10.14.05.13

.13 Application Process for Cancer Secondary Prevention Grants.

An applicant for a cancer secondary prevention grant shall:

A. Submit a completed application to the CCPC by the due date stated in the application packet; and

B. Include in the application packet the following information, as specified in the Department's application packet:

(1) An executive summary describing:

(a) How the grant funds will be used;

(b) What persons will be involved in the application;

(c) What cancer secondary prevention activities will be conducted;

(d) Whether the proposed activities are included in a recommendation in the Maryland Comprehensive Cancer Control Plan;

(e) What population groups will be served and in what jurisdiction groups will be served;

(f) What services will be offered, such as:

(i) Outreach;

(ii) Screening;

(iii) Case management;

(iv) Quality assurance;

(v) Data collection; and

(vi) Partnership building;

(g) What the eligibility for services will be; and

(h) What outcome is expected as a result of the grant funds;

(2) A description of previous literature in the area documenting the effectiveness of the cancer secondary prevention activity;

(3) A description and justification of the need for the cancer secondary prevention activity in the population group to be served;

(4) A description of the population to be served including, at a minimum, a description of the following for the individuals to be served:

(a) Age;

(b) Race;

(c) Gender;

(d) Residency;

(e) Educational level;

(f) Income level; and

(g) Health insurance requirements of persons to be served;

(5) A description of the screening guidelines to be used for clinical services and the eligibility guidelines for these services, including age, symptoms, and, if appropriate, risk factors;

(6) A description of the reimbursement levels to be used for clinical services provided with grant funds;

(7) A proposed cancer secondary prevention plan describing:

(a) The estimated number of individuals to be served;

(b) The goals, objectives, and activities to be conducted with the grant funds;

(c) Evaluation measures for each activity;

(d) Who will be involved in the plan; and

(e) What the expected results of the funded activity are;

(8) A description of how the proposed cancer secondary prevention activities will address the goal of eliminating disparities between racial and ethnic minorities and the white population;

(9) A list of key staff to be involved in the project, including:

(a) If existing staff will be used in the project, a description of the experience of the key staff in carrying out similar cancer secondary prevention activities; or

(b) If new staff will be hired for this activity, a job description of the staff responsible for carrying out the project;

(10) A description of the previous experience of the applicant's organization in implementing similar cancer secondary prevention activities;

(11) A timeline showing the expected start date and completion date for each activity to be conducted with the grant funds;

(12) An organizational chart showing:

(a) Where the cancer secondary prevention grant activities fall within the applicant's organizational structure; and

(b) The relationship of the applicant with other organizations involved in the project;

(13) A statement that the grant funds will not be used to supplant any existing funding for this cancer secondary prevention activity and, if an applicant receives funding for a similar cancer secondary prevention activity, a list of the funding:

(a) Source;

(b) Amount; and

(c) Period for the activity;

(14) A line item budget for the cancer secondary prevention grant; and

(15) A written budget justification for each line item requested.