans, staffing, and training
o Volunteer plans, staffing, and training



Planning and performance resources
o JRA process, timeframe, and plans
o At-risk population risk assessment and plans
o Drills, Exercises, and Incidents



Equipment
o

Inventory and function

CDC plans to expand the ORR to encompass measurement of all hazards for all public health
preparedness capabilities. Implementation of the ORR for all hazards will be introduced over the
project period. PHEP awardees will be expected to achieve or make substantial progress toward
achieving a status level of “established.” CDC will provide assistance as necessary to assure that
awardees conduct assessments and submit data for all local CRI planning jurisdictions within the
required time-frame.
3. Annual technical assistance plans. Developed in consultation with PHEP and MCM specialists,
technical assistance plans will be used to evaluate progress in addressing gaps identified through
the MCM ORR process, including gaps in pandemic influenza preparedness. Periodic updates will be
required to track progress on addressing identified gaps and to ensure that awardees meet the CDC
standard of achieving an overall status level of “established” by the end of this five-year project
period.

77

4. Additional Process measures: CDC requires timely submission of all required progress reports,
financial reports, and other program deliverables. In addition, awardees will report on the following
specific process measures on key program requirements and deliverables.
 Number of times a year that a jurisdiction activated (partial or full activation) the public health
emergency operations center (EOC) or state EOC (when public health is involved)
 Percent of funds that are allocated to local and tribal health departments
 Successful completion of a jurisdictional JRA
 Number of days from the start of the budget period to execution of subawardee contracts to
local/tribal public health if applicable (not during an emergency)
 Number of days from the start of the budget period to execution of subawardee contracts to
local/tribal public health during a public health incident where there is CDC emergency
supplemental funding (if applicable)
 Number of days from CDC funding for Ebola and Zika response to executing subawardee
contracts to local/tribal public health (if applicable)
 Development and submission of a jurisdictional plan that ensures emergency funding moves
quickly through the state (or local) fiscal systems and reaches the impacted population in time
to achieve the maximum public health impact.
 Percent of funds that are left unspent by the end of the two-year budget spend-down period.
 Successful completion and submission of MYTEPs, ARR/IPs, and pandemic influenza
requirements.
Outcome Measurement
In addition to the process performance measures and reports described, PHEP awardees must submit
outcome performance measures over the five-year project period. These are measures related to the
short-term outcomes depicted in the logic model and described in the narrative approach. CDC will
aggregate selected outcome measures reported by awardees into a program measure that presents a
national picture of preparedness to include (but not limited to:


Timely assessment and sharing of essential elements of information
o Joint Program Measure 1: Percent of awardees effectively using information sharing to
respond to an emergency or exercise.


PHEP Performance Measure: Percent of awardees that receive requested updates
about E. coli lab data (required to test epidemiology and laboratory communication)
or a related real incident.
Target time for requested information: 45 minutes (New measure).



Earliest possible identification and investigation of an incident
o Program Measure 1: Percent of awardees that receive reports for E. coli STEC (shiga toxinproducing E. coli) within seven days.
78



PHEP Performance Measure: Percentage of E. coli STEC reports received by a public
health agency within seven days (PHEP 13.1).

o Program Measure 2: Percent of awardees that meet target response time of 45 minutes or
less for laboratory/epidemiologist emergency on-call contact drill.


PHEP Performance Measure: Time to complete notification in both directions
between CDC, on-call laboratorian, and on-call epidemiologist (PHEP 12.2).

o Program Measure 3: Percent of awardees that pass all biological laboratory samples.



PHEP Performance Measure: Proportion of LRN-B proficiency tests successfully
passed by PHEP-funded laboratories (PHEP 12.11, PHEP Benchmark).

Timely implementation of intervention and control measures
o Program Measure 4: Percent of awardees that initiate control measures for E. coli, within
three days of initial case identification.




PHEP Performance Measure: Percentage of E. coli reports that met the target for
initiating control measures within three days of initial case identification (PHEP
13.2).

Timely communication of situational awareness and risk information by partners
o Program Measure 5: Percent of awardees that use partners as channels of distribution for
emergency information.




PHEP Performance Measure: TBD

Continuity of emergency operations throughout the surge of an emergency or incident
o Program measure 6: Percent of awardees that assemble pre-identified staff required to
cover a public health incident in 60 minutes or less.


PHEP Performance Measure: 60 minutes or less for pre-identified staff covering
activated public health agency incident management lead roles to report for duty
(PHEP 3.1).

o Potential Additional Program Measure: TBD


Timely coordination and support of response activities with healthcare and other partners
o Program Measure 7: Percent of awardees that have plans, processes, and procedures in
place to manage volunteers supporting an emergency or incident.


PHEP Performance Measure: Plans, processes, and procedures are in place to
manage volunteers who support an emergency or health incident.

o Joint Program Measure 2: Percent of awardees able to request, activate, and deploy
volunteers appropriately within requested time (HPP-PHEP 15.1).
79



PHEP Performance Measure: Percentage of volunteers deployed in appropriate time
to support an incident or exercise (formerly HPP-PHEP 15.1).
Target time for volunteers to activate and deploy: TBD



Continuous learning and improvements are systematic
o Program/Process Measure 8: Percent of awardees with a progressive planning, drill and
exercise review process using HSEEP principles in place.


PHEP Performance Measure: TBD

PHEP Budget Period 1 Benchmarks Subject to Withholding
Based on the process measures and outcome measures presented earlier, CDC will continue to set
PHEP benchmarks and collect data accordingly; CDC may revise the PHEP benchmarks over the course
of the project period. Additionally, CDC will continue to collect data for the Government Performance
and Results act (GPRA) measures, which may also be revised during this project period. These include
PHEP 3.1 (GPRA); PHEP 12.5 (PHEP Benchmark), 12.6 (PHEP Benchmark), 12.7 (PHEP Benchmark),
12.14 (GPRA), and 12.15.
CDC has identified the following fiscal year 2017 benchmarks for Budget Period 1 to be used as a basis
for withholding of fiscal year 2018 funding for PHEP awardees. Awardees that fail to “substantially
meet” the benchmarks are subject to withholding penalties to be applied the following fiscal year.
Awardees that demonstrate achievement of these requirements are not subject to withholding of
funds.
PHEP Budget Period 1 Benchmarks Subject to Withholding
PHEP
Benchmark
1

Awardees must demonstrate capability to receive, stage, store, distribute, and
dispense material during a public health emergency. This benchmark applies to all 62
awardees. In Budget Period 1: 100% of PHEP awardees must complete and submit:



MCM operational readiness review self-assessment data;
Status reports demonstrating significant annual progress in mitigating
MCM gaps identified through the MCM ORR process, including gaps in
pandemic influenza preparedness; and
 Review 50% of local CRI planning jurisdictions and provide ORR data for
each review. Such updates are required to track progress on addressing
identified gaps.
In subsequent budget periods, 100% of PHEP awardees must submit annual status
reports that demonstrate they continue to make measurable progress in mitigating
MCM gaps identified through their most recent MCM ORR findings, including gaps in
pandemic influenza preparedness to ensure that awardees meet the CDC standard of
achieving an overall status level of “established” by the end of this five-year project
period.

80

PHEP Budget Period 1 Benchmarks Subject to Withholding
By the end of Budget Period 5, June 30, 2022, 100% of PHEP awardees must achieve
an overall status level of “established” for MCM operational readiness.
PHEP
Benchmark
2

Awardees must demonstrate that Laboratory Response Network laboratories
biological (LRN-B) can pass proficiency testing which includes the ability to receive,
test, and report on one or more suspected biological agents. This benchmark applies
to the 50 states and Los Angeles County, New York City, and Washington, D.C.
PHEP-funded LRN-B laboratories cannot fail more than one proficiency test challenge
during Budget Period 1. Successful demonstration of this capability is defined by the
LRN-B proficiency testing policy. CDC will use these elements to determine if the
awardee met this benchmark:


Number of LRN-B proficiency tests successfully passed by the PHEP-funded
laboratory during any attempt, including remediation, if applicable



Number of LRN-B proficiency tests participated in by the PHEPfunded laboratory, including remediation, if applicable

CDC’s LRN-B program office requires state public health laboratories to participate in
all available proficiency testing challenges specific to each laboratory’s testing
capability; if a laboratory has testing capability for a specific agent and a proficiency
testing challenge for that agent is being offered, the PHEP-funded laboratory must
participate in that proficiency testing challenge. PHEP-funded laboratories that are
offline for extended periods, undergoing renovation, or have other special
circumstances are not expected to have their proficiency testing challenges
completed by partner or back-up labs (such as municipal labs or labs in neighboring
states). Instead, those laboratories are expected to report to the LRN-B program
office what they would do in real situations had the proficiency testing challenge
been associated with a true emergency event. In such a circumstance, this will not
adversely affect an awardee in terms of determining whether this benchmark has
been met.
PHEP
Benchmark
3

Awardees must ensure that at least one LRN chemical (LRN-C) laboratory in their
jurisdictions passes the LRN-C specimen packaging, and shipping (SPaS) exercise. This
benchmark applies to the 50 states and the directly funded localities of Los Angeles
County, New York City, and Washington, D.C.;


This annual exercise evaluates the ability of a laboratory to collect relevant
samples for clinical chemical analysis and ship those samples in compliance with
International Air Transport Association regulations. Awardees must ensure at
least one LRN-C laboratory passes CDC’s SPaS exercise. If a laboratory fails the
exercise on its first attempt but passes on the second attempt, then the awardee
will meet the benchmark. If a PHEP awardee has multiple laboratories, at least
one laboratory must participate and pass. To pass, a laboratory must score at
least 90% on a SPaS exercise.

81

PHEP Budget Period 1 Benchmarks Subject to Withholding
PHEP
Benchmark
4

Awardees must demonstrate that Laboratory Response Network laboratories
chemical (LRN-C) can pass proficiency testing. This benchmark applies to the 10
awardees with Level 1 laboratories: California, Florida, Massachusetts, Michigan,
Minnesota, New Mexico, New York, South Carolina, Virginia, and Wisconsin.


Awardees must ensure that LRN-C laboratories pass 90% of the proficiency
testing in core and additional analysis methods to meet the CDC benchmark
requirement. Although this benchmark does not apply to awardees with Level 2
laboratories, awardees with Level 2 laboratories must report on LRN-C proficiency
testing performance measures as specified in PHEP performance measure and
specifications guidance. Successful demonstration of this capability is defined by
the LRN-C proficiency testing policy. CDC will use these elements to determine if
awardees met this benchmark:
o Number of LRN-C proficiency tests successfully passed by the PHEPfunded laboratory, during any attempt, including remediation, if
applicable
o Number of LRN-C proficiency tests participated in by the PHEP-funded
laboratory, including remediation, if applicable

The LRN-C conducts proficiency testing for all Level 1 and Level 2 chemical
laboratories to support meeting the regulatory requirements for the reporting of
patient results as part of an emergency response program. Each high complexity test
is proficiency tested three times per budget period and each laboratory is evaluated
on the ability to report accurate and timely results through secure electronic
reporting mechanisms.
Pandemic
Influenza
Planning

All 62 PHEP awardees must have updated plans describing activities they will conduct
with respect to pandemic influenza as required by Sections 319C-1 of the PHS Act.
PHEP awardees must meet this annual requirement through their participation in
CDC’s MCM operational readiness review process, which will incorporate pandemic
influenza elements and mass vaccination requirements into the ORR tool. In addition,
awardees must address pandemic influenza planning gaps as part of their medical
countermeasure technical assistance action plans.

82

Criteria to Determine Potential Withholding of PHEP Fiscal Year 2018 Funds

Benchmark Measure
Did the awardee (all awardees) demonstrate capability to
receive, stage, store, distribute, and dispense material
during a public health emergency?
Did the applicable awardee demonstrate proficiency in
public health laboratory testing and/or exercises for
biological agents?
Did the applicable awardee demonstrate proficiency in
public health laboratory specimen packaging, and shipping
exercises for chemical agents?
Did the applicable awardee demonstrate proficiency in
public health laboratory testing for chemical agents?
Did the awardee (all awardees) meet the 2017 pandemic
influenza plan requirement?
Total Potential Withholding Percentage

Yes

No

Possible %
Withholding

10%

10%
20%

Scoring Criteria
The first four benchmarks are weighted the same, so failure to substantially meet any one of the four
benchmarks will count as one failure and result in withholding of 10% of the fiscal year 2018 PHEP
award. Failure to meet the pandemic influenza preparedness planning requirement may result in
withholding of 10% of the fiscal year 2018 PHEP award.
ii. Applicant Evaluation and Performance Measurement Plan

At the time of application, awardees must include in their project narrative a brief description of how
they plan to fulfill the requirements described in the ASPR-CDC Evaluation and Performance
Measurement and Project Description sections of this FOA, Awardees also must briefly outline the
scope of work, planned activities, and intended outcomes of work performed via subawardee
contracts, per domain. This document should be approved by the local jurisdictions whose work it
represents.
Awardees are required to submit, within the first six months of award, a brief evaluation and
performance measurement plan, including a DMP, as described in the Reporting section of this FOA.
ASPR and CDC do not require awardees to follow a specific evaluation template and will provide more
specific guidance prior to the deadline. ASPR and CDC recommend that awardees develop a five-year
evaluation plan that will evaluate interim progress including subawardee and local monitoring
annually.

83

c. Organizational Capacity of Awardees to Implement the Approach

Awardees must indicate their organizational capacity to implement the required activities, providing
information that:


Demonstrates the organizational capacity and skills to implement the award including public health
emergency management, incident management and response leadership, program planning,
program evaluation, performance monitoring, financial reporting, budget management and
administration, and personnel management.



Demonstrates existing organizational capacity, for example, program and staffing management;
performance measurement and evaluation systems; financial reporting systems; communication,
technological, and data systems required to implement the activities in an effective manner;
physical infrastructure and equipment; and workforce capacity, to successfully execute all
proposed strategies and activities to meet the program requirements.
Demonstrates the organizational capacity to manage partnerships with local health departments
and tribal entities in the jurisdiction regarding preparedness activities.




Describes their current status in applying for public health department accreditation or evidence of
accreditation. Information on accreditation may be found at http://www.phaboard.org.

In addition, awardees must provide current organizational charts for the HPP and PHEP programs.
d. Work Plan

Awardees must develop and submit detailed work plans for the first year of the project and a highlevel work plan for subsequent years. The high-level plan should crosswalk to the strategies and
activities, outcomes, and evaluation and performance measures described in the FOA. Awardees must
describe in their HPP and PHEP Budget Period 1 domain work plans their planned activities for
addressing the Strategies and Activities described in the ASPR-CDC Project Description, including:


Domains and aligned capabilities



Strategies and proposed activities



Program requirements and recommendations

Domains and Aligned Capabilities
ASPR and CDC expect HPP and PHEP awardees to continue efforts to build and sustain the public health
and health care preparedness capabilities through a revised format that groups the capabilities into
domains. Domains are groupings of capabilities that highlight significant dependencies between
capabilities for preparedness and response. Awardees can strengthen a domain by selecting domain
activities that align to strategies, which are derived from the HPP-PHEP logic model; or awardees can
add new and unique activities that will assist them in strengthening or sustaining a strategy. ASPR and
CDC expect that these core domain activities, at a minimum, will help awardees to achieve
84

preparedness and response outputs and outcomes. ASPR and CDC recommend awardees approach the
development of their work plans based on the most recently completed CPG self-assessment that
incorporates their current jurisdictional risk assessments and priorities (jurisdictional HVA, JRA, or
THIRA as well as state-specific data in the NHSPI). Awardees must also ensure planned activities adhere
to PHS Act, HPP, PHEP, and joint program requirements. ASPR and CDC encourage awardees to build
and sustain each capability to the scale that best meets their jurisdictional needs, so they are fully
capable of responding to public health emergencies, regardless of size or scenario.
A completed work plan for Budget Period 1 requires awardees to select each Domain Summary; the
related Strategy; provide a Planned Activity Type; and, if funds are associated, then select and add the
Associated Planned Activities. The following section describes the work plan components.
1) A chosen planned activity type for each capability, using one of the following options:


Build



Sustain



Scale back



No planned activities for Budget Period 1

If “sustain” is selected, awardees must identify in the short-term goal what level of sustainment or
target is desired during Budget Period 1.
2) If there are no planned activities, awardees must:


Identify any challenges or barriers that may have led to having no planned activities for Budget
Period 1.



Indicate and describe, if applicable, any self-identified technical assistance needs for the
capability.

3) Funding information
Awardees must select one of the following sources of funding for each capability with planned
activities:


HPP



PHEP



Other funding source (state, local, DHS, other)

Any capability with functions or objectives supported by HPP or PHEP funding must have at least one
line item associated with that function or objective in the budget.
4) Domain strategies and activities
Awardees should select the domain activities that best represent their approach to strengthening the
domain.
85



Select from the predefined list of domain activities or create jurisdiction-specific activities (see
Domain Activities section).



From there, awardees list the specific steps they plan to conduct to complete the domain
activity with associated timelines (see Planned Activities section).



Select capability functions or objectives to guide planned activities



List proposed outputs resulting from the planned activities.



Select the requirement(s) or recommendation(s) addressed by this domain activity.

Planned activities should describe specific actions that support the completion of a domain activity.
When reading the planned activities, the following should be easily determined: what will be
completed and by what quarter. Not all activities should be completed in the fourth quarter. It is
expected that if the activity will be conducted by local health agencies that assist the awardee in
reaching or sustaining a strategy then those activities should be aggregated and documented in this
section. Planned activities should lead to measurable outputs linked to program activities and
outcomes.
5)

Proposed outputs
Awardees must provide at least one proposed output. The proposed outputs should directly
relate to the expected results of completing the planned activities.

6)

Function/Objective association
Awardees must associate planned activities with functions or objectives for the related
strategy.

7)

Technical assistance
Awardees should indicate if technical assistance is requested for the strategy.

Awardees must submit the following work plan components.




Program Requirements Summary: Awardees must complete the HPP and PHEP Program
Requirements sections in the funding application module. See the strategies and activities
section of this FOA (and the 2017-2022 HPP-PHEP Supplemental Guidelines for more
information.
Subawardee Contracts (if applicable)

Work plans should address all CDC-RFA-TP17-1701 program outcomes, strategies, and activities and
reflect incorporation of all CDC-RFA-TP17-1701 general program requirements. Awardees must
describe how they plan to address and monitor each program outcome, strategy, and activity. ASPR
and CDC encourage awardees to build and sustain each capability to the scale that best meets their
jurisdictional needs, so they are fully capable of responding to public health emergencies, regardless of
size or scenario.
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PHEP awardees have the flexibility to choose the specific capabilities they address in a single budget
period. The overarching PHEP program goal is to achieve the greatest degree of readiness to respond
using their available resources. CDC encourages awardees to build and maintain each capability to the
scale that best meets their jurisdictional needs, so they are fully capable of responding to public health
emergencies, regardless of size or scenario.
HPP awardees are expected to build and sustain capability-based HPP or joint requirements within the
domain structure as described in this FOA. Awardees have some flexibility to choose the specific
requirements to work on during each budget period. However, awardees must plan activities
accordingly to meet FOA requirements, including product submissions and performance measure due
dates as described.

e. ASPR and CDC Monitoring and Accountability Approach

Monitoring activities include routine and ongoing communication between ASPR, CDC and awardees,
site visits, and awardee reporting (including work plans, performance, and financial reporting).
Consistent with applicable grants regulations and policies, ASPR and CDC expect the following to be
included in post-award monitoring for grants and cooperative agreements:
• Tracking awardee progress in achieving the desired outcomes.
• Ensuring the adequacy of awardee systems that underlie and generate data reports.
• Creating an environment that fosters integrity in program performance and results.
Monitoring may also include the following activities deemed necessary to monitor the award:
• Ensuring that work plans are feasible based on the budget and consistent with the intent of the
award.
• Ensuring that awardees are performing at a sufficient level to achieve outcomes within stated
timeframes.
• Working with awardees on adjusting the work plan based on achievement of outcomes,
evaluation results and changing budgets.
• Monitoring performance measures (both programmatic and financial) to assure satisfactory
performance levels.
Monitoring and reporting activities also assist grants management staff (e.g., grants management
officers and specialists, and project officers) in the identification, notification, and management of
high-risk awardees.
In addition to the general approach noted above, HPP and PHEP program staff specifically:



Monitor adherence to all relevant PHS, HHS, ASPR, and CDC rules, regulations and policies
regarding cooperative agreements.
Identify, coordinate, and provide technical assistance planning and consultation.

ASPR and CDC staff will actively work with HPP and PHEP awardees to develop individualized technical
assistance plans using standardized formats and processes. The plans will focus on technical assistance
87

needs identified jointly by awardees and program staff, as well as strategies for addressing those
needs. Project officers and awardees will monitor technical assistance plans on a regular basis.
Technical assistance can be provided on a variety of topics, including but not limited to:
 Facilitating access to ASPR and CDC preparedness subject matter experts in areas such as
medical surge, volunteer management, laboratory testing, epidemiology and surveillance,
environmental health, emergency operations management, and medical countermeasure
logistics.
 Translating promising or useful practices for dissemination to the field.
 Providing technical assistance on achievement of performance measures and benchmarks.
 Providing guidance on demonstrating achievement of capabilities and using quality
improvement-focused processes to document the process, especially for MCM-related
capabilities.
 Cooperative agreement fiscal management.
The strategy for monitoring and technical assistance planning requires regular contact such as monthly
conference calls, email conversations, and site visits every 12 months to 24 months. HPP and PHEP
project officers will conduct scheduled site visits to assess the strategies used to reach and maintain
capability in the domains. This includes noting the progress and challenges of awardees, and their
subawardees and providing technical assistance. HPP and PHEP site visits will be coordinated with
ASPR’s regional emergency coordinators (RECs) and conducted jointly whenever possible. Awardees
must be actively involved in the planning and execution of site visits and make available all program
documentation that substantiates achievement of capabilities and other programmatic requirements,
including all-hazards public health emergency preparedness and response plans.

f. ASPR and CDC Program Support to Awardees

In a cooperative agreement, ASPR and CDC staff are substantially involved in the program activities,
above and beyond routine grant monitoring. Project officers and subject matter experts will review
applications to ensure activities are in scope and do not duplicate those funded by other grants and
cooperative agreements. ASPR and CDC will use application submission information to identify
strengths and weaknesses, to update work plans, and to establish priorities for site visits and technical
assistance. To assist recipients in achieving the purpose of this award, ASPR and CDC will conduct the
following activities.





Provide ongoing guidance, programmatic support, and training and technical assistance as
related to health care and public health emergency preparedness.
Provide ongoing guidance, programmatic support, and training and technical assistance as
related to activities outlined in this FOA. Technical assistance resources include 2017-2022
HPP-PHEP Supplemental Guidelines, Budget Period 1 application instructions, spend plan
templates, and other resources as needed.
Facilitate communication among awardees to advance the sharing of expertise on
preparedness and response activities.
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



ASPR’s (TRACIE) provides ongoing technical assistance and resources for developing the
capabilities.
CDC’s (On-TRAC) facilitates technical assistance for public health preparedness planning and
response.
The Health Care Coalition Response Leadership Course sponsored by the Centers for
Domestic Preparedness in Anniston, Ala., will be available to HCCs to provide guidance and
training. Travel, lodging, and training costs will be covered by the Center for Domestic
Preparedness. Awardees and HCCs do not need to budget for these travel and training
costs.

B. Award Information
1. Funding Instrument Type:

Cooperative Agreement
ASPR’s and CDC's substantial involvement in this program appears in the ASPR and CDC Program
Support to Awardees section.
2. Award Mechanism:
U90
3. Fiscal Year:

2017
4. Approximate Total Fiscal Year Funding:

Hospital Preparedness Program: $228,500,000
Public Health Emergency Preparedness Program: $611,750,000
5. Approximate Project Period Funding:

$4,201,250,000, subject to the availability of funds.
6. Total Project Period Length:

Five years
7. Expected Number of Awards:

62
62 awardees includes:


States: 50
89




Localities: (4) Chicago, Los Angeles County, New York City, and Washington, D.C.
Territories and freely associated states: (8) American Samoa, Commonwealth of the
Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico, Republic
of the Marshall Islands, Republic of Palau, and U.S. Virgin Islands

8. Approximate Average Award:

PHEP: Approximately $10 million
HPP: Approximately $5.7 million
These amounts are for the first 12-month budget period and include both direct and indirect costs
9. Award Ceiling:

This amount is subject to the availability of funds.
10. Award Floor:

Set by formula established under section 319C-1(h) of the PHS Act.
11. Estimated Award Date:

July 1, 2017
12. Budget Period Length:

12 months.
Throughout the project period, ASPR and CDC will continue the award based on the availability of
funds, the evidence of satisfactory progress by the awardee (as documented in required reports), and
the determination that continued funding is in the best interest of the federal government. The total
number of years for which federal support has been approved (project period) will be shown in the
“Notice of Award.” This information does not constitute a commitment by the federal government to
fund the entire period. The total project period comprises the initial competitive segment and any
subsequent non-competitive continuation award(s).
13. Direct Assistance

Direct assistance (DA) is available through this FOA. Consistent with the cited authority for this
announcement, direct assistance may be available in the form of equipment, supplies and materials,
and/or federal personnel. If DA is provided as a part of your award, CDC will reduce the financial
assistance award amount provided directly to you as a part of your award. The amount by which your
award is reduced will be used to provide DA; the funding shall be deemed part of the award and as
having been paid to you, the awardee.
Awardees planning to request DA in lieu of financial assistance should complete and submit the DA
request form no later than November 16, 2017. Note that DA may be requested for personnel, such as
public health advisors, Career Epidemiology Field Officers, informatics specialists, or other technical
90

consultants), provided the work is within scope of the cooperative agreements and is financially
justified. DA also may be requested for any Statistical Analysis Software (SAS) licenses desired for
future budget periods.

C. Eligibility Information
1. Eligible Applicants

Government Organizations:
 States: 50
 Local governments or their bona fide agents: (4) Chicago, Los Angeles County, New York
City, and Washington, D.C.
 Territorial governments or their bona fide agents and freely associated states: (8) American
Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia,
Guam, Puerto Rico, Republic of the Marshall Islands, Republic of Palau, and U.S. Virgin
Islands
2. Additional Information on Eligibility

Eligible applicants for this funding opportunity announcement are limited to those currently funded
under CDC-RFA-TP12-1201, the Hospital Preparedness Program (HPP) and Public Health Emergency
Preparedness (PHEP) Cooperative Agreement.
3. Justification for Less than Maximum Competition

As defined in sections 319C-1 and 319C-2 of the PHS Act, eligible applicants for this funding
opportunity are states, a consortium of states, or eligible political subdivisions that prepare and submit
a sufficient application compliant with the statutory and administrative requirements described in this
document. For the purposes of this announcement, the term “state” may include a state, territory, or
freely associated state.
4. Cost Sharing or Matching

ASPR and CDC may not award a cooperative agreement to a state or consortium of states under these
programs unless the awardee agrees that, with respect to the amount of the cooperative agreements
awarded by ASPR and CDC, the state will make available nonfederal contributions in the amount of
10% ($1 for each $10 of federal funds provided in the cooperative agreement) of the award.
Match may be provided directly or through donations from public or private entities and may be in
cash or in kind, fairly evaluated, including plant, equipment or services. Amounts provided by the
federal government or services assisted or subsidized to any significant extent by the federal
government may not be included in determining the amount of such nonfederal contributions.
Please refer to 45 CFR § 75.306 for match requirements, including descriptions of acceptable match
resources. Documentation of match, including methods and sources, must be included in the Budget
Period 1 application for funds, follow procedures for generally accepted accounting practices, and
meet audit requirements
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Exceptions to Matching Funds Requirement
 The match requirement does not apply to the political subdivisions of Chicago, Los Angeles County,
or New York City.
 Pursuant to department grants policy implementing 48 U.S.C. 1469a(d), any required matching
(including in-kind contributions) of less than $200,000 is waived with respect to cooperative
agreements to the governments of American Samoa, Guam, U.S. Virgin Islands, or Northern
Mariana Islands (other than those consolidated under other provisions of 48 U.S.C. 1469). For
instance, if 10% (the match requirement) of the award is less than $200,000, then the entire match
requirement is waived. If 10% of the award is greater than $200,000, then the first $200,000 is
waived, and the rest must be paid as match.
 The match requirement is also waived for the freely associated states, including the Republic of
Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands.
 Matching does not apply to future contingent emergency response awards that may be authorized
under 311, 317(a), and 317(d) of the Public Health Service Act unless such a requirement were
imposed by statute or administrative process at the time.

5. Maintenance of Effort

Awardees must maintain expenditures for health care preparedness and public health security at a
level that is not less than the average level of such expenditures maintained by the awardee for the
preceding two-year period. This represents an awardee’s historical level of contributions or
expenditures (money spent) related to federal programmatic activities that have been made prior to
the receipt of federal funds. The maintenance of effort (MOE) is used as an indicator of nonfederal
support for public health security and health care preparedness before the infusion of federal funds.
These expenditures are calculated by the awardee without reference to any federal funding that also
may have contributed to such programmatic activities in the past. The definition of eligible state
expenditures for public health security and health care preparedness includes:
 Appropriations specifically designed to support health care or public health emergency
preparedness as expended by the entity receiving the award; and
 Funds not specifically appropriated for health care or public health emergency preparedness
activities but which support health care or public health emergency preparedness activities, such as
personnel assigned to health care or public health emergency preparedness responsibilities or
supplies or equipment purchased for health care or public health emergency preparedness from
general funds or other lines within the operating budget of the entity receiving the award.
Awardees must stipulate the total dollar amount in their cooperative agreement funding applications.
Awardees must be able to account for MOE separate from accounting for federal funds and separate
from accounting for any matching funds requirements; this accounting is subject to ongoing
monitoring, oversight, and audit. MOE may not include any subawardee matching funds requirement
where applicable.
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MOE does not apply to future contingent emergency response awards that may be authorized under
311, 317(a), and 317(d) of the Public Health Service Act unless such a requirement were imposed by
statute or administrative process at the time.
Note: This funding opportunity announcement uses one term that applies to both maintenance of
funding (MOF) and maintaining state funding (MSF). Section 319C-1 requires PHEP awardees to
maintain expenditures for public health security. Section 319C-2 requires HPP awardees to maintain
expenditures for health care preparedness. This provision addresses both requirements.

D. Application and Submission Information
1. Required Registrations

An organization must be registered at the three following locations before it can submit an application
for funding at www.grants.gov.
a. Data Universal Numbering System:
All applicant organizations must obtain a Data Universal Numbering System (DUNS) number. A
DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It
will be used as the Universal Identifier when applying for federal awards or cooperative agreements.
The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free)
or internet at http://fedgov.dnb.com/webform/displayHomePage.do. The DUNS number will be
provided at no charge. If funds are awarded to an applicant organization that includes subawardees,
those subawardees must provide their DUNS numbers before accepting any funds.
b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which
an entity must submit information required to conduct business as an awardee. All applicant
organizations must register with SAM, and will be assigned a SAM number. All information relevant to
the SAM number must be current at all times during which the applicant has an application under
consideration for funding by CDC. If an award is made, the SAM information must be maintained until a
final financial report is submitted or the final payment is received, whichever is later. The SAM
registration process can require 10 or more business days, and registration must be renewed annually.
Additional information about registration procedures may be found at www.SAM.gov.
c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov,
the official HHS E-grant Web site. Registration information is located at the “Get Registered” option
at www.grants.gov.
All applicant organizations must register at www.grants.gov. The one-time registration process usually
takes not more than five days to complete. Applicants should start the registration process as early as
possible.

93

Step
1

2

3

System
Data
Universal
Number
System
(DUNS)

Requirements
1. Click on
http://fedgov.dnb.com/webf
orm
2. Select Begin DUNS
search/request process
3. Select your country or
territory and follow the
instructions to obtain your
DUNS 9-digit #
4. Request appropriate staff
member(s) to obtain DUNS
number, verify & update
information under DUNS
number
System for
1. Retrieve organizations
Award
DUNS number
Management 2. Go to www.sam.gov and
(SAM)
designate an E-Biz POC (note
formerly
CCR username will not work
Central
in SAM and you will
Contractor
need to have an active SAM
Registration account before you can
(CCR)
register on grants.gov)
Grants.gov
1. Set up an individual
account in Grants.gov using
organization new DUNS
number to become an
authorized organization
representative (AOR)
2. Once the account is set up
the E-BIZ POC will be notified
via email
3. Log into grants.gov using
the password the E-BIZ POC
received and create new
password
4. This authorizes the AOR to
submit applications on
behalf of the organization

Duration
1-2 Business
Days

Follow Up
To confirm that you have
been issued a new DUNS
number check online at
(http://fedgov.dnb.com/
webform) or call 1-866705-5711

3-5 Business
Days but up to 2
weeks and must
be renewed
once a year

For SAM Customer
Service Contact
https://fsd.gov/fsdgov/home.do Calls: 866606-8220

Same day but
can take 8 weeks
to be fully
registered and
approved in the
system (note,
applicants MUST
obtain a
DUNS number
and SAM
account before
applying on
grants.gov)

Register early! Log into
grants.gov and check AOR
status until it shows you
have been approved

94

2. Request Application Package
Applicants may access the application package at www.grants.gov.
3. Application Package
Applicants must download the SF-424, Application for Federal Assistance, package associated with
this funding opportunity at www.grants.gov. If Internet access is not available, or if the online forms
cannot be accessed, applicants may call the CDC OGS staff at 770-488-2700 or e-mail OGS
[email protected] for assistance. Persons with hearing loss may access CDC telecommunications at
TTY 1-888-232-6348.
4. Submission Dates and Times
If the application is not submitted by the deadline published in the FOA, it will not be processed. Office
of Grants Services (OGS) personnel will notify the applicant that their application did not meet the
deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission
Requirements section for additional details). If the applicant is authorized to submit a paper
application, it must be received by the deadline provided by OGS.
a. Letter of Intent Deadline (must be emailed or postmarked by)

N/A
b. Application Deadline

April 4, 2017, 5 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and
cannot receive applications, and circumstances preclude advance notification of an extension, then
applications must be submitted by the first business day on which grants.gov operations resume.
Date for Information Conference Call

Wednesday, February 8, 1:30 p.m. to 3 p.m. EST
Monday, February 13, 1:30 p.m. to 3 p.m. EST
5. CDC Assurances and Certifications
All applicants are required to sign and submit “Assurances and Certifications” documents indicated
at http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx.
Applicants may follow either of the following processes:
• Complete the applicable assurances and certifications with each application submission, name
the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov
• Complete the applicable assurances and certifications and submit them directly to CDC on an
annual basis at
http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx
Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply
to all applications submitted to CDC by the applicant within one year of the submission date.
95

6. Content and Form of Application Submission
Applicants are required to include all of the following documents with their application package
at www.grants.gov.
7. Letter of Intent
LOI is not requested or required as part of the application for this FOA.
8. Table of Contents

(There is no page limit. The table of contents is not included in the project narrative page limit.): The
applicant must provide, as a separate attachment, the “Table of Contents” for the entire submission
package.
Provide a detailed table of contents for the entire submission package that includes all of the
documents in the application and headings in the "Project Narrative" section. Name the file "Table of
Contents" and upload it as a PDF file under "Other Attachment Forms" at www.grants.gov.
9. Project Abstract Summary
(Maximum 1 page)
A project abstract is included on the mandatory documents list and must be submitted
at www.grants.gov. The project abstract must be a self-contained, brief summary of the proposed
project including the purpose and outcomes. This summary must not include any proprietary or
confidential information. Applicants must enter the summary in the "Project Abstract Summary" text
box at www.grants.gov.
10. Project Narrative
(Unless specified in the "H. Other Information" section, maximum of 20 pages, single spaced, 12 point
font, 1-inch margins, number all pages. This includes the work plan. Content beyond the specified page
number will not be reviewed.)
Applicants must submit a Project Narrative with the application forms. Applicants must name this file
“Project Narrative” and upload it at www.grants.gov. The Project Narrative must include all of the
following headings (including subheadings): Background, Approach, Applicant Evaluation and
Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach,
and Work Plan. The Project Narrative must be succinct, self-explanatory, and in the order outlined in
this section. It must address outcomes and activities to be conducted over the entire project period as
identified in the ASPR-CDC Project Description section. Failure to follow the guidance and format may
negatively impact scoring of the application.
a. Background
Applicants must provide a description of relevant background information that includes the context of
the problem (See ASPR-CDC Background).
b. Approach
i. Purpose
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Applicants must describe in 2-3 sentences specifically how their application will address the public
health problem as described in the ASPR-CDC Background section.
ii. Outcomes
Applicants must clearly identify the outcomes they expect to achieve by the end of the project period,
as identified in the logic model in the Approach section of the ASPR-CDC Project Description. Outcomes
are the results that the program intends to achieve and usually indicate the intended direction of
change (e.g., increase, decrease).
iii. Strategies and Activities
Applicants must provide a clear and concise description of the strategies and activities they will use to
achieve the project period outcomes. Applicants must select existing evidence-based strategies that
meet their needs, or describe in the Applicant Evaluation and Performance Measurement Plan how
these strategies will be evaluated over the course of the project period. See the Strategies and
Activities section of the ASPR-CDC Project Description.
1. Collaborations
Applicants must describe how they will collaborate with programs and organizations either internal or
external to ASPR and CDC. Applicants must address the Collaboration requirements as described in the
ASPR-CDC Project Description.
2. Target Populations and Health Disparities

Applicants must describe the specific target population(s) in their jurisdiction and explain how such a
target will achieve the goals of the award and/or alleviate health disparities. The applicants must also
address how they will include specific populations that can benefit from the program that is described
in the Approach section. Applicants must address the Target Populations and Health Disparities
requirements as described in the ASPR-CDC Project Description.
c. Applicant Evaluation and Performance Measurement Plan
At the time of application, awardees must include in their project narrative a brief description of how
they plan to fulfill the requirements described in the ASPR-CDC Evaluation and Performance
Measurement and Project Description sections of this FOA. Awardees also must briefly outline the
scope of work, planned activities, and intended outcomes of work performed via subawardee
contracts, per domain. This document should be approved by the local jurisdictions whose work it
represents.
Awardees are required to submit, within the first six months of award, a brief evaluation and
performance measurement plan, including a DMP, as described in the Reporting section of this FOA.
ASPR and CDC do not require awardees to follow a specific evaluation template and will provide more
specific guidance prior to the deadline. ASPR and CDC recommend that awardees develop a five-year
evaluation plan that will evaluate interim progress including subawardee and local monitoring
annually.
d. Organizational Capacity of Applicants to Implement the Approach
Applicants must address the organizational capacity requirements as described in the ASPR-CDC
Project Description, as well as provide copies of organizational charts for their HPP and PHEP programs.
97

Applicants must name this file “HPP Organizational Chart” and “PHEP Organizational Chart” and upload
them as PDF files at www.grants.gov.
11. Work Plan
(Included in the Project Narrative’s page limit)
Awardees must prepare a high-level work plan consistent with the ASPR-CDC Project Description Work
Plan section. The work plan integrates and delineates more specifically how the awardee plans to
achieve the project period outcomes, strategies and activities, evaluation and performance
measurement. Awardees must name this file “Work Plan” and upload it as a PDF file at
www.grants.gov.
In addition, awardees must submit more detailed HPP and PHEP Budget Period 1 work plans that
describe their planned activities for addressing the Strategies and Activities described in the ASPR-CDC
Project Description. Awardees must name these files HPP Domain Work Plan and PHEP Domain Work
Plan and upload as PDF flies at www.grants.gov.
12. Budget Narrative
Applicants must submit an itemized budget narrative. When developing the budget narrative,
applicants must consider whether the proposed budget is reasonable and consistent with the purpose,
outcomes, and program strategy outlined in the project narrative. The budget must include:
• Salaries and wages
• Fringe benefits
• Consultant costs
• Equipment
• Supplies
• Travel
• Other categories
• Contractual costs
• Total Direct costs
• Total Indirect costs
Indirect costs could include the cost of collecting, managing, sharing and preserving data.
Indirect costs will not be reimbursed under grants to foreign organizations, international organizations,
and foreign components of grants to domestic organizations (does not affect indirect cost
reimbursement to the domestic entity for domestic activities).
Expanded Authority for Unobligated Funds
In accordance with 45 CFR § 75.308(d), awardees are given expanded authority to carry forward
unobligated balances to the successive budget period without receiving prior approval from CDC’s
Office of Grants Services. The following restrictions apply with this authority.

98

1. The expanded authority can only be used to carry over unobligated balances from one budget
period to the next successive budget period. Any unobligated funds not expended in the
successive budget period must be deobligated and returned to the Treasury as required.
2. Extensions will not be allowed for the last 12 months of the budget/project period.
3. The recipient must report the amount carried over on the Federal Financial Report for the
period in which the funds remained unobligated.
4. This authority does not diminish or relinquish ASPR and CDC administrative oversight of the
HPP and PHEP programs. The ASPR and CDC program offices will continue to provide oversight
and guidance to the award recipients to ensure they are in compliance with statutes,
regulations, and internal guidelines.
5. The roles and responsibilities of the ASPR and CDC project officers will remain the same as
indicated in the terms and conditions of the award.
6. The roles and responsibilities of the grants management specialists in CDC’s Office of Grants
Services will remain the same as indicated in the terms and conditions of the award.
7. All other terms and conditions remain in effect throughout the budget period unless otherwise
changed in writing by the CDC grants management officer.
Note: Awardees are responsible for ensuring that all costs allocated and obligated are allowable,
reasonable, and allocable and in line with the goals and objectives outlined in CDC-RFA-TP17-1701 and
approved work plans.
Support for Accreditation Standards
PHEP awardees may use funds for activities as they relate to the intent of this FOA to meet national standards or
seek health department accreditation through the Public Health Accreditation Board
(see: http://www.phaboard.org).





Applicant entities to whom this provision applies include state, local, territorial governments
(including the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, the
Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated
States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau), or their
bona fide agents, political subdivisions of states (in consultation with states), federally
recognized or state-recognized American Indian or Alaska Native tribal governments, and
American Indian or Alaska Native tribally designated organizations.
Activities include those that enable a public health organization to deliver public health services
such as activities that ensure a capable and qualified workforce, up-to-date information
systems, and the capability to assess and respond to public health needs. Use of these funds
must focus on achieving a minimum of one national standard that supports the intent of the
FOA. Proposed activities must be included in the budget narrative and must indicate which
standards will be addressed.

Applicants must name this file “Budget Narrative” and upload it as a PDF file at www.grants.gov. If
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requesting indirect costs in the budget, a copy of the indirect cost-rate agreement is required. If the
indirect costs are requested, include a copy of the current negotiated federal indirect cost rate
agreement or a cost allocation plan approval letter for those Grantees under such a plan. Applicants
must name this file “Indirect Cost Rate” and upload it at www.grants.gov.
For guidance on completing a detailed budget, see Budget Preparation Guidelines at:
http://www.cdc.gov/grants/interestedinapplying/applicationresources.html.
13. Funds Tracking
Proper fiscal oversight is critical to maintaining public trust in the stewardship of federal funds.
Effective October 1, 2013, a new HHS policy on subaccounts requires the CDC to set up payment
subaccounts within the Payment Management System (PMS) for all new grant awards. Funds
awarded in support of approved activities and drawdown instructions will be identified on the Notice
of Award in a newly established PMS subaccount (P subaccount). Grantees will be required to draw
down funds from award-specific accounts in the PMS. Ultimately, the subaccounts will provide
grantees and CDC a more detailed and precise understanding of financial transactions. The
successful applicant will be required to track funds by P-accounts/sub accounts for each
project/cooperative agreement awarded.
Applicants are encouraged to demonstrate a record of fiscal responsibility and the ability to provide
sufficient and effective oversight. Financial management systems must meet the requirements as
described 2 CFR 200 which include, but are not limited to, the following:
 Records that identify adequately the source and application of funds for federally-funded activities.
 Effective control over, and accountability for, all funds, property, and other assets.
 Comparison of expenditures with budget amounts for each Federal award.
 Written procedures to implement payment requirements.
 Written procedures for determining cost allowability.
 Written procedures for financial reporting and monitoring.

14. Intergovernmental Review
Executive Order 12372 does not apply to this program.

15. Pilot Program for Enhancement of Employee Whistleblower Protections
Pilot Program for Enhancement of Employee Whistleblower Protections: All applicants will be
subject to a term and condition that applies the terms of 48 Code of Federal Regulations
(CFR) section 3.908 to the award and requires that grantees inform their employees in writing (in the
predominant native language of the workforce) of employee whistleblower rights and protections
under 41 U.S.C. 4712.
16. Copyright Interests Provisions
This provision is intended to ensure that the public has access to the results and accomplishments of
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public health activities funded by ASPR and CDC. Pursuant to applicable grant regulations and CDC’s
Public Access Policy, awardees agree to submit into the National Institutes of Health (NIH) Manuscript
Submission (NIHMS) system an electronic version of the final, peer-reviewed manuscript of any
such work developed under this award upon acceptance for publication, to be made publicly
available no later than 12 months after the official date of publication. Also at the time of
submission, awardees and/or the submitting authors must specify the date the final
manuscript will be publicly accessible through PubMed Central (PMC). Awardees and or submitting
authors must also post the manuscript through PMC within twelve (12) months of the
publisher's official date of final publication; however the author is strongly encouraged to make the
subject manuscript available as soon as possible. The awardee must obtain prior approval from the
CDC for any exception to this provision.
The author's final, peer-reviewed manuscript is defined as the final version accepted for journal
publication, and includes all modifications from the publishing peer review process, and all graphics
and supplemental material associated with the article. Awardees and submitting authors working
under this award are responsible for ensuring that any publishing or copyright agreements
concerning submitted articles reserve adequate right to fully comply with this provision and the
license reserved by CDC. The manuscript will be hosted in both PMC and the CDC Stacks
institutional repository system. In progress reports for this award, awardees must identify publications
subject to the CDC Public Access Policy by using the applicable NIHMS identification number for
up to three (3) months after the publication date and the PubMed Central identification number
(PMCID) thereafter.
17. Funding Restrictions
Restrictions that must be considered while planning the programs and writing the budget are:
 Awardees may not use funds for research.
 Awardees may not use funds for clinical care except as allowed by law. For the purposes of this
FOA, clinical care is defined as "directly managing the medical care and treatment of patients.”
 Awardees may use funds only for reasonable program purposes, including personnel, travel,
supplies, and services.
 Generally, awardees may not use funds to purchase furniture or equipment. Any such proposed
spending must be clearly identified in the budget.
 Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written
approval to the awardee.
 Other than for normal and recognized executive-legislative relationships, no funds may be used for:
o publicity or propaganda purposes, for the preparation, distribution, or use of any material
designed to support or defeat the enactment of legislation before any legislative body
o the salary or expenses of any grant or contract recipient, or agent acting for such recipient,
related to any activity designed to influence the enactment of legislation, appropriations,
regulation, administrative action, or Executive order proposed or pending before any
legislative body
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







o See Additional Requirement (AR) 12 for detailed guidance on this prohibition and additional
guidance on lobbying for CDC awardees (http://www.cdc.gov/grants/documents/AntiLobbying_Restrictions_for_CDC_Grantees_July_2012.pdf).
The direct and primary recipient in a cooperative agreement program must perform a substantial
role in carrying out project outcomes and not merely serve as a conduit for an award to another
party or provider who is ineligible.
Awardees may not use funds for construction or major renovations.
Awardees may supplement but not supplant existing state or federal funds for activities described
in the budget.
Payment or reimbursement of backfilling costs for staff is not allowed.
None of the funds awarded to these programs may be used to pay the salary of an individual at a
rate in excess of Executive Level II or $187, 000 per year.
Awardees may use funds only for reasonable program purposes, including travel, supplies, and
services.



Awardees may purchase basic (non-motorized) trailers with prior approval from the CDC OGS.



HPP and PHEP funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts,
jumpsuits, sweatshirts, or T-shirts



HPP and PHEP funds may not be used to purchase or support (feed) animals for labs, including
mice. Any requests for such must receive prior approval of protocols from the Animal Control
Office within CDC and subsequent approval from the CDC OGS.



Recipients may not use funds to purchase a house or other living quarters for those under
quarantine.



HPP and PHEP awardees may (with prior approval) use funds for overtime for individuals directly
associated (listed in personnel costs) with the award.



PHEP awardees cannot use funds to purchase vehicles to be used as means of transportation for
carrying people or goods, such as passenger cars or trucks and electrical or gas-driven motorized
carts.
PHEP awardees can (with prior approval) use funds to lease vehicles to be used as means of
transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gasdriven motorized carts.
PHEP awardees can (with prior approval) use funds to purchase material-handling equipment
(MHE) such as industrial or warehouse-use trucks to be used to move materials, such as forklifts,
lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads.
PHEP awardees can use funds to purchase caches of antibiotics for use by first responders and their
families to ensure the health and safety of the public health workforce.
PHEP awardees can use funds to support appropriate accreditation activities that meet the Public
Health Accreditation Board’s preparedness-related standards.








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


HPP awardees cannot use funds to support standalone, single-facility exercises.
HPP awardees cannot spend HPP funds on training courses, exercises, and planning resources when
similar offerings are available at no cost.

HPP Vehicle Purchase
 Non-public road vehicles: HPP grant funds can (with prior approval) be used to purchase health
care coalition material-handling equipment (MHE) such as industrial or warehouse-use trucks to be
used to move health care coalition materials, supplies and equipment (such as forklifts, lift trucks,
turret trucks, etc.). Vehicles must be of a type not licensed to travel on public roads.
HPP Vehicle Leasing and Hauling Agreements
Passenger road vehicles:
 HPP grant funds cannot be used to purchase over-the road passenger vehicles.
 HPP grant funds can (with prior approval) be used to procure leased or rental vehicles as means of
transportation for carrying people (e.g., passenger cars or trucks) during times of need. Examples
include transporting health care coalition leadership to planning meetings, to an exercise, or during
a response.
Transportation of medical material:
 HPP grant funds can (with prior approval) be used to procure leased or rental vehicles for
movement of materials, supplies and equipment by HCC members.
 Additionally, HPP grant funds can (with prior approval) be used for health care coalitions to make
transportation agreements with commercial carriers for movement of health care coalition
materials, supplies and equipment. There should be a written process for initiating transportation
agreements (e.g., contracts, memoranda of understanding, formal written agreements, and/or
other letters of agreement). Transportation agreements should include, at a minimum, the
following elements:
o Type of vendor
o Number and type of vehicles, including vehicle load capacity and configuration
o Number and type of drivers, including certification of drivers
o Number and type of support personnel
o Vendor’s response time
o Vendor’s ability to maintain cold chain, if necessary to the incident
 This relationship may be demonstrated by a signed transportation agreement or documentation of
transportation planning meeting with the designated vendor. All documentation should be
available to the FPO for review if requested.

Deployment of HPP and PHEP Funded Personnel, Equipment, and Supplies during Emergencies
via the Emergency Management Assistance Compact (EMAC)

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Deployment of HPP- and PHEP-funded equipment, supplies and personnel via the Emergency
Management Assistance Compact (EMAC) for the purpose of mutual aid and assistance between
states during a governor declared State of emergency or disaster is permitted, but is subject to
the Federal provisions of 45 CFR 75. However, affected States must notify their CDC Grants
Management Specialist within a 24-hour period of the personnel, services and/or equipment
being loaned out for the emergency. Awardees should follow their state legislation which
governs how they will operate during an emergency or when another state requests assistance
via EMAC. Awardees may reference the EMAC website for detailed information via
www.emacweb.org . Additional guidance can be found in the 2017-2022 HPP-PHEP Supplemental
Guidelines.
Use of HPP Funds during a Declared Emergency
Consistent with section 319C-2 of the PHS Act, HPP funds may only be used to support activities that
prepare States for public health emergencies and to improve surge capacity . There are two situations
when States (see definition) may use HPP funds during a State or locally declared emergency, disaster,
or public health emergency (hereafter referred to as an “emergency”). These situations and related
criteria are described below.
Situation 1: HPP Staff Conducting Activities Consistent with Approved Project Goals
Awardees may use HPP funds to support positions performing preparedness-related activities
consistent with the awardee’s project goals and may utilize those positions within any phase of the
disaster cycle, provided that the staff members in those positions continue to do work within statutory
limitations, the notice of award, and the approved spending plan. For example, an employee’s salary
may be permissible for response activities if that employee is carrying out the same responsibilities he
or she would carry out as part of his or her preparedness responsibilities.
Situation 2: Using a Declared Emergency as a Training Exercise
Under certain conditions, HPP funds may, on a limited, case-by-case basis, be reallocated to support
response activities to the extent they are used for purposes provided for in Section 319C-2 of the PHS
Act (the program’s authorizing statute), applicable cost principles, the funding opportunity
announcement, and the awardee’s application (including the jurisdiction’s all-hazards plan). Awardees
should contact their assigned HPP project officer and grants management specialists for guidance on
the process to make such a change. ASPR encourages awardees to develop criteria such as costs versus
benefits for determining when to request a “scope-of-work” change to use a real incident as a required
exercise.
The request to use an actual response as a required exercise and to pay salaries with HPP funds for up
to seven days will be considered for approval under these conditions:


A state or local declaration of an emergency, disaster, or public health emergency is in effect.



No other funds are available for the cost.
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

The awardee agrees to submit within 60 days (of the conclusion of the disaster or public health
emergency) an after-action report, a corrective action plan, and other documentation that
supports the actual dollar amount spent.

Note: A change in the scope of work is required to use an actual event as an exercise whether or not
funds are needed to support salaries. Also, regardless of the amount of money used in response to an
event, the State is still required to meet all the requirements of the original award.
HPP General Funding Guidance
HPP funding must primarily support strengthening health care system preparedness through the
collaborative development of HCCs that prepare and respond as an entire regional health system,
rather than individual health care organizations. HPP recognizes that, at the conclusion of the previous
project period (2012-2017), some awardees only funded HCCs, some funded individual health care
entities (with a requirement that they participate in regional preparedness efforts), and others funded
a mixture of HCCs and individual health care entities.
During this project period (2017-2022), beginning in Budget Period 1, all awardees must allocate
funding to HCCs. For Budget Period 1, ASPR still permits providing direct funding from the awardee to
individual health care entities for regional preparedness efforts; however, ASPR expects that as the
project period progresses, the awardee’s funding strategy will include allocating funding to HCCs in a
graduated manner – such HCC funding should increase incrementally over the five-year project period.
As awardees allocate more funding to HCCs each year, individual health care entities can continue to
receive HPP funding, through the HCC, to ensure regional coordination and collaboration. HCCs will
determine the amount of funding for health care entities upon review of coalition projects, as well as
health care entity projects, based on the funding priorities for each budget period. This process will
ensure that HCC activities contribute to the overarching readiness, preparedness, and resilience of
health care systems.
Awardees may retain direct costs for the management and monitoring of the HPP cooperative
agreement during the 2017-2022 project period. Awardee-level direct costs are defined as personnel,
fringe benefits, and travel. Because the goal is to support HCCs and their health care system partners,
awardees must limit these direct costs to no more than 18 percent of the HPP cooperative agreement
award.
By the end of Budget Period 5, awardees must limit these direct costs to no more than 15 percent of
the HPP cooperative agreement award.
ASPR will consider requests for exemptions on a case-by-case basis. Requests for exemption must be
submitted with the Budget Period 1 application. Requests for exemption will be strengthened by
letters of support from the HCCs and the jurisdiction’s hospital association indicating these entities
understand and agree with the amount the awardee is retaining for awardee-level direct costs. Please
note that concurrence is not required, only recommended if an awardee is requesting an exemption.
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Within the first 60 days of each budget period, all awardees must provide a detailed spend plan,
including all budget line items, to all HCCs within their jurisdiction and any interested health care
entity. This spend plan must also be sent to FPOs.
Awardees are not required to submit position descriptions for HPP funded-staff with the application.
However, awardees may be required to submit this information to HPP if the roles and responsibilities
of the employee(s), and how they support health care preparedness are not clear in the budget
narrative section of the application.
HPP Funding Limitations for Individual Healthcare Facilities
HPP awardees and their subrecipients may provide funding to individual hospitals or other health care
entities, as long as the funding is used for activities to advance regional, HCC, or health care system
wide priorities, and are in line with ASPR’s four health care preparedness and response
capabilities. Funding to individual health care entities is not permitted to be used to meet Centers for
Medicare and Medicaid Services (CMS) conditions of participation, including CMS-3178-F Medicare and
Medicaid Programs: Emergency Preparedness Requirements for Medicare and Medicaid Participating
Providers and Suppliers. CMS-3178-F requires providers and suppliers to the following conditions of
participation.






Development of an emergency plan: Based on a risk assessment, develop an emergency plan using
an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for
a full spectrum of emergencies or disasters specific to the location of a provider or supplier. HPP
funding may not be provided to individual health care entities to meet this requirement; however,
ASPR encourages HCCs to provide technical assistance to their individual members to assist them
with the development of their emergency plans. HCCs are permitted to use HPP funding to develop
the staffing capacity and technical expertise to assist their members with this requirement.
Develop policies and procedures: Develop and implement policies and procedures based on the
plan and risk assessment. HPP funding may not be provided to individual health care entities to
meet this requirement; however, ASPR encourages HCCs to provide technical assistance to their
individual members to assist them with the development of policies and procedures. HCCs are
permitted to use HPP funding to develop the staffing capacity and technical expertise to assist their
members with this requirement.
Develop and maintain a communication plan: Develop and maintain a communication plan that
complies with both Federal and State law. Patient care must be well-coordinated within the facility,
across health care providers, and with State and local public health departments and emergency
systems. HPP funding may not be provided to individual health care entities to meet this
requirement; however, ASPR encourages HCCs to provide technical assistance to their individual
members to assist them with the development a communication plan that integrates with the
HCC’s communications policies and procedures. HCCs are permitted to use HPP funding for costs
associated with adding new providers and suppliers to their HCC who are seeking to join coalitions
to coordinate patient care across providers, public health departments, and emergency systems
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

(e.g., hiring additional staff to coordinate with the new members, providing communications
equipment and platforms to new members, conducting communications exercises, securing
meeting spaces, etc.)
Develop and maintain a training and testing program: Develop and maintain training and testing
programs, including initial and annual trainings, and conduct drills and exercises or participate in an
actual incident that tests the plan. HPP funding may not be provided to individual health care
entities for individual health care organizations’ trainings and exercises. HPP funding may be used
to plan and conduct trainings and exercises at the regional or HCC level.

18. Data Management Plan
As identified in the Evaluation and Performance Measurement section, applications involving data
collection must include a Data Management Plan (DMP) as part of their evaluation and performance
measurement plan. The DMP is the applicant’s assurance of the quality of the public health data
through the data’s lifecycle and plans to deposit data in a repository to preserve and to make the data
accessible in a timely manner. See web link for additional information:
http://www.cdc.gov/grants/additionalrequirements/index.html#ui-id-49
19. Other Submission Requirements
a. Electronic Submission: Applications must be submitted electronically at www.grants.gov. The
application package can be downloaded at www.grants.gov. Applicants can complete the application
package off-line and submit the application by uploading it at www.grants.gov. All application
attachments must be submitted using a PDF file format. Directions for creating PDF files can be
found at www.grants.gov. File formats other than PDF may not be readable by OGS Technical
Information Management Section (TIMS) staff.
Applications must be submitted electronically by using the forms and instructions posted for this
funding opportunity at www.grants.gov.
If Internet access is not available or if the forms cannot be accessed online, applicants may contact
the OGS TIMS staff at 770- 488-2700 or by e-mail at [email protected], Monday through Friday,
7:30 a.m.–4:30 p.m., except federal holidays. Electronic applications will be considered successful if
they are available to OGS TIMS staff for processing from www.grants.gov on the deadline date.
b. Tracking Number: Applications submitted through www.grants.gov are time/date stamped
electronically and assigned a tracking number. The applicant’s Authorized Organization
Representative (AOR) will be sent an e-mail notice of receipt when www.grants.gov receives the
application. The tracking number documents that the application has been submitted and initiates the
required electronic validation process before the application is made available to CDC.
c. Validation Process: Application submission is not concluded until the validation process is
completed successfully. After the application package is submitted, the applicant will receive a
“submission receipt” e-mail generated by www.grants.gov. A second e-mail message to applicants
will then be generated by www.grants.gov that will either validate or reject the submitted application
package. This validation process may take as long as two business days. Applicants are strongly
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encouraged to check the status of their application to ensure that submission of their package has
been completed and no submission errors have occurred. Applicants also are strongly encouraged to
allocate ample time for filing to guarantee that their application can be submitted and validated by
the deadline published in the FOA. Non-validated applications will not be accepted after the
published application deadline date.
If you do not receive a “validation” e-mail within two business days of application submission,
please contact www.grants.gov. For instructions on how to track your application, refer to the e-mail
message generated at the time of application submission or the Grants.gov Online User Guide.
http://www.grants.gov/help/html/help/index.htm?callingApp=custom#t=Get_Started%2FGet_Started.
htm
d. Technical Difficulties: If technical difficulties are encountered at www.grants.gov, applicants
should contact Customer Service at www.grants.gov. The www.grants.gov Contact Center is
available 24 hours a day, 7 days a week, except federal holidays. The Contact Center is available by
phone at 1-800-518-4726 or by e-mail at [email protected]. Application submissions sent by
e-mail or fax, or on CDs or thumb drives will not be accepted. Please note that www.grants.gov is
managed by HHS.
e. Paper Submission: If technical difficulties are encountered at www.grants.gov, applicants should
call the www.grants.gov Contact Center at 1-800-518-4726 or e-mail them at [email protected] for
assistance. After consulting with the Contact Center, if the technical difficulties remain unresolved and
electronic submission is not possible, applicants may e-mail CDC GMO/GMS, before the deadline, and
request permission to submit a paper application. Such requests are handled on a case-by-case basis.
An applicant’s request for permission to submit a paper application must:
1. Include the www.grants.gov case number assigned to the inquiry
2. Describe the difficulties that prevent electronic submission and the efforts taken with the
www.grants.gov Contact Center to submit electronically; and
3. Be received via e-mail to the GMS/GMO listed below at least three calendar days before the
application deadline. Paper applications submitted without prior approval will not be
considered.
If a paper application is authorized, OGS will advise the applicant of specific instructions for
submitting the application (e.g., original and two hard copies of the application by U.S. mail or
express delivery service).

E. Review and Selection Process
1. Review and Selection Process: Applications will be reviewed in three phases
a. Phase 1 Review
All applications will be initially reviewed for eligibility and completeness by CDC Office of Grants
Services. Complete applications will be reviewed for responsiveness by the Grants Management
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Officials and Program Officials. Non-responsive applications will not advance to Phase II review.
Applicants will be notified that their applications did not meet eligibility and/or published
submission requirements.
b. Phase II Review
A review panel will evaluate complete, eligible applications in accordance with the criteria below.
i. Approach
ii. Evaluation and Performance Measurement
iii. Applicant’s Organizational Capacity to Implement the Approach
Not more than thirty days after the Phase II review is completed, applicants will be notified
electronically if their application does not meet eligibility or published submission requirements.
Phase II Review Criteria
i. Approach (Maximum Points: 35)

ASPR and CDC will evaluate the extent to which the applicant:
 Presents outcomes that are consistent with the project period outcomes described in the
ASPR-CDC Project Description and logic model.
 Describes an overall strategy and activities consistent with the ASPR-CDC Project Description
and logic model.
 Describes strategies and activities that are achievable, appropriate to achieve the outcomes
of the project, and evidence-based (to the degree practicable).
 Shows that the proposed use of funds is an efficient and effective way to implement the
strategies and activities and attain the project period outcomes.
 Presents a work plan that is aligned with the strategies/activities, outcomes, and
performance measures in the approach and is consistent with the content and format
proposed by ASPR and CDC.
ii. Evaluation and Performance Measurement (Maximum Points: 35)

ASPR and CDC will evaluate the extent to which the applicant:
 Shows/affirms the ability to collect data on the process and outcome performance measures
specified by ASPR and CDC in the project description and presented by the applicant in their
approach.
 Describes clear monitoring and evaluation procedures and how evaluation and performance
measurement will be incorporated into planning, implementation, and reporting of project
activities.
 Describes how performance measurement and evaluation findings will be reported, and used
to demonstrate the outcomes of the FOA and for continuous program quality improvement.
 Describes how evaluation and performance measurement will contribute to developing an
evidence base for programs that lack a strong effectiveness evidence base.
 Includes a preliminary Data Management Plan (DMP), if applicable.
iii. Applicant’s Organizational Capacity to Implement the Approach (Maximum points: 30)
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Phase II Review Criteria

ASPR and CDC will evaluate the extent to which the applicant addresses the items below.
 Demonstrates relevant experience and capacity (management, administrative, and technical)
to implement the activities and achieve the project outcomes.
 Demonstrates experience and capacity to implement the evaluation plan.
 Provides a staffing plan and project management structure that will be sufficient to achieve
the project outcomes and which clearly defines staff roles. Provides an organizational chart.
Budget
Equipment requests totaling $5,000 or more must include three cost estimates.

c. Phase III Review
ASPR and CDC will conduct a thorough technical review of work plans and budgets to ensure they align
with the strategies and activities described in this FOA.
Review of risk posed by applicants.
Prior to making a Federal award, ASPR and CDC are required by 31 U.S.C. 3321 and 41 U.S.C. 2313 to
review information available through any OMB-designated repositories of government-wide eligibility
qualification or financial integrity information as appropriate. See also suspension and debarment
requirements at 2 CFR parts 180 and 376.
In accordance 41 U.S.C. 2313, ASPR and CDC are required to review the non-public segment of the
OMB-designated integrity and performance system accessible through SAM (currently the Federal
Awardee Performance and Integrity Information System (FAPIIS)) prior to making a Federal award
where the Federal share is expected to exceed the simplified acquisition threshold, defined in 41
U.S.C. 134, over the period of performance. At a minimum, the information in the system for a prior
Federal award recipient must demonstrate a satisfactory record of executing programs or activities
under Federal grants, cooperative agreements, or procurement awards; and integrity and business
ethics. ASPR and CDC may make a Federal award to a recipient who does not fully meet these
standards, if it is determined that the information is not relevant to the current Federal award under
consideration or there are specific conditions that can appropriately mitigate the effects of the nonFederal entity's risk in accordance with 45 CFR §75.207.
ASPR’s and CDC’s framework for evaluating the risks posed by an applicant may incorporate results of
the evaluation of the applicant's eligibility or the quality of its application. If it is determined that a
Federal award will be made, special conditions that correspond to the degree of risk assessed may be
applied to the Federal award. The evaluation criteria is described in this funding opportunity
announcement. In evaluating risks posed by applicants, ASPR and CDC will use a risk-based approach
and may consider any items such as the following:
(1) Financial stability;
(2) Quality of management systems and ability to meet the management standards prescribed in this
part;
(3) History of performance. The applicant's record in managing Federal awards, if it is a prior
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recipient of Federal awards, including timeliness of compliance with applicable reporting requirements,
conformance to the terms and conditions of previous Federal awards, and if applicable, the extent to
which any previously awarded amounts will be expended prior to future awards;
(4) Reports and findings from audits performed under subpart F 45 CFR 75 or the reports and
findings of any other available audits; and
(5) The applicant's ability to effectively implement statutory, regulatory, or other requirements
imposed on non-Federal entities.
ASPR and CDC must comply with the guidelines on government-wide suspension and debarment in 2
CFR part 180, and require non-Federal entities to comply with these provisions. These provisions
restrict Federal awards, subawards and contracts with certain parties that are debarred, suspended or
otherwise excluded from or ineligible for participation in Federal programs or activities.

2. Announcement and Anticipated Award Dates
Awardees will receive an e-mail from Grants Solutions with a link to their Notices of Award (NOA) no
later than July 1, 2017. Funding will take effect July 1, 2017.
F. Award Administration Information
1. Award Notices
Awardees will receive an e-mail from Grants Solutions with a link to their (NOA). The NOA
shall be the only binding, authorizing document between the awardee and CDC. The NOA will be
signed by an authorized GMO and emailed to the awardee business officer listed in application and
the program director.
Any applicant awarded funds in response to this FOA will be subject to the DUNS, SAM
Registration, and Federal Funding Accountability And Transparency Act Of 2006 (FFATA)
requirements.
Unsuccessful applicants will receive notification of these results by e-mail with delivery receipt or by
U.S. mail.
2. Administrative and National Policy Requirements

Awardees must comply with the administrative and public policy requirements outlined in 45 CFR
Part 75 and the HHS Grants Policy Statement, as appropriate. Brief descriptions of relevant provisions
are available at http://www.cdcgov/grants/additionalrequirements/index.html#ui-id-17.
The HHS Grants Policy Statement is available
at http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
Note that 45 CFR part 75 supersedes the administrative requirements (A-110 & A-102), cost principles
(A-21, A-87 & A-122) and audit requirements (A-50, A-89 & A-133).
111

The following Administrative Requirements (AR) apply to this project:
AR-7: Executive Order 12372
AR-9: Paperwork Reduction Act http://www.hhs.gov/ocio/policy/collection/infocollectfaq.html
AR-11: Healthy People 2020
AR-12: Lobbying Restrictions
AR-13: Prohibition on Use of CDC Funds for Certain Gun Control Activities
AR-14: Accounting System Requirements
AR-16: Security Clearance Requirement
AR-21: Small, Minority, And Women-owned Business
AR-24: Health Insurance Portability and Accountability Act
AR-25: Release and Sharing of Data
AR-26: National Historic Preservation Act of 1966
AR-29: Compliance with EO13513, “Federal Leadership on Reducing Text Messaging while Driving,”
October 1, 2009
AR-30: Compliance with Section 508 of the Rehabilitation Act of 1973
AR-33: Plain Writing Act of 2010
ARs applicable to awards related to conferences:
AR-20: Conference Support
AR-27: Conference Disclaimer and Use of Logos
For more information on the CFR visit http://www.access.gpo.gov/nara/cfr/cfr-table-search.html
3. Reporting
Reporting provides continuous program monitoring and identifies successes and challenges that
awardees encounter throughout the project period. Also, reporting is a requirement for awardees who
want to apply for yearly continuation of funding. Reporting helps CDC and awardees because it:
 Helps target support to awardees;
 Provides CDC with periodic data to monitor awardee progress toward meeting the FOA
outcomes and overall performance;
 Allows CDC to track performance measures and evaluation findings for continuous quality and
program improvement throughout the project period and to determine applicability of
evidence-based approaches to different populations, settings, and contexts; and
 Enables CDC to assess the overall effectiveness and influence of the FOA.
The table below summarizes required and optional reports. All required reports must be sent
electronically to GMS listed in the “Agency Contacts” section of the FOA copying the ASPR and CDC
project officers.
Report
Awardee Evaluation and

When?
6 months into award

Required?
Yes
112

Report
Performance Measurement
Plan, including Data
Management Plan (DMP)
Annual Performance Report
(APR)

Federal Financial Reporting
Forms

When?

Required?

No later than 120 days before
end of budget period. Serves as
yearly continuation application.

Yes

ASPR and CDC awardees must
submit summary information
regarding their responses to
real incidents involving partial
or full activation of their EOCs,
including virtual activations.
More information will be
provided with the APR
guidance.
90 days after end of calendar
quarter in which budget period
ends

Yes

CDC may require more frequent
financial reporting for PHEP
awardees based on individual
circumstances.
Monthly spend plan reports
that include obligation rates
Final Performance and
Financial Report
Payment Management System
(PMS) Reporting

5 days after the end of the
month
90 days after end of project
period
Quarterly reports

Yes
PHEP Awardees Only
Yes
Yes

a. Awardee Evaluation and Performance Measurement Plan (required)

With support from ASPR and CDC, awardees must elaborate on their initial applicant evaluation and
performance measurement plan. This plan must be no more than 20 pages; awardees must submit the
plan six months into the award. ASPR and CDC will review and approve the recipient’s monitoring and
evaluation plan to ensure that it is appropriate for the activities to be undertaken as part of the
agreement, for compliance with the monitoring and evaluation guidance established by ASPR and CDC
or other guidance otherwise applicable to this Agreement.
Awardee Evaluation and Performance Measurement Plan (required): This plan should provide
additional detail on the following:
113

Performance Measurement









Performance measures and targets
The frequency that performance data are to be collected.
How performance data will be reported.
How quality of performance data will be assured.
How performance measurement will yield findings to demonstrate progress towards achieving
FOA goals (e.g., reaching target populations or achieving expected outcomes).
Dissemination channels and audiences.
Other information requested as determined by the CDC program.

Evaluation







The types of evaluations to be conducted (e.g., process or outcome evaluations).
The frequency that evaluations will be conducted.
How evaluation reports will be published on a publically available website.
How evaluation findings will be used to ensure continuous quality and program improvement.
How evaluation will yield findings to demonstrate the value of the FOA (e.g., effect on improving
public health outcomes, effectiveness of FOA, cost-effectiveness or cost-benefit).
Dissemination channels and audiences.

In a cooperative agreement, ASPR and CDC staff are substantially involved in the program activities,
above and beyond routine grant monitoring. During the project period, ASPR and CDC will monitor
and evaluate the defined activities within the agreement and awardee progress in meeting work plan
priorities. The recipient must ensure reasonable access by ASPR and CDC or their designees to all
necessary sites, documentation, individuals and information to monitor, evaluate and verify the
appropriate implementation the activities and use of ASPR and CDC funding under this Agreement.
b. Annual Performance Report (APR) (required)
The awardee must submit the APR via www.grants.gov no later than 120 days before the end of the
budget period. This report must not exceed 45 pages excluding administrative reporting. Attachments
are not allowed, but web links are allowed. This report must include the following:
• Performance Measures: Awardees must report on performance measures for each budget
period and update measures, if needed. In addition, awardees must submit program
benchmark and pandemic influenza planning data. Awardees that fail to “substantially meet”
HPP and PHEP benchmarks and pandemic influenza planning information required by this FOA
are subject to withholding of a statutorily mandated percentage of the following year’s award.
• Evaluation Results: Awardees must report evaluation results for the work completed to date
(including findings from process or outcome evaluations).
• Work Plan: Awardees must update work plan each budget period to reflect any changes in
project period outcomes, activities, timeline, etc.
• Successes
114

•

•

•

•

o Awardees must report progress on completing activities and progress towards achieving
the project period outcomes described in the logic model and work plan.
o Awardees must describe any additional successes (e.g. identified through evaluation
results or lessons learned) achieved in the past year.
o Awardees must describe success stories.
Challenges
o Awardees must describe any challenges that hindered or might hinder their ability to
complete the work plan activities and achieve the project period outcomes.
o Awardees must describe any additional challenges (e.g., identified through evaluation
results or lessons learned) encountered in the past year.
ASPR and CDC Program Support to Awardees
o Awardees must describe how ASPR and CDC could help them overcome challenges to
complete activities in the work plan and achieving project period outcomes.
EOC Activations
o Awardees must submit summary information regarding their responses to real incidents
involving partial or full activation of their EOCs, including virtual activations. More
information will be provided with the APR guidance.
Administrative Reporting (No page limit)
o SF-424A Budget Information-Non-Construction Programs.
o Budget Narrative – Must use the format outlined in "Content and Form of Application
Submission, Budget Narrative" section.
o Indirect Cost Rate Agreement.

The awardees must submit the Annual Performance Report via www.grants.gov 120 days before the
end of the budget period.
c. Federal Financial Reporting (FFR) (required)
The annual FFR form (SF-425) is required and must be submitted no later than 90 days after the end of
the budget period. To submit the FFR, log into www.grantsolutions.gov , select “Reports” from the
menu, and click on Federal Financial Reports. The report must include only those funds authorized and
disbursed during the timeframe covered by the report. The final FFR must indicate the exact balance of
unobligated funds, and may not reflect any unliquidated obligations. There must be no discrepancies
between the final FFR expenditure data and the Payment Management System’s
(PMS) cash transaction data. Failure to submit the required information by the due date may adversely
affect the future funding of the project. If the information cannot be provided by the due date,
awardees are required to submit a letter of explanation to OGS and include the date by which the
Grants Officer will receive information.
CDC may require more frequent financial reporting for PHEP awardees based on individual
circumstances.
115

d. Final Performance and Financial Report (required)
This report is due 90 days after the end of the project period. CDC programs must indicate that this
report should not exceed 40 pages. This report covers the entire project period and can include
information previously reported in APRs. At a minimum, this report must include the following:
• Performance Measures – Awardees must report final performance data for all process and
outcome performance measures.
• Evaluation Results – Awardees must report final evaluation results for the project period for
any evaluations conducted.
• Impact/Results/Success Stories – Awardees must use their performance measure results and
their evaluation findings to describe the effects or results of the work completed over the
project period, and can include some success stories.
• A final Data Management Plan that includes the location of the data collected during the
funded period, for example, repository name and link data set(s)
• Additional forms as described in the Notice of Award (e.g., Equipment Inventory Report, Final
Invention Statement).

4. Federal Funding Accountability and Transparency Act of 2006 (FFATA)
Federal Funding Accountability and Transparency Act of 2006 (FFATA), P.L. 109–282, as amended
by section 6202 of P.L. 110–252 requires full disclosure of all entities and organizations receiving
Federal funds including awards, contracts, loans, other assistance, and payments through a single
publicly accessible Web site, http://www.USASpending.gov.
Compliance with this law is primarily the responsibility of the Federal agency. However, two
elements of the law require information to be collected and reported by applicants: 1) information on
executive compensation when not already reported through the SAM, and 2) similar information on
all sub-awards/subcontracts/consortiums over $25,000.
For the full text of the requirements under the FFATA and HHS guidelines, go to:
• https://www.gpo.gov/fdsys/pkg/PLAW-109publ282/pdf/PLAW-109publ282.pdf,
• https://www.fsrs.gov/documents/ffata_legislation_110_252.pdf
• http://www.hhs.gov/grants/grants/grants-policies-regulations/index.html#FFATA.

5. Reporting of Foreign Taxes (International/Foreign projects only)

A. Valued Added Tax (VAT) and Customs Duties – Customs and import duties, consular fees,
customs surtax, valued added taxes, and other related charges are hereby authorized as an allowable
cost for costs incurred for non-host governmental entities operating where no applicable tax
exemption exists. This waiver does not apply to countries where a bilateral agreement (or similar
legal document) is already in place providing applicable tax exemptions and it is not applicable to
Ministries of Health. Successful applicants will receive information on VAT requirements via their
Notice of Award.
B. The U.S. Department of State requires that agencies collect and report information on the amount
116

of taxes assessed, reimbursed and not reimbursed by a foreign government against commodities
financed with funds appropriated by the U.S. Department of State, Foreign Operations and Related
Programs Appropriations Act (SFOAA) (“United States foreign assistance funds”). Outlined below
are the specifics of this requirement:
1) Annual Report: The grantee must submit a report on or before November 16 for each foreign
country on the amount of foreign taxes charged, as of September 30 of the same year, by a foreign
government on commodity purchase transactions valued at 500 USD or more financed with United
States foreign assistance funds under this grant during the prior United States fiscal year (October 1 –
September 30), and the amount reimbursed and unreimbursed by the foreign government. [Reports
are required even if the grantee did not pay any taxes during the reporting period.]
2) Quarterly Report: The grantee must quarterly submit a report on the amount of foreign taxes
charged by a foreign government on commodity purchase transactions valued at 500 USD or more
financed with United States foreign assistance funds under this grant. This report shall be submitted
no later than two weeks following the end of each quarter: April 15, July 15, October 15 and January
15.
3) Terms: For purposes of this clause:
“Commodity” means any material, article, supplies, goods, or equipment;
“Foreign government” includes any foreign government entity;
“Foreign taxes” means value-added taxes and custom duties assessed by a foreign government on a
commodity. It does not include foreign sales taxes.
4) Where: Submit the reports to the Director and Deputy Director of the CDC office in the
country(ies) in which you are carrying out the activities associated with this cooperative agreement.
In countries where there is no CDC office, send reports to [email protected].
5) Contents of Reports: The reports must contain:
a. grantee name;
b. contact name with phone, fax, and e-mail;
c. agreement number(s) if reporting by agreement(s);
d. reporting period;
e. amount of foreign taxes assessed by each foreign government;
f. amount of any foreign taxes reimbursed by each foreign government;
g. amount of foreign taxes unreimbursed by each foreign government.
6) Subagreements. The grantee must include this reporting requirement in all applicable subgrants
and other subagreements.

G. Agency Contacts
ASPR and CDC encourage inquiries concerning this FOA.
Program Office Contact
For programmatic technical assistance, contact:
117

R. Scott Dugas, ASPR Project Officer
Department of Health and Human Services
Assistant Secretary for Preparedness and Response
200 C Street, SW
Washington, D.C. 20201
Telephone: (202) 245-0732
Email: [email protected]
Sharon Sharpe, CDC Project Officer
Department of Health and Human Services
Centers for Disease Control and Prevention
1600 Clifton Road, NE,
Mailstop D29
Atlanta, GA 30329-027

Grants Staff Contact
For financial, awards management, or budget assistance, contact:
Shicann Phillips, Lead Grants Management Specialist
Department of Health and Human Services
CDC Office of Grant Services
2920 Brandywine Road
Atlanta, GA 30341
Telephone: (770) 488-2809
Email: [email protected]
For assistance with submission difficulties related to www.grants.gov, contact the Contact Center
by phone at 1-800-518-4726.
Hours of Operation: 24 hours a day, 7 days a week, except on federal holidays.
For all other submission questions, contact:
Technical Information Management Section
Department of Health and Human Services
CDC Office of Financial Resources
Office of Grants Services
2920 Brandywine Road, MS E-14
Atlanta, GA 30341
Telephone: 770-488-2700
E-mail: [email protected]
CDC Telecommunications for persons with hearing loss is available at: TTY 1-888-232-6348

118

H. Other Information
Application Attachments
Following is a list of acceptable attachments awardees can upload as PDF files as part of their
applications at www.grants.gov. Awardees may not attach documents other than those listed; if other
documents are attached, applications will not be reviewed.
• Table of Contents for Entire Submission
• HPP Project Abstract
• PHEP Project Abstract
• HPP Project Narrative
• PHEP Project Narrative
• HPP Work Plan (high-level plan)
• HPP Domain Work Plan
• PHEP Work Plan (high-level plan)
• PHEP Domain Work Plan
• HPP Budget Narrative
• HPP Application for Federal Assistance (SF-424)
• HPP Budget Information for Non-Construction Programs (SF-424A)
• HPP Indirect Cost Rate Agreement
• PHEP Budget Narrative
• PHEP Application for Federal Assistance (SF-424)
• PHEP Budget Information for Non-Construction Programs (SF-424A)
• PHEP Indirect Cost Rate Agreement
• MYTEP – joint HPP-PHEP plan
• CDC Assurances and Certifications (PHS-5161)
• Senior State Health Official (SHO) Letter (PHEP only)
• Local Concurrence Letters (PHEP only)
• Tribal Input Letters (PHEP only)
• EMSC support letters (HPP only)
• HPP Organizational Chart
• PHEP Organizational Chart
• Disclosure of Lobbying Activities (SF-LLL)
Optional attachments:
 Memorandum of Agreement (MOA)
 Memorandum of Understanding (MOU)
 Bona Fide Agent status documentation, if applicable

119

Temporary Reassignment of State and Local Personnel during a Public Health Emergency
Section 201 of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013
(PAHPRA), Public Law 113-5 amends section 319 of the Public Health Service (PHS) Act to provide
the Secretary of the Department of Health and Human Services (HHS) with discretion to authorize
the temporary reassignment of state, tribal, and local personnel during a declared federal public
health emergency upon request by a state or tribal organization. The temporary reassignment
provision is applicable to state, tribal, and local public health department or agency personnel
whose positions are funded, in full or part, under PHS programs and allows such personnel to
immediately respond to the public health emergency in the affected jurisdiction. Funds provided
under the award may be used to support personnel who are temporarily reassigned in
accordance with section 319(e). This authority terminates September 30, 2018. Please see
detailed information available on the ASPR website at
http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx
HPP Budget Period 1 (Fiscal Year 2017) Funding
Awardee
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Chicago
Colorado
Connecticut
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Los Angeles County
Louisiana
Maine
Marshall Islands

FY 2017 Total
Funding Available
$3,316,320
$951,914
$278,422
$3,930,938
$2,002,932
$23,397,482
$2,736,056
$3,119,392
$2,330,641
$1,049,193
$11,822,752
$5,973,258
$374,754
$1,261,124
$1,247,694
$8,772,659
$3,934,926
$2,130,401
$2,117,146
$2,759,985
$9,263,958
$2,895,985
$1,065,567
$268,005
120

Awardee
Maryland
Massachusetts
Michigan
Micronesia
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
New York City
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Total

FY 2017 Total
Funding Available
$4,864,700
$4,315,709
$6,157,587
$276,806
$3,518,356
$2,176,032
$3,676,990
$920,601
$1,373,309
$1,911,347
$1,089,878
$5,633,732
$1,527,031
$9,639,512
$7,941,327
$6,112,501
$879,429
$270,356
$7,450,278
$2,602,493
$2,577,424
$255,373
$8,093,898
$2,576,010
$940,547
$3,117,650
$848,108
$4,040,788
$16,176,634
$2,271,467
$780,333
$305,611
$6,075,317
$4,279,234
$944,353
$1,405,606
$3,634,631
$837,538

$228,500,000

121

Public Health Emergency Preparedness (PHEP)
Budget Period 1 (Fiscal Year 2017) Funding*
Awardee

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

FY 2017 Base
Plus
Population
Funding
$8,463,734
$4,012,964
$360,798
$10,677,895
$6,348,875
$35,976,191
$8,039,978
$9,135,706
$7,037,812
$4,012,964
$25,794,260
$14,486,214
$484,271
$4,609,782
$4,860,905
$14,429,471
$10,443,574
$6,512,703
$6,274,028
$7,975,845
$16,072,996
$8,252,048
$4,494,778
$383,816
$9,753,965
$10,640,064
$14,157,552
$417,164
$9,172,836
$6,364,763
$9,840,854
$4,161,511
$5,132,192
$6,250,643
$4,496,217
$13,072,939
$5,344,624

FY 2017
Cities
Readiness
Initiative
Funding
$294,350
$169,600
$0

$1,139,655
$199,715
$5,265,278
$1,611,520
$699,105
$536,817
$311,709
$2,851,074
$1,431,277
$0

$254,457
$169,600
$1,885,757
$775,482
$201,283
$388,865
$366,410
$3,223,040
$532,494
$169,600
$0

$1,361,690
$1,246,987
$1,110,828
$0

$877,187
$234,840
$862,657
$169,600
$199,955
$526,292
$279,296
$2,211,804
$233,399

FY 2017
Level 1
Chemical
Laboratory
Funding
$0
$0
$0
$0
$0
$1,175,583

$0
$0
$0
$0
$932,317
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$1,080,144
$1,063,587
$0
$1,092,880
$0

$0
$0
$0
$0
$0
$0
$1,096,376

FY 2017
Level 2
Chemical
Laboratory
Funding**
$0
$0
$0
$0
$260,000
$0
$0
$260,000
$260,000
$0
$0
$0
$0
$0
$260,000
$0
$400,000
$0
$260,000
$0
$260,000
$260,000
$260,000
$0
$260,000
$0
$0
$0
$0
$260,000
$400,000
$260,000
$260,000
$0
$260,000
$260,000
$0

FY 2017
Total
Funding
Available
$8,758,084
$4,182,564
$360,798
$11,817,550
$6,808,590
$42,417,052
$9,651,498
$10,094,811
$7,834,629
$4,324,673
$29,577,651
$15,917,491
$484,271
$4,864,239
$5,290,505
$16,315,228
$11,619,056
$6,713,986
$6,922,893
$8,342,255
$19,556,036
$9,044,542
$4,924,378
$383,816
$11,375,655
$12,967,195
$16,331,967
$417,164
$11,142,903
$6,859,603
$11,103,511
$4,591,111
$5,592,147
$6,776,935
$5,035,513
$15,544,743
$6,674,399
122

Awardee

New York
New York City
North Carolina
North Dakota
N. Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Total

FY 2017 Base
Plus
Population
Funding
$16,066,980
$14,219,560
$14,292,742
$4,012,964
$357,539
$16,058,844
$7,398,148
$7,530,429
$323,735
$17,395,919
$6,906,583
$4,187,766
$8,505,527
$4,012,964
$10,421,781
$33,887,955
$6,368,795
$4,012,964
$415,036
$12,426,351
$11,062,782
$5,755,894
$5,073,651
$9,489,645
$4,012,964
$542,144,450

FY 2017
Cities
Readiness
Initiative
Funding
$1,791,571
$3,826,060
$522,554
$169,600
$0

$1,468,042
$340,871
$482,081
$0

$1,675,818
$0

$272,421
$296,405
$169,600
$723,955
$3,998,896
$294,706
$169,600
$0

$1,493,238
$1,052,317
$623,814
$183,875
$482,103
$169,600
$51,998,750

FY 2017
Level 1
Chemical
Laboratory
Funding
$1,726,734

$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$1,010,999

$0
$0
$0
$0
$0
$0
$962,945

$0
$0
$0
$1,445,235

$0
$11,586,800

FY 2017
Level 2
Chemical
Laboratory
Funding**
$0
$0
$0
$0
$0
$0
$0
$0
$0
$400,000
$260,000
$0
$0
$0
$0
$0
$0
$400,000
$0
$0
$260,000
$0
$260,000
$0
$0
$6,020,000

FY 2017
Total
Funding
Available
$19,585,285
$18,045,620
$14,815,296
$4,182,564
$357,539
$17,526,886
$7,739,019
$8,012,510
$323,735
$19,471,737
$7,166,583
$4,460,187
$9,812,931
$4,182,564
$11,145,736
$37,886,851
$6,663,501
$4,582,564
$415,036
$14,882,534
$12,375,099
$6,379,708
$5,517,526
$11,416,983
$4,182,564
$611,750,000

* PHEP funding subject to change based on the final fiscal year 2017 budget.
** Additional funding awarded to complete replacement of ICP-MS equipment.

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Cities Readiness Initiative (CRI)
Budget Period 1 (Fiscal Year 2017) Funding

Awardee

CRI City

2015 Census
Population

FY 2017
Awardee Total

Alabama

Birmingham

1,138,476

$294,350

Alaska

Anchorage

395,285

$169,600

Arizona

Phoenix

4,407,915

Arkansas

Little Rock

722,684

Arkansas

Memphis

49,765

California

Los Angeles

3,116,069

California

Riverside

4,392,801

California

Sacramento

2,221,525

California

San Diego

3,223,096

California

San Francisco

4,528,894

California

San Jose

1,925,706

California

Fresno

956,749

Chicago

Chicago

Colorado

Denver

2,703,972

Connecticut

Hartford

1,214,056

Connecticut

New Haven

862,224

Delaware

Philadelphia

549,643

Delaware

Dover

169,509

Florida

Miami

5,861,000

Florida

Orlando

2,277,816

Florida

Tampa

2,888,458

$2,851,074

Georgia

Atlanta

5,535,837

$1,431,277

Hawaii

Honolulu

984,178

$254,457

Idaho

Boise

651,402

$169,600

Illinois

Chicago

5,940,053

Illinois

St Louis

697,634

Illinois

Peoria

379,947

Indiana

Chicago

705,671

Indiana

Indianapolis

1,950,674

Indiana

Cincinnati

63,011

Indiana

Louisville

280,024

Iowa

Des Moines

601,187

Iowa

Omaha

122,542

Kansas

Wichita

638,884

$1,139,655
$199,715

$5,265,278

$1,611,520
$699,105
$536,817
$311,709

$1,885,757

$775,482

$201,283
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Awardee

CRI City

2015 Census
Population

FY 2017
Awardee Total

Kansas

Kansas City

848,063

Kentucky

Louisville

981,912

Kentucky

Cincinnati

435,275

Los Angeles

Los Angeles

Louisiana

Baton Rouge

819,861

Louisiana

New Orleans

1,239,697

$532,494

Maine

Portland

520,893

$169,600

Maryland

Baltimore

2,769,818

Maryland

Washington D.C

2,394,916

Maryland

Philadelphia

101,960

Massachusetts

Boston

4,270,286

Massachusetts

Providence

552,763

$1,246,987

Michigan

Detroit

4,296,416

$1,110,828

Minnesota

Fargo

60,879

Minnesota

Minneapolis

3,331,873

Mississippi

Jackson

577,070

Mississippi

Memphis

252,333

Missouri

St. Louis

2,128,940

Missouri

Kansas City

1,207,612

$862,657

Montana

Billings

164,716

$169,600

Nebraska

Omaha

773,377

$199,955

Nevada

Las Vegas

2,035,572

$526,292

New Hampshire

Boston

424,279

New Hampshire

Manchester

403,972

New Jersey

New York City

6,580,787

New Jersey

Philadelphia

1,317,972

New Jersey

Trenton

370,212

New Mexico

Albuquerque

902,731

New York

Albany

877,846

New York

Buffalo

1,135,734

New York

New York City

4,915,788

New York City

New York City

0

North Carolina

Charlotte

1,984,897

North Carolina

Virginia Beach

36,216

$522,554

North Dakota

Fargo

162,500

$169,600

Ohio

Cincinnati

1,641,180

$388,865
$366,410
$3,223,040

$1,361,690

$877,187
$234,840

$279,296
$2,211,804
$233,399
$1,791,571
$3,826,061

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Awardee

CRI City

2015 Census
Population

Ohio

Cleveland

2,064,483

Ohio

Columbus

1,972,375

$1,468,042

Oklahoma

Oklahoma City

1,318,408

$340,871

Oregon

Portland

1,864,574

$482,081

Pennsylvania

Philadelphia

4,066,105

Pennsylvania

Pittsburgh

2,358,926

Pennsylvania

New York City

56,632

Rhode Island

Providence

1,053,661

South Carolina

Columbia

792,530

South Carolina

Charlotte

353,895

$296,405

South Dakota

Sioux Falls

242,731

$169,600

Tennessee

Nashville

1,761,848

Tennessee

Memphis

1,038,238

Texas

Dallas

6,833,420

Texas

Houston

6,346,653

Texas

San Antonio

2,286,702

Utah

Salt Lake City

1,139,851

$294,706

Vermont

Burlington

215,081

$169,600

Virginia

Richmond

1,246,215

Virginia

Virginia Beach

1,677,485

Virginia

Washington D.C

2,851,789

Washington

Seattle

3,614,361

Washington

Portland

455,749

Washington D.C

Washington D.C

West Virginia

Charleston

223,922

West Virginia

Washington D.C

55,214

Wisconsin

Chicago

167,738

Wisconsin

Milwaukee

1,570,006

Wisconsin

Minneapolis

126,917

Wyoming

Cheyenne

95,431

Total CRI Funding

FY 2017
Awardee Total

$1,675,818
$272,421

$723,955
$3,998,896

$1,493,238

$1,052,317
$623,814

160,525,973

$183,875
$482,103
$169,600

$51,998,750

* CRI funding subject to change based on the final fiscal year 2017 budget.

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I. Glossary
Activities: The actual events or actions that take place as a part of the program.

Administrative and National Policy Requirements, Additional Requirements
(ARs): Administrative requirements found in 45 CFR Part 75 and other requirements mandated by
statute or ASPR and CDC policy. Awardees must comply with the ARs listed in the FOA.
To view brief descriptions of relevant provisions, see
http://www.cdc.gov/grants/additionalrequirements/index.html. Note that 45 CFR part 75 supersedes
the administrative requirements (A-110 & A-102), cost principles (A-21, A-87 & A-122) and audit
requirements (A-50, A-89 & A-133).
Approved but Unfunded: Approved but unfunded refers to applications recommended for approval
during the objective review process; however, they were not recommended for funding by the
program office and/or the grants management office.
Award: Financial assistance that provides support or stimulation to accomplish a public purpose.
Awards include grants and other agreements (e.g., cooperative agreements) in the form of money, or
property in lieu of money, by the federal government to an eligible applicant.
Budget Period or Budget Year: The duration of each individual funding period within the project
period. Traditionally, budget periods are 12 months or 1 year.
Carry-over: Unobligated federal funds remaining at the end of any budget period that, with the
approval of the GMO or under an automatic authority, may be carried over to another budget period
to cover allowable costs of that budget period either as an offset or additional authorization.
Obligated but liquidated funds are not considered carry-over.
Catalog of Federal Domestic Assistance (CFDA): A government-wide compendium published by
the General Services Administration (available on-line in searchable format as well as in printable
format as a .pdf file) that describes domestic assistance programs administered by the Federal
Government.
CFDA Number: A unique number assigned to each program and FOA throughout its lifecycle that
enables data and funding tracking and transparency.
CDC Assurances and Certifications: Standard government-wide grant application forms.
Competing Continuation Award: A financial assistance mechanism that adds funds to a grant and
adds one or more budget periods to the previously established project period (i.e., extends the “life”
of the award).
Continuous Quality Improvement: A system that seeks to improve the provision of services with
an emphasis on future results.
Contracts: An award instrument used to acquire (by purchase, lease, or barter) property or services
for the direct benefit or use of the Federal Government.
Cooperative Agreement: A financial assistance award with the same kind of interagency
relationship as a grant except that it provides for substantial involvement by the federal agency
funding the award. Substantial involvement means that the recipient can expect federal programmatic
collaboration or participation in carrying out the effort under the award.
Cost Sharing or Matching: Refers to program costs not borne by the Federal Government but by
the awardees. It may include the value of allowable third-party, in-kind contributions, as well as
expenditures by the awardee.
Direct Assistance: A financial assistance mechanism, which must be specifically authorized by
statute, whereby goods or services are provided to recipients in lieu of cash. DA generally involves
the assignment of federal personnel or the provision of equipment or supplies, such as vaccines. DA
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is primarily used to support payroll and travel expenses of CDC employees assigned to state, tribal,
local, and territorial (STLT) health agencies that are recipients of grants and cooperative agreements.
Most legislative authorities that provide financial assistance to STLT health agencies allow for the
use of DA. http://www.cdc.gov/grants/additionalrequirements/index.html.
DUNS: The Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number is a
nine-digit number assigned by Dun and Bradstreet Information Services. When applying for Federal
awards or cooperative agreements, all applicant organizations must obtain a DUNS number as the
Universal Identifier. DUNS number assignment is free. If requested by telephone, a DUNS number
will be provided immediately at no charge. If requested via the Internet, obtaining a DUNS number
may take one to two days at no charge. If an organization does not know its DUNS number or needs
to register for one, visit Dun & Bradstreet at http://fedgov.dnb.com/webform/displayHomePage.do.
Emergency Support Function (ESF): As defined in the National Response Framework, an ESF refers to a
group of capabilities of federal departments and agencies to provide the support, resources, program
implementation, and services that are most likely to be needed to save lives, protect property, restore
essential services and critical infrastructure, and help victims return to normal following a national
incident. An ESF represents the primary operational level mechanism to orchestrate activities to
provide assistance to state, tribal, or local governments, or to federal departments or agencies
conducting missions of primary federal responsibility.
Evaluation (program evaluation): The systematic collection of information about the activities,
characteristics, and outcomes of programs (which may include interventions, policies, and specific
projects) to make judgments about that program, improve program effectiveness, and/or inform
decisions about future program development.
Evaluation Plan: A written document describing the overall approach that will be used to guide an
evaluation, including why the evaluation is being conducted, how the findings will likely be used,
and the design and data collection sources and methods. The plan specifies what will be done, how it
will be done, who will do it, and when it will be done. The FOA evaluation plan is used to describe
how the awardee and/or CDC will determine whether activities are implemented appropriately and
outcomes are achieved.
Federal Funding Accountability and Transparency Act of 2006 (FFATA): Requires that
information about federal awards, including awards, contracts, loans, and other assistance and
payments, be available to the public on a single website at www.USAspending.gov.
Fiscal Year: The year for which budget dollars are allocated annually. The federal fiscal year starts
October 1 and ends September 30.
Grant: A legal instrument used by the federal government to transfer anything of value to a recipient
for public support or stimulation authorized by statute. Financial assistance may be money or
property. The definition does not include a federal procurement subject to the Federal Acquisition
Regulation; technical assistance (which provides services instead of money); or assistance in the form
of revenue sharing, loans, loan guarantees, interest subsidies, insurance, or direct payments of any
kind to a person or persons. The main difference between a grant and a cooperative agreement is that
in a grant there is no anticipated substantial programmatic involvement by the federal government
under the award.
Grants.gov: A "storefront" web portal for electronic data collection (forms and reports) for federal
grant-making agencies at www.grants.gov.
Grants Management Officer (GMO): The individual designated to serve as the HHS official
responsible for the business management aspects of a particular grant(s) or cooperative agreement(s).
The GMO serves as the counterpart to the business officer of the recipient organization. In this
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capacity, the GMO is responsible for all business management matters associated with the review,
negotiation, award, and administration of grants and interprets grants administration policies and
provisions. The GMO works closely with the program or project officer who is responsible for the
scientific, technical, and programmatic aspects of the grant.
Grants Management Specialist (GMS): A federal staff member who oversees the business and
other non-programmatic aspects of one or more grants and/or cooperative agreements. These
activities include, but are not limited to, evaluating grant applications for administrative content and
compliance with regulations and guidelines, negotiating grants, providing consultation and technical
assistance to recipients, post-award administration and closing out grants.
Health Disparities: Differences in health outcomes and their determinants among segments of the
population as defined by social, demographic, environmental, or geographic category.
Health Equity: Striving for the highest possible standard of health for all people and giving special
attention to the needs of those at greatest risk of poor health, based on social conditions.
Health Inequities: Systematic, unfair, and avoidable differences in health outcomes and their
determinants between segments of the population, such as by socioeconomic status (SES),
demographics, or geography.
Healthy People 2020: National health objectives aimed at improving the health of all Americans by
encouraging collaboration across sectors, guiding people toward making informed health decisions,
and measuring the effects of prevention activities.
Inclusion: Both the meaningful involvement of a community’s members in all stages of the program
process and the maximum involvement of the target population that the intervention will benefit.
Inclusion ensures that the views, perspectives, and needs of affected communities, care providers,
and key partners are considered.
Indirect Costs: Costs that are incurred for common or joint objectives and not readily and
specifically identifiable with a particular sponsored project, program, or activity; nevertheless, these
costs are necessary to the operations of the organization. For example, the costs of operating and
maintaining facilities, depreciation, and administrative salaries generally are considered indirect costs.
Intergovernmental Review: Executive Order 12372 governs applications subject to
Intergovernmental Review of Federal Programs. This order sets up a system for state and local
governmental review of proposed federal assistance applications. Contact the state single point of
contact (SPOC) to alert the SPOC to prospective applications and to receive instructions on the
State’s process. Visit the following web address to get the current SPOC
list: http://www.whitehouse.gov/omb/grants_spoc/.
Letter of Intent (LOI): A preliminary, non-binding indication of an organization’s intent to submit
an application.
Lobbying: Direct lobbying includes any attempt to influence legislation, appropriations, regulations,
administrative actions, executive orders (legislation or other orders), or other similar deliberations at
any level of government through communication that directly expresses a view on proposed or
pending legislation or other orders, and which is directed to staff members or other employees of a
legislative body, government officials, or employees who participate in formulating legislation or
other orders. Grass roots lobbying includes efforts directed at inducing or encouraging members of
the public to contact their elected representatives at the federal, state, or local levels to urge support
of, or opposition to, proposed or pending legislative proposals.
Logic Model: A visual representation showing the sequence of related events connecting the
activities of a program with the programs’ desired outcomes and results.
Maintenance of Effort: A requirement contained in authorizing legislation, or applicable regulations
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that a recipient must agree to contribute and maintain a specified level of financial effort from its own
resources or other non-government sources to be eligible to receive federal grant funds. This
requirement is typically given in terms of meeting a previous base-year dollar amount.
Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA): Document
that describes a bilateral or multilateral agreement between parties expressing a convergence of will
between the parties, indicating an intended common line of action. It is often used in cases where the
parties either do not imply a legal commitment or cannot create a legally enforceable agreement.
Nonprofit Organization: Any corporation, trust, association, cooperative, or other organization that
is operated primarily for scientific, educational, service, charitable, or similar purposes in the public
interest; is not organized for profit; and uses net proceeds to maintain, improve, or expand the
operations of the organization. Nonprofit organizations include institutions of higher educations,
hospitals, and tribal organizations (that is, Indian entities other than federally recognized Indian
tribal governments).
Notice of Award (NoA): The official document, signed (or the electronic equivalent of signature) by
a Grants Management Officer that: (1) notifies the recipient of the award of a grant; (2) contains or
references all the terms and conditions of the grant and Federal funding limits and obligations; and
(3) provides the documentary basis for recording the obligation of Federal funds in the HHS
accounting system.
Objective Review: A process that involves the thorough and consistent examination of applications
based on an unbiased evaluation of scientific or technical merit or other relevant aspects of the
proposal. The review is intended to provide advice to the persons responsible for making award
decisions.
Outcome: The results of program operations or activities; the effects triggered by the program. For
example, increased knowledge, changed attitudes or beliefs, reduced tobacco use, reduced morbidity
and mortality.
Performance Measurement: The ongoing monitoring and reporting of program accomplishments,
particularly progress toward pre-established goals, typically conducted by program or agency
management. Performance measurement may address the type or level of program activities
conducted (process), the direct products and services delivered by a program (outputs), or the results
of those products and services (outcomes). A “program” may be any activity, project, function, or
policy that has an identifiable purpose or set of objectives.
Plain Writing Act of 2010: Plain Writing Act of 2010, Public Law 111-274 requires federal
agencies to communicate with the public in plain language to make information more accessible and
understandable by intended users, especially people with limited health literacy skills or limited
English proficiency. The Plain Writing Act is available at www.plainlanguage.gov.
Program Strategies: Strategies are groupings of related activities, usually expressed as general
headers (e.g., Partnerships, Assessment, Policy) or as brief statements (e.g., Form partnerships,
Conduct assessments, Formulate policies).
Program Official: Person responsible for developing the FOA; can be either a project officer,
program manager, branch chief, division leader, policy official, center leader, or similar staff member.
Project Period Outcome: An outcome that will occur by the end of the FOA’s funding period.
Public Health Accreditation Board (PHAB): A nonprofit organization that works to promote and
protect the health of the public by advancing the quality and performance of public health
departments in the U.S. through national public health department
accreditation http://www.phaboard.org.
Regulation: An official rule or order, having legal force, usually issued by an administrative agency.
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Social Determinants of Health: Conditions in the environments in which people are born, live,
learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life
outcomes and risks.
Statute: An act of the legislature; a particular law enacted and established by the will of the
legislative department of government, expressed with the requisite formalities. In foreign or civil law
any particular municipal law or usage, though resting for its authority on judicial decisions, or the
practice of nations.
Statutory Authority: Authority provided by legal statute that establishes a federal financial
assistance program or award.
System for Award Management (SAM): The primary vendor database for the U.S. federal
government. SAM validates applicant information and electronically shares secure and encrypted
data with federal agencies' finance offices to facilitate paperless payments through Electronic Funds
Transfer (EFT). SAM stores organizational information, allowing www.grants.gov to verify identity
and pre-fill organizational information on grant applications.
Technical Assistance: Advice, assistance, or training pertaining to program development,
implementation, maintenance, or evaluation that is provided by the funding agency.
THIRA: The Threat and Hazard Identification and Risk Assessment (THIRA) is a 4 step common risk
assessment process that helps the whole community—including individuals, businesses, faith-based
organizations, nonprofit groups, schools and academia and all levels of government—understand its
risks and estimate capability requirements.
Work Plan: The summary of project period outcomes, strategies and activities, personnel and/or
partners who will complete the activities, and the timeline for completion. The work plan will outline
the details of all necessary activities that will be supported through the approved budget.
FOA-specific Glossary and Acronyms

Acute Care Hospital: A hospital that provides inpatient medical care and other related services for
surgery, acute medical conditions or injuries usually for a short term illness or condition.
Alternate Care System: The utilization of non-traditional settings and modalities for health care
deliver.
ASPR and CDC Assurances and Certifications: Standard U.S. government grant application forms.
Emergency Support Function (ESF): As defined in the National Response Framework, an ESF refers to a
group of capabilities of federal departments and agencies to provide the support, resources, program
implementation, and services that are most likely to be needed to save lives, protect property, restore
essential services and critical infrastructure, and help victims return to normal following a national
incident. An ESF represents the primary operational level mechanism to orchestrate activities to
provide assistance to state, tribal, or local governments, or to federal departments or agencies
conducting missions of primary federal responsibility.
ESF-8 Public Health and Medical Services: Provides the mechanism for coordinated federal assistance
to supplement state, tribal, and local resources in response to an emergency.
Fiscal Preparedness: The process of ensuring that fiscal and administrative authorities and practices
that govern funding, procurement, contracting, hiring, and legal capabilities necessary to mitigate,
respond to, and recover from public health emergencies can be accelerated, modified, streamlined,
and accountably managed at all levels of government.
Health Care Coalition: ASPR defines a health care coalition as a coordinating body that incentivizes
diverse and often competitive health care organizations and other community partners with differing
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priorities and objectives to work together to prepare for, respond to, and recover from emergencies
and other incidents that impact the public’s health
Health Care Coalition Member: ASPR defines an HCC member as an entity within the HCC’s defined
boundaries that actively contributes to HCC strategic planning, identification of gaps and mitigation
strategies, operational planning and response, information sharing, and resource coordination and
management.
Immediate Bed Availability: Immediate bed availability (IBA) is defined as the ability of a hospital to
provide no less than 20% bed availability of staffed beds within four hours of a disaster.
Mission Ready Package (MRP): Describes specific response and recovery resource capabilities that are
organized, developed, trained, and exercised prior to an emergency or disaster.
Outcome Measure: Also be called impact measures, outcome measures assess direct and indirect
program impact over time.
Process Measure: Focuses on the actual operation of a program to help identify progress as well as
strengths and weaknesses. Process measures help define the structural and process components of the
program and can be applied to document the delivery and improvement of the program.
Program Measure: For the purposes of the PHEP program evaluation, the program measures indicate
the level of implementation and improvement of the PHEP program and the impact of the program
overall across all awardees. Program measures are compiled from the individual awardee performance
measures to provide an overall measure of PHEP program impact.

132