Notice of CDC-RFA-DP24-0053: Frequently Asked Questions

General

What is the application due date?
The application due date for CDC-RFA-DP24-0053 NOFO is May 20, 2024, at 11:59 pm ET.

How many awards are expected to be made?
It is expected that up to 59 awards will be made.

Where can prospective applicants download a searchable version of the NOFO?
Once on this cooperative agreement's specific grants.gov page; please click on the "Package" tab, then click "Preview" under actions within the table. This will result in a pop-up, please click "download instructions." This will download a PDF that is searchable and where links are live. 

How can prospective applicants learn more about this NOFO?
There was an informational call related to this opportunity on March 26, 2024 at 3:00 PM Eastern Time. We will not be posting a recording of the informational call, but a script of the call is available.

The funding opportunity also has an informational webpage accessible at this link. On this page, prospective applicants can find additional information, resources, and a "frequently asked questions" page.

If a prospective applicant would like to contact the CDC team directly with a question, we ask that they do so by emailing NOFODP24-0053@cdc.gov. We will respond to all questions promptly.

How will my application be evaluated?
All applications will be reviewed for eligibility by CDC Office of Grants Services. Non-eligible applications will not advance to Phase II review. Eligible applications will be reviewed for responsiveness and completeness by the Grants Management Officials and Program Officials. For more information on the various review phases, please refer to section E, Review and Selection Process of the CDC-RFA-DP24-0053 notice of funding opportunity.

When will applicants be notified if awarded?
This funding opportunity is expected to begin on September 30, 2024.

I'm new to MMRCs, how can I learn more?
To learn more about Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM), please visit https://www.cdc.gov/maternal-mortality/php/erase-mm/index.html.

Is this opportunity only available for jurisdictions with existing MMRCs?
This funding opportunity has open eligibility, see "Eligibility Information" for a list of Eligible Applicants.

Can representatives from multiple states submit one application together? For example, two neighboring states, an ACOG District, or a Health and Human Services Region?
This funding opportunity has open eligibility, see "Eligibility Information" for a list of eligible applicants. To be considered responsive, applications must provide documentation on the required Authorities and Protections, Vital Records Access, and Ability to Share Data with CDC for each jurisdiction that is covered by an application. Some considerations for an application across multiple states:

• The funding awarded to a recipient will be based on the aggregate total of estimated pregnancy-associated deaths, as defined in this NOFO.
• Only one award will be made within a state or territory.
• Required Memorandums of Understanding (MOUs), Memorandums of Agreement (MOAs), Data Use Agreements (DSAs), and Letters of Support (LOS) will be necessary from each of the states/jurisdictions or their fiduciary agents would need to be included in the application.

Within a region of states, is it possible for each state to apply independently, but for each state to budget funding for a regional review and not just their own state review?
A motivation for standardized data and this NOFO is to encourage greater networking between MMRCs. As a result, it is acceptable for states within a region to include in their budget funding that would support their participation in regional collaboration. The budget should reflect the proposed work plan as described in the application and include innovative approaches like supporting regional activities.

Can foreign entities apply?
No, foreign entities cannot apply; this is domestic funding.

Is an applicant considered responsive if state legislation that provides "authority to access clinical and non-clinical records, and confidentiality protection of data collected, proceedings, and activities" is in process at the time of application?
To be responsive, an applicant must document the authority to access records for the purposes of MMRC case review (e.g., vital events, prenatal care, hospital admission, behavioral health, and social service records, etc.) and confidentiality protections for the MMRC as part of their application. This may come from a law specific to establishing a maternal mortality review committee, but it also may come from broader existing public health authority. In the absence of a law specific to establishing a maternal mortality review committee that includes required authority and protection, we suggest that applicants discuss with the appropriate legal counsel whether other existing laws may provide the required authority and protection and provide appropriate documentation.

What do we do if we do not currently have the partnerships listed as required collaborations?
Collaborations and/or partnerships required for eligibility review are limited to those that provide evidence of Authorities and Protections, Access to Vital Records, and an ability to share data with CDC via signed MMRIA MOU and MMRIA DSA. Other required partnerships can be addressed in narrative and a corresponding MOU or LOS. The narrative or attached MOU/LOS may specify how collaborations will be formalized if they are not currently in place.

Can we combine the evaluation section with the workplan?
We recommend that the content for the workplan and content for the evaluation section stay separate, as described in the NOFO. In the NOFO, there is a suggested workplan format for prospective applicant reference.

Information on our current approach is requested in both "Approach" and "Organizational Capacity to Implement the Approach" sections. Should we provide information on our current approaches in both sections of our response/our Project Narrative submission? Will it be okay to have information duplicated in the application submission?
Please provide pertinent information, as you see fit, in the various sections requested by the NOFO. You can also reference across sections of your Narrative as appropriate. The overall page limit of the Project Narrative and work plan is 20 pages, single spaced, 12-point font, 1-inch margins.

How do I navigate the CDC WONDER page to find my state's 3-year average count of pregnancy-associated deaths described under Section IV, Funding Strategy?
Instructions for using CDC WONDER to identify your state's 3-year average count of deaths is available at this link. In addition, a table of which states fit into each average count range is available at this link.

Can prospective applicants submit internal information to change their 3-year (2019–2021) average count of pregnancy-associated deaths from that listed in the NOFO?
No, a prospective applicant cannot provide internal information to change their 3-year average count. To determine case counts and to apply them to funding levels, CDC is required to use an objective and publicly available data source, which is why we use CDC WONDER data. We use the 3-year average to strike a balance between timely data, and to have a count more representative of a typical year.

Can applicants adjust the timeliness benchmarks outlined in the NOFO, i.e., 18-month timeline for case abstraction and preparation for review?
The 18-month timeline for case preparation for abstraction reflects the need for timelier MMRC data available to inform prevention activities. Technical assistance will be provided for performance monitoring and helping funded jurisdictions meet or improve towards this timeline. Applications can set goals to meet shorter timelines. Additional information on reporting the priority performance measures, will be provided after award.

One of the strategies in the NOFO is informant interviews, will recipients be required to fully implementing informant interviews at the time of award?
Applicants may propose activities that address planning, piloting, or other activities required to remove barriers to fully implementing informant interviews in their jurisdiction during the award period. The full, ongoing implementation of an informant review process is not a requirement at the time of application but should be an objective for the project period.

Can you describe the components of the Annual Progress Report if selected for award?
Annual Progress Reporting guidance is outlined in general under the "Reporting" section of the opportunity. Typically, further guidance on the reporting is provided to recipients with at least 30 days to respond. Recipient reporting may include administrative reporting, a progress narrative, and a submission on performance measure achievements.

Our organization was unable to attend the Informational Conference Call held on March 26, 2024. Can a recording of the Informational Conference Call be provided?
We will not be posting a recording of the informational call, but a script of the call is posted on the NOFO webpage, and we updated the FAQs related to this opportunity based on the questions asked during the call and additional questions submitted to the NOFO inbox.

Is there another guidance document that outlines submission requirements, e.g., font, total grant pages?
Please see content on page 28 of the opportunity for information on font and page limit for the project narrative – "maximum of 20 pages, single spaced, 12-point font, 1-inch margins, number all pages. This includes the work plan. Content beyond the specified page number will not be reviewed." Other application components/ attachments do not have a page limit. Our program does not post an additional guidance document – if you have other questions, please submit them to the NOFO inbox at nofodp24-0053@cdc.gov.

What is the definition of a "jurisdiction"?
A jurisdiction is the state or territorial entity – the opportunity uses the term 'jurisdiction' to be inclusive of territorial jurisdictions and states. Per the NOFO, final review will verify only the applicant with the specified authorities and protections and vital records access that fully encompass the State, US territory or Freely Associated State, or the District of Columbia is selected for funding.

In the grant application, it states that local governments are an eligible recipient. Is it possible for a city or county-based applicant to apply and receive funding?
Per HHS policies almost all of CDC NOFOs are fully open and competitive. However, due to the nature of this work and our funding mandates from Congress, we have specific eligibility and review criteria that will be considered when we make awards under this opportunity. Only one award will be made per state, territory, or the District of Columbia, and a final review will verify only the applicant with the specified authorities and protections and vital records access that fully encompass the State, US territory or Freely Associated State, or the District of Columbia is selected for funding. See page 14 under "Funding Strategy" and page 38 under "Phase III Review" for this language in the opportunity.

Would you like applicants to list references, and if so, how? Would it count toward the narrative page limit?
Applicants can provide references and footnotes as necessary to support their application, but this additional content will count towards the page limit if included as part of the project narrative.

With regard to receiving data from Medicaid - we attempted to get Medicaid data previously and were told by their legal team that we may request Medicaid client records for the purpose of completing a review as long as we have received written consent from the decedent's administrator, estate executor, or other authorized legal representative. We do not have the capacity to do this. What should we do in this situation?
A programmatic agreement between your MMRC program office and Medicaid could outline elements of collaboration that exist or are planned such as documenting a Medicaid-designated representative (member) on the MMRC or Medicaid's commitment to disseminating or acting on MMRC recommendations. It does not have to be an explicit collaboration on individual data access if that is not feasible in your current context.

Regarding the state medical examiner/coroner offices, our state does not have a statewide office. We have individual officers for each of our 100+ counties. As a health department would we be expected to have a letter from each office, or would a sampling be sufficient?
In this case, a letter/letters providing evidence of support among offices that the jurisdiction would view as important for the MMRC operations would be sufficient. Jurisdictions can also consider letters of support from professional organizations representing medical examiner/coroner offices in jurisdiction.

Are you able to clarify expectations/activities surrounding program evaluation? We do not currently have a program evaluator. We need to know whether we need to set aside personnel funds specific to an evaluator.
The CDC Evaluation and Performance Management strategy for this opportunity begins on page 16 of 57. This section includes a summary of the overall priority performance measures and CDC's Program Evaluation Strategy. Also refer to the section on the Annual Performance Report, beginning on page 44 of 57. If these requirements necessitate additional support from an evaluator in your context, then that would be an acceptable use of funds under this award. In addition, if you propose any evaluation activities beyond what is required to report on the performance measures and complete annual reporting, and that are separate from your MMRIA analyses, those would be reviewed during the Technical Review for this opportunity.

It will be important to ensure you have sufficient data analyst or epidemiologist time supporting the overall activities of an MMRC and the MMRIA data quality and use expectations of this award. In some places, the position designations for an evaluator and an analyst may be similar – so please determine what works for your context.

Do we need to create an overall corresponding "Outcome Measure" for each "Period of Performance Outcome" (i.e., 3 Short Term and 2 Intermediate Outcome Measures) in our work plan?
Priority outcome measures for each period of performance outcome are identified as Performance Measures under the CDC Evaluation and Performance Measurement Strategy Section of the NOFO, beginning on page 16 of 57. These measures will be a part of the CDC performance management approach. You may include additional process or outcome measures as relevant to meet any internal objectives or program strategies in addition to the required strategies.

Regarding the priority performance measures mapped to the "Short Term or Intermediate Outcome" beginning on page 16 of 57, do we need to map each outcome or process measure to the required 15 Strategies and Activities listed beginning on page 7 of 57 in our work plan. If our proposed activities don't align or are not exactly mapped to each of the required outcome or process measures, do we need to create our own outcome or process measures?
Not every strategy needs an outcome measure in the work plan. You may want to add process measures for internal planning, monitoring, or accountability.

MMRIA

Does MMRIA allow for new data fields to be added (i.e., new variables)?
The content of MMRIA was developed in partnership with MMRCs and the system reflects their expertise and input. The content is ever-evolving alongside MMRCs, and jurisdictions may submit new data fields to the CDC team for potential addition to MMRIA; however, MMRIA does not have the capacity to include state-specific customized items at this time.

The NOFO discusses the data that is expected to be entered into MMRIA as "all relevant case data". Is there any further clarification on what this would entail specifically?
We do not have specific guidance on which variables in MMRIA abstraction forms are relevant for each case scenario as, in general, you should only be abstracting information that is relevant to the cause of death. However, all death certificate fields and select home record fields should be completed for all identified pregnancy-associated deaths. Refer to https://demo-mmria.cdc.gov/data-dictionary for specifics. Information on data fields that are considered potential identifiers that are necessary to share with CDC through MMRIA are noted in Appendix A of the Data Sharing Agreement.

The NOFO for this opportunity referenced data quality assurance checks, can you please explain that more or what the process entails?
Recipients of funding through this NOFO will work with CDC to implement processes for improving the quality of the MMRC's MMRIA data. The expectation is that recipients will conduct routine reviews of their MMRIA data based on their own programmatic protocols. MMRIA data quality reports are provided by CDC and available to all users within the system and may be a tool to support data quality assurance processes.

Our jurisdiction is re-applying for funding and we have an existing DSA with CDC. Is this DSA still valid to submit with our application or would we need to use the new template that is provided on the website for submission?
Existing agreements that are active satisfy the requirement.

What if this DSA form does not completely align with the current DSA in place? Is there flexibility on timing for submitting this document?
If applicants have existing, unexpired DSA's in place, that document can be included as part of the application to satisfy the eligibility requirement. If an applicant is selected as a recipient, CDC will work with the recipient to update the DSA as appropriate.

Our MMRC MOU and DSA were signed as one document previously. How should we load these documents if they are one document?
Applicants should upload MOUs and DSAs as described in the NOFO. If these documents were signed in tandem or are stored as one document, please upload the document twice with the appropriate naming conventions for the MOU and the DSA as outlined in the opportunity.

For the MMRIA MOU and MMRIA DSA, how do we go about getting the document signed by the Team Lead with the CDC (David Goodman, M.S., Ph.D.) to submit?
Applicants can submit the MMRIA MOU and DSA without a CDC signatory. Once identified as a recipient, CDC will work with the applicant to get the necessary CDC signature.

What is the requested naming convention for the required MMRIA Data Sharing Agreement? Page 10 of the NOFO requires the agreement to be named as: MMRIA_DSA. Page 49 of the NOFO requires the document of ability to share data to be named as: Data_Share_Evid. These instructions appear to be referring to the same item.
For the eligibility review, it is important to use the naming convention prescribed under “Additional Information on Eligibility” on page 23 of the opportunity. The file containing the MMRIA Data Sharing Agreement should be uploaded as a PDF named “MMRIA_DSA”. The MMRIA Data Sharing Agreement is sufficient as evidence of ability to share data and does not need to be submitted twice, but there may be other examples of an applicant’s ability to share data that they may want to include as Data_Share_Evid.

Budget

When does the budget period start? How long is the period of performance?
This funding opportunity's period of performance is five years and includes 5 individual budget periods. The first budget period for this funding opportunity is expected to begin on September 30, 2024, and end on September 29, 2025.

Can we be considered if our MMRC already has a funding from another source (for example, funding from state revenue)?
A Maternal Mortality Review Committee (MMRC) that has funding from another, non-CDC source can be considered for funding through this funding opportunity. In this situation, please consider and describe how additional funding could be used to enhance and/or improve your MMRC processes, activities, and outputs.

In trying to complete the budget, we are trying to determine how much travel is expected. The NOFO refers to the annual CDC hosted reverse site visit. Is the intent to travel our whole MMRC team or a certain number of representatives from each team?
Applicant's proposed budget should include a trip to Atlanta, GA for a minimum of 4 representatives at the annual MMRIA User Meeting during the period of performance. Travelers should include staff, contractors, consultants, and/or committee members who function in roles as case abstractors (including informant interviewers), data analysts, program coordinators, and committee leaders/facilitators. Funding may also be used to bring other committee leadership or key community partners as relevant to each specific jurisdiction. Please anticipate 2 full days for the meeting. This does not include travel time.

Could you clarify whether the budget and budget narrative required for this application is only required for Year 1?
A detailed budget and budget narrative is required for the first year. Subsequent budget years for the project period, i.e., budget years 2 – 5, will be initially approved via the non-competing continuation process once an award is made.

Our budget office has asked a question for clarification regarding the CFDA number. The current CFDA number for our ERASE MM funding is 93.478. For the DP24-0053 opportunity the CFDA # is 93.946. Should we consider this a new grant?
Yes, it is an opportunity for a new 5-year cooperative agreement. It is not a grant. This current opportunity for ERASE MM funding is under the CDFA 93.946 – which is the Safe Motherhood and Infant Health appropriation – so while we consider it a "follow on" to the FY19 program funding, the number did change as a result of a change in sub-budget activities in CDC's appropriation.

Where do we include the required Contractual Elements in the application?
Please include the elements for any planned contract in the Budget Narrative. See the CDC budget prep guidelines. If the information for a contract is detailed (i.e., those required elements including name, method of selection, period of performance, etc.) in the application's budget narrative, and the budget narrative is approved as a part of the application package, the contract will be approved at the time of the initial award. If this information is not provided or provided as TBD, a budget revision will be required.

Also, if you are currently funded under DP19-1908, DP22-2211, or DP23-0066, you will need to close out that award completely after the September 2024 end of the project period. Money will not roll over into the new cooperative agreement.

Please consult your institution's financial office for support on how to categorize this funding internally to your organization.