**Billing Code: 4163-18-P**

**DEPARTMENT OF HEALTH AND HUMAN SERVICES**

**Centers for Disease Control and Prevention**

**Childhood Lead Poisoning Prevention Program (CLPPP)**

**ALL AMENDMENTS CAN BE FOUND IN RED WITHIN THE DOCUMENT.**

**Announcement Type:** New

**Funding Opportunity Number:** CDC-RFA-EH06-602

**Catalog of Federal Domestic Assistance Number:** 93.197

**Key Dates:**

**Application Deadline: February 21, 2006**

# I. Funding Opportunity Description

**Authority:** This program is authorized under Sections 317(k)(2), 317A
and 317B of the Public Health Service Act, \[42 U.S.C. 247b(k)(2),
247b-1, and 247b-3\], as amended. Relevant provisions of the Project
Grant for Preventive Health Services Regulations are set forth at 42 CFR
Part 51b.

**Background:** From 1990 to 2005, CDC has appropriated funds to state
and local health departments to support childhood lead poisoning
prevention programs. During FY 2005 alone, CDC allocated nearly 30
million dollars to state and city health departments. As a result of the
collaboration between Department of Housing and Urban Development (HUD),
and Environmental Protection Agency (EPA) and the support of state and
local activities, the geometric mean (GM) blood lead levels in children
one through five years of age have dropped to an average of 1.9
micrograms per deciliter (µg/dL) from a high of 15 µg/dL in the early
1980s.

Childhood lead poisoning remains a major preventable environmental
health problem. It is a serious illness with potential lifelong negative
health effects for children in all socioeconomic strata, but it
disproportionately affects poor, and minority children.

According to the National Health and Nutrition Survey (NHANES), during
the 1999-2002 survey period, children aged one-five years had a
prevalence of elevated blood lead levels of 1.6 percent. An estimated
310,000 children in that age group remain at risk to lead levels that
have been associated with decreased intelligence, behavioral
disturbances, delayed development, and other adverse health effects.
Moreover, disparities in exposure remain: the geometric mean (GM) BLL of
children enrolled in Medicaid is significantly higher than children who
are not enrolled (2.5µg/dL vs 1.9 µg/dL, respectively).

According to the 1999 General Accounting Office (GAO) "Report on Lead
Poisoning", the majority (83%) of children with elevated blood lead
levels (≥10µg/dL) were Medicaid eligible. Currently, less than half
(43%) of Medicaid- eligible children ever receive a blood lead screening
test. The sources of lead poisoning for most of these children are lead
paint in homes and lead paint-contaminated dust and soil.

In recent years, with an increasing number of refugees and other
immigrants entering the United States, a corresponding increase has been
seen in non-paint lead exposure (e.g., lead has been found in some
homeopathic remedies, candies, pottery and other dishes used in food
storage, preparation and serving).

In 2004, newly arrived children in New Hampshire from Africa were
identified with elevated blood lead levels. The medical records
indicated that the blood lead elevations, in some cases frank lead
poisoning, occurred after the children were relocated to the United
States. The children also showed evidence of extreme chronic
malnutrition (MMWR January 21, 2005).

Most U.S. children today who have lead poisoning or who are at high-risk
for lead poisoning, including the recent arrivals are impoverished and
live in older, deteriorating housing and children whose nutritional
status is compromised are at an even greater risk.

CDC believes that with a continued concerted effort, especially in the
area of primary prevention, lead poisoning will be virtually eliminated
by 2010, and the nation's health objective to \"eliminate blood lead
levels in children,\" as presented in the U.S. Department of Health and
Human Services' \"Healthy People 2010" (objective no.8-11) will be
achieved.

Program efforts need to increase focus in the area of housing-based
primary prevention policy development and provide the necessary data to
policy makers that will assure their support of those policies.
Housing-based primary prevention policy will assure lead-safe housing is
available for families with young children beyond 2010.

After 2010, program efforts will continue to focus on blood lead
surveillance, however, other surveillance activities that reveal changes
in housing risk status and non-paint exposure sources will likely be
added.

**Purpose:** The purpose of the program is to assist state and local
partners in building capacity to eliminate childhood lead poisoning as a
major public health problem. The focus of the program is children under
the age of six years with special emphasis on children under the age of
three years. Special emphasis will be placed on building capacity for
primary prevention of lead poisoning and on implementing protective
housing-based policy that will remain in place beyond 2010.

All appendices and attachments posted with this announcement are also
posted on the CDC Web site at:
[www.cdc](http://www.cdc.gov/nceh/lead/lead.htm).gov/od/pgo/funding/grantmain.htm

Measurable outcomes of the program will align with one (or more) of the
following performance goal(s) for the National Lead Poisoning Prevention
Branch (LPPB) of the National Center for Environmental Health (NCEH):

1.  To reduce the burden of lead poisoning in children,

2.  To improve the ability of state childhood lead poisoning prevention
    programs' to monitor the burden of lead poisoning in children, and

3.  To assure implementation of systems to control/eliminate lead
    sources before children are exposed.

This announcement is only for non-research activities supported by CDC.
If research is proposed, the application will not be reviewed. For the
definition of research, please see the CDC Web site at:
<http://www.cdc.gov/od/ads/opspoll1.htm>

Applicants must provide information related to the lead burden in their
jurisdiction using blood lead testing data (see Appendix IX), population
data, poverty status/Medicaid data, and age of housing or other
housing-specific condition data and present data about non-paint sources
of lead exposure in high-risk urban, suburban, and rural areas (if
applicable) and describe populations living in those areas.

**RECIPIENT ACTIVITIES:** Awardee activities for this program are the
following elements:

Note that the following elements are to be included as components of the
Work Plan, including the goals, objectives and activities detailed under
each element. The goals, objectives and activities of the Evaluation
Plan should also be included as a component of the Work Plan.

**A) Elimination Plan**

Applicants with an existing strategic elimination plan shall provide a
copy of the plan as an attachment to the application. The plan shall
include activities for periodic meeting of the elimination advisory
group (at least semiannually, preferably quarterly), indicate how data
are used to assess progress, and to provide guidance to advance the
plan. The elimination advisory group is made up of stakeholders
interested in childhood lead poisoning issues. This advisory group is
convened by the applicant for the purpose of seeking the stakeholders
advice on the development and implementation of the jurisdiction's lead
poisoning elimination plan. The elimination plan shall include goals,
objectives, and activities. Applicants shall include activities to
monitor/evaluate the elimination advisory group's activities on a
regular basis for the purpose of enhancing the overall plan. In addition
to the urban areas, the plan must include specific goals, objectives,
and activities related to older suburban and rural areas, as applicable.

The elimination plan shall include a graphic representation (e.g.,
table, chart) of total projected numbers of children with elevated blood
lead levels (≥10µg/dL) by budget year with projected reduction by budget
year until elimination of elevated blood lead levels in children is
achieved.

Applicants without an existing elimination plan will develop, publish
and implement one by the end of the first budget period. See Appendix V.

**B) Screening/Case Management Plan**

Applicants with an existing blood lead screening/case management plan
shall provide a copy of the plan as an attachment to the application.
The applicants must include the following activities in their work plan
or case management plan:

-   Review of the plan, annually, including how the review outcome will
    be utilized to increase the number of high risk children who receive
    blood lead screening.

-   Methodology used to measure screening performance of providers
    (including Medicaid providers).

-   Provision of education and communication of risk information to the
    high-risk populations identified in the Need Section of the
    application.

-   Assessment of the timeliness, quality and improvement of the
    provision of case management services in compliance with
    recommendations from Advisory Committee on Childhood Lead Poisoning
    Prevention, "*Managing Elevated Blood Lead Levels Among Young
    Children*" (CDC, March 2002).

-   Provision of electronic case management data, including inspection
    data and hazard control/intervention data into an electronic
    database and sent to CDC, portions of which will be made available
    for public use. Applicant must include written data quality
    assurance procedures.

-   Enforcement, or a plan to develop, regulations within the state or
    jurisdiction requiring elimination or control of lead hazards in
    housing units occupied by children with an elevated blood lead
    level, in collaboration with state and local housing and
    environmental quality authorities.

-   Enforcement, or plan to develop, regulations within the state or
    local jurisdiction that provide resident/tenant protection from
    retaliatory eviction or other discrimination related to disclosure
    of lead hazards or elevated blood lead levels.

-   Requirement of the reduction of lead hazards, including performance
    of mandatory dust wipe testing to assure clearance standards are met
    after remediation work in accordance with EPA standards 40 CFR Part
    745.227. This citation can be accessed at
    <http://www.access.gpo.gov/nara/cfr/waisidx_03/40cfr745_03.html>

-   Accessing information during environmental inspections related to
    the HUD Disclosure Rule (Section 1018 of the Residential Lead-Based
    Paint Hazard Reduction Act of 1992) and forward potential violations
    of federal regulations to HUD and EPA Regional Office for
    enforcement and potential violations of local ordinances to local
    housing enforcement authorities.

Sharing of unit-specific data obtained during environmental
investigations with appropriate public agencies (e.g., state and local
housing and environmental quality authorities, Medicaid, HUD and EPA
Regional Offices). Applicants shall describe how elevated blood lead
data will be provided quarterly to housing authorities of federally
subsidized housing, as required under HUD 1012 Lead-Safe Housing Rule 24
CFR 35.1225. This citation can be accessed at
<http://www.gpoaccess.gov/cfr/retrieve.html>

Applicants without an existing screening/case management plan will
provide activities with a timeline to ensure that the plan will be
developed, published and implemented by the end of the first budget
period.

**C) Surveillance**

Applicants with an existing surveillance system shall provide
description of the system (e.g., what data are collected and how they
are used by program) and a detailed flow chart for both individual and
summary blood lead test data in the application as an appendix.
Applicants must include written data quality assurance procedures.

Applicants must include the following activities in their work plan:

-   Enforcement, or a plan to develop regulations that require
    *electronic* reporting of [all]{.underline} blood lead and
    environmental test results for children less than 72 months of age.
    See Appendix I for definition of "Electronic Laboratory-Based
    Reporting (ELR)".

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-   Maintenance of an existing, or development of an electronic data
    base to collect, compile and share blood lead and case management
    data, including environmental inspection, hazard identification,
    remediation, and clearance data. These data shall integrate or
    interface with other maternal child and environmental public health
    databases (e.g., immunization registries, Adult Blood Lead
    Epidemiology and Surveillance \[ABLES\]; National Electronic Disease
    Surveillance System \[NEDSS\]; Medicaid; and Special Supplemental
    Nutrition Program for Women, Infants and Children \[WIC\]; state and
    local housing and environmental quality authorities).

-   Identification of Medicaid-eligible children who have not received
    required blood lead testing (e.g., data sharing, data matching) in
    partnership with state Medicaid agency.

-   Development and publishing of an annual report for stakeholders;
    include distribution plan for elimination planning group, HUD and
    EPA Regional Offices, state and local leaders of governing bodies,
    and Health Departments (e.g., Governor, Mayor, state and local
    legislators, Health Commissioner, and state and local Health
    Directors). Applicants shall include in report the number of
    inspections, risk assessments, EBLL investigations, abatements,
    interim control applications, and similar lead hazard identification
    and control activities in its jurisdiction.

-   Provision of public access to data without personal identifiers.

Applicants developing a new data system shall include in the application
as an appendix, a complete listing of partners involved in the
development, describe the planned data system and its resource
requirements, including both development and maintenance costs and
provide evidence (i.e., letters of support) that partners include, but
are not limited to the following: state epidemiology group, state
information technology department and state EPHTP (Environmental Public
Health Tracking Program, if one exists). See list of state and city
EPHTPs at <http://www.cdc.gov/nceh/tracking/projects/home.htm>.

Applicants without an existing surveillance system shall include
specific activities describing the surveillance system that will be
designed and implemented by the end of the first budget period.
Applicants must include written data quality assurance procedures. See
Appendix VI for guidance.

**D) Primary Prevention**

Applicants shall provide specific goals and objectives that include
primary prevention objectives for families: those who live in pre-1978
housing (prioritized to pre-1950), pregnant women, women of childbearing
age, families with young children and others at risk for lead exposure.

Applicants shall include in their work plan the following specific
activities:

-   Systematic standardized assessment of housing in the jurisdiction;
    inspections shall include testing of deteriorated paint, dust wipe
    testing and testing of bare soil to locate all lead-based paint
    hazards, as defined in EPA 40 CFR Part 745.226. This citation can be
    accessed at
    <http://www.access.gpo.gov/nara/cfr/waisidx_03/40cfr745_03.html>

-   Performance of inspection activities in housing where a child with
    an elevated blood lead level lives, where the child spends a
    significant amount of time, secondary residences, and other areas
    where the child (or other children) may be exposed to lead hazards
    (e.g., in buildings with more than one housing unit, conduct
    inspection not only in the elevated blood lead child's residence,
    but also in adjacent units where children could be at risk.

-   Development of primary prevention activities that are consistent
    with the *Preventing Lead Exposure In Young Children: A
    Housing-Based Approach to Primary Prevention of Lead Poisoning*
    (CDC, October 2004). See Appendix IV for examples of primary
    prevention activities.

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-   Assurance of lead-safe work practices, conduct lead-safe work
    practice training, provision of resources to help families, building
    owners, maintenance and housing rehabilitation workers, and others
    to reduce lead hazards (in accordance with Sections 1012-1013 of
    Title X of the Residential Lead-Based Paint Hazard Reduction Act of
    1992, as implemented in 24 CFR Part 35). Guidance on this Rule can
    be found
    <http://www.hud.gov/offices/lead/leadsaferule/LSHRGuidance21June04.rtf>

-   Ensure dust wipe test clearance standards are met after abatement
    work, remediation, or other hazard control work is completed,
    consistent with EPA 40 CFR Part 745.227. This citation can be found
    at <http://www.access.gpo.gov/nara/cfr/waisidx_03/40cfr745_03.html>

-   Enforcement, or a plan to develop, regulations within the state or
    jurisdiction requiring elimination or control of lead hazards in
    housing units occupied by children and based on the existence of the
    lead hazard alone in housing units that could be occupied by
    children, with the exception of housing where a child is not
    expected to reside, such as elderly housing.

> ● Risk communication/health education activities that support primary
> prevention activities and are targeted to the high-risk populations
> identified in the Need section of the application.

**E) Strategic Partnerships**

-   State Health Commissioner/local Health Director ensures that child
    health data will be used to facilitate development of child health
    and housing-based legislative policy and that those policies will be
    supported through implementation.

-   The state Health Commissioner/local Health Director shall endorse
    CLPPP participation in emerging health situations related to lead
    exposure (e.g., African refugee lead exposure).

Applicants shall include in their application as appendices, evidence of
partnership, collaboration or planned partnership or collaboration with:

-   Appropriate stakeholders via letters of support or MOUs with housing
    agencies, financial institutions, CBOs, Medicaid, WIC, landlord
    groups, lead inspectors, hazard control and/or construction and/or
    maintenance contractors, etc. [Note: letters of support or MOUs
    shall include meeting frequency, roles, and specific
    responsibilities/activities for each partner]{.underline}.

-   EPHTP (if one exists). See list of state and city EPHTPs at
    <http://www.cdc.gov/nceh/tracking/projects/home.htm>.

-   State's Office of Rural Health. See list of state contacts at

<http://ruralhealth.hrsa.gov/funding/50sorh.htm>

-   State refugee coordinator. See list of state contacts at

> <http://www.acf.hhs.gov/programs/orr/partners/coordina.htm>

-   Cooperative State Research Education and Extension Service. See list
    of state contacts at

> <http://www.csrees.usda.gov/qlinks/partners/state_partners.html>

Applicants will establish effective, well-defined working relationships
within public health agencies and other agencies and organizations at
national, state, and community levels and include the following
activities in their work plan:

-   Collaboration with local housing agencies in the development of the
    lead poisoning prevention aspect of the jurisdiction's annual action
    and 5-year consolidated housing plan.

-   Collaboration and integration of lead services into existing
    maternal-child health home visitation, other environmental programs
    and/or housing subsidy program (e.g., Section 8 Housing Choice
    Voucher program).

-   Collaboration with regional HUD and EPA Offices in targeting
    enforcement of Section 1018 of Title X Lead Disclosure Rule. More
    information regarding this Rule can be found at
    <http://www.epa.gov/opptintr/lead/leadbase.htm>

-   Development of EPA Supplemental Environmental Projects (SEPs) and/or
    HUD Child Health Improvement Projects (CHIPs).

**WORKPLAN**

Applicants shall submit a work plan for the current budget period that
includes specific, measurable, achievable, realistic, and time-phased
goals, objectives and activities. Applicants must include the activities
provided in the program elements: A) elimination plan, B) screening/case
management plan, C) surveillance, D) primary prevention, and E)
strategic partnerships. Those objectives and activities must be in
alignment with the applicant's existing or proposed elimination plan and
targeted to those populations and areas identified as high-risk in the
Need section of the application.

Applicants shall include supporting activities of 1) local programs and
other organizations that are sub-grantees of funds awarded under this
announcement and 2) activities of other communities that have been
identified as high risk in the Need section of this application, but
which are not necessarily sub-grantees of funds awarded under this
announcement.

Include with the application as an appendix, a tentative work plan
outline for years two through five of the project period that is in
alignment with the elimination plan tentative goals and objectives for
years two through five of the project period. See Appendix VII.

**EVALUATION PLAN**

An evaluation plan must be included with the application and part of the
Work Plan. The evaluation plan must include:

-   Measures related to each goal in the elimination plan.

-   Measures that evaluate the objectives and activities of the annual
    work plan.

-   Includes the name or, if person has not been hired, position
    (include job description) responsible for conducting the evaluation.

-   Indicates evaluation frequency.

-   Indicates how the results will be used to improve the program.

Applicants must include in the application as an appendix, a logic model
that addresses the program as a whole, including inputs and activities
of staff, and strategic partners; and activities, objectives, process,
and outcome/impact indicators that are consistent with the elimination
plan and the annual work plan. See Appendix VIII.

**PROJECT MANAGMENET, STAFFING AND RESOURCES**

Applicants must provide information that demonstrates their agency's
commitment to the elimination of childhood lead poisoning. Applicant
provides curriculum vitae for existing key personnel (job descriptions
for planned key personnel). As determined by the Grants Project Officer,
key personnel must have the level of education, experience and/or skills
necessary to successfully implement and complete the project. In
accordance with 45 CRF part 92.30(d)(3), found at
<http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?TITLE=45&PART=92&SECTION=30&YEAR=2001&TYPE=TEXT>

key personnel that require prior approval are the following: Program
Manager/Director, Principal Investigator, and Surveillance
Manager/Epidemiologist. Applicants must provide commitment that key
staff vacancies will be filled by end of first quarter, first budget
period and within one quarter when they become vacant during the project
period.

In a cooperative agreement, CDC staff is substantially involved in the
program activities, above and beyond routine grant monitoring. CDC
activities include, but are not limited to the following:

-   Foster collaboration with other federal, state, and local health;
    environmental; and housing agencies by initiating contacts,
    conference calls, and on-site visits to discuss programmatic issues.

-   To ensure program success, CDC will be an equal partner with
    programmatic involvement throughout the project period by provision
    of technical assistance, advice, and coordination.

-   Within first twelve (12) months, provide advice on the project's
    design/existing data collection approach to ensure that it is
    reasonable to achieve the goals of the program.

-   Provide technical advice about integrating blood lead and
    environmental data systems, including coordination of required
    quarterly or annual data submission to CDC.

-   Provide technical assistance in implementing activities and
    identifying major childhood lead poisoning prevention program
    issues, effective strategies, and priorities related to the
    cooperative agreement.

-   Advise on planning, development, implementation, and evaluation of
    elimination plan, including policy development and revisions to the
    plan, and approve the plan.

-   Facilitate and assist selected projects in the development and
    implementation of housing-based primary prevention surveillance
    activities.

-   Regularly review the literature to ensure that partners are being
    provided technical assistance and consultation that reflects the
    most current science and practice.

-   Advise on the development of an appropriate evaluation plan that
    measures the effectiveness of project activities and approve the
    plan within twelve (12) months of grant award.

-   Annually review screening/case management plans, and elimination
    plans including evaluation reports for the purpose of identifying
    opportunities for the provision of technical assistance.

-   Provide approval for key personnel.

# II. Award Information

**Type of Award:** Cooperative Agreement. CDC's involvement in this
program is listed in the Activities Section above.

**Fiscal Year Funds:** 2006

**Approximate Current Fiscal Year Funding:** \$30,000,000

**Approximate Number of Awards:** Up to 45 awards are expected to be
awarded.

**Approximate Average Award:** The average award is expected to be
\$667,000. (This amount is for the first 12-month budget period, and
includes both direct and indirect costs.)

**Floor of Individual Award Range:** None

**Ceiling of Individual Award Range:** The first year budget period
ceiling for an individual award is \$1,700,000.

**Anticipated Award Date:** July 1, 2006

**Budget Period Length:** 12 months

**Project Period Length:** Five years

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

# III. Eligibility Information

**III.1. Eligible applicants -** Eligible applicants that can apply for
this funding opportunity are as follows:

Applications may be submitted by state health departments, or their bona
fide agents and the local health departments of the following five
jurisdictions:

New York, NY; Chicago, IL; Detroit, MI; Los Angeles County, CA; and
Philadelphia, PA. CDC will give funding preference to these five local
jurisdictions with the highest estimated number of children with
elevated blood lead levels.

CDC will also give funding preference to state programs that have
significant estimated numbers of children with elevated blood lead
levels, and that direct federal funds to localities with high
concentrations of children at risk for childhood lead poisoning.

State health departments or their bona fide agents include the District
of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, the
Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the
Federated States of Micronesia, the Republic of the Marshall Islands,
the Republic of Palau and federally recognized Indian tribal
governments. Competition is limited to these entities by authorizing
legislation.

A bona fide agent is an agency or organization identified by the state
as eligible to submit an application under the state eligibility in lieu
of a state application. If applying as a bona fide agent of a state or
local government, a letter from the state or local government as
documentation of the status is required. Place this documentation behind
the first page of the application form. The bona fide agent
documentation will not be counted towards the 40-page limit.

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

-   Applicants must assure that income earned by the CLPPP will be
    returned to the program to support lead poisoning prevention
    activities.

-   In accordance with Section 2501 (a) of the Children's Health Act of
    2000,\[42 U.S.C. Section 247b-16\], the state agrees to expend
    (through state or local funds) \$1 for every \$2 provided under the
    grant. (States may include in-kind contributions and state share of
    Medicaid reimbursement funds for this match).

-   Preference will be given to those applicants that demonstrate
    detailed significant in-kind contributions. Significant in-kind
    contributions are those contributions in excess of the match
    requirement (i.e.,\>50**%).** This funding preference is given in
    accordance with Departmental policy in that,

    1.  The project or activities will have a greater likelihood of
        success if there are other contributors to the costs of the
        project, and

    2.  the likelihood that the project will become self-sustaining when
        CDC funding ends will be increased, and

    3.  the cooperative agreement support is only one of a number of
        known potential sources for the funding of an activity.

-   Costs and third party in-kind contributions counting towards
    satisfying a cost sharing or matching requirement must be verifiable
    from the records of grantees and sub-grantee or cost-type
    contractors. These records must show how the value placed on third
    party in-kind contributions was derived. To the extent feasible,
    volunteer services will be supported by the same methods that the
    organization uses to support the allocability of regular personnel
    costs. All in-kind contributions identified in the application must
    be reported on form 424A and tracked by the recipient.

**III.3.** **Other**

> If a funding amount greater than the ceiling of the award range is
> requested, the application will be considered non-responsive and will
> not be entered into the review process. The applicant will be notified
> that the application did not meet the submission requirements.

**Special Requirements:**

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

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

-   Applicants must show evidence of collaboration with housing agency
    and/or environmental quality authority in jurisdiction (i.e., letter
    of support or MOU).

-   Applicants must present letter of commitment from state Health
    Commissioner/local Health Department Director that assures child
    health data will be used to develop and support protective child
    health policy.

-   Applicants directly providing services must be enrolled with their
    state Medicaid agency as a Medicaid provider. Providers entering
    into agreements with the applicants to provide such services must be
    enrolled with their state Medicaid agency as a Medicaid provider. To
    satisfy this program requirement, applicants must present a copy of
    Medicaid Provider Certification/Statement as proof that this
    requirement is met. Failure to include this information will result
    in the application being returned. This information shall be placed
    immediately behind the Resource Worksheet pages and will not be
    counted towards the 40-page limit.

-   Applicants shall provide in the appendix, assurance that
    authorization for travel for CDC-funded personnel to attend CDC
    sponsored grantee meetings, conferences and trainings will be
    provided. (See section IV.5. Funding Restrictions)

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

# 

# IV. Application and Submission Information

**IV.1. Address to Request Application Package**

To apply for this funding opportunity, use application form PHS 5161-1.

**Electronic Submission:**

CDC strongly encourages the applicant to submit the application
electronically by utilizing the forms and instructions posted for this
announcement on [www.Grants.gov](http://www.Grants.gov/), the official
Federal agency wide E-grant Web site. Only applicants who apply on-line
are permitted to forego paper copy submission of all application forms.

Registering your organization through
[www.Grants.gov](http://www.Grants.gov/) is the first step in submitting
applications online. Registration information is located in the "Get
Started" screen of [www.Grants.gov](http://www.Grants.gov/). While
application submission through [www.Grants.gov](http://www.Grants.gov/)
is optional, we strongly encourage you to use this online tool.

Please visit [www.Grants.gov](http://www.Grants.gov/) at least 30 days
prior to filing your application to familiarize yourself with the
registration and submission processes. Under "Get Started", the one-time
registration process will take three to five days to complete. We
suggest submitting electronic applications prior to the closing date so
if difficulties are encountered, you can submit a hard copy of the
application prior to the deadline.

**Paper Submission:**

Application forms and instructions are available on the CDC Web site, at
the following Internet address: www.cdc.gov/od/pgo/forminfo.htm

If access to the Internet is not available, or if there is difficulty
accessing the forms on-line, contact the CDC Procurement and Grants
Office Technical Information Management Section (PGO-TIM) staff at
770-488-2700 and the application forms can be mailed

**IV.2. Content and Form of Submission**

**Application:** A project narrative must be submitted with the
application forms. The narrative must be submitted in the following
format:

-   Maximum number of pages for narrative: 40 pages. This includes the
    Need, Capacity, Work plan (include all program element activities),
    and Evaluation Plan. If your narrative exceeds the page limit, only
    the first pages within the page limit will be reviewed.

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-   Font size: 12 point unreduced

-   Double-spaced

-   Paper size: 8.5 by 11 inches

-   Page margin size: One inch

-   Number all pages of the application sequentially from page 1
    (Application Face Page) to the end of the application, including
    charts, figures, tables, and appendices.

-   Printed only on one side of page

-   Held together only by rubber bands or metal clips, not bound in any
    other way.

The narrative shall address specific goals, objectives, and activities
of the specific elements as the first budget period work plan, including
the evaluation plan. An outline of goals and objectives for years two
through five of the project period should be included as an appendix.
The application must include the following items in the order listed:

Cover letter \*

Project Abstract -- not to exceed 2 pages single spaced \*

SF424 \*

Bona fide agent documentation (if applicable) \*

Narrative includes: Need, Capacity, Work Plan and Evaluation Plan (not
to exceed 40 pages).

Budget narrative \*

Resource spreadsheet \*

Medicaid Provider Certification \*

Checklist \*

Assurances \*

Other Certifications \*

Disclosure Forms \*

Appendices \*

\* NOT included in 40-page limit

Information to be included in the application appendices:

-   Curriculum Vitas, Resumes, Organizational Charts, Letters of
    Support, MOUs, copies of elimination, screening/case management
    plans, matrix of work plan, logic model, outline of goals and
    objectives for years two through five of the project period, etc.

The agency or organization is required to have a Dun and Bradstreet Data
Universal Numbering System (DUNS) number to apply for a grant or
cooperative agreement from the Federal government. The DUNS number is a
nine-digit identification number, which uniquely identifies business
entities. Obtaining a DUNS number is easy and there is no charge. To
obtain a DUNS number, access www.dunandbradstreet.com or call
1-866-705-5711.

For more information, see the CDC Web site at:
<http://www.cdc.gov/od/pgo/funding/grantmain.htm>.

If the application form does not have a DUNS number field, please write
the DUNS number at the top of the first page of the application, and/or
include the DUNS number in the application cover letter.

Additional requirements that may require submittal of additional
documentation with the application are listed in section "VI.2.
Administrative and National Policy Requirements."

# IV.3. Submission Dates and Times

**Application Deadline Date:** **February 21, 2006**

**Explanation of Deadlines: Applications must be** **received** **in the
CDC Procurement and Grants Office by 4:00 p.m. Eastern Time on the
deadline date**.

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

If submittal of the application is done electronically through
Grants.gov (http://www.grants.gov), the application will be
electronically time/date stamped, which will serve as receipt of
submission. Applicants will receive an e-mail notice of receipt when CDC
receives the application.

If submittal of the application is by the United States Postal Service
or commercial delivery service, the applicant must ensure that the
carrier will be able to guarantee delivery by the closing date and time.
If CDC receives the submission after the closing date due to: (1)
carrier error, when the carrier accepted the package with a guarantee
for delivery by the closing date and time, or (2) significant weather
delays or natural disasters, the applicant will be given the opportunity
to submit documentation of the carrier's guarantee. If the documentation
verifies a carrier problem, CDC will consider the submission as having
been received by the deadline.

If a hard copy application is submitted, CDC will not notify the
applicant upon receipt of the submission. If questions arise on the
receipt of the application, the applicant should first contact the
carrier. If the applicant still has questions, contact the PGO-TIM staff
at (770)488-2700. The applicant should wait two to three days after the
submission deadline before calling. This will allow time for submissions
to be processed and logged.

This announcement is the definitive guide on application content,
submission address, and deadline. It supersedes information provided in
the application instructions. If the application submission does not
meet the deadline above, it will not be eligible for review, and will be
discarded. The applicant will be notified the application did not meet
the submission requirements.

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

Executive Order 12372 does not apply to this program.

**IV.5. Funding restrictions**

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

-   Funds may not be used for research.

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-   Reimbursement of pre-award costs is not allowed.

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-   Funds may not be used to pay for reimbursable Medicaid services for
    Medicaid-eligible children.

-   Funds may not be used for medical care and treatment, or for
    environmental remediation of lead hazards. However, the applicant
    must provide a plan to ensure that these program activities are
    carried out and demonstrate the program's appropriate involvement
    with medical care, treatment and remediation efforts.

-   Not more than 10 percent (exclusive of direct assistance) of any
    cooperative agreement or contract (subgrantee or consultant) funded
    through the cooperative agreement may be obligated for
    administrative costs. This 10 percent limitation is in lieu of, and
    replaces, the indirect cost rate.

-   A resource spreadsheet must be submitted with this application. The
    resource worksheet should be placed after the budget narrative and
    will not be counted towards the 40-page limit. See Resource
    Worksheet Appendix II and IIA.

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-   Applicants should include costs for up to two people to travel to
    Atlanta, GA (three-overnight stays) to attend a CDC sponsored Lead
    Poisoning Prevention Partners Conference.

-   Applicants should include costs for an appropriate number of
    CDC-funded staff to travel to Alexandria, VA (five overnight stays)
    to attend the CDC sponsored National Lead Poisoning Prevention
    Training Center (LPPTC). The appropriate number of staff to attend
    the LPPTC should be determined by each applicant's staff turnover
    rate.

Guidance for completing the budget can be found on the CDC Web site, at

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

**IV.6. Other Submission Requirements**

**Application Submission Address**:

Electronic Submission:

CDC strongly encourages applicants to submit applications electronically
at [www.grants.gov](http://www.grants.gov/). The application package can
be downloaded from [www.grants.gov](http://www.grants.gov/). Applicants
are able to complete it off-line, then upload and submit the application
via the grants.gov Web site. E-mail submissions will not be accepted. If
the applicant has technical difficulties in grants.gov, costumer service
can be reached by E-mail at <http://www.grants.gov/CustomerSupport> or
by phone at 1-800-518-4726 (1-800-518-GRANTS). The Customer Support
Center is open from 7:00 a.m. to 9:00 p.m. Eastern Time, Monday through
Friday.

CDC recommends that submittal of the application to grants.gov shall be
early to avoid any unanticipated difficulties before to the deadline.
Applicants may also submit a back-up paper submission of the
application. Any such paper submission must be received in accordance
with the requirements for timely submission detailed in Section IV.3. of
the grant announcement. The paper submission must be clearly marked
"BACK-UP FOR ELECTRONIC SUBMISSION." The paper submission must conform
to all requirements for non-electronic submissions. If both electronic
and back-up paper submissions are received by the deadline, the
electronic version will be considered the official submission.

**The applicant must submit all application attachments using a PDF file
format when submitting via Grants.gov. Directions for creating PDF files
can be found on the grants.gov Web site. Use of file formats other than
PDF may result in the file being unreadable by staff.**

***OR***

Paper Submission:

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

Technical Information Management- CDC-RFA***-***EH06-602

CDC Procurement and Grants Office

2920 Brandywine Road

Atlanta, GA 30341

# V. Application Review Information

**V.1. Criteria**

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

An independent review group appointed by CDC will evaluate each
application against the following criteria:

**NEED (Total of 25 points)**

> The announcement is focused on the elimination of childhood lead
> poisoning as a major public health problem, therefore, the assessment
> of need within the applicant's jurisdiction should include focus on
> communities and populations where there is significant evidence of
> high numbers of children under six years old who are at high risk for
> lead poisoning. The applicant should:

-   Describe the program or planned program, including the number of
    years in existence and/or funded by CDC (if applicable). **(2
    points)**

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-   Extent of the problem as determined by [blood lead
    testing]{.underline} evidence. Programs in existence since 1997
    provide evidence for calendar years 1997-2004 by year (Appendix IX
    includes 1997-2003 data). The data should include the number of
    children 0-36 months and 37-72 months tested and the number with
    confirmed blood lead levels ≥ 10 micrograms per deciliter (µg/dL).

-   The applicant should also use:

    i.  population data; **(5 points**)

    ii. poverty/Medicaid data; **(5 points)**

    iii. age of housing or housing-specific condition data; **(5
         points)**

    iv. describe high-risk urban, suburban, and rural areas (if
        applicable) and the at- risk populations living in those areas;
        **(5 points)**

    v.  non-paint sources of lead exposure. **(3 points)**

**Program Elements - CAPACITY TO ELIMINATE CHILDHOOD LEAD POISONING as a
PUBLIC HEALTH PROBLEM** **(Total of 32 points to be distributed as
follows):**

1.  **Elimination Plan (Total of 8 points)**

The applicant provides evidence that they have implemented an
elimination plan or will implement such a plan by the end of the first
budget period. A copy of the plan should be included as an appendix in
the application. An elimination plan should include:

-   A mission. **(1 point)**

-   Describes lead burden as consistent with those populations and areas
    identified in the NEED section. **(1 point)**

-   Clear, measurable goals, objectives, and activities in the proposed
    work plan; outline for years 2-5. **(1 point)**

-   Person(s) or positions responsible for completion of objectives are
    named. **(1 point)**

-   Using data to evaluate and guide the plan. (1 point)

-   Describes activities that assure the advisory group members stayed
    engaged in the process to monitor and refine the plan. **(1 point)**

-   Provides supporting evidence, meeting agendas/minutes and list of
    attendees by name, title, and organization. **(1 point)**

-   Includes a graphic representation (e.g., chart, graph) of total
    projected numbers of children with elevated blood lead levels by
    year with projected reduction by year until elimination of elevated
    blood lead levels. **(1 point)**

**2. Screening/Case Management Plan (Total of 5 points)**

The applicant provides evidence that they have implemented a
screening/case management plan that targets resources to children at
highest risk or will implement such a plan by the end of the first
budget period.

A copy of the screening/case management plan is included as an appendix
and clearly describes:

-   Blood lead testing of children less than 6 years is consistent with
    those identified as high-risk in the Need section. **(1 point)**

-   Electronic case management data systems are in place or planned to
    be in place by the end of the first budget period to identify and
    track children who receive timely and appropriate case management
    services and data are used, at least annually, to evaluate the case
    management process for key aspects: timeliness, written care plan,
    environmental inspections and lead hazard remediation, decrease in
    blood lead levels, and rates of case closure. **(1 point)**

-   Minimally be consistent with recommendations from the Advisory
    Committee on Childhood Lead Poisoning Prevention, "*Managing
    Elevated Blood Lead Levels Among Young Children*" (CDC, March 2002).
    **(1 point)**

-   Enforcement, or a plan to develop, regulations within the state or
    jurisdiction that require elimination or control of lead hazards in
    housing units occupied by children with an elevated blood lead level
    and resident/tenant protection from retaliatory eviction or other
    lead-related discrimination. **(1 point)**

-   Current Medicaid reimbursement methodology or specific proposed
    reimbursement planned by end of first budget year for environmental
    inspections and case management services for Medicaid-eligible
    children and that the reimbursement plan will be reviewed at least
    annually, and updated as costs increase. **(1 point)**

**3. Surveillance (Total of 10 points)**

The extent to which the applicant describes their current, or planned
childhood blood lead surveillance system in the following areas:

-   Describes existing or plan for developing a child-specific data
    collection and management system allowing for multiple lab tests and
    multiple addresses to be related to a single child over multiple
    years. **(1 point)**

-   Describes enforcement, or plan to develop, regulations within the
    state or jurisdiction requiring the *electronic* reporting of
    [all]{.underline} blood lead and environmental test results for
    children less than 72 months of age. **(1 point)**

-   Describes an electronic connection to other child health and
    environmental public health data (e.g., Medicaid, immunization,
    National Electronic Disease Surveillance System \[NEDSS\], Adult
    Blood Lead Epidemiology and Surveillance \[ABLES\], and Special
    Supplemental Nutrition Program for Women, Infants, and Children
    \[WIC\], state and/or local housing and environmental quality
    authority, or other Web-based public health data system) or if not
    using NEDSS, NEDSS-based, or other compatible system, applicant
    shows evidence of partnership through specific activities and
    describes what new surveillance system they are developing and
    evidence (through letters of support) they are working with state
    epidemiology group, information technology group, and state
    Environmental Health Tracking Program. Applicant also describes
    ongoing maintenance needs of such system and source of funding for
    non-NEDSS system. If planning to use CDC Lead Program Area Module
    (PAM) with NBS, applicant shows evidence of communication with state
    NEDSS Coordinator or other NEDSS personnel (through letter of
    support). **(2 points)**

-   Describes current or planned data system for identification of
    Medicaid-eligible children. **(2 points)**

-   Describes adequate electronic database is in place to identify and
    track children who receive case management services. **(1 point)**

-   Describes plan to report all required data elements to CDC quarterly
    **(1 point)**

-   Describes plan to publish and distribute an annual data report for
    stakeholders. Stakeholders to include elimination planning group,
    HUD and EPA Regional Offices, state and local leaders of governing
    bodies, (e.g., Governor, Mayor, state and local legislators, state
    Health Commissioner, and local Health Directors). **(1 point)**

-   Presents a detailed flow chart in appendix of the surveillance
    system for both individual and summary data. The flow chart should
    minimally include: data entry, quality controls points, data
    usage/report generation and data transfer linkages. **(1 point)**

**4. Primary Prevention (Total of 5 points)**

The extent in which the applicant describes and demonstrates primary
prevention efforts in their jurisdiction and includes:

-   Electronically collect unit-specific housing inspection data and
    systematic assessment of lead-safe housing status in jurisdiction by
    performance of environmental investigation activities such as, lead
    dust screening, visual inspections, paint chip, and soil testing.
    **(1 point)**

-   Environmental screening for lead hazards of other high-risk housing
    (i.e., house next door, apartments nearby), as well as any secondary
    residences or day care is conducted when a child is identified with
    an elevated blood lead level. **(1 point)**

-   Build community capacity to conduct lead-safe training and provide
    resources to help families reduce lead hazards in their homes. **(1
    point)**

-   Health education plan, including various communications and
    trainings to increase awareness of lead poisoning prevention,
    includes medical providers in this educational plan and targets the
    plan to high-risk populations identified in Need section of
    application. **(1 point)**

-   Enforcement, or plan to develop, regulations within the state or
    local jurisdiction requiring the elimination or control of lead
    hazards in homes where children live or could live. **(1 point)**

**5. Strategic Partnerships (Total of 7 points)**

-   Applicant provides evidence of strategic partnerships via letters of
    support, MOUs, or contracts. Examples of key partners include
    housing agencies; Medicaid; Special Supplemental Nutrition for Women
    Infant and Children (WIC) Program; community-based organizations;
    landlord groups; realtors; banking; maintenance and construction
    contractors; Office of Rural Health; state Environmental Public
    Health Tracking Program (if one exists); the state refugee
    coordinator, and the Cooperative State Research Education and
    Extension Service. **(1 point)**

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-   Letters and/or MOUs describe meeting frequency, roles,
    responsibilities, and activities for each partner. **(1 point)**

-   Applicant presents a letter of commitment from state Health
    Commissioner/Health Department Director that assures child health
    data will be used to develop and support protective child health
    policy and endorses CLPPP response to emerging situations (e.g.,
    African refugee lead exposure). **(1 point)**

-   Applicant provides letter of support from jurisdiction's housing
    agency and/or housing authority and/or community development agency
    that specifies collaborative activities related to the development
    of the lead poisoning prevention element of the jurisdiction's
    annual and 5-year consolidated plan for housing. **(1 point)**

-   Applicant describes partnerships involving HUD and EPA Regional
    Offices in the targeting of Title X enforcement in jurisdiction.
    Describes current (or planned) protocol to access 1018 Disclosure
    Rule information during environmental inspections and forward
    potential violations to HUD and EPA for enforcement. **(1 point)**

-   Describes a plan for the development of EPA Supplemental
    Environmental Projects (SEPs) and/or HUD Children's Health
    Improvement Projects (CHIPs). **(1 point)**

-   Provides evidence that the program is collaborating with or plans to
    collaborate with other healthy home program issues, such as, asthma
    prevention, injury prevention and improvement in indoor air quality.
    **(1 point)**

**WORK PLAN (Total of 20 points to be distributed as follows)**

Applicant provides a work plan in this application that includes
specific, measurable, achievable, realistic, and time-phased goals,
objectives and activities for the first budget year. Applicant goals,
objectives, and activities must relate to elimination, screening & case
management, surveillance, primary prevention, and strategic
partnerships. Applicant should include evaluation measures for each
proposed objective and identify the program staff responsible for
accomplishing each objective.

Activities are targeted or prioritized to high-risk populations
identified in the Need section of application. **(10 points)**

Applicant provides work plans for potential sub-grantees awarded under
this announcement that are consistent with the applicant's work plan and
elimination plan. Activities of high-risk communities that are not
potential direct sub-grantees awarded under this announcement shall also
be included in objectives and/or supporting activities of the proposed
work plan and shall be consistent with the elimination plan. **(5
points)**

Applicant provides a tentative work plan outline for years two through
five of the project period. **(5 points)**

**Evaluation Plan (Total of 10 points)**

Applicant presents an evaluation plan that is consistent with goals and
objectives in work plan, indicates what data will be used to evaluate
program, names person(s) (or positions if not yet hired) responsible for
overall program evaluation, and indicates how results will be used to
enhance program success. Outcomes/impact indicators are tied to
elimination, represent substantial incremental progress leading to
elimination of elevated blood lead levels by 2010, and are supported by
surveillance and/or other data. **(5 points)**

Applicant presents a logic model that is reasonable, clear, and
consistent with objectives and activities identified in the work plan
and elimination plan. **(5 points)**

**PROJECT MANAGEMENT, STAFFING and RESOURCES**

**(Total of 8 points)**

The extent to which the applicant describes the proposed staffing,
includes job descriptions and curriculum vitae that indicates the
applicant's ability to carry out the recipient activities identified in
the program requirements section of this announcement. Descriptions
should include the position titles, education and experience, the staff
roles with their specific responsibilities, and their level of effort
and percentage of time each person will devote to the program and if key
positions are vacant provides commitment that those vacancies will be
filled by end of first quarter, first budget period. **(5 points)**

Applicants includes activities to seek reimbursement from third-party
payors, including Medicaid, for those case management and environmental
inspection and hazard control/intervention services that are
reimbursable. **(3 points)**

**Matching (2 points)**

Preference will be given to those applicants that demonstrate detailed
significant (i.e., \> 50% of the funds requested in this application)
in-kind contributions.

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

Applications will be reviewed for completeness by the Procurement and
Grants Office (PGO) staff, and for responsiveness jointly by National
Center for Environmental Health/Lead Poisoning Prevention Branch and
PGO. Incomplete applications and applications that are nonresponsive to
the eligibility criteria will not advance through the review process.
Applicants will be notified the application did not meet submission
requirements.

An independent objective review panel appointed by CDC will evaluate
complete and responsive applications according to the criteria listed in
the "V.1. Criteria" section above. The review is generally conduced by
committee or groups of field readers or by a combination of those
methods. The review of the applications is intended to be advisory and
not to replace the authority of the Public Health Service authority to
decide whether a grant shall be awarded.

In addition, the following factors may affect the funding decision:

-   Maintaining geographic diversity.

-   Preference to jurisdictions with high numbers of children under the
    age of 6 years with elevated blood lead levels.

Funding Preference

-   Funding preference will be given to applicants that demonstrate
    commitment through substantial in-kind contributions, as well as
    clear, active collaboration with other agencies, including
    environmental quality authorities and housing agencies engaged in
    childhood lead poisoning prevention.

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

Award announcement date is anticipated to be on or about March 24, 2006

# 

# VI. Award Administration Information

**VI.1. Award Notices**

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

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

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

-   Successful applicants should comply with the Code of Federal
    Regulations and 45 CFR Parts 74 and 92. The following additional
    requirements apply to this project:

    -   AR-9 Paperwork Reduction Act Requirements

    -   AR-10 Smoke-Free Workplace Requirements

    -   AR-11 Healthy People 2010

    -   AR-12 Lobbying Restrictions

    -   AR-14 Accounting System Requirements

    -   AR-24 Health Insurance Portability and Accountability Act
        Requirements

    -   AR-25 Release and Sharing of Data

**Where to Obtain Additional Information**

Two telephone conference calls for application technical assistance will
be held during the application period. Dates and times will be posted on
[www.cdc.gov/lead](http://www.cdc.gov/lead). For further information
please contact Paula Staley at 770-488-3300. This and other CDC
announcements, necessary applications and associated forms can be found
at [www.cdc.gov](http://www.CDC.gov/) (click on "Funding", then "Grants
and Cooperative Agreements").

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

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

An additional Certification form from the PHS5161-1 application needs to
be included in the grants.gov electronic submission only. Applicants
shall refer to

<http://www.cdc.gov/od/pgo/funding/PHS5161-1-Certificates.pdf>. Once the
applicant has filled out the form, it shall be attached to the
grants.gov submission as Other Attachments Form.

**VI.3. Reporting Requirements**

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

1.  Interim progress report, specifications of which will be provided
    under separate cover. The progress report will serve as the
    non-competing continuation application, and must contain the
    following elements:

    a.  Status of current budget period objectives (i.e., met, unmet, or
        partially met). If unmet or partially met, state why and when
        objective will be met or indicate how objective has been
        modified.

    b.  Programs that planned to develop an Elimination, Screening/Case
        Management and/or Surveillance Plans by the end of the first
        budget period must provide a draft copy of those plans as part
        of their first year interim progress report. Programs that do
        not submit a draft copy of proposed plans may be subject to
        increased reporting requirements, or other discipline, up to and
        including termination of the cooperative agreement.

    c.  Interim financial status report projected to the end of budget
        period, and indicates specifically those funds that are
        anticipated to be unobligated.

    d.  New budget period proposed objectives and activities and
        measures of evaluation (i.e., work plan).

    e.  Budget.

    f.  Additional Requested Information.

2.  Final financial status report due no more than 90 days after the end
    of the budget period.

3.  Final narrative performance reports, due no more than 90 days after
    the end of the budget period. Programs that planned to develop an
    Elimination, Screening/Case Management and/or Surveillance Plan by
    the end of the first budget period must provide a final copy of
    those plans as part of their final narrative performance report for
    the first budget year. Programs that do not submit a final copy of
    the plans proposed to be developed in the first budget year may be
    subject to increased reporting requirements, or other discipline, up
    to and including termination of the cooperative agreement.

4.  Quarterly data submissions are required. Additional information
    regarding data submissions will be provided to successful
    applicants. Data collection initiated under this cooperative
    agreement program has been approved by OMB under OMB number
    0920-0337 "National Blood Lead Surveillance System" Expiration Date:
    5/31/2008. See Appendix VI for listing of required data elements.

The reports must be mailed to the Grants Management Specialist listed in
the "Agency Contacts" section of this announcement.

Programs that fail to submit timely reports as determined by the Grant
Project Officer may be subject to discipline, up to and including,
termination of the cooperative agreement, as determined by the Grants
Management Officer.

Programs who exhibit poor performance through lack of significant
progress or completion of program goals, objectives and activities as
determined by the Grant Project Officer may be subject to more frequent
reporting or other discipline, up to and including termination of the
cooperative agreement as determined by the Grants Management Officer.

# VII. Agency Contacts

CDC encourages inquiries about this announcement.

For general questions, contact:

Technical Information Management Section

CDC Procurement and Grants Office

2920 Brandywine Road

Atlanta, GA 30341

Telephone: 770-488-2700

For program technical assistance, contact:

Paula Staley, Project Officer

4770 Buford Highway, MS F-40

Atlanta, GA 30341

Telephone: 770-488-3300

E-mail: bgx3@cdc.gov

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

> Gary R. Teague, Grants Management Specialist

CDC Procurement and Grants Office

2920 Brandywine Road, MS E-14

Atlanta, GA 30341

Telephone: 770-488-1981

E-mail: GTeague@cdc.gov

**VIII. Other Information**

Other CDC funding opportunity announcements can be found on the CDC Web
site at:
[http://www.cdc.gov](http://www.cdc.gov/)/od/pgo/funding/grantmain.htm

**Appendix I**

**Glossary of Terms**

Activities: Major tasks that must be done to accomplish each objective.

Assessment: Activities organized by a public health agency to regularly
and systematically collect, assemble, analyze, and make available
information about the health of the community, including statistics on
childhood lead poisoning risk status, community health needs, and
epidemiologic and other information related to childhood lead poisoning.

Assurance: Activities organized by a health department that services
necessary to achieve agreed-upon goals related to childhood lead
poisoning are provided, either by encouraging actions by other entities
(private or public sector), by requiring such action through
regulations, or by providing services directly.

CDC -- Centers for Disease Control and Prevention.

Childhood Lead Poisoning Prevention Program (CLPPP): A designated unit
within an agency responsible for implementing or coordinating a
systematic and comprehensive approach to childhood lead poisoning
prevention.

Consolidated Housing Plan -- A required document that local housing
agencies submit to HUD to receive certain HUD funding for housing and
community development purposes. One element of the consolidated plan
involves lead poisoning prevention. For more information about the
consolidated planning process, see
<http://www.hud.gov/offices/cpd/about/conplan/index.cfm>

Confirmed Elevated Blood Lead Level: One venous blood specimen with a
lead concentration greater than or equal to 10 micrograms per deciliter
(µg/dL), or two capillary blood specimens drawn within 12 weeks of each
other, both containing a lead concentration greater than or equal to 10
µg/dL. \[Source: Council of State and Territorial Epidemiologist (CSTE)
Position Statement #EH1.\] 

De minimus - De minimis levels. Safe work practices are not required
when maintenance or hazard reduction activities do not disturb painted
surfaces that total more than:

\(1\) 20 square feet (2 square meters) on exterior surfaces;

\(2\) 2 square feet (0.2 square meters) in any one interior room or
space; or

\(3\) 10 percent of the total surface area on an interior or exterior
type of component with a small surface area. Examples include window
sills, baseboards, and trim.

Electronic Laboratory-Based Reporting (ELR): The transmission of data of
public health importance from clinical laboratories to public health
agencies in electronic format. Data transmitted by ELR should be
automated and use standardized codes for tests and results allowing for
more timely and complete reporting. (Source: \"HISSB Archives\"
http://[www.cdc.gov/CIC/HISSB_Archive/HISSB\--Activities\--Electronic_Laboratory-Based_Reporting.htm](http://www.cdc.gov/CIC/HISSB_Archive/HISSB--Activities--Electronic_Laboratory-Based_Reporting.htm).)

Elimination (of childhood lead poisoning as a public health problem):
The National Health and Nutritional Examination Survey (NHANES), a
population-based survey designed to oversample children at greatest risk
for elevated blood lead levels (EBLLs), reports only a five percent
probability that the survey, as currently conducted, will identify any
children with EBLLs when there are fewer than 12,000 nationwide. At that
point, lead poisoning can no longer be considered a public health
problem (i.e., public health survey instruments cannot detect cases).

EPA -- U.S. Environmental Protection Agency.

Evaluation Measure: An indicator a program uses to determine achievement
of a goal, objective, or activity. It can be process or outcome/impact
based. Evaluation measures can be drawn from a wide range of data
sources, such as blood lead surveillance, housing and other public data,
Medicaid data, program documentation, special surveys, etc. The data
source(s) used for evaluation should be clearly described.

Goals: An outcome a program intends to accomplish during the program
period.

Healthy People 2010 goal (Objective 8-11): Eliminate elevated blood lead
levels in children. Target is zero percent.

High-risk: A term used to designate areas, populations, and individuals
with higher than average risk for lead exposure.

HUD -- U.S. Department of Housing and Urban Development.

Human Subjects: Interaction with living people for the purpose of
collecting data or specimens; use of identifiable data about living
people.

Lead Hazard: Accessible paint, dust, soil, water, or other source or
pathway that contains lead or lead compounds that can contribute to or
cause elevated blood lead levels.

Lead hazard remediation: The elimination, reduction, or containment of
known and accessible lead sources.

Logic Model -- A visual presentation of inputs, activities, impacts, and
outcomes that demonstrates how activities in the work plan relate to the
program's goals and objectives. Logic models are useful for project
planning, management, and evaluation. Measures of evaluation can be
drawn by monitoring the relations among the activities, objectives, and
goals and the overall outcome.

Measure of Evaluation: A comparison between actual and planned progress
in achieving programmatic goals and objectives. The measure must be
objective and quantitative and must measure the intended outcome. The
measure should be identified in the evaluation plan aspect of the work
plan.

Objectives: The steps a program will take to achieve the goal. They are
specific (identify who/what/where/when), measurable (define how
much/many), achievable, realistic, and time-phased. Objectives typically
include action verbs such as \"identify,\" \"develop,\" \"increase,\"
\"apply,\" or \"perform.\"

Outcome (or Impact) Evaluation: A measurement tool addressing whether
distal effects are changing in your jurisdiction, and/or if your
activity is responsible. Outcome/impact evaluation should be used to
measure both the success of an activity in moving toward elimination of
childhood lead poisoning and the comparative effectiveness of different
activities toward this goal. Note: \"Outcome\" tends to be used when
addressing whether an activity had the intended outcome, and \"Impact\"
when addressing if an activity had the intended impact on the community.

Policy Development: A public health agency responsibility to serve the
public interest in the development of comprehensive public health
policies related to childhood lead poisoning prevention and treatment by
promoting use of the scientific knowledge base in decision-making about
public health and by leading using a strategic approach, developed on
the basis of a positive appreciation for the democratic political
process.

Primary Prevention: The prevention of an adverse health effect in an
individual or population. Regarding lead poisoning prevention, this is
reducing or eliminating a lead hazard in the environment
[before]{.underline} the exposure of an individual or population.
(Source: Screening Young Children for Lead Poisoning: Guidance for State
and Local Public Health Officials. CDC, November 1997.) For
housing-based primary prevention recommendations, see Preventing Lead
Exposure In Young Children: A Housing-Based Approach to Primary
Prevention of Lead Poisoning. CDC, October 2004.

Process Evaluation Measures: A measurement that addresses whether
activities are being implemented as intended.

Program Staff Responsible: Team member(s) who have primary
responsibility for each activity.

Secondary Prevention -- Identifying and treating individuals with
established/confirmed lead poisoning. This includes those with lead
poisoning as well as those at high risk for developing lead poisoning.
Note that blood lead testing will determine the presence of or high risk
for developing lead poisoning and, as such, is a secondary prevention
activity.

Surveillance: A process that 1) systematically collects information over
time about children's blood lead levels using laboratory reports as the
primary data source; 2) is used to trigger follow-up of cases, including
medical and environmental field investigations, when necessary; 3)
collects data for timely analysis and 4) uses data to guide planning,
implementation, and evaluation of a program.

Time Frame for Completion: A projected time period recorded for each
goal, objective, and activity.

Work Plan: A program management tool that provides direction and
guidance for the overall program, as well as for each program component.
It is designed to be used for program planning, implementation, and
monitoring progress made toward program goals.

**Appendix II**

**Resource Worksheet iNSTRUCTIONS**

This guidance is offered for the preparation of a resource tool. This
resource tool is a valuable addition and will be used by both the
awardees and the CDC Project Officers to easily observe where agency and
other resources are allocated and in what amounts, as well as identify
where resources should be shifted to accomplish the Healthy People 2010
goal of elimination of lead poisoning. The CDC Project Officers will
provide technical assistance to the awardees in the use of this tool
during the project period. Place the Resource Worksheet after the Budget
Narrative in the application. The Worksheet is not included in the
maximum number of pages and is not scored.

Refer to the following numbers on the spreadsheets for definitions of
required information.

Column:

1.  a.  Salaries/Position

    b.  Fringe

    c.  Consultant

    d.  Equipment

    e.  Supplies

    f.  Travel

    g.  Other

    h.  Contractual

    i.  Total Direct Costs

    j.  Indirect

    k.  Program Income (include third party reimbursements). Include
        financial donations, etc. Can be estimate.

    l.  TOTAL

2.  CDC Requested funds for this application

3.  Federal funds (other than CDC)

    a.  HUD

    b.  EPA

    c.  Title V

4.  Specify type and amount of in-kind (non-financial) contributions.
    Include community-based organizations (CBOs); private foundation;
    and other state or local contributions, such as percent of time a
    state or city housing inspector performs primary prevention
    activities, etc.

5.  State financial funding with source (certification fees or dedicated
    fee fund, paint tax, general fund, Medicaid matching, etc.)

6.  Total funding for elimination of lead poisoning within the
    jurisdiction

7.  Program categories - indicate percent of effort (not amount of
    funding).

    a.  Elimination planning

    b.  Screening/case management

    c.  Surveillance

    d.  Primary prevention (include regulatory enforcement)

    e.  Strategic partnerships

    f.  Program evaluation

> **Appendix IIA**

  -------------------- -------------- --------- --------- --------- --------- ------------- ---------------- -------------- ------------- ------------- ------------
  **Appendix IIA**                                                                                                                                      

  **RESOURCE                                                                  **(7) Program                                                             
  WORKSHEET**                                                                 categories-                                                               
                                                                              indicate                                                                  
                                                                              percent of                                                                
                                                                              effort**                                                                  

  **(1)**              **(2)**        **(3)**   **(4)**   **(5)**   **(6)**   **(a)**       **(b)**          **( c)**       **(d)**       **(e)**       **(f)**
                       Requested from Other     Other     State     Total     Elimination   Screening/case   Surveillance   Primary       Strategic     Program
                       CDC (this      federal   in-kind   funding   funding   Planning      management                      prevention    partnership   evaluation
                       application)   funds                         for lead                                                (includes                   
                                                                    program                                                 regulatory                  
                                                                                                                            enforcement                 

  Salaries/Positions                                                                                                                                    

  Fringe                                                                                                                                                

  Consultant                                                                                                                                            

  Equipment                                                                                                                                             

  Supplies                                                                                                                                              

  Travel                                                                                                                                                

  Other                                                                                                                                                 

  Contractual                                                                                                                                           

  Total Direct Costs                                                                                                                                    

  Indirect                                                                                                                                              

  Program Income                                                                                                                                        

  TOTAL                                                                                                                                                 
  -------------------- -------------- --------- --------- --------- --------- ------------- ---------------- -------------- ------------- ------------- ------------

**Appendix III**

**Selected U.S. Census information indicating estimated number of
children at highest risk for elevated blood lead, based on poverty and
housing, states and funded cities or counties.**

  ------------------- ------------ ------------ -------------- ------------
  **State/Funded City **Number of  **Number of  **Estimated    **Number of
  or County**         children     children     number of      pre-1950
                      ages 5 years ages 5 years children ages  housing
                      and younger, and younger  1-5 years in   units,
                      2000\***     living in    poverty living 2000†**
                                   poverty in   in pre-1950    
                                   1999†**      housing units, 
                                                2003‡**        

  Alabama             356,676      82,914       8,235          261,970

  Alaska              57,620       7,718        370            12,472

  Arizona             459,141      94,187       2,560          99,986

  Arkansas            217,545      53,196       5,620          153,008

  California          3,018,386    596,765      83,255         2,092,267

  Colorado            357,202      44,237       12,635         261,751

  Connecticut         270,187      29,348       10,605         435,884

  Delaware            62,122       8,536        2,605          59,008

  District of         39,326       12,696       3,710          141,138
  Columbia                                                     

  Florida             1,142,293    208,747      17,635         433,564

  Georgia             714,090      127,351      14,230         337,036

  Hawaii              94,446       13,940       920            45,073

  Idaho               116,942      19,341       3,995          95,144

  Illinois            1,059,514    161,727      66,550         1,555,079

  Indiana             508,845      73,230       25,065         717,111

  Iowa                227,062      29,202       9,975          483,849

  Kansas              226,862      32,253       9,790          320,648

  Kentucky            320,380      71,871       10,965         335,067

  Louisiana           381,826      108,795      18,020         285,831

  Maine               85,915       13,338       1,960          233,187

  Maryland            427,939      48,656       9,820          439,180

  Massachusetts       480,422      58,454       36,900         1,121,552

  Michigan            814,505      123,830      51,135         1,131,959

  Minnesota           397,581      41,403       9,010          560,322

  Mississippi         246,122      69,506       5,455          135,350

  Missouri            445,566      77,253       13,645         577,060

  Montana             66,452       14,358       3,175          101,166

  Nebraska            141,081      19,380       5,620          233,764

  Nevada              175,408      27,287       3,335          28,525

  New Hampshire       92,378       8,190        1,530          157,121

  New Jersey          681,609      76,446       22,390         998,852

  New Mexico          157,439      42,736       2,185          90,327

  New York            1,500,961    308,272      122,640        3,309,770

  North Carolina      647,879      113,199      17,795         449,819

  North Dakota        47,613       8,173        780            77,231

  Ohio                911,072      152,373      49,005         1,502,331

  Oklahoma            283,208      63,051       13,590         272,451

  Oregon              268,083      44,662       6,895          299,403

  Pennsylvania        884,030      141,187      57,595         2,113,422

  Rhode Island        77,648       14,548       7,425          172,412

  South Carolina      318,543      62,856       7,505          194,461

  South Dakota        61,352       11,948       2,510          98,826

  Tennessee           451,520      89,329       14,595         349,462

  Texas               1,948,297    425,138      45,655         878,981

  Utah                248,430      28,442       4,065          120,546

  Vermont             41,709       5,448        1,935          101,489

  Virginia            557,736      71,726       12,065         453,297

  Washington          475,456      73,029       12,360         475,191

  West Virginia       122,919      32,491       8,720          243,886

  Wisconsin           414,337      52,607       28,035         722,078

  Wyoming             37,226       6,319        330            46,514

                                                               

  Chicago, IL         263,486      74,071       35,555         602,934

  Detroit, MI         93,365       33,217       28,870         210,588

  Los Angeles County, 896,143      221,882      36,270         822,456
  CA                                                           

  New York, NY        652,423      188,213      77,920         1,642,098

  Philadelphia, PA    119,359      38,114       16,190         386,382

                                                               

  United States       23,140,901   4,101,689    886,415        25,815,821
  ------------------- ------------ ------------ -------------- ------------

\* Source: 2000 U.S. Census, Summary File 1 (SF1).

† Source: 2000 U.S. Census, Summary File 3 (SF3).

‡ Source: American Community Survey (ACS), 2003. Further information
regarding the ACS is available at <http://www.census.gov/acs/www/>

**Appendix IV**

**Examples of Primary Prevention Activities**

-   Link families with young children at high risk for lead poisoning to
    housing inspection and environmental intervention resources
    [before]{.underline} a child's blood lead level becomes elevated.

-   Evaluate lead-safe housing status of the community by conducting
    systematic environmental investigation activities (such as lead dust
    wipes, visual inspections, paint chip and soil analysis) based on
    the high-risk status of the housing (i.e., pre-1950 housing in poor
    condition), compiling those data in an electronic format, and
    developing an ongoing evaluation component.

-   Strengthen regulatory infrastructure to create lead-safe housing.
    Develop and codify specifications for lead-safe housing treatments.

-   Partner with housing agencies to incorporate lead hazard
    identification into ongoing housing code or other inspections.

-   Assure that policy changes needed to promote childhood lead
    poisoning prevention and lead-safe environments are recommended and
    supported with data.

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-   Collaborate with other agencies and organizations and incorporate
    lead poisoning educational information into other health, housing,
    and community services that reach high-risk families. Use data to
    expand resources and motivate action for primary prevention.

-   Conduct family and community education that support primary
    prevention activities.

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```
-   Conduct professional and public health education, risk
    communication, and training activities to increase lead poisoning
    *prevention* awareness.

-   When a child is identified with an elevated blood lead level, assure
    that environmental testing of nearby units is conducted.

-   Assure that housing units identified previously as sources for lead
    exposure for a child are prioritized for remediation, so that the
    units do not remain a source for poisoning subsequent children.

-   Provide and/or build community capacity to conduct lead-safe
    training and provide resources to help families reduce lead hazards
    in their homes.

-   Assure that all lead abatement contractors are certified and that
    all renovation and other contractors who work in pre-1978 housing
    are trained in lead-safe work practices.

**Appendix V**

**Strategic Elimination Plan Guidance**

The development of a strategic elimination plan to eliminate childhood
lead poisoning as a public health problem by 2010 is an important tool
in helping communities focus efforts and resources toward this goal. It
is also instrumental in measuring progress and determining midpoint
adjustments necessary to ensure success.

I. The applicant must establish an advisory committee (or expand the
scope of its current advisory group) to develop and implement a
jurisdiction-wide strategic elimination plan. This committee should also
monitor the progress of the elimination plan, leverage resources, and
have the ability to enhance cooperative efforts needed to attain the
goal.

> This committee should include representation from the various
> stakeholders who will be involved in eliminating the jurisdiction's
> lead poisoning problem. They must have sufficient authority (i.e.,mid
> to upper management) to commit staff and resources to the plan.
>
> The representatives should include, but are not limited to, the
> following:
>
> Regional HUD Office, state and local housing program and/or
> environmental quality management staff.
>
> EPA regional staff.
>
> Real estate and landlord organizations.
>
> Community representatives such as parents, concerned citizens, child
> advocates, etc.
>
> State and local elected officials.
>
> State Medicaid agency and managed care organizations (MCOs) management
> staff.
>
> Physicians, physician organizations and/or other health care providers
> and organizations.
>
> Community banking representatives.
>
> Public health department maternal-child health and environmental
> management staff.
>
> State office of rural health representative.
>
> State refugee coordinator.
>
> Cooperative state research education and extension service
> representative.
>
> Grassroots advocacy groups focused on the jurisdiction's most at-risk
> populations and community-based organizations (CBOs) focused on
> children's health issues.
>
> Other maternal-child health programs whose participants are likely to
> be at high risk for lead poisoning (e.g., WIC, Immunization, Asthma
> Prevention, Injury Prevention, Head Start and Healthy Start).

II\. At a minimum, strategic elimination plan should contain:

A. Mission Statement.

B. Statement of Purpose.

> C. Statement of historical context and assessment of the current lead
> poisoning problem specific to the jurisdiction. The assessment should
> be based on all available data sources (e.g., blood lead tests and
> housing surveillance, Medicaid eligibility, tax assessor, census) that
> may assist the committee in determining goals, objectives, and
> activities. Data will also be used to measure the progress made in
> terms of both children (e.g., the number of children with elevated
> blood levels and the number of those children who remain at risk) and
> housing (e.g. the increase in the number of lead-safe housing units)
> as the applicant moves toward elimination.
>
> D. Goals, Objectives, and Activities.
>
> 1\. Develop annual goals, objectives, and activities that address, at
> a minimum, primary prevention, including regulatory infrastructure;
> screening/case management services, including environmental inspection
> and remediation; and surveillance data, including blood lead and
> housing.
>
> 2\. Support each goal with 12-month (annual) objectives. **The goals,
> objectives, and activities for first budget period should be included
> as part of the annual program work plan.** Potential awardees should
> include specific annual goals, objectives, and activities from
> existing elimination plan (if applicable) in the first budget year of
> this project period and briefly describe progress on objectives and
> activities and clearly demonstrate "next steps" to be taken in
> elimination plan. If no prior elimination plan exists potential
> awardee must include specific activities for first budget year of this
> project period as part of their work plan. See Appendix VII.

3.  The goals and objectives for years two through five should be
    provided in outline format only, because they may change based on
    the outcomes of the first year. Activities may change as well.

> 4\. Annual objectives of the strategic elimination plan should be
> included in the annual program evaluation. See Appendix VIII.

E. The application should include letters of support from key
elimination planning group participants. Letters of support should
identify specific activities of the participant, including commitment of
agency resources to the goal of eliminating childhood lead poisoning by
2010.

**Appendix VI**

**SURVEILLANCE SYSTEM GUIDANCE**

A childhood blood lead surveillance system should include case
management and environmental inspection data as well as program
monitoring capabilities, and should provide data needed to determine
screening and elevated blood lead level (EBLL) rates among specific
high-risk populations including Medicaid-eligible children. The system
should be based on laboratory reports of blood lead test results to the
state and/or local childhood lead poisoning prevention program (CLPPP).
The system should use and plan to increase electronic transfer of data
from laboratories, WIC, immunizations, and birth certificates, and
between local and state health departments.

The system should contain unique identifiers within a jurisdiction for
each child and address, and should have minimum built-in data entry and
import edit checks. The system should be Web-based to obtain real-time
information. The system should collect core/standard data elements
including at least the following:

**[Patient Data]{.underline}**

> CHILD ID
>
> Name: Last, First, Middle
>
> Address: Street, City, State, Zip
>
> County Code: FIPS
>
> Home phone number
>
> Date of birth
>
> Sex
>
> Gender
>
> Race
>
> Ethnicity

## Guardian Name: Last, First

**[Health Care Provider]{.underline}**

> [Provider ID -- assigned by CLPPP]{.underline}
>
> [Provider Name]{.underline}
>
> [Provider Address: Street, City, County, State, Zip]{.underline}

**[Follow-up Data]{.underline}**

Case Management

Home visit date(s)

> Referrals, including type, date referred, and date completed
>
> Date case closed
>
> Reason: Complete, incomplete, administrative
>
> Environmental Information:
>
> Investigation Start Date
>
> Investigation Reason
>
> Investigation Completion Date
>
> Investigation Closure Reason
>
> Date Remediation or Abatement Completed
>
> Investigation Findings/Source(s)Identification
>
> Clearance Testing Results
>
> Date Clearance Testing Completed

**[Laboratory/Sample Data]{.underline}**

> LAB ID
>
> Laboratory Name
>
> Laboratory Address: Street, City, State, Zip
>
> Date Sample Drawn
>
> Date Sample Analyzed
>
> Requisition number
>
> Accession number
>
> Type of test (lead, EP, etc.)
>
> Result (with Units)
>
> Sample type (venous, capillary, unknown)
>
> Sample purpose

The system should have the capability to send quarterly data extractions
to CDC.

**[Core Surveillance:]{.underline}**

The core of the surveillance system should be a child-specific,
relational database that allows for multiple lab tests and multiple
addresses to be followed over time. The system should allow for tracking
inspections and remediation activities.

The surveillance system should have the technologic capability to
receive and report all blood lead tests performed on children in the
applicant's jurisdiction. Applicants should describe plans and methods
to achieve complete reporting for all children tested for lead and for
all blood lead levels in their jurisdiction and entering all of these
results into the surveillance system, where programmatic or legislative
barriers have not been resolved.

Applicants should provide current baseline percentage of tests reported
electronically by laboratories, other heath departments, and/or other
sources and describe plans to increase the yearly percentage by at least
10% each year until overall electronic reporting reaches at least 90% of
all tests. To be considered electronic reporting, the data must be
imported into the system rather than entered manually by a user. (For
example, if data are sent on a diskette as an Excel spreadsheet, but the
program is not capable of manipulating the spreadsheet to import it into
the system, and instead prints out the spreadsheet for the data entry
operator to type into the system, this is not electronic reporting.)
\[See Appendix I for definition of Electronic Laboratory-Based Reporting
(ELR)\].

Goals for increased electronic reporting should be higher than 10% per
year until 85%-90% is reached, where appropriate and based on the need
for improvement.

System should have a detailed flow chart of the surveillance system for
both individual test data and summary information. The flow chart should
minimally include, but not be limited to, data entry, quality control
points, data usage/report generation, and data transfer/linkages.

The flow chart should be included in the application appendix. CLPPP
staff, including administrative, surveillance, case management,
environmental, and other CLPPP or health department staff, should meet
regularly to discuss improving the quality and utility of surveillance
and other data to best meet CLPPP needs and the goal of eliminating lead
poisoning as a public health problem. This should be recorded as part of
permanent surveillance system management documentation. This
documentation should include how improvements in surveillance are being
made based on this input.

Programs should submit quality assurance protocols for data process for
cleaning and editing data. Applicants should demonstrate use of the
surveillance system to guide, monitor, and evaluate CLPPP components and
activities, minimally to include:

o Use of surveillance data for development and evaluation of the
jurisdiction-wide targeted screening plan.

o Assessment of effectiveness of case management within the CLPPP
jurisdiction, minimally including time between key control points such
as how long it takes after a child is identified as a case to conduct
the investigation and remediation compared to standards set by the CLPPP
and current best public health practices.

o Assessment of rates of screening and EBLLs among Medicaid eligible
children. (See \"Medicaid and Other Linkages\" below for additional
requirements in this area.)

o Assessment of comparative effectiveness of interventions or activities
intended to reduce the case burden in the applicant's jurisdiction.

Program should produce an annual report for the CLPPP's internal and
external stakeholders. The report should include the number and
percentage of children screened and elevated by specific demographic
variables. It should include analysis and interpretation of
jurisdictional surveillance data, and present trends and important
public health findings.

The program should produce periodic supplementary reports targeted for
specific internal and/or external use on a more frequent basis.

The program should identify standard core reports with frequency and
target audience. The applicant should identify their ability to respond
to information requests and produce reports as needed.

State applicants should demonstrate collaboration with the National
Electronic Disease Surveillance System (NEDSS) contact(s) in their state
to work toward incorporation of childhood lead poisoning surveillance
into an integrated statewide surveillance system. Non-state applicants
should demonstrate collaboration with the NEDSS contact in their state
and/or with their state CLPPP to work toward incorporation of local
childhood lead poisoning surveillance into an integrated statewide
surveillance system.

Until approved by the Lead Poisoning Prevention Branch to submit
quarterly data extractions, applicants should submit annual surveillance
data to CDC as required by OMB No. 0920-0337. Please note recent changes
to the specifications document, as required by OMB race coding changes.

Applicants should evaluate their surveillance system at least annually,
including:

o A description of the surveillance system, how it is being used, and
how data are disseminated

o Data Quality

o Acceptability

o Positive Predictive Value

o Representativeness

o Timeliness

Programs should also identify ongoing evaluation measures of their
surveillance system. These ongoing measures and the activities designed
for improving surveillance based on these measures should be recorded.

**Medicaid and Other Linkages**

Programs will have a system for ongoing identification of
Medicaid-eligible children. The preferred method for achieving this
objective would include performing data linkages or matches between
surveillance and Medicaid enrollment data sets; however, alternative
methods are acceptable, with justification, if valid estimates can be
made.

Programs will use the system described above to produce and share with
the state and local Medicaid agencies annual reports that describe the
following:

o The number and percent of all Medicaid-eligible children less than 72
months of age who receive a blood lead screening test by age and the
number and percent of all Medicaid-eligible children with elevated blood
lead levels by age.

o If the program cannot conduct these activities electronically at the
time of the application, the applicant will submit a measurable,
time-phased work plan for being able to accomplish this task within 1
year of award.

Programs will establish a substantial target for the annual reduction in
percent of Medicaid children with elevated blood lead levels using the
above data and estimates. This target should be included in the
elimination plan and annual work plan.

Programs will conduct other data linking as consistent with the intent
of the Children's Health Act of 2000, as amended.

**Appendix VII**

**Work Plan Guidance**

A work plan is a program management tool that provides program direction
and guidance. It is designed for program planning and implementation as
well as monitoring progress made toward reaching program goals and
objectives. Each program requirement described within the application:
\[A) Elimination Plan; B) Screening/Case Management Plan; C)
Surveillance; D) Primary Prevention; E) Strategic Partnerships; F)
Program Evaluation\] must be a part of the work plan.

The portion of the work plan addressing the elimination plan describes
implementation of [annual]{.underline} goals and objectives for the
strategic elimination plan.

Applicants must have work plan goals and objectives that include
specific activities for high-risk populations identified in the Need
section of application and that are aligned with the elimination plan
goals and objectives. In addition to those high-risk communities that
are subgrantees of cooperative agreement funds awarded under this
announcement, high-risk communities that are [not]{.underline} direct
subrecipients of cooperative agreement funds awarded under this
announcement should be included in objectives and supporting activities
in the proposed work plan.

Each work plan should include the following in matrix format: 1) goals,
2) objectives, 3) activities planned to achieve objectives, 4) a
timeline to assess progress or completion, 5) named person(s)
responsible for activities, and 6) description of data to assess
activities (process indicators) and overall measures of effectiveness
(impact/outcome).

Applicants are required to provide measures of effectiveness that will
demonstrate the accomplishment of the various identified objectives of
the cooperative agreement. Measures must be quantifiable, and must
measure the intended outcome/impact.

Suggested Work Plan matrix format:

+---------+---------+---------+---------+-----------+--------------+
| *       | **Obje  | **Act   | **Time  | **        | **Evaluation |
| *Goal** | ctive** | ivity** | frame** | Person(s) | Measure**    |
|         |         |         |         | Resp      |              |
| **(A    | *       | *       | **(Pr   | onsible** | **(Indicator |
| st      | *(Steps | *(Major | ojected |           | that         |
| atement | to      | task to | time to | **(Lead   | measures     |
| or      | achieve | acc     | c       | person    | achievement  |
| out     | the     | omplish | omplete | for       | of goal or   |
| come)** | goal)** | objec   | acti    | ac        | objective)** |
|         |         | tive)** | vity)** | tivity)** |              |
+---------+---------+---------+---------+-----------+--------------+
| A       | I       | CLPPP   | D       | Mary      | > Number of  |
| dequate | ncrease | will    | ecember | Smith,    | > housing    |
| number  | the     | partner | 2005    | CLPPP     | > units      |
| of lead | number  | with    |         | Manager   | > identified |
| safe    | of      | housing |         |           | > with lead  |
| housing | hi      | program |         |           | > hazards    |
| units   | gh-risk | to      |         |           | > during     |
| will be | homes   | in      |         |           | > routine    |
| av      | where   | tegrate |         |           | > housing    |
| ailable | lead    | lead    |         |           | >            |
| for     | hazards | hazard  |         |           |  inspections |
| oc      | are     | ins     |         |           | > and        |
| cupancy | ide     | pection |         |           | > remediated |
| by      | ntified | into    |         |           | > before a   |
| f       | and     | e       |         |           | > child is   |
| amilies | con     | xisting |         |           | > poisoned.  |
| with    | trolled | housing |         |           |              |
| young   | before  | ins     |         |           |              |
| ch      | c       | pection |         |           |              |
| ildren. | hildren | pro     |         |           |              |
|         | are     | tocols. |         |           |              |
|         | p       |         |         |           |              |
|         | oisoned |         |         |           |              |
|         | from x  |         |         |           |              |
|         | to x.   |         |         |           |              |
+---------+---------+---------+---------+-----------+--------------+

Goal(s) should be presented for each of program element.

Objective(s) in support of each program element goal.

> Activities planned to achieve each objective.
>
> Timeframe for completion for each objective and activity.
>
> Person(s) responsible for completion, by name and/or position.
>
> Evaluation indicator(s) addressing both activities (process) and
> objectives (impact/outcome) describing data that will be used.

**Appendix VIII**

**PROGRAM EVALUATION GUIDANCE**

Program evaluation is the art and science of collecting and using data
to improve performance of your program activities. It is used to
determine how specific activities are contributing to the overall goals
and objectives of your program. Program evaluation answers two key
questions:

-   Are we doing things right? (Process evaluation)

-   Are we doing the right things? (Outcome/impact evaluation)

It is necessary to do program evaluation so you can assess whether a
program activity or element is having the desired effect to the extent
intended (outcome/impact evaluation). It is also crucial in
understanding whether program activities are implemented and functioning
as planned, or whether certain aspects should be altered to improve
overall efficiency (process evaluation).

Program evaluation is more than a summary of activities; it is a
comparison that explains what is working well or what could be made
better. The comparison is the key element of program evaluation that
determines how well the activity or element is faring compared to
another option, plan, or time period. The comparison could be between
two or more types of activities, or between the work plan or benchmarks
and the implementation in the field, or between baseline data and data
collected at time intervals during an activity.

Evaluation measures are selected indicators used to make these
comparisons. They are collected from a wide variety of data sources.
Creating a logic model is useful when designing an evaluation framework.

LOGIC MODEL

A logic model demonstrates how activities included in the work plan
relate to goals and objectives. In addition, the logic model includes
all inputs into the program, even those not funded by the cooperative
agreement. These visual presentations can be especially useful for
relating the work of the program to the overall goal of elimination of
childhood lead poisoning by 2010, including incremental annual progress.

Logic models can also be used as a project planning, management, and as
an evaluation tool by relating the specifics to the big picture.
Evaluation measures can be drawn from the logic models by examining the
relations among the goals, objectives, and activities, as well as the
overall outcomes of the program. The following resources are provided to
assist you in the development of a logic model:

**Resources**

1\. CDC. Framework for program evaluation in public health. MMWR
1999;48(No. RR-11). Available from URL:
http://[www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm).

2\. CDC Public Health Training Network. Practical evaluation of public
health programs. Available from URL:
http://[www.phppo.cdc.gov/phtn/Pract-Eval/workbook.asp](http://www.phppo.cdc.gov/phtn/Pract-Eval/workbook.asp).

3.CDC Evaluation Workgroup Resources. Available from URL:
http://[www.cdc.gov/eval/](http://www.cdc.gov/eval/). (Click on
resources and you will find different methods and books on step-by-step
methods, including logic models.)

4\. CDC. Updated guidelines for evaluating public health surveillance
systems. MMWR 2001;50(No. RR-13). Available from URL:
http://[www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm).

5.United Way. Outcome Measurement Resource Network. Available from URL:
<http://national.unitedway.org/outcomes/library>/. (Portions are on the
Web site for free. The book, videotape, and train the trainer package
cost about \$40.)

6\. Taylor-Powell E, Jones L, Henert E. Enhancing program performance
with logic models. University of Wisconsin-Extension; 2002. Available
from URL: <http://www1.uwex.edu/ces/lmcourse/>.

7\. US Department of Housing and Urban Development. Logic model
broadcast materials. Available from URL:
<http://www.hud.gov/offices/adm/grants/nofa05/logicmodelfiles.cfm>.

**Appendix IX**

**Children ages \< 72 months for whom blood lead surveillance data were
reported to CDC with confirmed blood lead levels (BLLs) ≥ 10 µg/dL by
state, county or city, year and BLL group --- selected U.S. sites,
1997-2003. Table represents data present in the Childhood Lead
Surveillance (CLS) database as of October 1, 2005.**

  -----------------------------------------------------------------------------------------------------------------------------------------------------
  **State/County/City**   **Year**   **Number of **Total       **Confirmed   **Number of                                                      
                                     children    number of     EBLLs as % of confirmed                                                        
                                     tested**    children with children      children by                                                      
                                                 confirmed\*   tested**      highest blood                                                    
                                                 BLLs ≥10**                  lead level                                                       
                                                 **µg/dL**                   (µg/dL) at or                                                    
                                                                             after                                                            
                                                                             confirmation**                                                   
  ----------------------- ---------- ----------- ------------- ------------- ---------------- ----------- ----------- ----------- ----------- ---------
                                                                             **10-14**        **15-19**   **20-24**   **25-44**   **45-69**   **≥70**

                          1997       22,875      1,501         6.56%         890              410         120         76          5           0

                          1998       17,827      988           5.54%         586              250         85          61          6           0

                          1999       17,660      549           3.11%         344              114         44          41          6           0

  Alabama                 2000       13,719      315           2.30%         205              62          20          21          7           0

                          2001       12,107      642           5.30%         392              129         62          54          5           0

                          2002       22,495      454           2.02%         257              103         51          38          4           1

                          2003       21,307      503           2.36%         299              107         50          42          4           1

                                                                                                                                              

                          1997       142         2             1.41%         1                1           0           0           0           0

                          1998       242         2             0.83%         2                0           0           0           0           0

                          1999       103         1             0.97%         1                0           0           0           0           0

  Alaska                  2000       73          1             1.37%         0                1           0           0           0           0

                          2001       52          3             5.77%         3                0           0           0           0           0

                          2002       115         2             1.74%         1                0           1           0           0           0

                          2003       77          2             2.60%         0                1           1           0           0           0

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1999§      1,929       168           8.71%         93               42          12          18          3           0

  Arizona                 2000       7,249       181           2.50%         105              35          19          20          2           0

                          2001       8,026       170           2.12%         109              34          10          17          0           0

                          2002       12,005      227           1.89%         159              42          16          9           1           0

                          2003¶      ---         229           ---           165              35          13          15          1           0

                                                                                                                                              

                          1997¶      11,462      1,764         15.39%        397              509         448         362         41          7

                          1998¶      11,257      1,649         14.65%        420              481         393         316         34          5

  California†             1999¶      4,638       919           19.81%        247              279         190         181         18          4

  (excluding Los          2000¶      5,350       878           16.41%        253              261         162         181         16          5

  Angeles County)         2001¶      6,783       877           12.93%        229              281         165         178         21          3

                          2002¶      20,089      1,394         6.94%         390              467         260         250         25          2

                          2003¶      154,043     1,525         0.99%         857              319         167         156         24          2

                                                                                                                                              

                          1997¶      948         511           53.90%        165              169         94          72          11          0

                          1998¶      541         198           36.60%        69               65          36          25          3           0

  Los Angeles             1999¶      5,416       630           11.63%        117              191         166         133         19          4

  County, CA†             2000¶      7,367       598           8.12%         147              150         145         138         16          2

                          2001¶      8,260       525           6.36%         95               162         116         144         6           2

                          2002¶      1,800       176           9.78%         72               52          26          25          1           0

                          2003¶      79,499      1,033         1.30%         698              171         80          77          7           0

                                                                                                                                              

                          1997       5,077       180           3.55%         108              36          16          17          2           1

                          1998       4,151       125           3.01%         78               24          6           14          3           0

                          1999       3,815       102           2.67%         64               20          10          7           1           0

  Colorado                2000       6,606       112           1.70%         71               21          7           12          1           0

                          2001       8,984       113           1.26%         62               20          18          12          1           0

                          2002\$     0           0             0             0                0           0           0           0           0

                          2003\$     0           0             0             0                0           0           0           0           0

                                                                                                                                              

                          1997       22,435      298           1.33%         196              54          26          20          2           0

                          1998       60,725      2,410         3.97%         1,284            523         293         275         31          4

                          1999       65,603      2,155         3.28%         1,246            460         219         196         31          3

  Connecticut             2000       64,685      2,371         3.67%         1,353            514         258         218         26          2

                          2001       67,512      2,026         3.00%         1,206            449         191         156         22          2

                          2002       69,670      1,813         2.60%         1,059            392         186         157         14          5

                          2003       68,038      1,551         2.28%         951              308         129         141         17          5

                                                                                                                                              

                          1997       28          15            53.57%        1                1           6           4           3           0

                          1998       8,881       245           2.76%         118              57          34          34          1           1

                          1999       10,343      245           2.37%         109              56          36          40          4           0

  Delaware                2000       9,648       231           2.39%         102              50          42          33          4           0

                          2001       14,555      254           1.75%         127              80          20          25          2           0

                          2002       13,008      253           1.94%         158              59          10          25          1           0

                          2003¶      7,277       131           1.80%         88               20          13          9           1           0

                                                                                                                                              

                          1997       183         131           71.58%        10               23          51          43          4           0

                          1998       6,810       225           3.30%         71               67          40          39          8           0

  District of             1999       11,777      215           1.83%         84               57          35          37          2           0

  Columbia                2000       14,040      175           1.25%         100              35          21          15          3           1

                          2001       16,042      156           0.97%         73               33          15          33          2           0

                          2002       15,755      122           0.77%         49               27          21          20          5           0

                          2003       9,229       193           2.09%         87               70          16          18          1           1

                                                                                                                                              

                          1997       38,803      2,347         6.05%         1,592            486         142         109         13          5

                          1998       33,803      2,146         6.35%         1,495            396         138         110         7           0

                          1999       34,389      1,509         4.39%         967              347         108         75          10          2

  Florida                 2000       45,896      723           1.58%         467              149         40          58          9           0

                          2001       63,382      643           1.01%         397              137         56          50          3           0

                          2002       70,550      827           1.17%         526              158         71          60          9           3

                          2003       105,831     774           0.73%         478              147         78          55          11          5

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998       22,496      445           1.98%         246              122         41          36          0           0

                          1999       20,588      512           2.49%         283              131         42          49          7           0

  Georgia                 2000       27,609      466           1.69%         276              108         35          43          3           1

                          2001       33,097      422           1.28%         267              90          26          38          0           1

                          2002       33,620      295           0.88%         184              58          24          24          4           1

                          2003       53,530      381           0.71%         221              86          37          33          1           3

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998§      15          13            86.67%        3                6           2           2           0           0

                          1999       3,736       92            2.46%         51               28          11          2           0           0

  Hawaii                  2000       4,897       93            1.90%         63               19          6           5           0           0

                          2001       7,391       88            1.19%         48               22          8           6           4           0

                          2002       9,171       100           1.09%         62               18          12          7           1           0

                          2003       7,967       81            1.02%         48               16          6           10          1           0

                                                                                                                                              

                          1997       75,035      6,192         8.25%         3,588            1,401       570         575         50          8

                          1998       71,067      4,649         6.54%         2,813            959         412         410         46          9

  Illinois                1999       81,297      3,676         4.52%         2,202            799         321         320         30          4

  (excluding              2000       90,167      3,697         4.10%         2,237            752         360         301         40          7

  Chicago)                2001       82,714      3,120         3.77%         1,825            636         316         312         28          3

                          2002       87,903      2,938         3.34%         1,726            620         298         256         31          7

                          2003       92,695      2,688         2.90%         1,570            599         233         257         27          2

                                                                                                                                              

                          1997       96,140      23,800        24.76%        13,255           5,804       2,257       2,189       249         46

                          1998       95,263      19,616        20.59%        11,907           4,137       1,783       1,555       196         38

                          1999       91,947      15,960        17.36%        9,919            3,241       1,343       1,291       139         27

  Chicago, IL             2000       96,569      13,872        14.36%        8,561            2,855       1,232       1,078       116         30

                          2001       104,501     11,645        11.14%        7,207            2,502       946         860         111         19

                          2002       104,264     9,302         8.92%         5,840            1,898       767         703         82          12

                          2003       103,701     6,691         6.45%         4,317            1,312       503         505         41          13

                                                                                                                                              

                          1997       28,640      894           3.12%         534              181         88          72          16          3

                          1998       26,563      733           2.76%         387              179         88          70          9           0

                          1999       26,030      755           2.90%         436              177         73          66          2           1

  Indiana                 2000       25,307      567           2.24%         343              117         60          41          5           1

                          2001       27,442      599           2.18%         347              140         66          42          4           0

                          2002       29,105      604           2.08%         351              138         48          58          6           3

                          2003       38,944      654           1.68%         373              145         71          60          5           0

                                                                                                                                              

                          1997       25,335      1,422         5.61%         755              355         158         136         16          2

                          1998       26,254      1,299         4.95%         696              289         130         163         16          5

                          1999       27,823      1,061         3.81%         552              236         128         130         14          1

  Iowa                    2000       30,031      1,054         3.51%         556              251         121         105         19          2

                          2001       37,085      1,071         2.89%         578              239         116         111         23          4

                          2002       42,534      1,135         2.67%         619              262         110         130         9           5

                          2003       43,824      1,035         2.36%         565              231         106         115         16          2

                                                                                                                                              

                          1997§      36          3             8.33%         1                0           0           2           0           0

                          1998       3,485       71            2.04%         24               24          7           14          2           0

                          1999       4,010       224           5.59%         108              61          26          27          2           0

  Kansas                  2000       7,244       222           3.06%         120              50          16          31          5           0

                          2001       10,715      322           3.01%         191              61          33          32          4           1

                          2002       15,564      354           2.27%         198              82          31          36          7           0

                          2003       26,037      365           1.40%         220              79          41          21          4           0

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1999       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

  Kentucky†               2000§      16,346      145           0.89%         65               30          20          27          3           0

                          2001       27,022      351           1.30%         177              69          46          52          3           4

                          2002¶      3,956       44            1.11%         23               6           7           8           0           0

                          2003       28,225      190           0.67%         99               35          25          24          6           1

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998§      23,168      551           2.38%         227              152         82          81          6           3

                          1999       21,587      690           3.20%         318              191         94          76          10          1

  Louisiana               2000       30,805      1,023         3.32%         484              270         137         122         8           2

                          2001       44,458      1,061         2.39%         563              249         118         125         3           3

                          2002       54,205      1,044         1.93%         542              255         115         121         9           2

                          2003       61,668      982           1.59%         526              222         131         100         3           0

                                                                                                                                              

                          1997       10,414      412           3.96%         255              89          33          29          4           2

                          1998       10,025      398           3.97%         262              78          26          31          1           0

                          1999       9,608       336           3.50%         192              86          28          28          2           0

  Maine†                  2000       10,107      330           3.27%         205              68          29          20          8           0

                          2001       11,381      327           2.87%         209              62          29          23          2           2

                          2002       14,390      292           2.03%         196              62          19          11          3           1

                          2003       14,571      253           1.74%         182              38          17          15          1           0

                                                                                                                                              

                          1997¶      2,051       1,807         88.10%        345              455         568         409         25          5

                          1998¶      2,189       1,914         87.44%        363              763         470         286         28          4

                          1999¶      2,040       1,427         69.95%        346              524         327         209         18          3

  Maryland                2000       69,582      3,742         5.38%         1,963            1,009       415         322         25          8

                          2001       82,093      3,478         4.24%         2,032            875         278         263         28          2

                          2002       66,795      1,795         2.69%         1,101            376         175         135         8           0

                          2003       64,506      1,551         2.40%         1,006            306         122         104         13          0

                                                                                                                                              

                          1997       241,872     7,810         3.23%         5,197            1,531       629         423         27          3

                          1998       253,513     5,905         2.33%         3,954            1,199       408         317         27          0

                          1999       260,588     5,279         2.03%         3,607            980         395         267         27          3

  Massachusetts†          2000       255,247     4,334         1.70%         3,028            759         274         244         23          6

                          2001       246,363     3,644         1.48%         2,520            652         251         204         12          5

                          2002       242,915     3,211         1.32%         2,176            614         217         182         21          1

                          2003       235,222     2,219         0.94%         1,527            415         139         128         10          0

                                                                                                                                              

                          1997       8,699       796           9.15%         418              203         85          87          3           0

                          1998       35,647      1,732         4.86%         1,030            356         166         152         27          1

  Michigan                1999       51,316      2,225         4.34%         1,248            531         240         189         17          0

  (excluding              2000       54,942      2,031         3.70%         1,253            452         171         144         9           2

  Detroit)                2001       57,928      1,857         3.21%         1,174            369         166         120         24          4

                          2002       59,095      1,394         2.36%         850              301         124         101         17          1

                          2003       58,734      1,144         1.95%         700              226         122         81          12          3

                                                                                                                                              

                          1997       14,892      3,228         21.68%        1,630            703         461         395         36          3

                          1998       26,304      5,086         19.34%        3,077            1,105       447         414         38          5

                          1999       24,622      3,824         15.53%        2,329            794         371         296         29          5

  Detroit, MI             2000       24,213      2,691         11.11%        1,692            545         219         211         22          2

                          2001       30,815      3,398         11.03%        2,174            694         263         236         26          5

                          2002       32,786      3,016         9.20%         1,883            667         233         191         38          4

                          2003       31,596      2,155         6.82%         1,314            452         180         184         21          4

                                                                                                                                              

                          1997       37,404      1,871         5.00%         1,098            398         201         151         18          5

                          1998       35,654      1,551         4.35%         917              340         138         134         16          6

                          1999       36,724      1,214         3.31%         733              258         111         94          15          3

  Minnesota               2000       41,176      1,018         2.47%         584              218         96          105         12          3

                          2001       47,098      1,079         2.29%         638              221         104         100         11          5

                          2002       53,136      868           1.63%         505              161         80          109         10          3

                          2003       61,826      807           1.31%         468              174         75          77          10          3

                                                                                                                                              

                          1997       545         520           95.41%        111              269         83          53          4           0

                          1998       890         485           54.49%        115              259         61          47          3           0

                          1999       7,945       767           9.65%         501              180         47          38          1           0

  Mississippi             2000       11,107      169           1.52%         99               40          18          11          0           1

                          2001       16,771      435           2.59%         306              74          29          23          3           0

                          2002       26,258      525           2.00%         329              113         45          35          1           2

                          2003       36,882      520           1.41%         353              104         25          36          2           0

                                                                                                                                              

                          1997       41,747      5,060         12.12%        2,827            1,200       542         441         42          8

                          1998       44,459      5,045         11.35%        2,933            1,168       448         434         56          6

                          1999       49,004      4,790         9.77%         2,788            1,150       418         385         46          3

  Missouri                2000       56,987      4,946         8.68%         2,903            1,149       390         460         41          3

                          2001       65,137      3,352         5.15%         2,087            710         278         241         34          2

                          2002       66,606      2,838         4.26%         1,735            652         223         206         17          5

                          2003       72,166      2,744         3.80%         1,777            574         186         186         21          0

                                                                                                                                              

                          1997       856         40            4.67%         28               7           4           0           1           0

                          1998       1,126       30            2.66%         24               5           1           0           0           0

                          1999       3,400       19            0.56%         16               2           0           1           0           0

  Montana                 2000       2,394       18            0.75%         13               4           1           0           0           0

                          2001       2,210       6             0.27%         4                1           1           0           0           0

                          2002\$     0           0             0             0                0           0           0           0           0

                          2003\$     0           0             0             0                0           0           0           0           0

                                                                                                                                              

                          1997       5,190       318           6.13%         165              64          33          49          6           1

                          1998       8,510       357           4.20%         190              78          37          40          10          2

                          1999       11,117      390           3.51%         202              84          51          46          6           1

  Nebraska                2000       13,881      312           2.25%         160              61          40          41          6           4

                          2001       14,530      296           2.04%         162              66          31          33          4           0

                          2002       17,867      246           1.38%         136              56          16          32          6           0

                          2003       17,602      271           1.54%         137              57          37          36          4           0

                                                                                                                                              

                          1997       15,775      503           3.19%         269              118         54          57          4           1

                          1998       15,243      538           3.53%         301              123         64          46          4           0

  New                     1999       14,350      555           3.87%         319              138         51          41          4           2

  Hampshire               2000       13,977      501           3.58%         317              117         38          27          1           1

                          2001       13,509      390           2.89%         246              84          24          34          2           0

                          2002       14,551      397           2.73%         248              82          38          25          3           1

                          2003       14,353      412           2.87%         256              89          36          26          5           0

                                                                                                                                              

                          1997¶      12,336      2,865         23.22%        824              500         765         687         75          14

                          1998¶      11,193      2,350         21.00%        685              389         617         586         67          6

                          1999¶      8,249       1,716         20.80%        494              302         466         389         60          5

  New Jersey              2000       135,297     3,823         2.83%         1,438            667         790         801         105         22

                          2001       146,950     3,025         2.06%         1,206            591         533         584         103         8

                          2002       153,290     1,936         1.26%         999              453         190         257         35          2

                          2003       151,584     2,919         1.93%         1,542            616         337         379         40          5

                                                                                                                                              

                          1997       5,936       71            1.20%         43               12          4           10          1           1

                          1998       4,525       24            0.53%         9                9           5           1           0           0

                          1999       4,488       28            0.62%         16               7           5           0           0           0

  New Mexico              2000       3,253       23            0.71%         18               3           1           1           0           0

                          2001       2,695       39            1.45%         24               9           2           4           0           0

                          2002\$     0           0             0             0                0           0           0           0           0

                          2003\$     0           0             0             0                0           0           0           0           0

                                                                                                                                              

                          1997       206,547     13,026        6.31%         7,810            2,967       1,165       1,009       66          9

                          1998       194,784     10,664        5.47%         6,435            2,520       915         715         71          8

                          1999       181,768     8,281         4.56%         5,123            1,844       663         592         49          10

  New York                2000       181,036     6,171         3.41%         3,854            1,308       521         427         52          9

  (excluding New          2001       183,201     5,166         2.82%         3,229            1,122       403         368         37          7

  York City)              2002       179,769     4,493         2.50%         2,842            946         356         309         36          4

                          2003       160,825     3,767         2.34%         2,286            845         318         285         28          5

                                                                                                                                              

                          1997       297,531     9,906         3.33%         6,873            1,565       728         648         76          16

                          1998       303,710     10,370        3.41%         7,229            1,808       652         610         62          9

                          1999       295,584     7,990         2.70%         5,627            1,362       492         450         53          6

  New York, NY            2000       319,312     6,734         2.11%         4,764            1,223       360         340         43          4

                          2001       306,389     4,914         1.60%         3,344            937         291         302         34          6

                          2002       297,177     4,128         1.39%         2,839            753         240         268         25          3

                          2003       304,130     3,526         1.16%         2,270            690         261         260         41          4

                                                                                                                                              

                          1997       97,167      1,259         1.30%         718              313         120         95          11          2

                          1998       96,729      1,067         1.10%         641              257         78          83          8           0

                          1999       107,096     1,039         0.97%         628              235         100         72          4           0

  North Carolina          2000       116,947     1,261         1.08%         772              287         108         83          8           3

                          2001       121,940     995           0.82%         616              215         79          78          5           2

                          2002       122,501     921           0.75%         584              196         75          62          3           1

                          2003       122,911     908           0.74%         611              187         57          47          5           1

                                                                                                                                              

                          1997       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1998       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

                          1999       N/A         N/A           N/A           N/A              N/A         N/A         N/A         N/A         N/A

  North Dakota            2000§      24          1             4.17%         0                1           0           0           0           0

                          2001       1,089       4             0.37%         1                1           0           2           0           0

                          2002       1,271       13            1.02%         4                3           3           3           0           0

                          2003       1,054       17            1.61%         11               3           1           2           0           0

                                                                                                                                              

                          1997       75,193      12,445        16.55%        6,832            2,790       1,395       1,258       149         21

                          1998       76,279      11,859        15.55%        6,717            2,670       1,318       1,027       113         14

                          1999       106,151     9,346         8.80%         5,417            2,123       985         739         74          8

  Ohio                    2000       96,322      7,360         7.64%         4,149            1,695       812         636         60          8

                          2001       103,659     6,604         6.37%         3,878            1,449       657         541         68          11

                          2002       114,446     5,949         5.20%         3,500            1,314       557         501         64          13

                          2003       115,844     4,978         4.30%         2,973            1,038       460         440         64          3

                                                                                                                                              

                          1997       9,183       342           3.72%         233              57          20          31          1           0

                          1998       7,550       164           2.17%         107              28          16          10          3           0

                          1999       8,630       127           1.47%         81               20          8           17          1           0

  Oklahoma                2000       9,483       154           1.62%         103              36          9           6           0           0

                          2001       11,842      145           1.22%         88               32          11          13          1           0

                          2002       12,781      145           1.13%         80               39          11          12          2           1

                          2003       12,969      145           1.12%         92               31          11          11          0           0

                                                                                                                                              

                          1997       4,928       80            1.62%         51               11          10          7           1           0

                          1998       5,766       100           1.73%         59               23          10          8           0           0

                          1999       6,166       112           1.82%         71               26          9           5           1           0

  Oregon                  2000       6,887       108           1.57%         71               20          6           9           0           2

                          2001       8,817       96            1.09%         57               21          10          7           0           1

                          2002       10,917      94            0.86%         50               25          8           9           2           0

                          2003       11,028      98            0.89%         56               23          10          7           0           2

                                                                                                                                              

                          1997       8,626       1,399         16.22%        351              539         232         250         21          6

                          1998       15,239      1,773         11.63%        727              518         240         253         29          6

  Pennsylvania            1999       39,797      2,199         5.53%         881              662         289         335         27          5

  (excluding              2000       42,488      2,020         4.75%         819              567         291         316         26          1

  Philadelphia)           2001       24,639      1,468         5.96%         615              356         177         248         62          10

                          2002       23,436      1,278         5.45%         554              392         167         146         15          4

                          2003       33,625      1,102         3.28%         491              310         130         146         22          3

                                                                                                                                              

                          1997       26,941      7,203         26.74%        3,307            2,007       1,026       773         78          12

                          1998       29,781      7,238         24.30%        3,974            1,778       798         639         42          7

                          1999       25,197      4,110         16.31%        2,368            972         421         314         34          1

  Philadelphia, PA        2000       33,389      4,916         14.72%        2,874            1,154       475         384         29          0

                          2001       22,509      2,970         13.19%        1,797            651         269         229         23          1

                          2002       31,549      4,133         13.10%        2,557            889         396         267         21          3

                          2003       11,970      1,650         13.78%        1,216            273         93          61          6           1

                                                                                                                                              

                          1997       33,749      2,972         8.81%         1,706            675         299         260         29          3

                          1998       34,000      2,526         7.43%         1,558            521         215         196         23          13

                          1999       34,230      2,344         6.85%         1,474            477         184         184         22          3

  Rhode Island            2000       33,826      2,057         6.08%         1,274            425         163         171         22          2

                          2001       34,751      2,029         5.84%         1,267            404         178         167         11          2

                          2002       34,661      1,774         5.12%         1,175            352         121         114         11          1

                          2003       33,813      1,312         3.88%         863              271         91          81          6           0

                                                                                                                                              

                          1997       13,310      684           5.14%         436              151         57          37          3           0

                          1998       9,307       457           4.91%         292              92          46          25          2           0

                          1999       26,432      548           2.07%         386              111         31          19          1           0

  South Carolina          2000       33,528      680           2.03%         439              157         38          45          1           0

                          2001       46,025      566           1.23%         377              122         37          27          2           1

                          2002       49,158      512           1.04%         350              106         32          21          3           0

                          2003       45,797      376           0.82%         274              66          15          19          1           1

                                                                                                                                              

                          1997       6,351       374           5.89%         240              82          26          25          1           0

                          1998       9,015       689           7.64%         455              141         55          34          4           0

                          1999       9,555       644           6.74%         447              123         34          34          6           0

  Tennessee               2000       12,567      372           2.96%         239              91          28          13          1           0

                          2001§      37,281      404           1.08%         247              85          35          30          5           2

                          2002       57,040      477           0.84%         310              96          21          46          2           2

                          2003       48,753      295           0.61%         175              70          30          17          3           0

                                                                                                                                              

                          1997¶      1,286       50            3.89%         36               9           3           0           2           0

                          1998¶      877         24            2.74%         15               5           3           1           0           0

                          1999¶      960         61            6.35%         16               8           18          17          1           1

  Texas                   2000¶      12,380      352           2.84%         160              92          45          50          4           1

                          2001       172,397     1,741         1.01%         1,070            346         158         151         12          4

                          2002¶      0           0             0             0                0           0           0           0           0

                          2003       252,036     1,798         0.71%         1,121            351         156         153         16          1

                                                                                                                                              

                          1997       1,794       44            2.45%         19               15          4           6           0           0

                          1998       2,493       53            2.13%         33               15          3           2           0           0

                          1999       2,608       19            0.73%         13               3           2           1           0           0

  Utah                    2000       3,583       22            0.61%         12               8           1           1           0           0

                          2001       3,438       19            0.55%         9                5           2           3           0           0

                          2002       4,343       25            0.58%         16               4           0           5           0           0

                          2003¶      4,127       24            0.58%         15               6           1           2           0           0

                                                                                                                                              

                          1997       6,744       306           4.54%         186              74          23          22          1           0

                          1998       6,253       239           3.82%         143              51          26          14          5           0

                          1999       6,181       170           2.75%         94               37          24          15          0           0

  Vermont                 2000       6,428       179           2.78%         105              48          12          13          1           0

                          2001       6,465       145           2.24%         75               43          17          8           2           0

                          2002       6,731       149           2.21%         91               30          14          12          1           1

                          2003       6,864       133           1.94%         73               30          15          13          2           0

                                                                                                                                              

                          1997       12,905      868           6.73%         415              226         115         103         6           3

                          1998       23,863      942           3.95%         481              239         111         86          24          1

                          1999       24,388      501           2.05%         266              143         58          29          5           0

  Virginia                2000       25,786      617           2.39%         369              141         47          57          3           0

                          2001       39,771      470           1.18%         238              112         56          52          12          0

                          2002       51,459      560           1.09%         314              123         51          62          10          0

                          2003\$     51,444      411           0.80%         222              96          46          41          5           1

                                                                                                                                              

                          1997       3,715       38            1.02%         21               4           6           7           0           0

                          1998       3,278       40            1.22%         25               8           2           5           0           0

                          1999       3,117       28            0.90%         16               3           4           4           1           0

  Washington              2000       3,617       40            1.11%         19               4           9           6           1           1

                          2001       3,491       32            0.92%         19               4           3           5           1           0

                          2002       6,606       42            0.64%         20               15          1           6           0           0

                          2003       5,581       31            0.56%         13               12          2           3           1           0

                                                                                                                                              

                          1997       11,637      263           2.26%         169              53          23          15          3           0

                          1998       10,483      237           2.26%         150              56          18          12          1           0

                          1999       9,571       167           1.74%         112              35          13          6           1           0

  West Virginia           2000       11,753      173           1.47%         115              36          12          9           0           1

                          2001       12,194      147           1.21%         89               33          15          9           1           0

                          2002       13,649      149           1.09%         98               28          13          9           1           0

                          2003       14,664      161           1.10%         93               26          22          18          1           1

                                                                                                                                              

                          1997       68,464      7,010         10.24%        3,681            1,794       781         677         64          13

                          1998       69,590      5,334         7.66%         2,972            1,299       532         480         44          7

                          1999       70,686      4,567         6.46%         2,581            1,132       417         397         36          4

  Wisconsin               2000       70,382      3,910         5.56%         2,325            807         389         351         28          10

                          2001       79,225      3,659         4.62%         2,159            823         344         295         33          5

                          2002       81,608      3,363         4.12%         2,057            705         299         266         32          4

                          2003       81,077      2,820         3.48%         1,669            654         242         233         20          2

                                                                                                                                              

                          1997       642         11            1.71%         6                1           2           2           0           0

                          1998       851         15            1.76%         6                4           2           3           0           0

                          1999       1,241       6             0.48%         5                0           0           1           0           0

  Wyoming                 2000       1,191       3             0.25%         2                0           0           0           0           1

                          2001       1,277       4             0.31%         3                0           1           0           0           0

                          2002       1,581       4             0.25%         2                1           0           0           1           0

                          2003       1,726       8             0.46%         5                1           0           2           0           0

                                                                                                                                              

                          1997       1,611,569   122,641       7.61%         67,793           28,312      13,473      11,693      1,170       200

                          1998       1,761,674   114,571       6.50%         66,305           25,636      11,498      9,896       1,076       160

                          1999       1,891,870   94,438        4.99%         55,603           20,813      9,140       7,930       842         110

  United States¶          2000       2,216,700   87,792        3.96%         51,646           18,922      8,509       7,753       814         148

                          2001       2,538,008   76,992        3.03%         45,856           16,502      7,060       6,647       800         127

                          2002       2,454,181   65,811        2.68%         39,817           14,191      5,779       5,329       597         98

                          2003       2,729,136   55,765        2.04%         34,232           11,586      4,781       4,578       514         74

                                                                                                                                              
  -----------------------------------------------------------------------------------------------------------------------------------------------------

**Note:** State data and analysis may vary from CDC data because of
strict CDC guidelines for data acceptance

\* Confirmed by either one elevated venous test or two elevated
capillary tests \<12 weeks apart

† BLLs between 10--24 μg/dL may be underreported -- reporting
requirements of BLLs within this range differ by state

§ Statewide surveillance start-up year

¶ Incomplete data: CDC does not have the state's complete dataset

\$ Not funded by CDC, so not required to report BLL data

N/A - State surveillance system not in place

**Frequently Asked Questions (FAQs)**

During technical assistance conference calls held on 12/15/05 and
12/19/05 questions were from potential applicants were posed, to which
the following responses are presented in the form of frequently asked
questions (FAQs).

+-----------------------------------------------------------------------+
| Matching                                                              |
+-----------------------------------------------------------------------+
|   \                                                                   |
| What funds can be used for match?                                     |
|                                                                       |
| 1.  State and local funds                                             |
|                                                                       |
| 2.  State share of Medicaid reimbursement for lead screening and      |
|     covered lead case management and environmental risk assessments.  |
|                                                                       |
| 3.  Hardware costs for implementing Lead PAM                          |
|                                                                       |
| 4.  Software development costs for enhancements to non-NEDSS-based    |
|     system.                                                           |
|                                                                       |
| 5.  Maintenance costs for non-NEDSS-based system.                     |
|                                                                       |
| How to account for matching funds in the application?\                |
| \                                                                     |
| Matching funds can be detailed in Letters of Support.\                |
| \                                                                     |
| Are these matching funds a cash match?\                               |
| \                                                                     |
| No, what we are looking for is a level of effort, not actual cash     |
| contribution to the program, however that level of effort has a cost  |
| associated with it. For example, the state share of Medicaid          |
| reimbursement goes to pay a claim for a lead service, not to the      |
| CLPPP to buy more pamphlets. In this example, use historical data to  |
| estimate the state share of the Medicaid reimbursement. Provide a     |
| Letter of Support from state Medicaid agency that indicates the       |
| estimated amount of state share for lead services in first budget     |
| year.\                                                                |
| \                                                                     |
| Can Community Development Block Grants (CDBG) funds be used as        |
| match?\                                                               |
| \                                                                     |
| No, CDBG are federal funds.\                                          |
| \                                                                     |
| Can community based organizations funding be used as match?\          |
| \                                                                     |
| Yes, the amount of funds that originate from state or local funds and |
| are used to further the lead program goals and objectives.\           |
| \                                                                     |
| What accounting method is required for the match during the first     |
| budget year?\                                                         |
| \                                                                     |
| Specific guidance will be provided to successful awardees.\           |
|                                                                       |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Medicaid Provider Certificate/Statement                               |
+-----------------------------------------------------------------------+
| What must we include in the application?\                             |
| \                                                                     |
| A Medicaid Provider Certificate or Statement that indicates that      |
| those entities that provide services to Medicaid eligible children    |
| are authorized as Medicaid providers to bill Medicaid for covered     |
| services.\                                                            |
| \                                                                     |
| If a Medicaid Provider Certificate/Statement is not included with the |
| application, will the application be returned?\                       |
| \                                                                     |
| Yes.                                                                  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| [Back to                                                              |
| top](http://wwwdev.cdc.gov/nceh/lead/about/program_faq.htm#top%23top) |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Partnerships with Housing Entities                                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Can you define housing entities and give some examples?\              |
| \                                                                     |
| Housing entities generally oversee and/or distribute HUD funds for    |
| housing in the state or locale and are responsible for completion of  |
| the state or local HUD Consolidated Plan for Housing.                 |
|                                                                       |
| -   State environmental quality agencies that are most often attached |
|     to the state health department. They generally oversee the EPA    |
|     lead disciplines training and certification grant programs.\      |
|                                                                       |
|                                                                       |
| -   Regional or local housing authorities that oversee HUD subsidized |
|     housing.\                                                         |
|                                                                       |
|                                                                       |
| -   Local housing agencies that enforce local housing codes.          |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Surveillance                                                          |
+-----------------------------------------------------------------------+
|  \                                                                    |
| Where are the environmental data elements that CDC will require to be |
| reported as part of the quarterly data submission?\                   |
| \                                                                     |
| The environmental data elements are listed in the Surveillance        |
| Appendix VI.                                                          |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Environmental Public Health Tracking Programs                         |
+-----------------------------------------------------------------------+
| Where are existing programs located?\                                 |
| \                                                                     |
| Existing Public Health Tracking Programs are identified at            |
| <http://www.cdc.gov/nceh/tracking/projects/home.htm>.                 |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Screening/Case Management                                             |
+-----------------------------------------------------------------------+
| Are you expecting one plan to be submitted for both screening and     |
| case management?\                                                     |
| \                                                                     |
| No, they are generally two separate plans, but we would like for them |
| to be presented together as two parts of overall plan for secondary   |
| prevention.\                                                          |
| \                                                                     |
| Will CDC provided funds for blood lead testing?\                      |
| \                                                                     |
| Our policy remains unchanged regarding blood lead testing, we will    |
| not provide funds for blood lead testing.                             |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| [Back to                                                              |
| top](http://wwwdev.cdc.gov/nceh/lead/about/program_faq.htm#top%23top) |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Primary Prevention                                                    |
+-----------------------------------------------------------------------+
| What activities are you looking for in the application with regard to |
| women of childbearing age?\                                           |
| \                                                                     |
| Lead poisoning prevention educational activities.\                    |
|                                                                       |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Letters of Support                                                    |
+-----------------------------------------------------------------------+
| To whom should the Letters of Support be addressed?\                  |
| \                                                                     |
| Gary Teague, Grant Management Specialist                              |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Appendix IX                                                           |
+-----------------------------------------------------------------------+
| Appendix IX column heading appear to have shifted.\                   |
| \                                                                     |
| Appendix IX will be reformatted and provided on Grants.gov in early   |
| January.                                                              |
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| Data requested in NEED Section                                        |
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| Please clarify the age ranges for blood lead screening and elevated   |
| blood lead levels data requested.\                                    |
| \                                                                     |
| We are asking for number of children tested and number of children    |
| confirmed with BLL\>=10 that are less than 6 years old (\< 72         |
| months). The age groups are 0 through 35 months (for children less    |
| than 3 years) and 0 through 71 months (for children less than 6       |
| years).                                                               |
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| Under Program Element Surveillance (C ), what is meant by activities  |
| that require enforcement or development of regulations that require   |
| electronic reporting of all *environmental* test results for children |
| \< 72 months of age?                                                  |
|                                                                       |
| The applicant should provide evidence that they have the ability to,  |
| (or planning activities that will result in the ability to) assess    |
| the lead safe status of [all]{.underline} target housing within their |
| jurisdiction (not only housing occupied by a child with an EBLL). To  |
| assess the lead safe status of [all]{.underline} target housing,      |
| requires the applicant to compile the results of [all]{.underline}    |
| lead inspections/risk assessments performed within their              |
| jurisdiction. Not lead [sample]{.underline} results (i.e., XRF        |
| readings, paint chip, soil, water analysis results), but *results*    |
| meaning whether lead hazards were identified or not. Follow up        |
| activities that take place (or not) in those target housing units     |
| where lead hazards are identified is also an integral aspect of that  |
| assessment.                                                           |
|                                                                       |
| The regulatory aspect is related to the possibility of making the     |
| provision of these certain data from all lead inspections/risk        |
| assessments a condition of lead inspector/risk assessor state         |
| licensure or perhaps a local requirement.                             |
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