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Office of Direct Service and Contracting Tribes; Tribal Management Grant Program

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Start Preamble

Announcement Type: New and Competing Continuation.

Funding Announcement Number: HHS-2018-IHS-TMD-0001.

Catalog of Federal Domestic Assistance Number (CFDA): 93.228.

Key Dates

Application Deadline Date: August 17, 2018.

Review Date: August 20-24, 2018.

Earliest Anticipated Start Date: September 1, 2018.

Signed Tribal Resolutions Due Date: August 17, 2018.

Proof of Non-Profit Status Due Date: August 17, 2018.

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting competitive grant applications for the Tribal Management Grant (TMG) Program. This program is authorized under 25 U.S.C. § 5322(b)(2) and 25 U.S.C. § 5322(e) of the Indian Self-Determination and Education Assistance Act (ISDEAA), Public Law (P.L.) 93-638, as amended. This program is described in the Catalog of Federal Domestic Assistance (CFDA) under 93.228.


The TMG Program is a competitive grant program that is capacity building and developmental in nature and has been available for federally recognized Indian Tribes and Tribal Organizations (T/TOs) since shortly after enactment of the ISDEAA in 1975. The TMG Program was established to assist T/TOs to prepare for assuming all or part of existing IHS programs, functions, services, and activities (PFSAs) and further develop and improve Tribal health management capabilities. The TMG Program provides competitive grants to T/TOs to establish goals and performance measures for current health programs; assess current management capacity to determine if new components are appropriate; analyze programs to determine if a Tribe or Tribal Organization's management is practicable; and develop infrastructure systems to manage or organize PFSAs.


The purpose of this IHS grant announcement is to announce the availability of the TMG Program to enhance and develop health management infrastructure and assist T/TOs in assuming all or part of existing IHS PFSAs through a Title I contract and assist established Title I contractors and Title V compactors to further develop and improve management capability. In addition, Tribal Management Grants are available to T/TOs under the authority of 25 U.S.C. 5322(e) for the following: (1) Obtaining technical assistance from providers designated by the Tribe/Tribal Organization (including T/TOs that operate mature contracts) for the purposes of program planning and evaluation, including the development of any management systems necessary for contract management, and the development of cost allocation plans for indirect cost rates; and (2) planning, designing, monitoring, and evaluating Federal programs serving T/TOs, including Federal administrative functions.

II. Award Information

Type of Award


Estimated Funds Available

The total amount of funding identified for the current fiscal year (FY) 2018 is approximately $2,412,000. Individual award amounts are anticipated to be between $50,000 and $100,000. The amount of funding available for new and competing continuation awards issued under this grant announcement is subject to the availability of appropriations and budgetary priorities of the Agency. The IHS is under no obligation to make awards that are selected for funding under this grant announcement.

Anticipated Number of Awards

Approximately 16-18 awards will be issued under this grant announcement.

Period of Performance

The Tribal Management Grant (TMG Project) period of performance vary based on the project type selected. Period of performance could run from 1 to 3 years and will run consecutively from the earliest anticipated start date of September 1, 2018 through August 31, 2019, for 1-year projects; September 1, 2018, through August 31, 2020, for 2-year projects; and September 1, 2018, through August 31, 2021, for 3-year projects. Please refer to “Eligible TMG Project Types, Maximum Funding Levels, and Periods of Performance,” for additional details. State the number of years for the period of performance and include the exact dates.

III. Eligibility Information


1. Eligibility

Eligible Applicants: “Indian Tribes” and “Tribal Organizations” (T/TOs) as defined by the ISDEAA are eligible to apply for the TMG Program. The definitions for each entity type are outlined below. Only one application per Tribe/Tribal organization is allowed.

Definitions: “Indian Tribe” means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. 25 U.S.C. 5304(e).

“Tribal organization” means the recognized governing body of any Indian Tribe; any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult Start Printed Page 31402members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. 25 U.S.C. 5304(l).

A Tribal Organization must provide proof of non-profit status.

Eligible TMG Project Types, Maximum Funding Levels, and Project Periods: The TMG Program consists of four project types: (1) Feasibility study; (2) planning; (3) evaluation study; and (4) health management structure. Tribal applicants may submit applications for one project type only. An application must state the project type selected. Any application that address more than one project type will be considered ineligible and will not be reviewed. The maximum funding levels noted must include both direct and indirect costs. Application budgets may not exceed the maximum funding level or period of performance identified for a project type. Any application with a budget or period of performance that exceeds the maximum funding level or period of performance will be considered ineligible and will not be reviewed. Please refer to Section IV.5, “Funding Restrictions,” for further information regarding ineligible project activities.

1. FEASIBILITY STUDY (Maximum funding/project period: $70,000/12 months).

A Feasibility Study must include a study of a specific IHS program or segment of a program to determine if Tribal management of the program is possible. The study shall present the planned approach, training, and resources required to assume Tribal management of the program. The study must include the following four components:

  • Health needs and health care service assessments that identify existing health care services and delivery systems, program divisibility issues, health status indicators, unmet needs, volume projections, and demand analysis.
  • Management analysis of existing management structures, proposed management structures, implementation plans and requirements, and personnel staffing requirements and recruitment barriers.
  • Financial analysis of historical trends data, financial projections, and new resource requirements for program management costs and analysis of potential revenues from Federal/non-Federal sources.
  • Decision statement/report that incorporates findings; conclusions; and recommendations; the presentation of the study and recommendations to the Tribal governing body for determination regarding whether Tribal program assumption is desirable or warranted.

2. PLANNING (Maximum funding/project period: $50,000/12 months).

Planning projects involve data collection to establish goals and performance measures for health programs operation or anticipated PFSAs under a Title I contract. Planning projects will specify the design of health programs and the management systems (including appropriate policies and procedures) to accomplish the health priorities of the Tribe or Tribal Organization. For example, planning projects could include the development of a Tribe-specific Health Plan or a Strategic Health Plan, etc. Please note that updated Healthy People information and Healthy People 2020 objectives are available in electronic format at the following website:​healthypeople/​publications. The United States (U.S.) Public Health Service (PHS) encourages applicants submitting strategic health plans to address specific objectives of Healthy People 2020.

3. EVALUATION STUDY (Maximum funding/project period: $50,000/12 months).

An Evaluation Study must include a systematic collection, analysis, and interpretation of data for the purpose of determining the value of a program. The extent of the evaluation study could relate to the goals and objectives, policies and procedures, or programs regarding targeted groups. The evaluation study could also be used to determine the effectiveness and efficiency of a Tribe or Tribal Organization's program operations (i.e., direct services, financial management, personnel, data collection and analysis, third-party billing, etc.), as well as to determine the appropriateness of new components of a Tribe or Tribal Organization's program operations that will assist efforts to improve Tribal health care delivery systems.

4. HEALTH MANAGEMENT STRUCTURE (Average funding/project period: $100,000/12 months; maximum funding/project period: $300,000/36 months).

The first year maximum funding level is limited to $150,000 for multi-year projects. The Health Management Structure component allows for implementation of systems to manage or organize PFSAs. Management structures include health department organizations, health boards, and financial management systems, including systems for accounting, personnel, third-party billing, medical records, management information systems, etc. This includes the design, improvement, and correction of management systems that address weaknesses identified through quality control measures, internal control reviews, and audit report findings under required financial audits and ISDEAA requirements.

For the minimum standards for the management systems used by a Tribe or Tribal Organization when carrying out Self-Determination contracts, please see 25 CFR part 900, Contracts Under the Indian Self-Determination and Education Assistance Act, Subpart F—“Standards for Tribal or Tribal Organization Management Systems,” §§ 900.35-900.60. For operational provisions applicable to carrying out Self-Governance compacts, please see 42 CFR part 137, Tribal Self-Governance, Subpart I,—“Operational Provisions,” §§ 137.160-137.220.

Please refer to Section IV, “Application and Submission Information,” for information on how to obtain a copy of the TMG application package.


Please refer to Section IV, (Application and Submission Information/Subsection 2, Content and Form of Application Submission) for additional proof of applicant status documents required, such as Tribal Resolutions, proof of non-profit status, etc.

2. Cost Sharing or Matching

The IHS does not require matching funds or cost sharing for grants or cooperative agreements.

3. Other Requirements

If the application budget exceeds the highest dollar amount outlined under the “Estimated Funds Available” section within this grant announcement, the application will be considered ineligible and will not be reviewed. If deemed ineligible, the IHS will not return the application. The applicant will be notified by email by the IHS Division of Grants Management (DGM) of this decision.

The following documentation is required.

Tribal Resolution

A. An Indian Tribe or Tribal Organization that is proposing a project affecting another Tribe must include Tribal Resolutions from each affected Tribe served. Applications by Tribal Organizations will not require a specific Tribal Resolution if the current Tribal Resolution(s) under which they operate would encompass the proposed grant activities.

A signed Tribal Resolution must be received by the IHS DGM prior to a Notice of Award being issued to any Start Printed Page 31403applicant selected for funding. However, if a signed Tribal Resolution cannot be submitted with the electronic application submission prior to the official application deadline date, a draft Tribal Resolution must be submitted by the application deadline for the application to be considered complete and eligible for review. The draft Tribal Resolution is not in lieu of the required signed Tribal Resolution, but is acceptable until a signed Tribal Resolution is received. If a signed Tribal Resolution is not received by IHS DGM when funding decisions are made, then a Notice of Award will not be issued to that applicant and they will not receive any IHS funds until such time as they have submitted a signed Tribal Resolution to the Grants Management Specialist listed in this grant announcement.

B. Tribal Organizations applying for technical assistance and/or training grants must provide written notice that the Tribal Organization is applying upon the request of the Indian Tribe and/or Tribes it intends to serve.

C. Documentation for Priority I participation requires a copy of the Federal Register notice or letter from the Bureau of Indian Affairs verifying establishment of recognized Tribal status within the past 5 years. The date on the documentation must reflect that Federal recognition was received during or after March 2013.

D. Documentation for Priority II participation requires a copy of the most current transmittal letter and Attachment A from the Department of Health and Human Services (HHS), Office of Inspector General (OIG), National External Audit Review Center (NEAR). See “Funding Priorities” for more information. If an applicant is unable to provide a copy of the most recent transmittal letter or needs assistance with audit issues; information or technical assistance may be obtained by contacting the IHS Office of Finance and Accounting, Division of Audit by telephone at (301) 443-1270, or toll-free at the NEAR help line at (800) 732-0679 or (816) 426-7720. Recognized Indian Tribes or Tribal Organizations not subject to Single Audit Act requirements must provide a financial statement identifying the Federal dollars received in the footnotes. The financial statement must also identify specific weaknesses/recommendations that will be addressed in the TMG proposal and that are related to 25 CFR part 900, subpart F—“Standards for Tribal or Tribal Organization Management Systems.”

E. Documentation of Consortium participation—If an applicant is a member of an eligible intertribal consortium, the Tribe must:

—Identify the consortium.

—Indicate if any of the consortium member Tribes intend to submit a TMG application.

—Demonstrate that the Tribe's application does not duplicate or overlap any objectives of the consortium's application.

—Identify all consortium member Tribes.

—Identify if any of the consortium member Tribes intend to submit a TMG application of their own.

—Demonstrate that the consortium's application does not duplicate or overlap any objectives of other consortium members who may be submitting their own TMG application.

Funding Priorities: The IHS has established the following funding priorities for TMG awards:

  • PRIORITY I—Any Indian Tribe that has received Federal recognition (including restored, funded, or unfunded) within the past 5 years, specifically received during or after March 2013, will be considered Priority I.
  • PRIORITY II—Federally recognized Indian T/TOs submitting a new application or a competing continuation application for the sole purpose of addressing audit material weaknesses will be considered Priority II. Priority II participation is only applicable to the Health Management Structure project type. For more information, see “Eligible TMG Project Types, Maximum Funding Levels, and Project Periods,” in Section II.
  • PRIORITY III—Eligible Direct Service and Title I recognized Indian T/TOs submitting a new application or a competing continuation application will be considered Priority III.
  • PRIORITY IV—Eligible Title V Self-Governance recognized Indian T/TOs submitting a new application or a competing continuation application will be considered Priority IV.

The funding of approved Priority I applicants will occur before the funding of approved Priority II applicants. Priority II applicants will be funded before approved Priority III applicants. Priority III applicants will be funded before approved Priority IV applicants. Funds will be distributed until depleted.

The following definitions are applicable to the PRIORITY II category:

Audit finding—deficiencies that the auditor is required by 45 CFR § 75.516, to report in the schedule of findings and questioned costs.

Material weakness—“Statements on Auditing Standards 115” defines material weakness as a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis.

Significant deficiency—“Statements on Auditing Standards 115,” defines significant deficiency as a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance.

The audit findings are identified in Attachment A of the transmittal letter received from the HHS/OIG/NEAR. Please identify the material weaknesses to be addressed by underlining the item(s) listed in Attachment A.

Federally Recognized T/TOs not subject to Single Audit Act requirements must provide a financial statement identifying the Federal dollars received in the footnotes. The financial statement should also identify specific weaknesses/recommendations that will be addressed in the TMG proposal and that are related to 25 CFR part 900, “Subpart F, “Standards for Tribal and Tribal Organization Management Systems.”

Proof of Non-Profit Status

Organizations claiming non-profit status must submit proof. A copy of the 501(c)(3) Certificate must be received with the application submission by the Application Deadline Date listed under the Key Dates section on the first page of this announcement.

An applicant submitting any of the above additional documentation after the initial application submission due date is required to ensure the information was received by the IHS DGM by obtaining documentation confirming delivery (e.g., FedEx tracking, postal return receipt, etc.)


A decision to award a TMG does not represent a determination from the IHS regarding the T/TO's eligibility to contract for a specific PFSA under the ISDEAA. An application for a TMG does not constitute a contract proposal.

IV. Application and Submission Information

1. Obtaining Application Materials

The TMG application package and detailed instructions for this announcement can be found at or​dgm/​funding/​. Start Printed Page 31404

Questions regarding the electronic application process may be directed to Mr. Paul Gettys by telephone at (301) 443-2114 or (301) 443-5204.

2. Content and Form of Application Submission

Each applicant must include the project narrative as an attachment to the TMG application package. Mandatory documents for all applicants include:

  • Table of contents.
  • Abstract (1 page) summarizing the project.
  • Application forms:

○ SF-424, Application for Federal Assistance.

○ SF-424A, Budget Information—Non-Construction Programs.

○ SF-424B, Assurances—Non-Construction Programs.

  • Budget Justification and Narrative (must be single spaced and not exceed 5 pages).
  • Project Narrative (must be single spaced and not exceed 15 pages).

○ Background information on the organization.

○ Proposed scope of work, objectives, and activities that provide a description of what will be accomplished, including a 1-page Timeframe Chart.

  • Tribal Resolution(s).
  • 501(c)(3) Certificate (if applicable).
  • Position descriptions for key personnel.
  • Contractor/Consultant resumes or qualifications and scope of work.
  • Disclosure of Lobbying Activities (SF-LLL).
  • Certification Regarding Lobbying (GG-Lobbying Form).
  • Copy of current Negotiated Indirect Cost (IDC) rate agreement (required) in order to receive Indirect Cost.
  • Organizational Chart (optional).
  • Documentation of current Office of Management and Budget (OMB) Financial Audit (if applicable).

○ Email confirmation from the Federal Audit Clearinghouse (FAC) that audits were submitted; or

○ Face sheets from audit reports. These can be found on the FAC Website at​facdissem/​Main.aspx.

Public Policy Requirements

All Federal public policies apply to IHS grants and cooperative agreements, with exception of the discrimination policy.

Requirements for Project and Budget Narratives

A. Project Narrative: This narrative should be a separate Word document that is no longer than 15 pages and must be: Single-spaced, type written, have consecutively numbered pages, use black type not smaller than 12-point font, and be printed on one side only of standard size 8-1/2 by 11 inch paper.

Be sure to succinctly answer all questions listed under the evaluation criteria (refer to Section V.1, “Evaluation criteria” in this grant announcement) and place all responses and required information in the correct section (noted below), or the application shall be considered ineligible and will not be reviewed. These narratives will assist the Objective Review Committee (ORC) in becoming familiar with the applicant's activities and accomplishments prior to this possible grant award. If the narrative exceeds the page limit, only the first 15 pages will be reviewed. The 15-page limit for the narrative does not include the work plan, standard forms, Tribal Resolution(s), table of contents, budget, budget justifications, narratives, and/or other appendix items.

There are three parts to the narrative: Part A—Program Information; Part B—Program Planning and Evaluation; and Part C—Program Report. See below for additional details about what must be included in the narrative.

Part A: Program Information (2-Page Limit)

Section 1: Needs.

Describe how the T/TO has determined the need to either enhance or develop Tribal management capability to either assume PFSAs or not in the interest of Self-Determination. Note the progression of previous TMG projects/awards if applicable.

Part B: Program Planning and Evaluation (11-Page Limit)

Section 1: Program Plans.

Describe fully and clearly the direction the Tribe or Tribal Organization plans to take with the selected TMG Project type in addressing their health management infrastructure, including how the T/TO's plans to demonstrate improved health and services to the community or communities it serves. Include proposed timelines.

Section 2: Program Evaluation.

Describe fully and clearly the improvements that will be made by the Tribe or Tribal Organization that will impact their management capability or prepare them for future improvements to their organization that will allow them to manage their health care system and identify the anticipated or expected benefits for the Tribe.

Part C: Program Report (2-Page Limit)

Section 1: Describe major accomplishments over the past 24 months.

Please identify and describe significant program achievements associated with the delivery of quality health services. Provide a comparison of the actual accomplishments to the goals established for the project period, or if applicable, provide justification for the lack of progress.

Section 2: Describe major activities over the past 24 months.

Please identify and summarize recent significant health related project activities of the work done during the project period.

B. Budget Narrative (5-Page Limit)

This narrative must include a line item budget, with a justification for all expenditures that identify reasonable, allowable, and/or allocable costs necessary to accomplish the goals and objectives as outlined in the project narrative. Budget should match the scope of work described in the project narrative.

3. Submission Dates and Times

Applications must be submitted electronically through by 11:59 p.m., Eastern Daylight Time (EDT) on the Application Deadline Date listed in the Key Dates section on page 1 of this announcement. Any application received after the application deadline will not be accepted for processing, nor will it be given further consideration for funding. will notify the applicant via email if the application is rejected.

If technical challenges arise and assistance is required with the electronic application process, contact Customer Support via email at or toll-free at (800) 518-4726. Customer Support is available to address questions 24 hours per day, 7 days per week (except on Federal holidays). If problems persist, contact Mr. Gettys (, DGM Grant Systems Coordinator, by telephone at (301) 443-2114 or (301) 443-5204. Please be sure to contact Mr. Gettys at least 10 days prior to the application deadline. Please do not contact the DGM until you have received a tracking number. In the event you are not able to obtain a tracking number, call the DGM as soon as possible.

4. Intergovernmental Review

Executive Order 12372 requiring intergovernmental review is not applicable to this program.Start Printed Page 31405

5. Funding Restrictions

  • Pre-award costs are not allowable.
  • The available funds are inclusive of direct and appropriate indirect costs.
  • Only one grant will be awarded per applicant.
  • The IHS will not acknowledge receipt of applications.
  • The TMG may not be used to support recurring operational programs or to replace existing public and private resources. Funding received under a recurring Public Law 93-638 contract cannot be totally supplanted or totally replaced. Exception is allowed to charge a portion or percentage of salaries of existing staff positions involved in implementing the TMG grant, if applicable. However, this percentage of TMG funding must reflect supplementation of funding for the project and not supplantation of existing ISDEAA contract funds. Supplementation is defined as “adding to a program” whereas supplantation is defined as “taking the place of” funds. An entity cannot use the TMG funds to supplant the ISDEAA contract or recurring funding.
  • Ineligible Project Activities—The inclusion of the following projects or activities in an application will render the application ineligible.

○ Planning and negotiating activities associated with the intent of a Tribe to enter the IHS Self-Governance Project. A separate grant program is administered by the IHS for this purpose. If you are interested in this program, please contact Mr. Jeremy Marshall, Policy Analyst, Office of Tribal Self-Governance, or Ms. Roxanne Houston, Program Analyst, Office of Tribal Self-Governance, Indian Health Service, 5600 Fishers Lane, Mail Stop 08E05, Rockville, MD, 20857, (301) 443-7821, and request information concerning the “Tribal Self-Governance Program Planning Cooperative Agreement Announcement” or the “Negotiation Cooperative Agreement Announcement.”

○ Projects related to water, sanitation, and waste management.

○ Projects that include direct patient care and/or equipment to provide those medical services to be used to establish, or augment, or continue direct patient clinical care. Medical equipment that is allowable under the Special Diabetes Program for Indians is not allowable under the TMG Program.

○ Projects that include recruitment efforts for direct patient care services.

○ Projects that include long-term care or provision of any direct services.

○ Projects that include tuition, fees, or stipends for certification or training of staff to provide direct services.

○ Projects that include pre-planning, design, and planning of construction for facilities, including activities relating to program justification documents.

○ Projects that propose more than one project type. Refer to Section II, “Award Information,” specifically “Eligible TMG Project Types, Maximum Funding Levels, and Project Periods,” for more information. An example of a proposal with more than one project type that would be considered ineligible may include the creation of a strategic health plan (defined by TMG as a planning project type) and improving third-party billing structures (defined by TMG as a health management structure project type). Multi-year applications that include in the first year planning, evaluation, or feasibility activities with the remainder of the project years addressing management structure are also deemed ineligible.

○ Any Alaska Native Village that is neither a Title I nor a Title V organization and does not have the legal authority to contract services under the ISDEAA as it is affiliated with one of the Alaska health corporations as a consortium member and has all of its IHS funding for the Village administered through an Alaska health corporation, a Title V compactor, is not eligible for consideration under the TMG program.

Moreover, Congress has reenacted its moratorium in Alaska on new contracting under the ISDEAA with Alaska Native Tribes that do not already have contracts or compacts with the IHS under this Act. See the Consolidated Appropriations Act, 2014 (Jan. 17, 2014), Public Law 113-76, 128 Stat. 5, 343-44: § 424. (a) Notwithstanding any other provision of law, and until October 1, 2018, the IHS may not disburse funds for the provision of health care services pursuant to Public Law 93-638 (25 U.S.C. 5301 et seq.) to any Alaska Native Village or Alaska Native Village corporation that is located within the area served by an Alaska Native regional health entity.

Consequently, Alaska Native Villages will not have any opportunity to enter into an ISDEAA contract with the IHS unless this law lapses on October 1, 2018, due to congressional inaction.

  • Other Limitations—A current TMG recipient cannot be awarded a new, renewal, or competing continuation grant for any of the following reasons:

○ The grantee will be administering two TMGs at the same time or have overlapping project/budget periods;

○ The current project is not progressing in a satisfactory manner;

○ The current project is not in compliance with program and financial reporting requirements; or

○ The applicant has an outstanding delinquent Federal debt. No award shall be made until either:

The delinquent account is paid in full; or

A negotiated repayment schedule is established and at least one payment is received.

6. Electronic Submission Requirements

All applications must be submitted electronically. Please use the website to submit an application electronically and select the “Find Grant Opportunities” link on the homepage. Follow the instructions for submitting an application under the Package tab. Electronic copies of the application may not be submitted as attachments to email messages addressed to IHS employees or offices.

If the applicant needs to submit a paper application instead of submitting electronically through, a waiver must be requested. Prior approval must be requested and obtained from Mr. Robert Tarwater, Director, DGM, IHS (see Section IV.6 below for additional information). A written waiver request must be sent to with a copy to The waiver must: (1) Be documented in writing (emails are acceptable), before submitting a paper application; and (2) include clear justification for the need to deviate from the required electronic grants submission process.

Once the waiver request has been approved, the applicant will receive a confirmation of approval email containing submission instructions and the mailing address to submit the application. A copy of the written waiver must be submitted along with the copy of the application that is mailed to DGM. Paper applications that are submitted without a copy of the signed waiver from the Director, DGM, will not be reviewed or considered for funding. The applicant will be notified via email of this decision by the Grants Management Officer of the DGM. Paper applications must be received by the DGM no later than 5:00 p.m., EDT, on the Application Deadline Date listed in the Key Dates section on page 1 of this announcement. Late applications will not be accepted for processing or considered for funding. An applicant who does not adhere to the timelines for System for Award Management (SAM) and/or registration or who fails to request timely assistance with technical issues Start Printed Page 31406will not be considered for a waiver to submit a paper application.

Please be aware of the following:

  • Please search for the application package in by entering the CFDA number or the Funding Announcement Number. Both numbers are located in the header of this announcement.
  • If you experience technical challenges while submitting your application electronically, please contact support directly at: or toll-free at (800) 518-4726. Customer Support is available to address questions 24 hours per day, 7 days per week (except on Federal holidays).
  • Upon contacting, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver from the Agency must be obtained.
  • Applicants are strongly encouraged not to wait until the deadline date to begin the application process through as the registration process for SAM and could take up to 15 working days.
  • Please use the optional attachment feature in to attach additional documentation that may be requested by the DGM.
  • All applicants must comply with any page limitation requirements described in this funding announcement.
  • After electronically submitting the application, the applicant will receive an automatic acknowledgment from that contains a tracking number. The DGM will download the application from and provide necessary copies to the appropriate Agency officials. Neither the DGM, nor the IHS Office of Direct Service and Contracting Tribes (ODSCT) will notify the applicant that the application has been received.
  • Email applications will not be accepted under this announcement.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)

All IHS applicants and grantee organizations are required to obtain a DUNS number and maintain an active registration in the SAM database. The DUNS number is a unique 9-digit identification number provided by D&B that uniquely identifies each entity. The DUNS number is site specific; therefore, each distinct performance site may be assigned a DUNS number. Obtaining a DUNS number is easy, and there is no charge. To obtain a DUNS number, you may access it through​webform, or to expedite the process, call (866) 705-5711.

All HHS recipients are required by the Federal Funding Accountability and Transparency Act of 2006, as amended (Transparency Act), to report information on sub-awards. Accordingly, all IHS grantees must notify potential first-tier sub-recipients that no entity may receive a first-tier sub-award unless the entity has provided its DUNS number to the prime grantee organization. This requirement ensures the use of a universal identifier to enhance the quality of information available to the public pursuant to the Transparency Act.

System for Award Management (SAM)

Organizations that were not registered with Central Contractor Registration and have not registered with SAM will need to obtain a DUNS number first and then access the SAM online registration through the SAM home page at (U.S. organizations will also need to provide an Employer Identification Number from the Internal Revenue Service that may take an additional 2-5 weeks to become active). Completing and submitting the registration takes approximately one hour to complete and SAM registration will take 3-5 business days to process. Registration with the SAM is free of charge. Applicants may register online at

Additional information on implementing the Transparency Act, including the specific requirements for DUNS and the SAM, can be found on the IHS Grants Management, Grants Policy website at​dgm/​policytopics/​.

V. Application Review Information

The instructions for preparing the application narrative also constitute the evaluation criteria for reviewing and scoring the application. Weights assigned to each section are noted in parentheses. The 15-page narrative should include only the first year of activities; information for multi-year projects should be included as an appendix. See “Multi-Year Project Requirements,” at the end of this section for more information. The narrative section should be written in a manner that is clear to outside reviewers unfamiliar with prior related activities of the applicant. It should be well-organized, succinct, and contain all information necessary for reviewers to understand the project fully. Points will be assigned to each evaluation criteria adding up to a total of 100 points. A minimum score of 70 points is required for funding. Points are assigned as follows:

1. Criteria

A. Introduction and Need for Assistance (20 Points)

(1) Describe the Tribe or Tribal Organization's current health operation. Include a list of programs and services that are currently provided (e.g., federally funded, State-funded, etc.), information regarding technologies currently used (e.g., hardware, software, services, etc.), and identify the source(s) of technical support for those technologies (i.e., Tribal staff, Area office IHS, vendor, etc.). Include information regarding whether the Tribe or Tribal Organization has a health department and/or health board and how long it has been operating.

(2) Describe the population to be served by the proposed project. Include the total number of eligible IHS beneficiaries currently using the services.

(3) Describe the geographic location of the proposed project, including any geographic barriers to health care users in the area to be served.

(4) Identify all TMGs received since FY 2013, dates of funding, and a summary of project accomplishments. State how previous TMG funds facilitated the progression of health development relative to the current proposed project. (Copies of reports will not be accepted.)

(5) Identify the eligible project type and priority group of the applicant.

(6) Explain the need or reason for the proposed TMG project. Identify specific weaknesses and gaps in service or infrastructure that will be addressed by the proposal. Explain how these gaps and weaknesses will be assessed.

(7) If the proposed TMG project includes information technology (i.e., hardware, software, etc.), provide further information regarding measures that have occurred or will occur to ensure the proposed project will not create other gaps in services or infrastructure (e.g., negatively affect or impact IHS interface capability, Government Performance and Results Act reporting requirements, contract reporting requirements, Information Technology (IT) compatibility, etc.) if applicable.

(8) Describe the effect of the proposed TMG project on current programs (e.g., federally funded, State-funded, etc.), and if applicable, on current equipment (e.g., hardware, software, services, etc.). Include the effect of the proposed project on planned or anticipated programs and equipment.Start Printed Page 31407

(9) Address how the proposed TMG project relates to the purpose of the TMG Program by addressing the appropriate description that follows:

  • Identify whether the Tribe or Tribal Organization is an IHS Title I contractor. Address if the Self-Determination contract is a master contract of several programs or if individual contracts are used for each program. Include information regarding whether or not the Tribe or Tribal Organization participates in a consortium contract (i.e., more than one Tribe participating in a contract). Address what programs are currently provided through those contracts and how the proposed TMG project will enhance the organization's capacity to manage the contracts currently in place.
  • Identify if the Tribe or Tribal Organization is not a Title I organization. Address how the proposed TMG project will enhance the organization's management capabilities, what programs and services the organization is currently seeking to contract and an anticipated date for contract.
  • Identify if the Tribe or Tribal Organization is an IHS Title V compactor. Address when the Tribe or Tribal Organization entered into the compact and how the proposed project will further enhance the organization's management capabilities.

B. Project Objectives, Work Plan, and Approach (40 Points)

(1) The proposed project objectives must be:

  • Measureable and (if applicable) quantifiable.
  • Results-oriented.
  • Time-limited.

Example: By installing new third-party billing software, the Tribe proposes to increase the number of claims processed by 15 percent within 12 months.

(2) For each objective address how the proposed TMG project will result in change or improvement in program operations or processes. Also address what tangible products are expected from the project (i.e., policies and procedures manual, health plan, etc.)

(3) Address the extent to which the proposed project will build local capacity to provide, improve, or expand services that address the needs of the target population.

(4) Submit a work plan in the Appendix that includes the following:

  • Provide action steps on a timeline for accomplishing the proposed project objectives.
  • Identify who will perform the action steps.
  • Identify who will supervise the action steps taken.
  • Identify tangible products that will be produced during and at the end of the proposed project.
  • Identify who will accept and/or approve work products during the duration of the proposed TMG project and at the end of the proposed project.
  • Include a description of any training activities proposed. This description will identify the target audience and training personnel.
  • Include work plan evaluation activities

(5) If consultants or contractors will be used during the proposed project, please complete the following information in their scope of work. (If consultants or contractors will not be used, please make note in this section):

  • Educational requirements.
  • Desired qualifications and work experience.
  • Expected work products to be delivered, including a timeline.

If potential consultants or contractors have already been identified, please include a resume for each consultant or contractor in the Appendix.

(6) Describe updates that will be required for the continued success of the proposed TMG project (i.e., revision of policies/procedures, upgrades, technical support, etc.) Include a timeline of anticipated updates and source of funding to conduct the update and/or maintenance.

C. Program Evaluation (20 Points)

Each proposed objective requires an evaluation activity to assess its progression and ensure completion. This should be included in the work plan.

Describe the proposal's plan to evaluate project processes and outcomes. Outcome evaluation relates to the results identified in the objectives, and process evaluation relates to the work plan and activities of the project.

(1) For outcome evaluation, describe:

  • The criteria for determining whether or not each objective was met.
  • The data to be collected to determine whether the objective was met.
  • Data collection intervals.
  • Who will be responsible for collecting the data and their qualifications.
  • Data analysis method.
  • How the results will be used.

(2) For process evaluation, describe:

  • The process for monitoring and assessing potential problems, then identifying quality improvements.
  • Who will be responsible for monitoring and managing project improvements based on results of ongoing process improvements and their qualifications.
  • Provide details with regards to the ways ongoing monitoring will be used to improve the project.
  • Describe any products, such as manuals or policies, that might be developed and how they might lend themselves to replication by others.
  • How the Tribe or Tribal Organization will document what is learned throughout the project period.

(3) Describe any additional evaluation efforts planned after the grant period has ended.

(4) Describe the ultimate benefit to the Tribe or Tribal Organization that is expected to result from this project. An example would be a Tribe or Tribal Organization's ability to expand preventive health services because of increased billing and third-party payments.

D. Organizational Capabilities, Key Personnel, and Qualifications (15 Points)

This section outlines the Tribe or Tribal Organization's capacity to complete the proposal outlined in the work plan. It includes the identification of personnel responsible for completing tasks and the chain of responsibility for completion of the proposed plan.

(1) Provide the organizational structure of the Tribe or Tribal Organization.

(2) Provide information regarding plans to obtain management systems if a Tribe or Tribal Organization does not have an established management system currently in place that complies with 25 CFR part 900, subpart F, “Standards for Tribal or Tribal Organization Management Systems.” State if management systems are already in place and how long the systems have been in place.

(3) Describe the ability of the Tribe or Tribal Organization to manage the proposed project. Include information regarding similarly sized projects in scope and financial assistance as well as other grants and projects successfully completed.

(4) Describe equipment (e.g., fax machine, telephone, computer, etc.) and facility space (i.e., office space) will be available for use during the proposed project. Include information about any equipment not currently available that will be purchased through the grant.

(5) List key project personnel and their titles in the work plan. Provide the position descriptions and resumes for all key personnel in the Appendix. The included position descriptions should: (1) Clearly describe each position's Start Printed Page 31408duties; and (2) indicate desired qualifications and project associated experience. Each resume must include a statement indicating that the proposed key personnel is explicitly qualified to carry out the proposed project activities. If no current candidate for a position exists please provide a statement to that effect in the Appendix.

(6) If an individual is partially funded by this grant, indicate the percentage of his or her time to be allocated to the project and identify the resources used to fund the remainder of that individual's salary.

(7) Address how the Tribe/Tribal Organization will sustain the proposal created positions after the grant expires. Please indicate if the project requires additional personnel (i.e., IT support, etc.) If no additional personnel is required please indicate that in this section.

E. Categorical Budget and Budget Justification (5 Points)

(1) Provide a categorical budget for each of the 12-month budget periods requested.

(2) If indirect costs are claimed, indicate and apply the current negotiated rate to the budget. Include a copy of the rate agreement in the Appendix.

(3) Provide a narrative justification explaining why each categorical budget line item is necessary and relevant to the proposed project. Include sufficient cost and other details to facilitate the determination of cost allowability (e.g., equipment specifications, etc.)

Multi-Year Project Requirements

For projects requiring a second and/or third year, include only Year 2 and/or Year 3 narrative sections (objectives, evaluation components, and work plan) that differ from those in Year 1. For every project year, include a full budget justification and a detailed, itemized categorical budget showing calculation methodologies for each item. The same weights and criteria that are used to evaluate a 1-year project or the first year of a multi-year project will be applied when evaluating the second and third years of a multi-year application. A weak second and/or third year submission could negatively impact the overall score of an application and result in elimination of the proposed second and/or third years with a recommendation for only a 1-year award.

Additional documents can be uploaded as Appendix Items in

  • Work plan, logic model, and/or timeline for proposed objectives.
  • Position descriptions for key staff.
  • Resumes of key staff that reflect current duties.
  • Consultant or contractor proposed scope of work and letter of commitment (if applicable).
  • Current Indirect Cost Agreement.
  • Organizational chart.
  • Additional documents to support narrative (e.g., data tables, key news articles, etc.).

2. Review and Selection

Each application will be prescreened by DGM staff for eligibility and completeness as outlined in this funding announcement. Applications that meet the eligibility criteria shall be reviewed for merit by the ORC based on evaluation criteria in this funding announcement. The ORC could be composed of both Tribal and Federal reviewers appointed by the IHS program to review and make recommendations on these applications. The technical review process ensures selection of quality projects in a national competition for limited funding. Incomplete applications and applications that are non-responsive to the eligibility criteria will not be referred to the ORC. The applicant will be notified via email of this decision by the DGM Grants Management Officer. Applicants will be notified by the DGM, via email, to outline minor missing components (e.g., budget narratives, audit documentation, key contact form, etc.) needed for an otherwise complete application. All missing documents must be sent to the DGM on or before the due date listed in the email of notification of missing documents required.

To obtain a minimum score for funding by the ORC, applicants must address all program requirements and provide all required documentation.

Please note that a decision to award a TMG does not represent a determination from the IHS regarding the Tribe or Tribal Organization's eligibility to contract for a specific PFSA under the ISDEAA. An application for a TMG does not constitute a contract proposal.

VI. Award Administration Information

1. Award Notices

The Notice of Award (NoA) is a legally binding document signed by the Grants Management Officer that serves as the official notification of the TMG award. The NoA will be initiated by the DGM in our grant system, GrantSolutions ( Each entity approved for funding under this announcement will need to request or have a user account in GrantSolutions in order to retrieve their NoA. The NoA is the authorizing document for which funds are dispersed to the approved entities and reflects the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period.

Disapproved Applications

Applicants that received a score less than the recommended funding level for approval (70 points) and that are deemed to be disapproved by the ORC, will receive an Executive Summary Statement from the IHS ODSCT within 30 days of the conclusion of the ORC, outlining the strengths and weaknesses of their application submitted. The summary statement will be sent to the Authorized Organizational Representative identified on the face page (SF-424) of the application. The IHS ODSCT will also provide additional contact information as needed to address questions and concerns, as well as provide technical assistance if desired.

Approved but Unfunded Applications

Approved but unfunded applications that met the minimum scoring range and that are deemed by the ORC to be “Approved,” but were not funded due to lack of TMG funding, will have their applications held by DGM for a period of 1 year. If additional funding becomes available during the course of FY 2018, the approved, but unfunded application may be re-considered by the awarding program office for possible funding. The applicant will also receive an Executive Summary Statement from the IHS program office within 30 days of the conclusion of the ORC.


Any correspondence other than the official NoA signed by an IHS grants management official announcing to the project director that an award has been made to their organization is not an authorization to implement their program on behalf of IHS.

2. Administrative Requirements

Grants are administered in accordance with the following regulations and policies:

A. The criteria as outlined in this program announcement.

B. Uniform Administrative Regulations for Grants:Start Printed Page 31409

  • Uniform Administrative Requirements for HHS Awards, located at 45 CFR part 75.

C. Grants Policy:

  • HHS Grants Policy Statement, Revised January 2007.

D. Cost Principles:

  • Uniform Administrative Requirements for HHS Awards, “Cost Principles,” located at 45 CFR part 75, subpart E.

E. Audit Requirements:

  • Uniform Administrative Requirements for HHS Awards, “Audit Requirements,” located at 45 CFR part 75, subpart F.

3. Indirect Costs

This section applies to all TMG recipients who request reimbursement of IDC in their grant application. In accordance with HHS Grants Policy Statement, Part II-27, the IHS requires applicants to obtain a current IDC rate agreement prior to award. The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate covers the applicable grant activities under the current award's budget period. If the current rate is not on file with the DGM at the time of award, the IDC portion of the budget will be restricted. The restrictions remain in place until the current rate is provided to the DGM.

Generally, IDC rates for IHS grantees are negotiated with the Division of Cost Allocation (DCA)​ and the Department of the Interior (Interior Business Center)​ibc/​services/​finance/​indirect-Cost-Services/​indian-tribes. For questions regarding the IDC policy, please contact the Grants Management Specialist listed under “Agency Contacts,” or the main DGM office by telephone (301) 443-5204.

4. Reporting Requirements

The grantee must submit required reports consistent with the applicable TMG deadlines. Failure to submit required reports within the time allowed may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions, such as withholding payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in one or both of the following: (1) The imposition of special award provisions; and/or (2) non-funding or non-award of other eligible projects or activities. This requirement applies whether the delinquency is attributable to the failure of the grantee organization or the individual responsible for preparation of the reports. Per IHS DGM policy, all reports are required to be submitted electronically by attaching them as a “Grant Note” in GrantSolutions. Personnel responsible for submitting reports will be required to obtain a login and password for GrantSolutions. Please see the Agency Contacts list in Section VII for systems contact information.

The reporting requirements for this program are noted below.

A. Progress Reports

Program progress reports are required semi-annually within 30 days after the budget period ends. These reports must include the following: A brief comparison of actual accomplishments to the goals established for the period, or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the budget/project period.

B. Financial Reports

Federal Financial Report FFR (SF-425), Cash Transaction Reports are due 30 days after the close of every calendar quarter to the Payment Management Services, HHS, at It is recommended that the applicant also send a copy of the FFR (SF-425) report to the Grants Management Specialist. Failure to submit timely reports may cause a disruption in timely payments to the organization.

Grantees are responsible and accountable for accurate information being reported on all required reports: The Progress Reports and FFR.

C. Federal Sub-Award Reporting System (FSRS)

This award may be subject to the Transparency Act sub-award and executive compensation reporting requirements at 2 CFR part 170.

The Transparency Act requires the OMB to establish a single searchable database, accessible to the public, with information on financial assistance awards made by Federal agencies. The Transparency Act also includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards.

The IHS has implemented a Term of Award into all IHS Standard Terms and Conditions, NoAs, and funding announcements regarding the FSRS reporting requirement. This IHS Term of Award is applicable to all IHS grant and cooperative agreements issued on or after October 1, 2010, with a $25,000 sub-award obligation dollar threshold met for any specific reporting period. Additionally, all new (discretionary) IHS awards (when the period of performance is made up of more than one budget period) and: (1) The period of performance start date was October 1, 2010, or after; and (2) the primary awardee will have a $25,000 sub-award obligation dollar threshold during any specific reporting period will be required to address the FSRS reporting.

For the full IHS award term implementing this requirement and additional award applicability information, visit the DGM Grants Policy website at​dgm/​policytopics/​.

D. Compliance With Executive Order 13166 Implementation of Services Accessibility Provisions for All Grant Application Packages and Funding Opportunity Announcements

Recipients of Federal financial assistance (FFA) from the HHS must administer their programs in compliance with Federal civil rights law. This means that recipients of HHS funds must ensure equal access to their programs without regard to a person's race, color, national origin, disability, age and, in some circumstances, sex and religion. HHS provides guidance to FFA recipients on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. Please see​civil-rights/​for-individuals/​special-topics/​limited-english-proficiency/​guidance-federal-financial-assistance-recipients-title-VI/​.

The HHS Office for Civil Rights (OCR) also provides guidance on civil rights law enforcement compliance. Please see​civil-rights/​for-individuals/​section-1557/​index.html;​ and​civil-rights/​index.html. Recipients of FFA also have specific legal obligations for serving qualified individuals with disabilities. Please see​civil-rights/​for-individuals/​disability/​index.html. Please contact the HHS OCR for additional information about obligations and prohibitions under Federal civil rights laws at​ocr/​about-us/​contact-us/​index.html or toll-free by telephone at (800) 368-1019 or TDD (800) 537-7697. Also note it is an HHS goal to ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations. For further guidance on providing culturally and linguistically appropriate services, recipients should review the Start Printed Page 31410National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care at​omh/​browse.aspx?​lvl=​2&​lvlid=​53.

Pursuant to 45 CFR 80.3(d), an individual shall not be deemed subjected to discrimination by reason of his or her exclusion from benefits limited by Federal law to individuals eligible for benefits and services from the IHS.

Recipients will be required to sign the HHS-690 Assurance of Compliance form which can be obtained from the following website:​sites/​default/​files/​forms/​hhs-690.pdf, and send it directly to the: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Room 509F, Washington, DC 20201.

E. Federal Awardee Performance and Integrity Information System (FAPIIS)

The IHS is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) before making any award in excess of the simplified acquisition threshold (currently $150,000) over the period of performance. An applicant may review and comment on any information about itself that a Federal awarding agency previously entered. The IHS will consider any comments by the applicant, in addition to other information in FAPIIS in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by the applicant as described in 45 CFR 75.205.

As required by 45 CFR part 75 Appendix XII of the Uniform Guidance, non-Federal entities (NFEs) are required to disclose in FAPIIS any information about criminal, civil, and administrative proceedings, and/or affirm that there is no new information to provide. This applies to NFEs that receive Federal awards (currently active grants, cooperative agreements, and procurement contracts) greater than $10,000,000 for any period of time during the period of performance of an award/project.

Mandatory Disclosure Requirements

As required by 2 CFR part 200 of the Uniform Guidance, and the HHS implementing regulations at 45 CFR part 75, effective January 1, 2016, the IHS must require a non-Federal entity or an applicant for a Federal award to disclose, in a timely manner, in writing, to the IHS or pass-through entity, all violations of Federal criminal law involving fraud, bribery, or gratutity violations potentially affecting the Federal award.

Submission is required for all applicants and recipients, in writing, to the IHS and to the HHS Office of Inspector General. 45 CFR 75.113.

Disclosures must be sent in writing to: U.S. Department of Health and Human Services, Indian Health Service, Division of Grants Management, ATTN: Robert Tarwater, Director, 5600 Fishers Lane, Mailstop: 09E70, Rockville, MD 20857. (Include “Mandatory Grant Disclosures” in subject line).

Telephone: (301) 443-5204.

Fax: (301) 594-0899.



U.S. Department of Health and Human Services, Office of Inspector General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 20201.

Website:​fraud/​reportfraud/​index.asp. (Include “Manatory Grant Disclosures” in subject line).

Fa x: (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or


Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371 Remedies for noncompliance, including suspension or debarment (See 2 CFR part 180 and Part 376, and 31 U.S.C. 3321).

VII. Agency Contacts

1. Questions on the programmatic issues may be directed to: Ms. Roselyn Tso, Director, Office of Direct Service and Contracting Tribes, Indian Health Service, 5600 Fishers Lane, Mail Stop: 08E17, Rockville, MD 20857, Telephone: (301) 443-1104, Email:

2. Questions on grants management and fiscal matters may be directed to: Ms. Vanietta Armstrong, Grants Management Specialist, Indian Health Service, OMS/DGM, 5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Telephone: (301) 443-4792, Fax: (301) 594-0899, Email:

3. Questions on technical systems matters may be directed to: Mr. Paul Gettys, Grant Systems Coordinator, 5600 Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Telephone: (301) 443-2114; or the DGM main line (301) 443-5204, Fax: (301) 594-0899, Email:

VIII. Other Information

The Public Health Service strongly encourages all recipients of cooperative agreement and contracts provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Pubic Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of the facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the HHS mission to protect and advance the physical and mental health of the American people.

Start Signature

Dated: June 26, 2018.

Michael D. Weahkee,

RADM, Assistant Surgeon General, USPHS, Acting Director, Indian Health Service.

End Signature End Preamble

[FR Doc. 2018-14426 Filed 7-3-18; 8:45 am]