U.S. Department of Health and Human Services

**Health Resources and Services Administration**

####### Bureau of Primary Health Care

HRSA Health Disparities Collaboratives (HDC)

**Cluster Leadership of the HRSA HDC**

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## New Competition 

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HRSA-06-061

## *Catalog of Federal Domestic Assistance (CFDA) No. 93.129* 

# Program Guidance

Fiscal Year 2006

**Application Due Date: *November 14, 2005 at 5:00 P.M. ET***

**Release Date: October 14, 2005**

Cicely Nelson

Public Health Analyst, Division of Policy and Development

Telephone: (301) 594-4496

Fax: (301) 480-7225

Email: <CNelson@hrsa.gov>

Authority: Public Health Service Act, Title III, Section 330(m), 42
U.S.C.254b

**EXECUTIVE SUMMARY**

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An extremely important element of the commitment by the Health Resources
and Services Administration (HRSA) to ensure access to quality primary
health care and reduction of health disparities is its support of the
Health Disparities Collaboratives (HDC) effort. The HDC is a multi-year
program that implements models of patient care and change management to
transform the Consolidated Health Center system of care for underserved
populations. The program involves collaborative efforts by teams from
different health centers to improve quality by applying a specific care
model, a quality improvement model and various series of learning
sessions. The population-based care model, tested and implemented
through participation in the HDC, identifies which patients have an
illness or need preventive services, ensures delivery of evidence-based
care, and actively aids patients and families to participate in their
own care. The improvement model is an approach to accelerate large-scale
system change through rapid, small scale testing cycles, documenting and
institutionalizing those changes that result in improvement.

This program has already led to significant improvements in the clinical
operations of the participating health centers and their patients.
Initially implemented through chronic disease management-based
improvements, the HDC program is now transforming health center
activities not only in the area of clinical treatment of chronic
diseases, but also in prevention activities and efforts to improve
operational and financial aspects of health center management, thus
improving the provision of care for millions of patients. To effectively
integrate the various HDC types already piloted into a Primary Health
Care Collaborative model, various indices for health centers to use in
measuring their improvements have been developed and will continue to be
developed and revised, so as to help evolve the structure for an
institutional alignment of actions to proactively improve the care of
all health center patients.

HRSA has been funding the HDC efforts since 1999. One feature of this
effort has been the use of lead agencies from each of five clusters of
States and Territories to help participating health centers within their
cluster in various aspects of the HDC effort. At this time, for each of
the same five geographical clusters of States and Territories, both
current Lead PCAs and other entities with equivalent management
capabilities and experience are being invited to compete for management
of a Cluster-level infrastructure for fiscal year (FY) 2006. Up to \$6.6
million is available for five cluster-level HDC leadership and support
cooperative agreements.

This guidance details the eligibility requirements, performance
expectations, and application instructions for the entities that will
compete for the cluster-level leadership role for integration activities
of the HDC for each of the five clusters beginning April 1, 2006 and
ending March 31, 2007.

The Bureau of Primary Health Care (BPHC) will hold one pre-application
conference call for applicants seeking funding through this opportunity.
The call will provide an overview and other information regarding this
application guidance and will include a question and answer session.
Please visit the BPHC website at:
<http://bphc.hrsa.gov/pinspals/pins.htm> for the date, time, dial-in,
and other information for the call.

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**Applicants may obtain additional information regarding this program
guidance or the application process in general by contacting:**

> Cicely Nelson
>
> Public Health Analyst, Division of Policy and Development
>
> Attn: Cluster Leadership of the HRSA HDC
>
> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Room 17-61
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4496
>
> Fax: (301) 480-7225
>
> Email: <CNelson@hrsa.gov>

**Applicants may obtain additional information related to the overall
program issues by contacting:**

> Richard Lee
>
> Public Health Analyst, Division of Clinical Quality
>
> Attn: Cluster Leadership of the HRSA HDC
>
> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Room 17C-10
>
> Rockville, MD 20857
>
> Telephone : (301) 594-3729
>
> Fax : (301) 594-4081
>
> Email : RCLee@hrsa.gov

**Table of Contents**

**I. FUNDING OPPORTUNITY DESCRIPTION 5**

> 1\. Purpose 5
>
> 2\. Background 5
>
> 3\. Program Expectations 6

**II. AWARD INFORMATION 7**

> 1\. Type of Award 7
>
> 2\. Summary of Funding 8

**III. ELIGIBILITY INFORMATION 8**

> 1\. Eligible Applicants 8
>
> 2\. Cost Sharing/Matching 9

**IV. APPLICATION AND SUBMISSION INFORMATION 9**

1\. Address to Request Application Package 9

> 2\. Content and Form of Application Submission 9
>
> Application Preparation 9
>
> Application Format Requirements 9
>
> Application Format 10

i.  Application Face Page 10

ii. Table of Contents 11

iii. Application Checklist 11

iv. Budget 11

v.  Budget Justification 11

vi. Staffing Plan and Personnel Requirements 12

vii. Assurances 13

viii. Certifications 13

ix. Project Abstract 13

x.  Program Narrative 13

xi. Appendices 15

> 3\. Submission Dates and Times 16
>
> 4\. Intergovernmental Review 17
>
> 5\. Funding Restrictions 17
>
> 6\. Other Submission Requirements 17

**V. APPLICATION REVIEW INFORMATION 19**

1.  Review Criteria 19

2.  Review and Selection Process 23

**VI. AWARD ADMINISTRATION INFORMATION 23**

1.  Award Notices 23

2.  Administrative and National Policy Requirements 24

3.  Reporting 24

4.  Performance Review 25

**VII. AGENCY CONTACTS 25**

**VIII. TIPS FOR WRITING A STRONG APPLICATION 26**

**IX. ATTACHMENTS 27**

> Attachment 1 - Program Expectations for Cluster Lead Entities 27
>
> Attachment 2 - Sample Project Work Plan 38

# Funding Opportunity Description

#### 1. Purpose

Section 330(m) of the Public Health Act, as amended, authorizes the
provision of technical and other non-financial assistance to eligible
entities to assist such entities in meeting requirements applicable to
health centers. Services provided may include necessary technical and
non-financial assistance, including fiscal and program management
assistance and training in such management. This guidance details the
eligibility requirements, performance expectations, and application
instructions for the entities that will compete for the cluster-level
leadership role for integration activities of the Health Disparities
Collaboratives (HDC) for each of the five clusters for the period April
2006 to March 2007.

The purpose of the Health Resources and Services Administration (HRSA)
HDC activities is to improve the health care delivery system in HRSA -
funded Consolidated Health Centers and partner institutions. Four
long-term goals exist: 1) to improve the quality of care delivered to
the medically underserved; 2) to improve the efficiency and management
of health centers; 3) to improve health outcomes; and 4) to eliminate
health disparities. The HDC strategy is to implement two evidence-based
models (a care model and an improvement model) via a system-change
integration approach to improve quality of health care practice of the
health centers, using a method that involves senior leadership of the
Health Centers, develops key partnerships at the local, regional, State,
and national levels, and supports a national and cluster-level
infrastructure to sustain improvement.

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**2. Background**

The HRSA HDC is a national effort to achieve strategic system change in
the delivery of primary health care. The HDCs first focused on chronic
disease conditions of greatest importance to the health centers in terms
of cost, volume of patient visits, and/or complexity of care needed. The
HDCs have evolved, with the use of a national and cluster-level
infrastructure, to add collaborative activities to improve the delivery
of prevention services, cancer screening, and treatment of conditions of
an acute nature. Other collaborative efforts are in progress, such as
the Finance Redesign Collaborative and the Advanced Access
Demonstration, which focus on the operational functionalities of the
health center, whether or not related to a specific acute condition or
the business activity of the whole health center, such as scheduling and
billing functions and other fiscal aspects of operation of the health
center. Currently, the HDCs are in the process of integration of all of
the collaborative activities into a Primary Health Care Collaborative,
using the experiences gained from the Chronic Disease Collaboratives,
Prevention Collaboratives and others. The program is also addressing
complex conditions that require integration of the health centers into
the community health system, such as the Perinatal and Patient Safety
Collaborative. Ultimately, the entire effort is a Community Oriented
Primary Health Care (COPC) model for system change for quality
improvement. After the Initial Learning Year in which the models are
learned, health centers have been developing system-change integration
activities for continuous quality improvement of the clinical and
operational functions of the health center via applying the care model
and the improvement model. This summation of these activities is known
as "Transformational" activities of the HDC.

As the number of health centers in the HDC increases, so must the
efficiency of the cluster infrastructure required to execute the HDC
Transformational activities. The current cluster infrastructure includes
cluster directors, cluster coordinators and information systems
specialists located in the cluster, as well as cluster steering
committees. Cluster Leads are expected to use this infrastructure to
provide administrative support for: (1) the Health Center Teams from the
cluster who are in the Initial Learning Year, and (2) Health Center
Teams from the cluster working on sustaining and spreading the use of
the HDC models in their Transformational activities.

The Cluster Leads are specifically responsible for coordination of the
participation of Health Center Teams in the Initial Learning Year (known
as HDC Phase 1 Teams) from their cluster in the various infrastructure
activities of the HDC, including the three HRSA National learning
sessions and a National Forum. The Cluster Leads are also responsible
for ensuring participation of Health Center Teams from their cluster
engaged in Transformation activities, (known as HDC Phase 2 Teams) in
one cluster summit session, as well as a representative Phase 2 Team
attending at least one of the Learning Sessions of Phase 1 Teams. They
are also responsible for arranging conference calls and electronic
communication among Phase 1 Teams in their cluster, among Phase 2 Teams
in their cluster and for site visits to those cluster teams needing
additional support. The Cluster Leads collect and collate monthly
reports from the teams in their cluster, act as part of the faculty at
learning sessions, provide TA on the care model, and support health
center interoperability of their information systems with systems used
in the Collaborative efforts.

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**3. Program Expectations for Cluster Leads**

Cluster leads will need to support the following major ongoing HDC
activities and objectives:

1.  Document the learning activities and improvements in those health
    centers that are new to participating in the HDCs;

2.  Participate as requested by HRSA in the Perinatal and Patient Safety
    Collaborative and other types of ongoing collaboratives;

3.  Strengthen and document the support given to health centers working
    to sustain and spread the transformation improvements made during
    the first year of the collaborative learning model;

4.  Facilitate behavioral health care assessment into as many care
    collaboratives, as possible, including skills training for
    clinicians and innovations in patient care management;

5.  Strengthen the role of the cluster steering committees;

6.  Revise and implement a flexible, integrated clinical information
    system that supports chronic disease care (diabetes, asthma,
    depression, etc.) and prevention of diabetes, cardiovascular
    disease, cancer, and other diseases, as well as idealized office
    redesign and financial management, and improvement of perinatal
    outcomes and patient safety improvements;

7.  Continue development of a national health disparities collaborative
    addressing prevention and treatment of diabetes and cardiovascular
    disease and other diseases;

8.  Actively engage networks of health centers to build private and
    public community partnerships which support improved patient
    outcomes;

9.  Revise and implement training manuals related to
    diabetes/cardiovascular prevention and depression treatment;

10. Update regionally developed improvement tools, materials, and
    quarterly reports for inclusion in a national centralized HDC web
    site;

11. Support the integration of technology which provides efficiencies in
    the management of patient health outcomes;

12. Document the equivalency of developmental prototypes supporting
    implementation and spread of the HDC models through collaborative
    activity funded and operated by non-traditional HRSA HDC programs
    such as foundation, state, privately funded, and community-based
    health center network- supported collaboratives; and

13. Identify additional national and state partners with expertise in
    HRSA sponsored collaborative activities to assist health centers.

The HRSA HDC national team will be inclusive of the HRSA federal staff,
the staff of the National Project Management staff, and the 5 Lead
cluster staffs. Together this team will provide national leadership in
the coming year\'s activities.

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See Attachment 1 for additional detail.

# II. Award Information

#### 1. Type of Award

Funding will be provided in the form of a cooperative agreement.
Cooperative agreements are a type of Federal assistance that involves a
substantial level of government participation in planning and
coordinating funded activities.

***Federal Responsibilities***

Federal responsibilities under the cooperative agreement include, but
are not limited to, the following:

-   Collaborate with each Cluster Lead on the development, evolution and
    coordination of the cluster's operational work plan for funded
    activities, to reflect HRSA priorities for the national HDC program.

-   Ongoing monitoring of the cluster activities through face-to-face
    and telephone meetings and review of progress reports and other
    deliverables.

-   Attend and participate in appropriate cluster meetings (e.g.,
    cluster summits).

-   Coordinate among the various Clusters to develop synergies in their
    activities and maintain consistency as needed.

***Cluster Lead responsibilities***

-   Develop and maintain an operational work plan for funded activities
    consistent with HRSA priorities.

-   Attend and participate in appropriate HDC system-wide meetings
    (e.g., meetings of representatives of all clusters, meetings of the
    national HDC team).

-   Assure regular reporting by all cluster health center teams
    participating in HDC activities.

-   Submit regular progress reports.

## 2. Summary of Funding

Approximately \$6.6 million is expected to be available to fund up to
five cooperative agreements, one per Cluster, in FY 2006. The average
award is expected to be approximately \$1,320,000. Awards will be made
for a 12-month budget period beginning April 1, 2006 and ending March
31, 2007.

**III. ELIGIBILITY INFORMATION**

**1.** **Eligible Applicants**

Eligible applicants include Primary Care Associations (funded under
Section 330 of the Public Health Service Act) and other public or
private, non-profit entities that have current experience working with
health centers funded under Section 330.

The applicant does not have to be incorporated in the cluster, nor
specifically work within the cluster. The applicant must be able to
demonstrate the ability to service the specific cluster for which the
application is submitted. Applicants may submit applications for
servicing more than one of the clusters, but this must be done via
separate submittals for each cluster that is proposed to be serviced by
that applicant.

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**CLUSTERS** are defined as five separate geographic areas that each
includes a set list of states and territories, as follows:

-   **North-East:** HHS Regions I, II, and III, defined to include
    Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
    Vermont, New Jersey, New York, Delaware, the District of Columbia,
    Maryland, Pennsylvania, Virginia, West Virginia, Puerto Rico, and
    the Virgin Islands.

-   **South-East**: HHS Region IV, defined to include Alabama, Florida,
    Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and
    Tennessee.

-   **Mid-West**: HHS Regions V and VII, defined to include Illinois,
    Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas,
    Missouri, and Nebraska.

-   **West-Central**: HHS Regions VI and VIII, defined to include
    Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Colorado, Montana,
    North Dakota, South Dakota, Utah, and Wyoming.

-   **Pacific-West**: HHS Regions IX and X, defined to include Arizona,
    California, Hawaii, Nevada, Alaska, Idaho, Oregon, Washington,
    American Samoa, Guam, Palau, and the Northern Mariana Islands.

### 2. Cost Sharing/Matching

There is no cost sharing or matching required for this funding
opportunity.

# IV. Application and Submission Information

### 1. Address to Request Application Package

**Application Materials**

Applicants must submit proposals using the appropriate Public Health
Service (PHS) Application Form 5161-1. This form contains additional
general information and instructions for grant applications, proposal
narratives, and budgets. The form may be obtained from the following
sites by:

a.  Downloading from
    [www.hrsa.gov/grants/forms.htm](http://www.hrsa.gov/grants/forms.htm);
    or

b.  Contacting the HRSA Grants Application Center at:

> The Legin Group, Inc.

###### Attn: Cluster Leadership of the HRSA HDC

> *Program Announcement No. HRSA-06-061*
>
> *CFDA No. 93.129*
>
> 901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

> Telephone: (877) 477-2123
>
> Email: <HRSAGAC@hrsa.gov>
>
> []{.mark}

Instructions for preparing portions of the application that must
accompany PHS Application Form 5161-1 appear in the "Application Format"
section below.

### 2. Content and Form of Application Submission

#### 

### Application Preparation

Applicants are encouraged to thoroughly review the program guidance
prior to submitting an application. Applicants should provide all
required information in the sequence and format described in the
instructions. Information and data should be accurate and consistent and
directions and written instructions should be followed carefully and
completely. **Applicants that do not meet the program guidance
requirements (e.g., failure to include all required documents) may
result in an application being considered incomplete or non-responsive,
returned without processing, or rated low by the Objective Review
Committee (ORC).**

**Only those documents included with the application and submitted by
the announced deadline will be considered**. Supplemental documents
submitted after the application deadline will not be included for
consideration. Documents such as letters of support should be submitted
as part of the application. Letters of support sent directly to DHHS,
HRSA, or BPHC administrators will not be considered by the ORC.

#### 

#### Application Format Requirements

If applying on-line, the total size of all uploaded files **may not
exceed the equivalent of 80 pages when printed by HRSA, approximately 10
MB.** **This 80-page limit includes the abstract, project and budget
narratives, attachments, appendices and letters of commitment and
support.**

> If applying on paper, **the entire application may not exceed 80 pages
> in length.** Pages must be numbered consecutively.

**Applications, whether submitted on paper or electronically, that
exceed the specified limits (80 pages or approximately 10 MB, or that
exceed 80 pages when printed by HRSA) will be deemed non-compliant. All
non-compliant applications will be returned to the applicant without
further consideration.**

a.  Number of Copies (Paper Applications only)

> Please submit one original and two unbound copies of the application.
>
> Please do not bind or staple the application. Application must be
> single sided.

b.  Font

> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12 point and 1.0 line spacing.
> Applications not adhering to 12 point font requirements may be
> returned.
>
> []{.mark}

c.  Paper Size and Margins

> For scanning purposes, please submit the application on 8 ½" x 11"
> white paper. Margins must be at least one inch at the top, bottom,
> left and right of the paper. Please left-align text.
>
> []{.mark}

d.  Numbering

> Please number the pages of the application sequentially from page 1
> (face page) to the end of the application, including charts, figures,
> tables, and appendices.

e.  Names

> Please include the name of the applicant on each page.

f.  Section Headings

> Please put all section headings flush left in bold type.

#### *Application Format*

Applications for funding must consist of the following documents in the
following order:

##### Application Face Page 

> Public Health Service (PHS) Application Form 5161-1 is provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance (CFDA), the CFDA Number is 93.129.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
> or call 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page. Applications ***will
> not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization will be required to register
> with the Federal Government's Central Contractor Registry (CCR) in
> order to do electronic business with the Federal Government.
> Information about registering with the CCR can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

##### Table of Contents

> Provide a Table of Contents for the remainder of the application
> (including appendices), with page numbers.

##### Application Checklist 

> Use PHS Application Form 5161-1, provided with the application
> package.

##### Budget

> This announcement is inviting applications for a one-year project
> period.
>
> Use PHS Application Form 5161-1 provided with the application package.
> Please complete Sections A, B, C, E, and F, and then provide a line
> item budget for the requested year of funding (April 1, 2006 to March
> 31, 2007) using the budget categories in the SF 424A.

##### Budget Justification

> Provide a narrative that explains the amounts requested for each line
> in the budget. The budget justification should specifically describe
> how each item would support the achievement of proposed objectives.
> The budget period is for ONE year. Line item information must be
> provided to explain the costs entered in appropriate form, Application
> Form 5161-1. **The budget justification must clearly describe each
> cost element and explain how each cost contributes to meeting the
> project's objectives/goals**. Be very careful about showing how each
> item in the "other" category is justified. The budget justification
> MUST be concise. Do NOT use the justification to expand the project
> narrative.

Include the following in the Budget Justification narrative:

> **Personnel Costs:** In general, personnel costs should be explained
> by listing each staff member who will be supported from requested
> grant funds, name (if possible), position title, percent full-time
> equivalency, annual salary, and the exact amount requested for each
> project year.
>
> **Fringe Benefits:** Itemize the components that comprise the fringe
> benefit rate, for example, health insurance, taxes, life insurance,
> retirement plan, tuition reimbursement, etc. Provide an explanation
> for any increase greater than five percent over the prior year rate.
> In general, the fringe benefits should be directly proportional to
> that portion of personnel costs that are allocated for the project.
>
> **Travel:** List travel costs according to local and long distance
> travel. For local travel, the mileage rate, number of miles, reason
> for travel and staff member/consumers completing the travel should be
> outlined. The budget should also reflect the travel expenses
> associated with participating in meetings and other proposed training
> or workshops.
>
> **Equipment:** List equipment costs and provide justification for the
> need for the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items.
>
> **Supplies:** List the items that the project will use. Categorize
> supplies according to type -- medical, lab, pharmacy, office, etc.
> Office supplies could include paper, pencils, and the like; medical
> supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Explain how the amounts were developed (e.g., medical supplies were
> based on 20,000 encounters at \$2 per encounter to arrive at the
> \$40,000 appearing in the budget).
>
> **Contractual (Subcontracts):** To the extent possible, all
> subcontract budgets and justifications should be standardized, and
> contract budgets should be presented by using the same object class
> categories contained in the Standard Form 424A. Provide a clear
> explanation as to the purpose of each contract, how the costs were
> estimated, and the specific contract deliverables.
>
> **Alteration and Renovation:** In general, Alteration and Renovation
> (A&R) is work required to change the interior arrangements or other
> physical characteristics of an existing facility or installed
> equipment so that it may be more effectively utilized for it's
> currently designated purpose or adapted to an alternative use to meet
> a programmatic requirement. A&R costs that do not constitute
> construction are allowable charges to PHS supported projects and
> activities. Section 330 grant funds may not be used to support
> construction of facilities.
>
> **Other:** Put all costs that do not fit into any other category into
> this category and provide and explanation of each cost in this
> category. Itemize all costs in this category and explain in sufficient
> detail. In most cases, consultant costs for technical assistance,
> legal fees, rent, utilities, insurance, dues, subscriptions, and audit
> related costs would fall under this category.
>
> **Indirect Costs**: Only those organizations with a pre-approved
> federally negotiated indirect cost rate should include an indirect
> cost rate in the budget presentation. Indirect costs are those costs
> incurred for common or joint objectives which cannot be readily
> identified but are necessary to the operations of the organization,
> e.g., the cost of operating and maintaining facilities, depreciation,
> and administrative salaries. For institutions subject to OMB Circular
> A-21, the term "facilities and administration" is used to denote
> indirect costs. If the applicant does not have an indirect cost rate,
> you may obtain one by visiting the Division of Cost Allocation
> website: http://www.rates.psc.gov. Please refer to PHS 5161-1, page 31
> for further information.

##### Staffing Plan and Personnel Requirements

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Position descriptions that include the roles,
> responsibilities, and qualifications of proposed project staff must be
> included in Appendix C. Copies of biographical sketches for any key
> employed personnel that will be assigned to work on the proposed
> project must be included in Appendix C.

##### Assurances

> Application Form 5161-1 provided with the application package.

##### Certifications

> Application Form 5161-1 provided with the application package.

##### Project Abstract

> Provide a summary of the application. Because the abstract is often
> distributed to provide information to the public and Congress, please
> prepare this so that it is clear, accurate, concise, and without
> reference to other parts of the application. It must include a brief
> description of the proposed grant project including the needs to be
> addressed, the proposed services, and the population group(s) to be
> served.
>
> Please place the following at the top of the abstract:

-   Project title

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

-   Congressional district(s) for the applicant organization and the
    project (if different)

-   Existing Federal funding received

> The project abstract must be single-spaced and limited to one page in
> length.

##### Program Narrative

> The program narrative should describe in general the applicant's
> overarching goal of assisting HRSA to manage quality improvement and
> detail the applicant's planned contributions to assisting HRSA/BPHC in
> the management and implementation support of the HDC.
>
> In keeping with the HRSA strategy to reach all health centers and thus
> all patients, there are critical elements that should be addressed by
> the application. The program narrative should provide a detailed
> description of the methodologies for system change implementation,
> implementation plans for working with HRSA to build the Bureau's
> capacity and infrastructure to develop, measure and report, and
> promote and disseminate positive breakthrough changes in health
> centers.
>
> The program narrative should provide a comprehensive framework and
> description of all aspects of the proposed program. It should be
> succinct, self-explanatory and well organized so that reviewers can
> understand your proposed project.
>
> All applicants should ensure that the Program Narrative completely
> addresses all elements within the Review Criteria detailed in Section
> V: Application Review Information.
>
> The program narrative should be organized using the following section
> headers:
>
> INTRODUCTION\
> The introduction is intended to be a **brief synopsis** of the
> proposed project, describing the background of the proposed project,
> critically evaluating how the applicant will assist health center
> providers in sustaining and spreading the HRSA HDC Primary Health Care
> Collaborative Model and how these evidence-based concepts will
> generate major improvements in health center processes and outcomes
> that result in improved care of underserved populations.
>
> NEED\
> See Criterion 1: NEED in the Review Criteria (p. 19) for the specific
> elements that should be addressed.
>
> RESPONSE\
> See Criterion 2: RESPONSE in the Review Criteria (p.19) for the
> specific elements that should be addressed.
>
> This section provides a format for applicants to demonstrate the
> clarity, feasibility, and scope of proposed goals and measurable
> objectives. The work plan's activities, goals, and objectives should
> be aligned with, and appropriate for, the needs assessment, proposed
> budget and organizational capacity.
>
> **There are two components to this section: a.** Work Plan Matrix,
> which depicts the relationship between program goals, objectives,
> responsible person(s), timelines, and measures of success; and **b.**
> Work Plan Narrative, which expands on the work plan matrix to provide
> details of program implementation. These sections should address the
> Cluster Leadership Management core activities described in the program
> expectations.

a.  Work Plan Matrix

> Applicants must submit a one-year work plan beginning April 1, 2006
> and ending March 31, 2007. The work plan should be used to outline
> goals and objectives for the quality improvement work areas as
> identified in the program expectations, demonstrating the applicant's
> overarching goal of assisting HRSA to manage quality improvement. It
> is strongly recommended that applicants use a landscaped orientation
> to format the work plan. The work plan should be structured as
> follows:

-   Goals/Core activities;

-   Objectives;

-   Action steps;

-   Identification of deliverables/outcomes and performance indicators
    (as applicable/available);

-   Responsible individual(s); and

-   Due date(s).

> It is important to remember the work plan will provide the basis for
> the continued monitoring and reporting of proposed activities.

b.  Work Plan Narrative

> This section should expand upon the work plan matrix. Specifically,

-   Describe how the project will be implemented.

-   Provide evidence of how the work plan addresses the needs identified
    in the Need section.

-   Address all core activities within the program expectations.

-   Discuss challenges that are likely to be encountered in designing
    and implementing the activities described in the proposed work plan
    and approaches that will be used to resolve such challenges.

-   Provide a description of all contractual relationships and personnel
    supported including level, role (including percentage of effort) and
    amount of support.

-   Describe plans for directing, managing, and evaluating the success
    of those activities.

-   Describe roles and responsibilities of key project personnel (i.e.,
    identify responsible persons for implementation of each activity).

> EVALUATIVE MEASURES\
> See Criterion 3: EVALUATIVE MEASURES in the Review Criteria (p. 21)
> for the specific elements that should be addressed.
>
> IMPACT
>
> See Criterion 4: IMPACT in the Review Criteria (p. 22) for the
> specific elements that should be addressed.
>
> RESOURCES/CAPABILITIES\
> See Criterion 5: RESOURCES/CAPABILITIES in the Review Criteria (p. 22)
> for the specific elements that should be addressed.
>
> SUPPORT REQUESTED\
> See Criterion 6: SUPPORT REQUESTED in the Review Criteria (p.
> 2[[23]{.mark}](#_Ref96500731)) for the specific elements that should
> be addressed.

##### Appendices 

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative. Be
> sure each appendix is clearly labeled.

1)  Appendix A: Tables, Charts, etc.

> This provides further details about the proposal.

2)  Appendix B: Project Organizational Chart

> Provide a one-page figure that depicts the organizational structure of
> the project, including subcontractors and other significant
> collaborators.

3)  Appendix C: Position Descriptions and Biographical Sketches

> Provide copies of biographical information and position descriptions.

4)  Appendix D : Overview of Healthy People 2010

> Provide a brief overview of the relationship of the proposed project
> and which objectives/ activities relate to the goals of the Healthy
> People 2010 Initiative in this section. Refer to section VI, Award
> Administration Information below for additional information.
>
> 5\) Appendix E: Other Relevant Documents
>
> Include here any other documents that are relevant to the application,
> including letters of supports. Letters of support must be dated.
>
> Include only letters of support, which specifically indicate a
> commitment to the project/program (in-kind services, dollars, staff,
> time and space, equipment, etc.) Letters of agreements and support
> must be dated. List all other support letters on one page.

### 3. Submission Dates and Times

#### 

#### *Application Due Date* 

The due date for applications under this grant announcement is November
14, 2005 at 5:00 P.M. ET.

Applications will be considered as meeting the deadline if they are
either:

> \(1\) Received on or before the due date; or
>
> \(2\) Post marked or E marked on or before the due date, and received
> in time for the Independent Review Committee review.

The Chief Grants Management Officer (CGMO) or a higher level designee
may authorize an extension of published deadlines when justified by
circumstances such as acts of God (e.g. floods or hurricanes),
widespread disruptions of mail service, or other disruptions of
services, such as a prolonged blackout. The authorizing official will
determine the affected geographical area(s).

**Electronic Submission:**

Applications must be submitted by 5:00 P.M. ET. **To ensure that you
have adequate time to follow procedures and successfully submit the
application, we recommend you start submission no later than noon on the
due date.** Applications submitted electronically will be time/date
stamped electronically, which will serve as receipt of submission.

**Paper Submission:**

Upon receipt of a paper application, the Grants Application Center will
mail an acknowledgement of receipt to the applicant organization's
Program Director.

In the event that questions arise about meeting the application due
date, applicants must have a legibly dated receipt from a commercial
carrier or the U.S. Postal Service. Private metered postmarks will not
be accepted as proof of timely mailing.

**Late applications:**

Applications that do not meet the criteria above are considered late
applications. Health Resources and Services Administration (HRSA) shall
notify each late applicant that its application will not be considered
in the current competition.

### 4. Intergovernmental Review

### Executive Order 12372, as implemented by 45 CFR Part 100, does not apply to this funding opportunity.

### 5. Funding Restrictions

Grant funds may **NOT** be used for any of the following:

-   Construction

-   Reserve requirements for state insurance licensure

-   Support for lobbying/advocacy efforts

### 

### 6. Other Submission Requirements 

**Electronic Submission**

You may submit your application to us either in electronic or paper
format. To submit an application electronically, please use the
[http://www.Grants.gov](http://www.Grants.gov/) apply site. If you use
Grants.Gov you will be able to download a copy of the application
package, complete it off-line, and then upload and submit the
application via the Grants.gov site. You may not e-mail an electronic
copy of a grant application to us.

Please note the following if you plan to submit your application
electronically via Grants.Gov:

> • Electronic submission is voluntary
>
> • When you enter the Grants.Gov site, you will find information about
> submitting an application electronically through the site, as well as
> the hours of operation. We strongly recommend that you do not wait
> until the application deadline date to begin the application process
> through Grants.Gov. The registration process is a separate process
> from submitting an application. **Applicants are, therefore,
> encouraged to register early**. The registration process can take
> approximately two weeks to be completed. Therefore, registration
> should be done in sufficient time to ensure it does not impact your
> ability to meet required submission deadlines. You will be able to
> submit your application online anytime after you receive your
> e-authentication credentials.
>
> • To use Grants.gov, you, as the applicant, must have a DUNS Number
> and register in the Central Contractor Registry (CCR). You should
> allow a minimum of five days to complete the CCR registration.
>
> • You will not receive additional point value because you submit a
> grant application in paper format.
>
> • You may submit all documents electronically, including all
> information typically included on the SF424 and all necessary
> assurances and certifications.
>
> • Your application must comply with any page limitation requirements
> described in this program announcement.
>
> • After you electronically submit your application, you will receive
> an automatic acknowledgement from Grants.Gov that contains a
> Grants.Gov tracking number. The Health Resources and Services
> Administration will retrieve your application from Grants. Gov.
>
> • You may access the electronic application for this program on
> [http://www.Grants.gov](http://www.Grants.gov/).
>
> • You must search for the downloadable application package by the CFDA
> number.
>
> • The grants.gov website provides customer support via (800)
> 518-GRANTS (this is a toll-free number) or through e-mail at
> [**support@grants.gov**](mailto:support@grants.gov). The customer
> support center is open from 7:00 a.m. to 9:00 p.m. Eastern time,
> Monday through Friday, except federal holidays, to address grants.gov
> technology issues. For technical assistance to program related
> questions, contact the number listed in the Program Section of the
> program you are applying for.

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. 

**Formal submission of the electronic application:** Applications
completed online are considered formally submitted when the Authorizing
Official electronically submits the application to HRSA. However, to
complete the submission requirements, a hard-copy of the SF-424/5161
Face Sheet must be printed, signed, and submitted to the HRSA Grants
Application Center. The SF-424/5161 can be printed from the online
application.

 

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the below address and received by HRSA
by no later than five days after the application due date.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.Gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the deadline date

 

REMINDER: Only applicants who apply online are permitted to forego
hard-copy submission of all application forms EXCEPT the signed
SF-424/5161.

 

If the application is submitted as a hard copy, the rules of submission
as described elsewhere in this guidance must be followed.

***Paper Submission***

If you choose to submit paper copy, please send the original and two
copies of the application to:

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: Cluster Leadership of the HRSA HDC
>
> Program Announcement No: HRSA-06-061
>
> CFDA No: 93.129
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

In the event that questions arise about meeting the application due
date, applicants must have a legibly dated receipt from a commercial
carrier or the U.S. Postal Service. Private metered postmarks will not
be accepted as proof of timely mailing.

Whether you submit electronically or via paper, please understand that
we will not consider additional information and/or materials submitted
after your initial application. You must therefore ensure that all
materials are submitted together, whether electronically or on paper.

#### V. Application Review INFORMATION

### 1. Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Review Criteria are used to review and
rank applications. Critical indicators have been developed for each
review criterion to assist the applicant in presenting pertinent
information related to that criterion and to provide the reviewer with a
standard for evaluation. The six review criteria for the Cluster Lead
applications are outlined below with specific detail and maximum scoring
points for each.

**Criterion 1: NEED (5 points)**

1.  Applicant demonstrates an understanding of the scope and purpose of
    the HDC project, including how evidence-based implementation of the
    Planned Care Model and Improvement Model can generate major
    improvements in quality of treatment, efficiency of treatment
    processes and outcomes for participant health centers and their
    patients.

2.  Applicant demonstrates an understanding of the role of Cluster-level
    leadership and activities in ensuring the success of the HDC program
    at improving quality at cluster health centers, by relating the
    specific objectives to the goal of eliminating health disparities.

3.  The applicant demonstrates an understanding of the specific HDC
    needs within its cluster, including: (a) the number of cluster
    health centers that have not yet participated in Phase 1 (Initial
    Learning Year) activities; (b) the number of cluster health centers
    that have completed Phase 1 and are involved in Phase 2
    (Transformation) activities; (c) the number of Phase 2 health
    centers that are ready for "scale-up" activities such as Prevention
    and Cancer screening; and (d) the number of health centers not yet
    ready for scale-up because of data systems difficulties or other
    issues.

**Criterion 2: RESPONSE (35 points)**

*Application Overview of Activities and Strategy*

The application must include a 12-month work plan describing all the
activities proposed. Activities should be time-framed and objective, and
should identify the key personnel responsible for the implementation of
each activity and the relevant outcome measures.

The proposal must adequately address all the goals and objectives of the
HDC through proposed activities. All major project requirements must
also be addressed. The work plan must demonstrate the applicant's
overarching goal of assisting HRSA to manage quality improvement.

The proposal must contain effective and efficient approaches to
accomplishing project requirements, applicable to the cluster for which
the application is submitted. The applicant must describe the
activities, methods, and techniques to be used to accomplish the
objectives of the HDC in the cluster.

Maximum scoring for this criterion is depended on the extent that the
Work Plan addresses the following:

**Component A: Health Disparities Collaborative Initial Learning Year (7
Points)**

1.  Ensuring participation of appropriate 4-person clinical teams from
    Cluster Phase 1 health centers (selected in 2005) in three HDC
    Initial Learning Sessions and one National Forum to be held in the
    HDC April 2006 to March 2007 year, that will be focused on
    prevention and treatment of diabetic and cardiovascular disease.
    (This does not include responsibility for traveling these teams.)

2.  Providing monthly conference calls for cluster Phase 1 teams and
    encouraging and supporting their ongoing communication via listserv
    and the nationally supported web site.

3.  The applicant will ensure reporting of all results and aggregate
    results at the State, cluster and national levels through the HDC
    national reporting website.

> **Component B: Transformation Activities (18 points)**

1.  The proposal demonstrates that technical assistance will be provided
    in local and national meetings to support teams to sustain the
    improvements made after the initial learning and testing year of the
    HDC, to include:

```{=html}
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```
a)  Continued support for HDC initiatives including Cancer and
    Prevention Scale-Up; Perinatal and Patient Safety Scale-Up;
    Innovation Community; Dental, Community Network, and Patient Flow
    and Fiscal Collaboratives; as well as the Workforce Development
    Collaboratives.

b)  Continuing support of health center finance and integration of
    change package (i.e., a list of evidenced-based interventions with
    positive improvement outcomes) in national and local collaborative
    learning sessions and other technical assistance meetings.
    Continuing to develop knowledge for integrating collaborative in
    cancer screening and general prevention into the redesigned Primary
    Health Care Collaborative.

c)  Continuing to develop knowledge through models of integration toward
    a primary health care collaborative. Integration initiatives
    include: Cancer and Prevention, Innovation Community Initiative for
    Health Centers, Oral Health, and Community Network.

d)  Providing integrated monthly conference calls and ongoing
    communication via list serve and the nationally supported web site.

e)  Refining existing knowledge in preventive and primary health care by
    working with health center teams to identify high leverage changes
    for their successful improvements.

```{=html}
<!-- -->
```
2.  Scale- Up: The applicant demonstrates various effective methods to
    quality improvement learning at the health center level, including:

```{=html}
<!-- -->
```
a)  Capabilities in developing effective technology and practices to
    spread the knowledge and learnings of the HDC Primary Health Care
    Collaborative to all providers and sites.

b)  An ability to provide technical information systems consulting to
    health centers that are implementing the HRSA HDC for all patients
    in the HDC registry locally.

c)  An ability to provide financial information systems consulting to
    health centers including billing and benchmarking improvements
    results with payers.

**Component C: Local Leadership -- Development and Support (10 Points)**

1.  Providing technical support and ongoing advice to local health
    center teams and the local infrastructure.

2.  Assisting health centers in learning the HRSA HDC Primary Health
    Care Collaborative model.

3.  Contributing to leadership development for organization-wide
    learning and improvement in the health centers utilizing all
    HRSA-supported HDC infrastructures.

4.  Local Knowledge Management: Providing HRSA sponsored HDC
    infrastructure with up-to-date knowledge, expertise, and learning in
    primary health care quality improvement.

5.  Working in concert with Federal and national partners to implement
    the HRSA strategy for the second generation of the HDC that
    integrates cancer/prevention, general prevention, and operational
    quality improvements to improve financial vitality and
    accountability for health centers. Federal and national partners
    include the: Office of the Secretary/Office of Minority Health
    (OS/OMH), Centers for Disease Control and Prevention (CDC),
    Environment Protection Agency (EPA), National Institute of Health
    (NIH) , Centers for Medicare & Medicaid Services (CMS), Agency for
    Health Care Research Quality (AHRQ), Substance Abuse and Mental
    Health Services Administration (SAMHSA), National Association of
    Community Health Center (NACHC) and the National Clinical Networks,
    as well as the Bureaus within the Health Resources and Services
    Administration (HRSA): the Bureau of Health Professions (BHPr),
    Maternal Child Health Bureau (MCHB), HIV Aids Bureau (HAB) and the
    Health Systems Bureau (HSB).

6.  Participating in monthly conference calls and ongoing communication
    via list serve and the nationally supported web site.

**Criterion 3: EVALUATIVE MEASURES (10 points)**

1.  The application includes an outcome/results oriented evaluation plan
    with qualitative and quantitative measures for performance of
    proposed activities. This plan should also address maximizing
    program resources, a quality control and completion of work on
    schedule.

2.  The applicant's plan includes periodic critical evaluation of its
    on-going efforts to assist health center providers in sustaining and
    spreading the Planned Care Model, and assessment of how these
    evidence-based concepts generate major improvements in process and
    outcomes.

**Criterion 4: IMPACT (10 points)**

1.  The applicant discusses challenges likely to be encountered in
    designing and implementing the activities described in the Work
    Plan, and approaches that will be used to resolve such challenges,
    including the multiple requirements of the scale-up activities
    necessary at the cluster level to reach 16 Million anticipated
    patients at the national level.

**Criterion 5: RESOURCES / CAPABILITIES (30 points)**

1.  The applicant describes their current experience, skills and
    knowledge, including individuals on staff, materials published, and
    previous work of a similar nature, clearly demonstrating the
    applicant's relevant experience toward accomplishing the project
    objectives.

2.  The proposed staffing plan and duties are appropriate given the
    scope of the proposed project.

3.  The staff training and expertise is appropriate for the proposed
    project.

4.  The applicant demonstrates experience in providing technical
    assistance to health center teams in collaborative or similar
    projects.

5.  The applicant organization has appropriate facilities and equipment
    available to meet all project requirements.

6.  The applicant provides information on its current mission and
    structure, scope of current activities, and an organizational chart,
    and describes how these will contribute to the ability of the
    organization to conduct the program requirements and meet program
    expectations.

7.  The applicant demonstrates that staff responsibilities are
    appropriate for the proposed project, including:

    a.  Ability to provide assistance to health centers in implementing
        operational guidelines of the HDCs, under direction of the HRSA.

    b.  Scheduling conference calls with Phase 1, Phase 2 and prototype
        teams; creating agendas and maintaining and distributing minutes
        from each call.

    c.  Identifying and coaching health center team members to present
        at learning sessions, and ability to modify curriculum for each
        of the areas of focus as needed.

    d.  Designating facilitators for cluster-level Phase 2 Learning
        Sessions and cluster annual summit meetings, two cluster-level
        strategic planning meetings per year, and two HRSA- supported
        cluster infrastructure trainings per year for the HDC registry.
        Applicant provides agendas and materials and will submit
        registration and summary reports within 10 days following the
        meetings.

    e.  Ability to obtain ethnically and culturally diverse faculty as
        needed for each area of focus of the cluster-level activities of
        the HDC program.

    f.  Continuous work with Clinical Quality Improvement Branch and
        other BPHC staff to ensure alignment with BPHC Information
        Technology planning.

8.  The applicant discusses their management strategy for the cluster's
    HDC data and reporting, including work with Information System
    developers to implement regular reports that describe both
    qualitative and quantitative information for health center clinical
    and performance measures.

9.  The applicant demonstrates how they will coordinate with the
    cluster's PCAs, networks and other State, local, regional and HDC
    national partners to:

    a.  Provide technical assistance with performance measures to
        document improvements in the health status of the underserved
        and minority populations.

    b.  Coordinate the deployments of distance based learning activities
        with improvements already achieved in web based reporting.

    c.  Facilitate web based reporting of health center engagement in
        equivalency demonstrations.

    d.  Develop and implement plans with recommendations in conjunction
        with the Information Systems contractor for a Customer Relations
        Management System for Primary Health Care Information Health
        System Specialists tracking questions from health centers and
        communicating them more efficiently.

10. The applicant demonstrates the ability to help develop, manage,
    refine, and provide access to electronic manuals, tools and other
    materials for each health condition and/or process addressed by the
    Collaboratives (including but not limited to cancer, asthma,
    finance/redesign, prevention, diabetes prevention/cardiovascular
    disease, and depression).

11. The applicant demonstrates the ability to maintain cluster
    Information Systems and provide regular updates on the HDC web site
    as needed depending on program needs, and to provide support to
    address HRSA OIT implementation requests related to this web site.

**Criterion 6: SUPPORT REQUESTED (10 points)**

1.  []{#_Ref96500731 .anchor}The applicant includes in the budget
    presentation the total resources required to achieve the goals and
    objectives of the project plan (i.e., total project budget).

2.  The budget appears reasonable and appropriate given the scope and
    size of the proposed project.

3.  The applicant demonstrates the proposed work plan is a
    cost-effective approach to meeting the HRSA/BPHC needs in supporting
    the management and implementation of the HDC.

### 2. Review and Selection Process

The Division of Independent Review is responsible for managing objective
reviews within HRSA. Applications competing for federal funds receive an
objective and independent review performed by a committee of experts
qualified by training and experience in particular fields or disciplines
related to the program being reviewed. In selecting review committee
members, other factors in addition to training and experience may be
considered to improve the balance of the committee, e.g., geographic
distribution, race/ethnicity, and gender. Each reviewer is screened to
avoid conflicts of interest and is responsible for providing an
objective, unbiased evaluation based on the review criteria noted above.
The committee provides expert advice on the merits of each application
to program officials responsible for final selections for award.

# VI. Award Administration Information

### 1. Award Notices

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the expert committee's
assessment of the application's merits and weaknesses, and whether the
application was selected for funding. Applicants who are selected for
funding may be required to respond in a satisfactory manner to
Conditions placed on their application before funding can proceed.
Letters of notification do not provide authorization to begin
performance. The Notice of Grant Award, which is signed by the Grants
Management Officer and is sent to the applicant agency's Authorized
Representative, is the authorizing document. It will be sent prior to
the start date of April 1, 2006.

### 2. Administrative and National Policy Requirements

# *Title 45 of the Code of Federal Regulations*

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate.

[]{.mark}

***Public Health Policy Issuance: Healthy People 2010***

**Healthy People 2010** is a national initiative led by HHS that sets
priorities for all HRSA programs. The initiative has two major goals:
(1) To increase the quality and years of a healthy life; and (2)
Eliminate our country's health disparities. The program consists of 28
focus areas and 467 objectives. HRSA has actively participated in the
work groups of all the focus areas, and is committed to the achievement
of the Healthy People 2010 goals.

Applicants must summarize the relationship of their projects and
identify which of their programs objectives and/or sub-objectives relate
to the goals of the Healthy People 2010 initiative. Please attach the
summary as Appendix B.

Copies of the Healthy People 2010 may be obtained from the
Superintendent of Documents or downloaded at the Healthy People 2010
website: [http://www.health.gov/healthypeople/document]{.underline}/.

***Smoke Free Workplace***

The Public Health Service strongly encourages all award recipients to
provide a smoke-free workplace and to promote the non-use of all tobacco
products. Further, Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities (or in some cases, any portion
of a facility) in which regular or routine education, library, day care,
health care, or early childhood development services are provided to
children.

### 3. Reporting

The successful applicant under this guidance must:

i.  Comply with audit requirements of OMB Circular A-133. Information on
    the scope, frequency, and other aspects of audits can be found at
    [www.whitehouse.gov/omb/circulars](http://www.whitehouse.gov/omb/circulars).

ii. Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Submit the electronic report to the:

> Division of Payment Management
>
> DPM/FMS/PSC/ASAM/HHS
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (301) 443-1660

iii. Submit a Financial Status Report. A financial status report is
     required within 90 days of the end of each grant year. The report
     is an accounting of expenditures under the project that year and
     should be submitted by hard copy to the Grants Management Office.

iv. Submit quarterly Progress Reports to BPHC on health centers'
    progress in the HDC. The applicant will also submit quarterly
    progress reports to the BPHC on activities that are outlined in this
    guidance.

**4. Performance Review**

HRSA's Office of Performance Review (OPR) serves as the agency's focal
point for reviewing and enhancing the performance of HRSA funded
programs within communities and States. As part of this agency-wide
effort, HRSA grantees will be required, where appropriate, during their
project period to participate in an on-site performance review of their
HRSA funded program(s) by an OPR review team. When a grantee receives
more than one HRSA grant, each of the grantee's HRSA funded programs
will be reviewed during the same performance review. For additional
information on performance reviews, please visit:
<http://www.hrsa.gov/performancereview>.

Upon completion of the performance review, grantees will be required to
prepare an Action Plan to address any identified program requirement
issues as well as identify key actions to improve program performance.
In addition, performance reviews also provide an opportunity for
grantees to offer direct feedback to the agency about the impact of HRSA
policies on program implementation and performance within communities
and States.

# VII. Agency Contacts

Applicants may obtain additional information regarding business,
administrative, or fiscal issues related to this grant announcement by
contacting:

Mike Rowland

Attn: Cluster Leadership of the HRSA HDC

HRSA, Division of Grants Management Operations

> 5600 Fishers Lane, Mail Stop 11A-16
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4243
>
> Email: <MRowland@hrsa.gov>

Applicants may obtain additional information related to the overall
program issues by contacting:

> Richard Lee
>
> Public Health Analyst, Division of Clinical Quality

Attn: Cluster Leadership of the HRSA HDC

> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Mail Stop 17C-26
>
> Rockville, MD 20857
>
> Telephone: (301) 594-3729
>
> Fax: (301) 594-4081
>
> Email: [RCLee@hrsa.gov](../RCLee@hrsa.gov)

Technical assistance regarding this funding announcement may be obtained
by contacting:

> Cicely Nelson
>
> Public Health Analyst, Division of Policy and Development

Attn: Cluster Leadership of the HRSA HDC

> Bureau of Primary Health Care, HRSA\
> 5600 Fishers Lane, Mail Stop 17-61
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4496
>
> Fax: (301) 594-4997
>
> Email: <CNelson@hrsa.gov>

**VIII.** **TIPS FOR WRITING A STRONG APPLICATION**

**Keep your audience in mind.** Reviewers will use only the information
contained in the application to assess the applicant. Therefore, the
applicant should be sure the application and responses to the program
requirements and expectations are complete and clearly written. Do not
assume that reviewers are familiar with the applicant organization. Keep
the review criteria in mind when writing the application.

**Start preparing the application early.** Allow plenty of time to
gather required information from various sources.

**Follow the instructions in this guidance carefully.** The instructions
call for a particular organization of the materials, and reviewers are
accustomed to finding information in specific places. Do not have
reviewers hunting through your application for information.

**Be brief, concise, and clear.** Make your points understandable.
Provide accurate and honest information, including candid accounts of
problems and realistic plans to address them. If any required
information or data is omitted, explain why. Make sure the information
provided in each table, chart, attachment, etc., is consistent with the
proposal narrative and information in other tables.

**Be organized and logical.** Many applications fail because the
reviewers cannot follow the thought process of the applicant or because
parts of the application do not fit together.

**Be careful in the use of appendices.** Do not use the appendices for
information that is required in the body of the application. Be sure to
cross-reference all tables and attachments located in the appendices to
the appropriate text in the application.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages are numbered (including appendices) and that page limits are
followed.

**Limit the use of abbreviations and acronyms**, and define each one at
its first use and periodically throughout application. If using specific
methodological, clinical terms be sure to define these as well.

**Contact program staff.** Finally, please contact the persons listed in
the "Agency Contacts" section, above, if any questions arise when
preparing the application.

**Attachment 1**

**PROGRAM EXPECTATIONS FOR CLUSTER LEAD ENTITIES**

**A. TRANSFORMATION & DISSEMINATION OF QUALITY IMPROVEMENTS: BUILDING
THE COLLABORATIVE COMMUNITY**

1.  Develop a detailed project work plan for Transformational activities
    of the Cluster to be submitted to HRSA. Work plan should include:

    a.  Efforts to engage Senior leadership of PCAs in the cluster and
        of all cluster health centers in Transformational activities;

    b.  Efforts to familiarize cluster health centers who have not
        previously participated in HDC with the models and approaches
        the HDCs use, and other readiness activities, with involvement
        of all PCAs and network teams in the cluster;

    c.  Encourage all Phase 2 teams in the cluster to deal with scale-up
        issues via either cancer screening and/or prevention tools, or
        combined screening tools;

    d.  Assist cluster health centers to develop, without losing
        quality, an organizational plan for scale-up of their internal
        registries, and a communication strategy;

    e.  Assist cluster health centers to develop a sequenced integration
        strategy to their collaborative activity so as to include all
        patients with diabetes, asthma, or depression, or at risk for
        diabetes, cardiovascular disease, and/or cancer;

    f.  Support cluster health centers in developing plans for
        integration of information technology which can provide
        efficiencies in the management of patient health outcomes;

    g.  Assist cluster health centers in integration of the HDC
        improvement model into their organizational quality improvement
        programs, including the use of techniques developed in the
        access/patient flow redesign Collaboratives.

    h.  Provide a document that outlines the process to be used and
        cluster personnel with specific responsibility for each action
        area listed within this guidance. (This should be done in a
        spreadsheet format.)

2.  Actively engage all PCAs in the cluster, and other local public and
    private partner organizations, in the Transformation strategy, to
    promote improved health outcomes through proactive use of the care
    and improvement models.

3.  Implement and document, within the plan, a proposed protocol for HDC
    conference calls with cluster health centers (including distribution
    of summary action items following the call), and for site visits for
    technical assistance to them as needed. Utilize existing National,
    State or regional telecommunications where feasible.

4.  Document proposed management plans and activities, including as a
    minimum overseeing the reporting of quarterly data and narrative
    information from health centers to the national HDC reporting site.

5.  Generate a quarterly cluster aggregate narrative report and share
    with HRSA HDC officials, HDC National Project Management staff, and
    other cluster directors by the 20^th^ of the month following the end
    of each quarter (July, October, January, and April). \[Cluster and
    National Project Management staff should work together to ensure
    consistency in the format and categorical content of these quarterly
    reports across the clusters.\]

6.  Facilitate attendance of Phase 2 health centers engaged in
    Transformational activities, to enable health center participating
    in at least one cluster summit Transformation learning session per
    year, to include Information Technology training to support the
    electronic patient registry of the HDC. Health center executive
    director, a governing board member, Information Technology staff
    person, and medical, dental and/or mental health professional should
    be encouraged to attend (at the health center's expense). Cluster
    leads should coordinate their respective cluster planning activities
    and exercises for local training with the National HDC Team
    Conference Calls and National Meetings such as the NACHC National
    Meetings.

7.  Collect quality improvement success stories from health center
    collaborative teams, utilizing the HDC national website, and
    facilitate sharing of this information quarterly with regional
    partners and HRSA.

8.  Provide three to five documented examples each quarter demonstrating
    participating health center impact on decreasing health disparities
    in their community. Technical assistance for this task will be
    available through the national project management staff.

9.  Describe the cluster's proposed strategy to sustain and promote high
    performing cluster teams and improve performance for lower
    performing teams.

10. Identify and submit to HRSA all current Memoranda of Agreement (MOA)
    with national clinical networks (e.g. the Migrant Clinicians
    Network, the Homeless Clinicians Network, and/or the National
    Network for Oral Health Access), and with Health Center Controlled
    Network (HCCN) in the cluster. Develop such MOAs with any HCCN in
    the cluster not already covered, and who wants to develop such an
    MOA, so as to encourage an effective collaborative strategic
    approach that integrates the effective use of technology to promote
    improved patient health outcomes.

11. Build an expert faculty at the cluster level in clinical and quality
    improvement subjects and the care model that will assist with
    cluster Transformation meetings and provide continued mentoring as
    needed within the cluster. Where possible, this faculty should
    include partner HRSA-funded organizations such as the Area Health
    Education Centers. Clusters will be responsible for the travel,
    lodging and honoraria of such faculty for Cluster-sponsored
    meetings.

12. Assist HRSA in identifying ten successful HDC health center leaders
    annually from each cluster, for participation in national quality
    improvement advisor training. These leaders should include
    clinicians, operational and financial managers, and practice
    management experts actively engaged in HDC activities.

13. Help to support and facilitate partnerships between heath centers
    involved in the HDC and cluster CDC funded State-based Diabetes
    Control Programs, Cardiovascular Health Programs, Cancer Prevention
    Programs, and/or other cluster State-based programs related to
    diseases and prevention modalities addressed by the HDCs. Also
    facilitate support from other related cluster state and local
    programs/initiatives with health center teams working on HDC goals,
    funded by other agencies beside CDC, including private foundations
    and other national, state, and local organizations.

14. Facilitate and market local Depression treatment training as part of
    Transformational activities, along with other disease collaboratives
    already underway at the health centers.

# B. COORDINATION AND SUPPORT OF HDC Initial Learning Year ACTIVITIES (for Health centers in phase 1) 

#  

1.  Coordinate with the National Project Management staff and HRSA to
    help cluster health centers participate in Phase 1 training for
    cluster health center teams previously selected for HDC 2006 that
    will run from April 2006 through March 2007.

2.  Continue to provide HDC readiness technical assistance to those
    cluster health centers that have not yet participated in HDC
    activities.

3.  Develop a plan to complete exposure of all 330-funded health centers
    in the cluster to Phase 1 activities during the next HDC year (April
    2007 through March 2008), to include new access point health centers
    funded in FY 2006.

4.  With the assistance of Cluster steering committees, recruit, select
    and enroll health centers (including migrant, homeless, and public
    housing primary care health centers) for participation as Phase 1
    health centers in HDC 2007 (April 2007 through March 2008).

5.  Help to assure that HDC 2006 Phase 1 health center teams from each
    cluster (Four- member team including Information Technology (IT)
    staff member and executive director) attend three national learning
    sessions and the National Forum. Each learning session will be up to
    four days in length and will include IT patient registry training.
    In addition to the 4-member team, a dental and/or mental health
    professional may also attend the second national learning session,
    at the cost of the health center. Facilitate the additional
    attendance of a governing board member and/or IT staff member of the
    health center, at health center expense.

6.  Encourage at least one high performing team member and at least one
    senior leader from prior health disparities collaboratives to serve
    as faculty for National learning sessions. Selection of these team
    member(s) and senior leader(s) will be coordinated with the National
    Project Management staff and HRSA.

7.  In coordination with HRSA and the National Project Management staff,
    continue to involve senior leaders in test cycles, and recruit
    senior leaders to attend learning sessions and the national forum.

8.  Facilitate and market the depression training provided at previous
    learning sessions and the integration of depression assessment into
    all Collaboratives.

9.  With HRSA, refine and continue to implement Cluster-based approach
    for project management, including effective communication, a
    reporting strategy that includes the centralized HDC web site to
    share information across clusters, and other tools, success stories,
    monthly reports, etc.

10. Promote participating sites' enrollment in and use of list-serves,
    disease-specific list-serves and disease-specific virtual offices
    through the national HDC website, consistent with the national
    communication strategy.

11. Collaborate with HRSA and national partners (e.g., CDC) to identify
    additional State infrastructure and resources to participate in the
    collaborative.

12. Facilitate use of distance-based learning tools developed by HRSA
    funded Clinical Networks and Health Center Controlled Networks, as
    appropriate.

13. Incorporate redesign concepts into learning opportunities and action
    periods for health center teams.

14. Refine cluster strategy to utilize high performing teams in the
    Collaborative.

15. Facilitate sharing of Phase 1 success stories and information from
    Phase 1 teams on a quarterly basis with HRSA, the National Project
    Management staff, and other clusters.

16. Implement (within project plan) a protocol for conference calls with
    health centers (with distribution of summary minutes), facilitate
    monthly health center reporting to national HDC national reporting
    website, and provide site visits as needed.

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17. Implement a communication/reporting plan that include monthly
    cluster and national aggregate information, highlights of successful
    models and partnerships, and is shared on a monthly basis with
    partners, participating health centers and HRSA.

18. Assist health center teams to submit HDC storyboards electronically
    on a timely basis - two weeks in advance of Learning Sessions and
    the National Forum - to national directors for distribution by
    CD-ROM and website to participants.

19. Support cluster infrastructure, to include cluster director, cluster
    coordinators and information systems specialist, to attend learning
    sessions and national forum for training support.

######## C. DEVELOPMENT AND INTEGRATION OF PREVIOUS DEMONSTRATIONS OF HEALTH DISPARITIES COLLABORATIVES 

######## Develop and share with HRSA and other clusters a plan for the integration of the various HDC demonstrations with other HDC activities going on in its cluster.

######## Help the national apparatus to provide HRSA-supported health center HDC participants with access to information technology registry software and technical assistance as needed to implement the various HDC demonstrations.

1.  Help ensure that all cluster HDC health center participants report
    core nationally-defined measures for appropriate conditions through
    the national web-based reporting system. Technical assistance will
    be available through the national Information Systems contractor.

2.  Provide quarterly aggregate report to HRSA on the progress of HDC
    demonstrations within the cluster.

######## 

######## D. CLINICAL INFORMATION SYSTEMS 

1.  Continue to provide technical assistance to health centers in both
    the Initial Learning Year and during Transformation efforts through:

    a.  Assisting health centers in use of the National HDC website.

    b.  Participating in National conference calls and web telecasts as
        appropriate, and setting up cluster-level (and cluster State or
        other appropriate sub-cluster group) conference calls, web
        telecasts, and other innovative communication modes.

    c.  Participating in Learning Session Question &Answer, Individual
        and Group training sessions.

    d.  Promoting use of cost effective innovative technology (e.g.,
        Desktop Streaming, web-based training, etc.).

    e.  Site visits at PCAs or health centers as needed.

    f.  State-based training and technical assistance opportunities as
        appropriate.

2.  Provide readiness assessment for utilization of information
    technology during application and Learning Session pre-work process.

3.  Aligned with HRSA national strategy, continue cluster Information
    System Specialist technical support for transition of health centers
    from DEMS and CVDEMS to PECS or successor registry systems where
    needed.

4.  Develop partnerships at local and State level for technical
    assistance related to Clinical Information Systems.

5.  Aligned with HRSA national strategy, help train Cluster
    Directors/Coordinators in functions and use of registry systems.

6.  Provide computer hands-on information systems training for
    participating HDC teams at the Cluster level summits.

7.  In coordination with HRSA, participate in ongoing Web-based training
    with entire national Clinical Information Systems team for registry
    software features, functions, and use.

8\. Provide input into training curriculum and aids for the
implementation of registries in health centers at Learning Sessions and
for local use in collaboration with the national Clinical Information
Systems team.

9.  With the national Clinical Information Systems team and HRSA,
    develop readiness and implementation plans for appropriate
    information systems training for health center teams engaged in
    initial learning year and Transformation activities.

10. All Cluster information system specialists will attend two 2-day
    Information Systems training sessions regarding registry
    functionality with the national Clinical Information Systems team
    and HRSA. Provide travel and lodging expenses for the sessions.

11. Support collection and aggregation of cluster health center- level
    key measure data to share nationally on centralized web site.

12\. Provide technical assistance to cluster health centers as needed to
ensure timely, accurate and uniform Cluster-level reports. Distribute
and implement standard data reporting templates.

13\. Provide technical assistance to health centers regarding web-based
collaborative national reporting system. Ensure timely submission of
data and senior leader reports to the reporting website.

**E. THE SUPPORT SYSTEM: BUILDING and STRENGTHENING THE INFRASTRUCTURE
AT STATE, CLUSTER and NATIONAL LEVELS**

1.  Conduct cluster steering committee strategic planning sessions at
    least twice yearly. Cluster strategic planning sessions should
    include all cluster PCAs, the cluster director, cluster coordinators
    and Information System specialists, PCA Clinical Networks, and
    Health Center Controlled Networks.

2\. Provide training to steering committee members in care and
improvement models and orientation to familiarize members with
electronic registry software.

3\. Evaluate and improve the communication strategy for the cluster and
the process for decision-making within the cluster.

4\. Utilize National Clinical Network coordinators as faculty and
partners to strengthen the infrastructure, further spread the
collaborative work, incorporate oral health and mental health
activities, and give appropriate emphases to migrant and homeless
populations.

5\. Ensure capacity for cluster directors, cluster coordinators and
Information System specialists to meet HRSA HDC scope of work.

6.  Provide notification to HRSA regarding HDC-dedicated cluster
    infrastructure staffing changes in a timely manner.

7.  Have the cluster steering committee develop a strategy, in
    partnership with the HRSA and National Project Management staff to
    train and mentor new cluster directors, coordinators and Information
    System specialists.

8.  Document to HRSA partnerships that have leveraged existing state
    infrastructure and private partnerships to expand support to health
    centers.

#### F. SENIOR LEADERSHIP OF HEALTH CENTERS

1.  Encourage senior leaders from the health centers to attend national
    learning sessions, national forum and Transformational cluster
    summits.

2.  Encourage one health center governing board member to attend
    Learning Session Three of HDC 2006 at the health center's expense.

3.  Facilitate at least two health center senior leader conference calls
    in each cluster during the year.

4.  Facilitate senior leader use of specific senior leadership
    electronic communications as appropriate.

5.  Submit a plan to share senior leader test cycles and changes that
    communicates senior leader activities.

6.  Aligned with the HRSA strategy, develop cluster strategy to engage
    and support health center leadership in sustaining and spreading the
    HDC model of care into transformational system change of day-to-day
    operations of the health center.

7.  Identify and document effective senior leadership change concepts
    and share with HRSA through quarterly reports.

#### G. COMMUNITY AND ORGANIZATIONAL PARTNERSHIP

1.  Develop and implement a cluster strategy to facilitate and
    strengthen community and State partnerships.

2.  Monitor partnership development and maintenance using monthly
    reports and information from agency partners.

3.  Encourage health centers to use tools developed from partner
    organizations (e.g., National Diabetes Education Program (NDEP),
    Open Airways program for asthma, and Diabetes Today) as part of the
    HDC activities.

4.  Help align, as appropriate, local or national initiatives with the
    HDC program (e.g., national diabetes initiative, state asthma
    initiatives).

######## H. ON-GOING FEEDBACK WITH HRSA-BPHC

1.  Provide written feedback on senior leader reports to 100 percent of
    participating health centers, monthly in Initial learning year and
    quarterly in Transformation and any readiness activities,
    acknowledging efforts and providing improvement guidance.

2.  Provide written notification from cluster steering committee to HRSA
    of any health center's withdrawal from participation in the HDC, as
    soon as possible and within no more than 30 days.

3.  Assist HRSA with revisions to update and ensure integrity of
    national databases (BPHC participation database, HDC reporting
    database), including health center Uniform Data System (UDS) number
    as a unique identifier.

4.  Facilitate sharing of cluster- developed resources through linkages
    to the national HDC website.

5.  Provide the conference call schedule for the cluster steering
    committee at least quarterly, including calls involving the sharing
    and discussion of HDC reports aggregated at the State, cluster and
    national levels, as applicable.

6.  Provide all health centers actively participating in Transformation
    activities with instructions on and access to graphs illustrating
    aggregate health center performance on HDC core measures, through
    use of the national HDC web-based reporting system. Feedback to
    Health Centers is to include information on change concepts that are
    proving most important and effective in the cluster and across the
    Nation.

7.  Facilitate the health centers' and HRSA supported infrastructure's
    use of the national HDC web site and communication modalities, such
    as training manuals, which currently include: manuals on diabetes,
    depression, cardiovascular disease, asthma, prevention, cancer
    screening and the Patient Electronic Care System.

8.  Provide feedback to HRSA regarding the centralized web site,
    distance-based learning materials, training manuals and videos.

# 

# I. Evaluation

1.  Collaborate as needed with HRSA and the Agency for Health Research
    and Quality (AHRQ) in the evaluation of the HDC, including efforts
    to identify and facilitate participation of health centers and local
    partners.

2.  Share current information and data with the evaluation team as
    appropriate.

**J. OTHER ACTIVITIES**

In addition to the above performance expectations, the project plan must
be consistent with the following activities:

1.  Have an advisory steering committee with representation from all
    PCAs in the cluster, multidisciplinary Clinical Networks within the
    cluster, health center senior leadership and clinicians. Conduct two
    strategic planning sessions involving the committee and complete a
    strategic plan.

2.  Submit progress reports on July 31, October 31, and January 31,
    during the Project Period, for the quarter ending at the end of the
    previous month, and an end of the project report. Include an
    aggregate cluster Initial learning year monthly and Transformational
    quarterly report, with narrative and graphed data. Include
    information regarding reporting status of participating Health
    Centers.

3.  Prepare a budget in accordance with PHS 5161-1, along with a one to
    three page justification. This justification should describe
    personnel, and infrastructure travel costs, and should clearly
    define resources for cooperating Clinical Networks and Health Center
    Controlled Networks. If appropriate, it should include contractual
    arrangements with PCAs and other organizations.

4.  Ensure that the Cluster Strategic Plan (item 1 above) promotes HDC
    participation to all HRSA-supported organizations in your cluster,
    and have a policy and plan to share all collaborative information
    and opportunities with all HRSA-supported organizations in the
    cluster, including Migrant Health Centers, Health Care for the
    Homeless projects, Public Housing Primary Care and School-Based
    Health Center grantees, Clinical Networks and Health Center
    Controlled Networks.

5.  Include both a cluster lead and a multidisciplinary Clinical Network
    in the application.

6.  Conduct Transformation meetings and activities to support health
    centers that have completed the initial learning year of a HDC,
    incorporating cultural competency and depression training in summit
    meetings. Plan for communicating to and supporting all
    Transformation health centers to engage them in Transformation
    Sustain and Spread activities.

7.  In alignment with HRSA national strategy for the HDCs, implement a
    process to monitor whether HDC activities are in fact improving
    health outcomes and shared national goals and reducing health
    disparities at the cluster level, utilizing health center reports
    and information available from partner agencies.

8.  Identify leadership activities to be performed by the Executive
    Director of the lead entity to support the aims and performance of
    health centers involved in sustain and spread, and to facilitate
    partnerships and communication.

9.  Identify principal activities by the lead cluster Clinical Network
    to support the aims and performance of cluster teams, and to
    facilitate partnerships and communication.

10. Include the most recent cluster HDC strategic plan.

11. Include a list current cluster public and private partners building
    activities that support HDC goals and describe collaborative plans
    and activities.

12. Present a plan, coordinated by the cluster steering committee, to
    support spread of HDC participation to all cluster States and
    HRSA-supported sites, and a process to monitor whether activities
    are in fact improving care.

13. Demonstrate a cluster strategy to sustain and promote high
    performing teams and improve performance for lower performing teams.
    Include the policy for engaging non-reporting teams and notifying
    HRSA of non-participation of health centers.

14. Include a communication plan that addresses the utilization of the
    HDC national website and effective means to provide training
    materials and distance-based learning tools to the health centers.

**K. PROGRESS REPORT**

As stated in Section J, item 2, each cluster lead will be required to
submit three Progress Reports. This report should include the following,
in a format to be approved by HRSA:

1.  Number of cluster health center grantees being supported in their
    Initial learning year and the number and percentage of these health
    centers submitting senior leadership reports. Number and names of
    health center grantees dropped from HDC participation during the
    Initial learning year through fiscal year 2005, with a description
    of the reasons for dropping out.

2.  Number of cluster health centers grantees engaged in Transformation,
    and the number and percentage of these health centers submitting
    senior leadership reports. Number of health center sites
    participating in Transformation and total number of eligible
    Transformation health center sites. Number and description of health
    center grantees/sites which have spread to another disease
    condition, health center site, and /or additional providers in
    Sustain and Spread. Name and number of health centers dropped from
    participation during Transformation, with description of reasons for
    dropping.

3.  Describe progress toward the goal of all health centers in cluster
    participating in at least one HDC. Include total number of health
    center grantees in cluster and the non-duplicated number who have
    participated in at least one HDC.

4.  Discuss performance in the Health Disparities Collaboratives
    (Initial learning year and Transformation activities) during the
    past year. Include the aggregate cluster Initial learning year and
    Transformation reports.

5.  Address each performance goal and Cluster effectiveness in meeting
    or exceeding the performance goals.

6.  Provide evidence of partnerships built to support of HRSA HDC goals.

7.  The degree of collaboration with NACHC, other federal and State
    agencies and partners in the development and implementation of HDC
    approaches and activities.

8.  Capacity of the PCAs and Clinical Networks to engage in these
    activities.

######## L. FINAL PROGRESS REPORT

The previous year's work plan should be annotated to reflect progress
from April 1, 2006 to March 31, 2007, with explanations for any changes
or delays.

**ATTACHMENT 2**

**Sample Project Work Plan**

+--------+-------------------+--------------+-------------+-----------+
|        | **ACTION STEPS**  | **DE         | **          | **DUE     |
|        |                   | LIVERABLES** | RESPONSIBLE | DATE**    |
|        |                   |              | PARTY**     |           |
|        |                   | Identify     |             |           |
|        |                   | deliverables | (Executive  |           |
|        |                   | and          | Director,   |           |
|        |                   | measurable   | Community   |           |
|        |                   | performance  | Development |           |
|        |                   | indicators   | staff,      |           |
|        |                   |              | etc.)       |           |
+========+===================+==============+=============+===========+
| **Ma   |                   |              |             |           |
| naging |                   |              |             |           |
| Phase  |                   |              |             |           |
| 2 of   |                   |              |             |           |
| the    |                   |              |             |           |
| HDC    |                   |              |             |           |
| *(E    |                   |              |             |           |
| xample |                   |              |             |           |
| of     |                   |              |             |           |
| P      |                   |              |             |           |
| rogram |                   |              |             |           |
| Exp    |                   |              |             |           |
| ectati |                   |              |             |           |
| on)*** |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 1 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 2 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 2.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 2.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ***P   |                   |              |             |           |
| rogram |                   |              |             |           |
| Expec  |                   |              |             |           |
| tation |                   |              |             |           |
| #2***  |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 1 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+