U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention (CDC)

State Public Health Approaches to Arthritis

Announcement Type: Program Announcement

> New -- Type 1

Funding Opportunity Number: CDC-PA-DP08-806

Catalog of Federal Domestic Assistance Number: 93.283

Key Dates:

Pre Application Conference Call: 01/23/2008 11:00 a.m. EST

3793. Pass Code: 14260

> Duration will not exceed two and a half hours

Application Deadline: March 17, 2008

Executive Summary:

**Component 1: Arthritis**

**Purpose**

-   The purpose of this announcement is to build state arthritis
    programs that exponentially expand access and use of evidence-based
    interventions by embedding intervention programs into existing
    systems, conducting surveillance and data analysis to inform
    decision making, and developing state-level intervention, policy,
    and communication focused partnerships that further program goals.

**Approximate Number of Individual Awards**

-   10---18 Cooperative Agreements

**Approximate Average Individual Award**

-   \$350,000---\$600,000

**Project Period Length**

-   4 years

**Eligible Applicants**

-   State and local governments or their Bona Fide Agents (this includes
    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)

**Application Limitations**

-   One application per state health department

**Cost Sharing or Matching Requirements**

-   Cost sharing or matching funds are not required

**Component 2: Lupus**

**Purpose**

-   The purpose of this announcement is to continue Lupus registry
    activities that have been undertaken in two states (Georgia and
    Michigan) under two previous cooperative agreements spanning the
    years 2003---2008.

**Approximate Number of Individual Awards**

-   2 Cooperative Agreements

**Approximate Average Individual Award**

-   \$450,000

**Project Period Length**

-   4 years

**Eligible Applicants**

-   State and local governments or their Bona Fide Agents (this includes
    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) funded
    for Lupus under Program Announcement 3022.

**Application Limitations**

-   One application per state health department

**Funding Requirements**

-   Matching funds (cost sharing) is not required

# I. Funding Opportunity Description

Authority: This program is authorized under section 301(a) and 317(k)
(2) of the

Public Health Service Act, \[42 U.S.C. section 241 (a) and 247b(k) (2),
as amended\].

This cooperative agreement is part of public health efforts described in
the National Arthritis Action Plan and also addresses Healthy People
2010 objectives for Arthritis.

**Background:**

**Component 1: Arthritis**

About 46 million U.S. adults have arthritis (21 percent of the U.S.
population) with 18.9 million Americans suffering activity limitations
because of arthritis. The long term goal of the CDC Arthritis Program is
to improve quality of life among people affected by arthritis. The
national program seeks to accomplish this through improving the science
base, measuring the burden of arthritis, reaching the public with
interventions and health information, supporting policy and decision
making to address arthritis, and building state arthritis programs.

**Component 2: Lupus**

Lupus is an autoimmune connective tissue disease with a diverse array of
clinical manifestations. Among rheumatic conditions, lupus has
relatively low prevalence but high severity. Evidence suggests that
rates of disease are highest among those aged 15 to 40, women, and
African-Americans. African-American women are at the highest risk of
lupus among all sex-race groups. Premature mortality occurs from kidney
and heart disease. Current national estimates of lupus prevalence vary
considerably, ranging from 239,000 to 4 million. Knowing the prevalence
of lupus is important to better understand the burden at both population
and personal levels, and to develop approaches to reduce the impact by
improving early diagnosis and appropriate clinical and self management.
The efforts necessary to estimate and monitor the prevalence of lupus
naturally extend to estimating incidence and characterizing those with
the illness. Case finding can be difficult because the condition is
relatively uncommon and the diagnosis is difficult. Given the wide range
of existing prevalence estimates, there is a need to better define the
prevalence of lupus.

**Purpose:**

**Component 1: Arthritis**

This announcement is to build state arthritis programs that expand
evidence-based intervention capacity and delivery, conduct surveillance
and data analysis to inform decision making, and develop state-level
partnerships that further program goals. It continues implementation of
the National Arthritis Action Plan: A Public Health Strategy (NAAP).

State arthritis programs have previously focused on building capacity to
disseminate and deliver evidence-based interventions. This funding
opportunity builds on lessons learned from these activities, with a new
emphasis on embedding arthritis interventions in existing systems to
exponentially expand access to and use of these interventions.

For the coming project period, CDC is seeking to fund arthritis programs
that capitalize on state health department approaches to chronic
disease, by encouraging states both to collaborate with related programs
on planning, partnerships, and intervention program delivery, and to
utilize successful policy and communication strategies employed by other
chronic disease programs.

By the end of this project period, CDC expects to identify model
dissemination efforts that can be replicated in other state agencies, as
well as models for working with partners at the state, regional, and
national level. By including activities related to policy development
and communication, CDC expects that state, regional, and national
systems will have a heightened awareness of arthritis as a public health
issue, creating new partners for further expanding the reach of a
growing tool box of evidence-based interventions.

**Component 2: Lupus**

This funding opportunity provides for ongoing lupus surveillance
activities to better characterize the burden of this low-prevalence but
high-impact rheumatic condition. It continues implementation of the
National Arthritis Action Plan: A Public Health Strategy (NAAP), through
implementation and completion of two population based registries for
systemic lupus erythematosus (SLE or lupus).

Initial funding for two SLE registries was provided to the Georgia and
Michigan state health departments from 2003-2008. This announcement
offers an opportunity to continue to completion those two registries.

**Component 1: Arthritis and component 2: Lupus - Focus Areas:**

This cooperative agreement addresses the "Healthy People 2010" focus
area of Arthritis.

Measurable outcomes of the programs will be in alignment with one or
more of the following Healthy People 2010 performance goals, which are
part of the overall mission of the National Center for Chronic Disease
Prevention and Health Promotion:

-   Healthy People 2010, Focus Area 2, Goal 2-8: Increase the proportion
    of adults with doctor-diagnosed arthritis who have had effective,
    evidence-based arthritis education as an integral part of the
    management of their condition.

-   Healthy People 2010, Focus Area 2, Goal 2-2: Reduce the proportion
    of adults with doctor-diagnosed arthritis who experience a
    limitation in activity due to arthritis or joint symptoms.

This announcement is only for non-research activities supported by CDC.
If research is proposed, the application will not be reviewed. For the
definition of research, please see the CDC Web site at the following
Internet address:
<http://www.cdc.gov/od/science/regs/hrpp/researchDefinition.htm>

**Recipient Activities:**

Awardee activities for this program are as follows:

**Component 1: Arthritis**

**A. Program Infrastructure:**

1\) Establish a full-time staff position (one person devoting 100% of
time to this cooperative agreement) to oversee arthritis program
activities and to carry out the activities identified in the work plan
submitted under this cooperative agreement. Additional staff will be
sufficiently skilled in carrying out the activities under this
cooperative agreement, which may include but are not limited to
expertise exemplified in the following examples: epidemiology (no more
than 25% FTE), program evaluation, partnership development,
communication, and/or management/administration.

The number and percent effort for additional staff must be justified and
congruent with the activities outlined in the submitted work plan.

2\) Commit to send at least one full-time staff person supported by this
cooperative agreement to the annual three-day arthritis grantee meeting
designated for State Public Health Approaches to Arthritis awardees
(dates and locations TBD).

**Performance measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) Program is appropriately staffed in a timely manner as evidenced by
the submission of staff name, the date of hire, and resume or curriculum
vitae for each position supported by funds under this cooperative
agreement promptly after award. Applicants are not required to include
resumes or CVs for staff supported at less than 10% FTE.

2\) Completion of the trainings, \"Arthritis: The Public Health
Approach\" and "The Arthritis Challenge" (located at
<http://www.prospectassoc.com/arthritis/> ) as documented by course
completion certificates by all staff contributing 25% effort or greater
promptly after award.

**B. Data Collection and Surveillance**

1\) Support the Behavioral Risk Factor Surveillance System (BRFSS)
arthritis modules (Arthritis Burden and Arthritis Management) in odd
years beginning with the 2009 survey.

2\) Produce periodic data reports highlighting the prevalence and impact
of arthritis in the state.

3\) Disseminate arthritis specific BRFSS data and reports to decision
makers, (e.g., state program managers, state health officials, voluntary
health agencies, chronic disease directors, state legislators).

**Performance measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) Arthritis Coordinator has requested continued support through the
state BRFSS coordinator for the core Arthritis Burden module during
national BRFSS deliberations for each year in which the questions are
proposed.

2\) Arthritis Coordinator has negotiated with the state BRFSS
coordinator to support the inclusion of the optional Arthritis
Management module both nationally and in the state during each year the
core Arthritis Burden module is used.

3\) BRFSS surveillance data are packaged and disseminated in appropriate
formats (e.g., reports, fact sheets, websites) to make the information
useful and available to decision makers and other partners throughout
the project period.

**C. Partnerships, Coalitions, and Strategic Planning**

1\) Create intervention delivery capacity by recruiting and nurturing
delivery system partners to embed interventions into their operations.
(This is essential to Recipient Activity D---Promote increased access
and use of evidence-based interventions).

2\) Forge linkages to partners that can achieve the program's goals and
meet performance measures (e.g., the Arthritis Foundation; Area Agencies
on Aging; State Units on Aging, and Cooperative State Research,
Education, and Extension Service; State Medicaid Agencies).

3\) Obtain advice and support from relevant partners, either through an
arthritis-specific advisory group or by including partners and topics
relevant to arthritis in related state advisory groups (e.g., state
chronic disease advisory committee, physical activity coalition).

4\) Ensure that there is state strategic planning that is relevant to
the objectives and activities proposed for the arthritis program, either
as a stand alone plan or as part of relevant state plans (e.g., state
chronic disease plan, state diabetes plan).

**Performance measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) Packaged Program Delivery Systems Objective: The estimated reach of
the systems engaged to deliver the evidence-based physical activity and
self management interventions throughout the project period is adequate
to achieve the Program Reach Objective (e.g., the number and size of
systems in which the programs are embedded have adequate capacity to
achieve the Packaged Intervention Reach Objective). This is also a
performance measure under Recipient Activity D---Promote increased
access and use of evidence-based interventions.

2\) Partner engagement throughout the project period includes key state
leaders (e.g. aging unit directors, Arthritis Foundation Chapters,
disability leaders, or health care provider organizations) who will
promote arthritis public health strategies.

3\) Relevant state advisory groups have arthritis-relevant public health
expertise and have agendas that will include arthritis relevant topics,
or the state has an arthritis specific advisory group, beginning
promptly after award.

4\) The state has a documented strategy for addressing arthritis within
the first project year, as evidenced by a state plan (either integrated
or stand alone) that supports the arthritis program.

**D. Promote Increased Access & Use of Interventions**

1\) Build substantial reach of evidence based interventions through the
recruitment and nurturing of sustainable delivery systems, based on
approved interventions listed in Appendix A (This is essential to
recipient activity C. Partnerships).

Programs must implement one of the Recommended Interventions in each
category: self-management, physical activity, and health communications.
In addition, programs may choose to implement one of the Promising
Practices. If choosing to implement a Promising Practice, programs must
provide a rationale for the choice of intervention (e.g., identified
need or opportunity) and demonstrate that it has potential for expansion
on a large scale through a systems approach that would not be achievable
with a Recommended Intervention. The proposal must also show evidence of
collaboration with the sponsor of the Promising Practice, to include a
letter of support indicating that needed materials, training, and
technical assistance will be made available to the program. Approved
evidence-based interventions for State Public Health Approaches to
Arthritis are listed in Appendix A. Additional information on both
recommended and promising practices can be found on the CDC Arthritis
website at <http://www.cdc.gov/arthritis/intervention/index.htm>
Information on interventions that may be approved in future years of
this cooperative agreement can be found on the same website at
<http://www.cdc.gov/arthritis/intervention/lists.htm#1>

2\) Work with appropriate partners to provide technical assistance to
delivery system partners

3\) Facilitate and support the state infrastructure for sustained
intervention program delivery.

4\) Collect reach data from all sites supported through this cooperative
agreement, taking into account that data for various interventions will
come from separate sources. CDC will share suggested data elements and
formats with grantees. Suggested data elements include: number of
certified trainers and leaders, number of participants, number of venues
programs are offered, number of programs held.

**Performance Measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) The majority of the program efforts support intervention delivery.

2\) Packaged Intervention Reach Objective: References to the number of
adults with arthritis and the four year reach objective by state are
available on the chart in Appendix B.

-   For grantees with under 250,000 adults with arthritis: By the end of
    the four year project period, at least 10,000 adults with arthritis
    in the state will participate in a packaged, evidence-based physical
    activity or self-management intervention related to program
    activities under this cooperative agreement, over and above the
    number participating prior to this project period or participating
    as a result of other efforts in the state. This measure excludes
    reach of the health communication interventions. Annual reach must
    be adequate to achieve this long-term goal during the project
    period.

-   For grantees with between 250,000 and 1,000,000 adults with
    arthritis: By the end of the four year project period, at least 4%
    of adults with arthritis in the state will participate in a
    packaged, evidence-based physical activity or self-management
    intervention related to program activities under this cooperative
    agreement, over and above the number participating prior to this
    project period or participating as a result of other efforts in the
    state. This measure excludes reach of the health communication
    interventions. Annual reach must be adequate to achieve this
    long-term goal during the project period.

-   For grantees with over 1,000,000 adults with arthritis: By the end
    of the four year project period, at least 40,000 adults with
    arthritis in the state will participate in a packaged,
    evidence-based physical activity or self-management intervention
    related to program activities under this cooperative agreement, over
    and above the number participating prior to this project period or
    participating as a result of other efforts in the state. This
    measure excludes reach of the health communication interventions.
    Annual reach must be adequate to achieve this long-term goal during
    the project period.

3\) Packaged Program Delivery Systems Objective: The estimated reach of
the systems engaged to deliver the evidence-based physical activity and
self management interventions throughout the project period is adequate
to achieve the Program Reach Objective (i.e., the number and size of
systems in which the programs are embedded have adequate capacity to
achieve the Packaged Intervention Reach Objective).

4\) Health Communication Objective: Total estimate of exposures to the
health communications campaign materials equals 3 times the number of
people with arthritis in the target area each time the campaign is
conducted.

5\) Collection of intervention reach data elements in a format to be
shared with CDC throughout the project period. A suggested format will
be available to grantees.

**E. Support Policy and Decision Making to Address Arthritis**

1\) Inform governmental and organizational policymaking about arthritis
burden and impact, and the benefits of evidence-based interventions.

2\) Partner with systems to promote policies that enhance access to and
use of arthritis interventions (e.g., health care system referrals to
interventions, reimbursement for interventions).

**Performance measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) Evidence of increased action to address arthritis as a public health
issue in governmental and or organizational policymaking.

2\) New data or major programmatic activities are shared through mass
communication venues, such as press releases and media engagement,
throughout the project period.

3\) Arthritis information is included in communications to decision
makers about chronic disease burden, programs, and strategies throughout
the project period.

**F. Enhance Capacity for Evaluation**

1\) Develop an evaluation plan that will describe how performance
measures are linked to work plan objectives, how they will be monitored,
and what baseline will be used.

2\) Provide an annual report that provides evidence of accomplishments
toward all performance measures, including important elements of program
reach data.

3\) Participate in the CDC centralized evaluation of dissemination
models including participating in both qualitative and quantitative data
collection efforts.

**Performance measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) An effective and appropriate evaluation plan will document progress
towards and completion of items in the work plan submitted under this
cooperative agreement, and will provide annual reports on performance
measures.

2\) Annual reports on performance measures are provided in a timely
manner.

**G. Work in Collaboration with Other Chronic Disease Programs**

1\) Develop and maintain governmental collaborations that support the
goal of reducing the burden and impact of arthritis. Partnerships may
include state department of health chronic disease programs, local
health department chronic disease programs, and other state agencies
involved with chronic diseases.

**Performance Measures:**

During the project period of 4 years, the proposed program will achieve
the following:

1\) Evidence of leverage activities with other state health department
programs that enhance the grantee's execution of the work plan submitted
under this cooperative agreement (e.g., shared support of staff
positions, joint funding of complementary activities, or joint planning
activities) .

2\) Active participation in the execution of the work plan by the types
of entities identified in this section throughout the project period.

**H. Itemized Budget and Justification**

1\) Provide an itemized budget covering the first 12 month grant period.
Justification of each line-item will show how it is connected with the
proposed project objectives and activities in the work plan. Additional
information, including a link to the required format, is found in
section IV-2.

**Performance measures:**

The budget will be reviewed but not scored and will not be counted
towards the 25-page limit.

**CDC Activities**

In a cooperative agreement, CDC staff is substantially involved in the
program activities, above and beyond routine grant monitoring.

CDC activities for component 1: Arthritis are as follows:

-   Conduct evaluation to compare state dissemination models at the
    national level

-   Provide consultation and subject matter expertise to plan,
    implement, and evaluate each component of the program.

-   Provide training on specific topic areas to increase staff and
    program capacity.

-   Provide current information on the status of National efforts as
    they relate to the implementation of recipient activities.

-   As needed, provide coordination of surveillance efforts and the use
    of other data systems to measure and characterize the burden and
    impact of arthritis.

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-   Continued support of the core Arthritis Burden Module and optional
    Arthritis Management module

-   Provide state-specific standard analyses of BRFSS data in odd years

-   Provide data for national level comparisons

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-   Facilitate communication among arthritis programs, other government
    agencies, and others involved in arthritis control and prevention
    efforts.

-   Collaborate across CDC Chronic Disease programs to support program
    integration efforts at the state level.

-   Provide technical assistance to support delivery of recommended
    intervention programs; provide guidance, as appropriate, on
    promising practice interventions.

**Component 2: Lupus**

(See Section III.1 Eligible Applicants; Component 2)

**A. Program Infrastructure:**

1\) Establish minimal but sufficient staff to see that contractor
activities under this cooperative agreement (especially abstracting and
data management) are properly and efficiently carried out.

2\) Develop an operational plan to guide all registry activities to meet
documented milestones.

**Performance measure:**

1\) Program is appropriately staffed in a timely manner (as evidenced by
the submission of curriculum vitae of project manager and other state
staff), and a plan for monitoring the contractor is followed.

2\) Operational plan is completed in a timely manner and includes
adequate detail to guide registry activities.

**B. Data Collection and Surveillance:**

1\) Continue activities undertaken during 2003-2008 to develop,
implement, support, and complete a population-based lupus registry that
collects data on all persons with SLE in the previously defined
catchment area. These activities include those agreed to in the Protocol
Standards and Milestones documents developed with the CDC technical
advisor, CDC consultant, and other registry site, and in the summaries
of monthly teleconferences held since 2003.

**Performance measures:**

1\) Participation in monthly teleconferences.

2\) Adherence to protocol standards.

3\) Quarterly submission of Milestones document showing case finding and
abstracting activities that demonstrate satisfactory progress toward
completion of the registry.

**C. Itemized Budget and Justification**

1\) Provide an itemized budget covering the first 12 month grant period.
Justification of each line-item will show how it is connected with the
proposed project objectives and activities in the work plan. Additional
information, including a link to the required format, is found in
section IV-2.

**Performance measures:**

The budget will be reviewed but not scored and will not be counted
towards the 25-page limit.

**CDC Activities**

In a cooperative agreement, CDC staff is substantially involved in the
program activities, above and beyond routine grant monitoring.

CDC activities for component 2: Lupus are as follows:

-   Provide consultation to plan, implement, and evaluate each component
    of the program.

-   Provide current information on the status of National efforts as
    they relate to the implementation of recipient activities.

-   As needed, provide subject matter expertise in the coordination of
    surveillance efforts and the use of other data systems to measure
    and characterize the burden of lupus.

-   Convene lupus researchers to exchange methodologies and approaches
    to findings.

-   Provide training and skill set expansion as needs are identified.

-   Direction publishing of preliminary and final data in National
    publications.

# II. Award Information 

# Component 1: Arthritis

Type of Award: Cooperative Agreement

CDC's involvement in this program is listed in the Activities Section
above.

Award Mechanism: U58 Chronic Disease Control Cooperative Agreement

Fiscal Year Funds: 2008

Approximate Current Fiscal Year Funding: \$6,000,000

Approximate Total Project Period Funding: \$24,000,000 (This amount is
an estimate for the four year grant period, and is subject to
availability of funds. The amount includes both direct and indirect
costs.)

Approximate Number of Awards: 10-18

Approximate Average Award: \$350,000 - \$600,000 (This amount is for the
first 12-month budget period, and includes both direct and indirect
costs.)

Floor of Individual Award Range: \$300,000

Ceiling of Individual Award Range: \$600,000 (This ceiling is for the
first 12-month budget period, and includes both direct and indirect
costs.)

Anticipated Award Date: 06/30/2008

Budget Period Length: 12 months

Project Period Length: 4 years

# Component 2: Lupus

Type of Award: Cooperative Agreement

CDC's involvement in this program is listed in the Activities Section
above.

Award Mechanism: U58 Chronic Disease Control Cooperative Agreement

Fiscal Year Funds: 2008

Approximate Current Fiscal Year Funding: \$900,000

Approximate Total Project Period Funding: \$3,600,000 (This amount is an
estimate for the four year grant period, and is subject to availability
of funds. The amount includes both direct and indirect costs.)

Approximate Number of Awards: 2

Approximate Average Award: \$450,000 (This amount is for the first
12-month budget period, and includes both direct and indirect costs.)

Floor of Individual Award Range: \$250,000

Ceiling of Individual Award Range: \$1,400,000 (This ceiling is for the
first 12-month budget period, and includes both direct and indirect
costs.)

Anticipated Award Date: 06/30/2008

Budget Period Length: 12 months

Project Period Length: 4 years

Throughout the project period, CDC's commitment to continuation of
awards will be conditioned on the availability of funds, evidence of
satisfactory progress by the recipient (as documented in required
reports), and the determination that continued funding is in the best
interest of the Federal government.

# III. Eligibility Information

**III.1. Eligible Applicants**

Eligible applicants that can apply for this funding opportunity are
listed below:

-   State and local governments or their Bona Fide Agents (this includes
    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)

A Bona Fide Agent is an agency or organization identified by the state
as eligible to submit an application under the state eligibility in lieu
of a state application. If applying as a bona fide agent of a state or
local government, a letter from the state or local government as
documentation of the status is required. Attach with "Other Attachment
Forms" when submitting via [www.grants.gov](http://www.grants.gov/).

Justification for less than maximum eligibility:

**Component 1: Arthritis**

Through this cooperative agreement, the Arthritis Program will limit
funding to state health departments to identify models for disseminating
evidence based interventions.

The awards to state and local governments or their bona fide agents are
required to successfully:

-   Leverage and integrate health department resources such as:

    -   shared support of chronic disease centered public health
        professionals,

    -   joint funding of complementary public health activities,

    -   achieving overarching state arthritis policies within the state
        chronic disease plan (state plan)

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-   Utilize the public health resources and capacity unique to state
    health departments to achieve a comprehensive state-wide arthritis
    system

-   Develop models that integrate with other state health department
    chronic disease programs affecting similar populations

-   Collect state-wide surveillance data on arthritis through unique
    data sources available to state health departments

Previous Arthritis Program cooperative agreements have demonstrated that
the eligible applicants have the unique capacities that are the basis
for this funding.

**Component 2: Lupus**

This cooperative agreement will continue the lupus registry activities
that have been undertaken in Georgia and Michigan under two previous
cooperative agreements spanning the years 2003-2008.

-   It is imperative that the two currently funded state health
    departments continue as grantees to complete the registry of the
    identified catchment areas if these geographic areas are to remain
    intact

-   The protected medical records used by the current grantees cannot be
    used by other organizations, thus the existing progress in current
    registry catchment areas cannot be duplicated by new grantees

-   To stop either of the existing registries short of completion will
    render the progress to date of no value, and prior investments would
    be lost

-   Collection of surveillance data on lupus, through the HIPAA
    surveillance exemption of these two states, provides unique access
    to medical records

The existing grantees' unique data sources are required to continue this
existing project to completion. They have been fully successful in their
performance under the previous cooperative agreements and the activities
have progressed at the desired rate.

**III.2. Cost Sharing or Matching**

Cost sharing or matching funds are not required for this program.

**III.3. Other**

CDC will accept and review applications with budgets greater than the
ceiling of the award range.

**Special Requirements:**

If the application is incomplete or non-responsive to the special
requirements listed in this section, it will not be entered into the
review process. The applicant will be notified the application did not
meet submission requirements.

-   Late applications will be considered non-responsive. See section
    "IV.3. Submission Dates and Times" for more information on
    deadlines.

-   Note: Title 2 of the United States Code Section 1611 states that an
    organization described in Section 501(c)(4) of the Internal Revenue
    Code that engages in lobbying activities is not eligible to receive
    Federal funds constituting a grant, loan, or an award.

# IV. Application and Submission Information

**Electronic Submission:**\
CDC strongly encourages the applicant to submit the application
electronically by utilizing the forms and instructions posted for this
announcement on www.Grants.gov, the official Federal agency wide E-grant
Web site. Only applicants who apply on-line are permitted to forego
paper copy submission of all application forms. Applicants are able to
complete it off-line, and then upload and submit the application via the
Grants.gov Web site. E-mail submissions will not be accepted.\
\
Registering your organization through www.Grants.gov is the first step
in submitting applications online. Registration information is located
in the "Get Registered" screen of www.Grants.gov. While application
submission through www.Grants.gov is optional, we strongly encourage you
to use this online tool.\
\
Please visit www.Grants.gov at least 30 days prior to filing your
application to familiarize yourself with the registration and submission
processes. Under "Get Registered," the one-time registration process
will take three to five days to complete; however, as part of the
Grants.gov registration process, registering your organization with the
Central Contractor Registry (CCR) annually, could take an additional one
to two days to complete. We suggest submitting electronic applications
prior to the closing date so if difficulties are encountered, you can
submit a hard copy of the application prior to the deadline.\
\
Agencies are also required to have a Dun and Bradstreet Data Universal
Numbering System (DUNS) number to apply for a grant or cooperative
agreement from the Federal government. The DUNS number is a nine-digit
identification number, which uniquely identifies business entities.
Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS
number, access the Dun and Bradstreet website or call 1-866-705-5711.\
\
**Paper Submission:**\
If access to the Internet is not available or if there is difficulty
accessing the forms on-line, contact the CDC Procurement and Grants
Office Technical Information Management Section (PGO-TIMS) staff at
770-488-2700. For technical difficulties in Grants.gov, customer service
can be reached by E-mail at support@grants.gov or by phone at
1-800-518-4726 (1-800-518-GRANTS). The Customer Support Center is open
from 7:00a.m. to 9:00p.m. Eastern Time, Monday through Friday.\
\
Application forms and instructions are available on the CDC Web site, at
the following Internet address:
http://www.cdc.gov/od/pgo/funding/grants/app_and_forms.shtm\
\
If submitting a paper application, the following additional format
requirements must be followed:\
\
• Paper size: 8.5 by 11 inches\
• Page margin size: One inch\
• Printed only on one side of page\
• Paper application should be held together only by rubber bands or
metal clips; not bound in any other way.\
• The paper submission must be clearly marked: "BACK-UP FOR ELECTRONIC
SUBMISSION."\
\
**IV-1 Content and Form of Submission**\
**First Step - Grants.gov Mandatory Documents**\
Applicants are required to open and complete all of the documents in the
Mandatory Documents Box in Grants.gov, starting with the 424 Form first.
Mandatory Documents are as follows:\
• Application for Federal Assurance SF424 form (Complete First)\
• Budget Info for Non-Construction Program (SF424A -- front page)\
• Budget Info for Non-Construction Program (SF424A -- back page)\
• Assurances\
• Disclosure of Lobbying Activities\
\
**Second Step -- Funding Opportunity Announcement Mandatory Documents**\
Applicants are required to upload or attach all of the following
mandatory documents by component in PDF file format in the order stated
below as attachments in Grants.gov. Directions for creating PDF files
can be found on the Grants.gov website. Use of file formats other than
PDF may result in an unreadable file.\
• SF424 Supplement Project Abstract (single spaced)\
• Project Narrative (25 pages or less and inclusive of the following
previously described sections):

**Component 1: Arthritis**

A.  Program Infrastructure

B.  Data Collection and Surveillance

C.  Partnerships, Coalitions, and Strategic Planning

D.  Promote Increased Access & Use of Interventions

E.  Support Policy and Decision Making to Address Arthritis

F.  Enhance Capacity for Evaluation

G.  Work in Collaboration with Other Chronic Disease Programs

H.  Itemized Budget and Justification

**Component 2: Lupus**

> (State and local governments or their Bona Fide Agents funded for
> Lupus under Program Announcement 3022 may apply for this funding)
>
> A. Program Infrastructure\
> B. Data Collection and Surveillance
>
> C. Itemized Budget and Justification

Additional information may be included in the application appendices.
The appendices will not be counted toward the narrative page limit. This
additional information includes:

> • Budget and Budget Justification by component (include Indirect Cost
> Rate Agreement/Cost Allocation Plan, if applicable)\
> • Resumes/Curriculum vitae (single spaced)\
> • Letters of Support (single spaced)\
> • Organizational Charts (single spaced, 10 point font)

These attachments must be submitted using the following format unless
otherwise indicated above:

> • 12 point unreduced font size, Times New Roman\
> • Double spaced\
> • Number all pages in each attachment\
> • The title for each attachment should be as follows:
>
> "806\_(state two letter abbreviation)\_(document name and extension)"\
> (e.g., 806_GA_ResumeSmith.pdf; 806_GA_OrgChartDivision.pdf)

**Third Step -- Other Applicant Determined Attachments**\
Additional applicant determined information may also be uploaded as
attachments in Grants.gov. These documents will not be counted toward
the narrative page limit. This additional information may include table
and charts (Times New Roman fonts as low as 10 point may be used for
tables and charts). No more than 10 electronic attachments should be
uploaded per application.\
\
SF424 Supplement Project Abstract\
\
Applicants are required to upload a Project Abstract in an Optional
Document called Project Abstract in Grants.gov. The Project Abstract
must contain a 2-3 paragraph single-spaced summary of the proposed
activities suitable for dissemination to the public. It should be a
self-contained description of the project and should contain a statement
of objectives and methods to be employed. It should be informative to
other persons working in the same or related fields and insofar as
possible understandable to a technically literate lay reader. This
Abstract must not include any proprietary/confidential information.\
\
**Project Narrative:**\
The Project Narrative should address activities to be conducted over the
entire period with more specific information included on year one
activities. The narrative may reference past relevant accomplishments.
The narrative must include the following items in the order listed
below:\
\
**Component 1: Arthritis** -- Provide a concise description for each
item using the referenced sections as a guide.\
\
• **Program Infrastructure** -- Section A (include staffing and
arthritis specific training)\
• **Data Collection and Surveillance** -- Section B (include plan to
utilize the BRFSS, related data products, and their dissemination)\
• **Partnerships, Coalitions, and Strategic Planning** -- Section C
(include intervention delivery system partners, forged linkages,
relevant advisors, and strategic state planning)\
• **Promote Increased Access & Use of Interventions** -- Section D
(include rationale for intervention choices, plan for achieving reach
objectives, infrastructure goals, and reach collection methodology)\
• **Support Policy and Decision Making to Address Arthritis** -- Section
E (include means of getting arthritis information to appropriate
individuals and organizations and partnerships to be used)\
• **Enhance Capacity for Evaluation** -- Section F (include evaluation
plan linked to work plan and annual report information)\
• **Work in Collaboration with Other Chronic Disease Programs** --
Section G (include shared resources, goals, target audiences, and
efforts)

• **Itemized Budget and Justification** -- Section H (refer to IV.2.
Budget and Budget Justification below)\
\
**Component 2: Lupus**: (State and local governments or their Bona Fide
Agents funded for Lupus under Program Announcement 3022 may apply for
this funding) -- Provide a concise description for each item using the
referenced sections as a guide:\
\
• **Program Infrastructure** -- Section A (include information regarding
program infrastructure, Operational Plan, and existing relationships
with contractor/staff)\
• **Data Collection and Surveillance** -- Section B (continued data
collection utilizing protocol standards and milestone documents)

• **Itemized Budget and Justification** -- Section C (refer to IV.2.
Budget and Budget Justification below)\
\
**IV.2**. **Budget and Budget Justification**\
A detailed budget with supporting justification must be provided and
should be related to the objectives stated in this guidance.\
\
Travel\
Identify mandatory travel requirements\
\
Contractors\
Provide name of contractor, method of selection (e.g., competitive, sole
source) scope of work, budget and budget justification, and method of
accountability. Additional justification must be provided for sole
source acquisitions.\
\
Indirect Costs\
If requesting indirect costs in the budget, a copy of the indirect cost
rate agreement or cost allocation plan is required. If the indirect cost
rate is a provisional rate, the agreement should be less than 12 months
of age. The indirect cost rate agreement should be uploaded as a PDF
file with "Other Attachment Forms" when submitting via Grants.gov.\
\
The recommended guidance for completing a detailed justified budget can
be found on the CDC Web site, at the following Internet address:\
<http://www.cdc.gov/od/pgo/funding/budgetguide.htm>

# IV.3. Submission Dates and Times

Application Deadline Date: March 17, 2008

Explanation of Deadlines: Applications must be received in the CDC
Procurement and Grants Office by 5:00 p.m. Eastern Time on the deadline
date.

Applications must be submitted electronically at
[www.Grants.gov](http://www.Grants.gov/). Applications completed on-line
through Grants.gov are considered formally submitted when the applicant
organization's Authorizing Organization Representative (AOR)
electronically submits the application to
[www.Grants.gov](http://www.Grants.gov/). Electronic applications will
be considered as having met the deadline if the application has been
successfully submitted electronically by the applicant organization's
AOR to Grants.gov on or before the deadline date and time.

When submission of the application is done electronically through
Grants.gov (http://www.grants.gov), the application will be
electronically time/date stamped and a tracking number will be assigned,
which will serve as receipt of submission. The AOR will receive an
e-mail notice of receipt when HHS/CDC receives the application.

This announcement is the definitive guide on LOI and application
content, submission address, and deadline. It supersedes information
provided in the application instructions. If the application submission
does not meet the deadline above, it will not be eligible for review.
The application face page will be returned by HHS/CDC with a written
explanation of the reason for non-acceptance. The applicant will be
notified the application did not meet the submission requirements.

**IV.4. Intergovernmental Review of Applications**

Executive Order 12372 does not apply to this program.

**IV.5. Funding Restrictions**

Restrictions, which must be taken into account while writing the budget,
are as follows:

-   Recipients may not use funds for research.

-   Recipients may not use funds for clinical care.

-   Recipients may only expend funds for reasonable program purposes,
    including personnel, travel, supplies, and services, such as
    contractual.

-   Awardees may not generally use HHS/CDC/ATSDR funding for the
    purchase of furniture or equipment. Any such proposed spending must
    be identified in the budget.

-   The direct and primary recipient in a cooperative agreement program
    must perform a substantial role in carrying out project objectives
    and not merely serve as a conduit for an award to another party or
    provider who is ineligible.

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-   Reimbursement of pre-award costs is not allowed.

**IV.6. Other Submission Requirements**

Paper Submission:

Applicants should submit the original and two hard copies of the
application by mail or express delivery service to:

Technical Information Management -- DP08-806

Department of Health and Human Services

CDC Procurement and Grants Office

2920 Brandywine Road, MS E-14

Atlanta, GA 30341

# V. Application Review Information

**V.1. Criteria**

Applicants are required to provide measures of effectiveness that will
demonstrate the accomplishment of the various identified objectives of
the cooperative agreement. Measures of effectiveness must relate to the
performance goals stated in the "Purpose" section of this announcement.
Measures must be objective and quantitative and must measure the
intended outcome. The measures of effectiveness must be submitted with
the application and will be an element of evaluation.

The application will be evaluated against the following criteria:

**Component 1: Arthritis**

Application will be scored on the extent to which the proposed plan
provides evidence that performance measures will be achieved during the
annual project years or cooperative agreement project period, as
appropriate, in each of the following areas (points indicate the weight
of each criterion):

1\) Promote increased access and use of interventions (35 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (D), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

2\) Partnerships (20 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (C), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

3\) Support policy development (15 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (E), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

4\) Work in collaboration with other chronic disease programs (10
points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (G), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

5\) Enhance capacity for evaluation to monitor/measure progress (10
points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (F), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

6\) Data collection and surveillance (5 points)

The extent to which the applicant has addressed specific Recipient
Activities in Section (B), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

7\) Program Infrastructure (5 points)

The extent to which the applicant has addressed specific Recipient
Activities in Section (A), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

The budget (SF 424A) and budget narrative (H) will be reviewed but not
scored.

**Component 2: Lupus**

1\) Existing infrastructure for data collection and surveillance
including arrangements with potential case finding sources in the
catchment area (50 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (A) and Section (B), and the extent to which the
applicant provides evidence that the planned activities will achieve the
performance measures listed.

2\) Existing relationship with contractor and or staff (30 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (A) and Section (B), and the extent to which the
applicant provides evidence that the planned activities will achieve the
performance measures listed.

3\) Operational plan including the anticipated schedule for completing\
the project (20 points)

The extent to which the applicant clearly describes specific Recipient
Activities in Section (A), and the extent to which the applicant
provides evidence that the planned activities will achieve the
performance measures listed.

The budget (SF 424A) and budget narrative (C) will be reviewed but not
scored.

**V.2. Review and Selection Process**

Applications will be reviewed for completeness by the Procurement and
Grants Office (PGO) staff, and for responsiveness jointly by the
National Center for Chronic Disease Prevention and Health Promotion and
PGO. Incomplete applications and applications that are non-responsive to
the eligibility criteria will not advance through the review process.
Applicants will be notified the application did not meet submission
requirements.

An objective review panel will evaluate complete and responsive
applications according to the criteria listed in the "V.1. Criteria"
section above. The panel will be comprised of CDC employees from both
inside and outside of the funding center. A primary, secondary, and
tertiary reviewer will score the applications and document their
strengths and weaknesses. The applications will be scored against the
criteria not against one another. These comments will be presented to
the panel and a vote will take place by the panel to determine if the
application is approved, disapproved, or deferred.

Applications will be funded in order by score and rank determined by the
review panel.

Funding preference may be given to states participating in the CDC
National Center for Chronic Disease Prevention and Health Promotion
negotiated agreement demonstration project. CDC will provide
justification for any decision to fund out of rank order.

**V.3. Anticipated Announcement Award Dates**

Notification of award will be made on or before June 30, 2008

# 

# VI. Award Administration Information

**VI.1. Award Notices**

Successful applicants will receive a Notice of Award (NoA) from the CDC
Procurement and Grants Office. The NoA shall be the only binding,
authorizing document between the recipient and CDC. The NoA will be
signed by an authorized Grants Management Officer and emailed to the
program director and a hard copy mailed to the recipient fiscal officer
identified in the application.

Unsuccessful applicants will receive notification of the results of the
application review by mail.

**VI.2. Administrative and National Policy Requirements**

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 and Part 92, as appropriate. The following
additional requirements apply to this project:

-   AR-6 Patient Care

-   AR-7 Executive Order 12372

-   AR-8 Public Health System Reporting Requirements

-   AR-9 Paperwork Reduction Act Requirements

-   AR-10 Smoke-Free Workplace Requirements

-   AR-11 Healthy People 2010

-   AR-12 Lobbying Restrictions

-   AR-13 Prohibition on Use of CDC Funds for Certain Gun Control

> Activities

-   AR-14 Accounting System Requirements

-   AR-15 Proof of Non-Profit Status

-   AR-16 Security Clearance Requirement

-   AR-20 Conference Support

-   AR-21 Small, Minority, and Women-Owned Business

-   AR-23 States and Faith-Based Organizations

-   AR-24 Health Insurance Portability and Accountability Act
    Requirements

-   AR-25 Release and Sharing of Data

-   AR-26 National Historic Preservation Act of 1966

> (Public Law 89-665, 80 Stat. 915)

-   AR-27 Conference Disclaimer and Use of Logos

Additional information on the requirements can be found on the CDC Web
site at the following Internet address:
<http://www.cdc.gov/od/pgo/funding/Addtl_Reqmnts.htm>.

CDC Assurances and Certifications can be found on the CDC Web site at
the following Internet address:
<http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm>

For more information on the Code of Federal Regulations, see the
National Archives and Records Administration at the following Internet
address: <http://www.access.gpo.gov/nara/cfr/cfr-table-search.html>

**VI.3. Reporting Requirements**

The applicant must provide CDC with an annual interim progress report
via www.grants.gov:

1.  The interim progress report is due no less than 90 days before the
    end of the budget period. The progress report will serve as the
    non-competing continuation application, and must contain the
    following elements:

    a.  Standard Form ("SF") 424S Form.

    b.  SF-424A Budget Information-Non-Construction Programs.

    c.  Budget Narrative.

    d.  Indirect Cost Rate Agreement.

    e.  Project Narrative.

Additionally, the applicant must provide CDC with an original, plus two
hard copies of the following reports:

2.  Financial status report and annual progress report, due 90 days
    after the end of the budget period.

    a.  Standard Form ("SF") 424S Form.

    b.  SF-424A Budget Information-Non-Construction Programs.

    c.  Budget Narrative.

    d.  Indirect Cost Rate Agreement.

    e.  Project Narrative.

3.  Final performance and Financial Status reports, no more than 90 days
    after the end of the project period.

These reports must be submitted to the attention of the Grants
Management Specialist listed in the VII. Agency Contacts section of this
announcement.

# VII. Agency Contacts

CDC encourages inquiries concerning this announcement.

For general questions, contact:

Technical Information Management Section

Department of Health and Human Services

CDC Procurement and Grants Office

2920 Brandywine Road, MS E-14

Atlanta, GA 30341

Telephone: 770-488-2700

For program technical assistance, contact:

Robbie Payne, Project Officer

Department of Health and Human Services

Centers for Disease Control and Prevention

4770 Buford Hwy., NE, MS K51

Atlanta, GA 30341-3717

Telephone: 770-488-5464

E-mail: arthritisprogram@cdc.gov

For financial, grants management, or budget assistance, contact:

> Wilhelmina Robertson, Grants Management Specialist

Department of Health and Human Services

CDC Procurement and Grants Office

2920 Brandywine Road, MS E09

Atlanta, GA 30341

Telephone: 770-488-1647

Fax: 770-488-2777

E-mail: wrobertson@cdc.gov

CDC Telecommunications for the hearing impaired or disabled is available
at: TTY 770-488-2783.

**VIII. Other Information**

Other CDC funding opportunity announcements can be found on the CDC Web
site, [***Internet address:
http://www.cdc.gov/od/pgo/funding/FOAs.htm.***](http://www.cdc.gov/od/pgo/funding/FOAs.htm)

Internet address for the CDC Arthritis Program:
[***http://www.cdc.gov/arthritis/index.htm***](http://www.cdc.gov/arthritis/index.htm)

Applicants may access the application process and other awarding
documents using the Electronic Research Administration System (eRA
Commons). A one-time registration is required for interested
institutions/organizations at
<http://era.nih.gov/ElectronicReceipt/preparing.htm>

Program Directors/Principal Investigators (PD/PIs) should work with
their institutions/organizations to make sure they are registered in the
eRA Commons.

1.  [Organizational/Institutional Registration in the eRA
    Commons](https://commons.era.nih.gov/commons/registration/registrationInstructions.jsp)

-   To find out if an organization is already eRA Commons-registered,
    see the \"[List of Grantee Organizations Registered in eRA
    Commons."](http://era.nih.gov/userreports/ipf_com_org_list.cfm)

-   Direct questions regarding the eRA Commons registration to:\
    eRA Commons Help Desk\
    Phone: 301-402-7469 or 866-504-9552 (Toll Free)\
    TTY: 301-451-5939\
    Business hours M-F 7:00 a.m. -- 8:00 p.m. Eastern Time\
    Email <commons@od.nih.gov>

> 2\. Project Director/Principal Investigator (PD/PI) Registration in
> the eRA Commons: Refer to the [NIH eRA Commons System (COM) Users
> Guide](http://era.nih.gov/Docs/COM_UGV2630.pdf).

-   The individual designated as the PD/PI on the application must also
    be registered in the eRA Commons. It is not necessary for PDs/PIs to
    register with Grants.gov.

-   The PD/PI must hold a PD/PI account in the eRA Commons and must be
    affiliated with the applicant organization. This account cannot have
    any other role attached to it other than the PD/PI.

-   This registration/affiliation must be done by the Authorized
    Organization Representative/Signing Official (AOR/SO) or their
    designee who is already registered in the eRA Commons.

-   Both the PD/PI and AOR/SO need separate accounts in the eRA Commons
    since both hold different roles for authorization and to view the
    application process.

Note that if a PD/PI is also an HHS peer-reviewer with an Individual
DUNS and CCR registration, that particular DUNS number and CCR
registration are for the individual reviewer only. These are different
than any DUNS number and CCR registration used by an applicant
organization. Individual DUNS and CCR registration should be used only
for the purposes of personal reimbursement and should not be used on any
grant applications submitted to the Federal Government.

Several of the steps of the registration process could take four weeks
or more. Therefore, applicants should check with their business official
to determine whether their organization/institution is already
registered in the eRA [Commons](https://commons.era.nih.gov/commons/).
HHS/CDC strongly encourages applicants to register to utilize these
helpful on-line tools when applying for funding opportunities.

**Appendix A. Approved Evidence-Based Interventions for State Public
Health\
Approaches to Arthritis**

Additional information on the approved interventions listed here can be
found on the CDC Arthritis website at
<http://www.cdc.gov/arthritis/intervention/index.htm> Information on
interventions that may be approved in future years of this cooperative
agreement can be found on the same website at
<http://www.cdc.gov/arthritis/intervention/lists.htm#1>

**[Self Management Education]{.underline}**

> Recommended Interventions

-   Arthritis Foundation Self Help Program

-   Spanish Arthritis Self Management Program

-   Chronic Disease Self Management Program

> Promising Practices

-   Mail Delivered Arthritis Self Management Program

**[Physical Activity]{.underline} (see note 1 below)**

> Recommended Interventions

-   Arthritis Foundation Exercise Program

-   EnhanceFitness

-   Active Living Every Day

> Promising Practices

-   Fit & Strong

-   Fitness & Exercise for People with Arthritis

> **[Health Communications]{.underline}**
>
> Recommended Interventions

-   Physical Activity. The Arthritis Pain Reliever

-   Buenos Dias, Artritis

> *Note 1: The Arthritis Foundation Aquatics Program remains a
> recommended evidence-based intervention for people with arthritis, but
> because it is already embedded in a sustainable national system,
> funding under this cooperative agreement should not be used to further
> disseminate it.*

**Appendix B. 2005 Population Estimates and Reach Objectives**

![](media/image1.png){width="5.843055555555556in"
height="6.238888888888889in"}

During the project period of 4 years, the proposed program will achieve
the following:

-   For grantees with under 250,000 adults with arthritis: By the end of
    the four year project period, at least 10,000 adults with arthritis
    in the state will participate in a packaged, evidence-based physical
    activity or self-management intervention related to program
    activities under this cooperative agreement, over and above the
    number participating prior to this project period or participating
    as a result of other efforts in the state. This measure excludes
    reach of the health communication interventions. Annual reach must
    be adequate to achieve this long-term goal during the project
    period.

-   For grantees with between 250,000 and 1,000,000 adults with
    arthritis: By the end of the four year project period, at least 4%
    of adults with arthritis in the state will participate in a
    packaged, evidence-based physical activity or self-management
    intervention related to program activities under this cooperative
    agreement, over and above the number participating prior to this
    project period or participating as a result of other efforts in the
    state. This measure excludes reach of the health communication
    interventions. Annual reach must be adequate to achieve this
    long-term goal during the project period.

-   For grantees with over 1,000,000 adults with arthritis: By the end
    of the four year project period, at least 40,000 adults with
    arthritis in the state will participate in a packaged,
    evidence-based physical activity or self-management intervention
    related to program activities under this cooperative agreement, over
    and above the number participating prior to this project period or
    participating as a result of other efforts in the state. This
    measure excludes reach of the health communication interventions.
    Annual reach must be adequate to achieve this long-term goal during
    the project period.