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DEPARTMENTOFHEALTH
8<
HUMANSERVICES
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OfficeoftheAssistantSecretaryforLegislationWashington,D.C.20201
JU"
1
a
2012
TheHonorableSusanCollinsRankingMemberCommitteeonHomelandSecurityandGovernmentalAffairsUnitedStatesSenateWashington,D.C.20515DearSenatorCollins:SecretarySebeliushasaskedmetothankyouforyourletterregardingtheCentersforDiseaseControlandPrevention's(CDC)programsanditsproperuseoffederalfunds,andaskedmetorespondonherbehalf.Weappreciateyoursupportforwellnessandpreventioneffortsandyourcommitmenttoensuringthatfederalfundsarebeingusedappropriately.TheDepartmentofHealthandHumanServices(HHS)andCDCshareyourcommitmenttotheseprinciples.Chronicdiseasessuchasheartdisease,cancer,anddiabetesaretheleadingcausesofdeathanddisability,accountingfor70percentofalldeathsintheUnitedStates.ThesediseasescausemajorlimitationsindailylivingforaboutoneoutoftenAmericans.Chronicdiseasesarealsocostly,accountingforapproximately75percentofthe$2.5trillionourNationspendsannuallyonhealthcare,yetchronicdiseasesarealsoamongthemostpreventable.Lackofphysicalactivityandpoornutrition-twomodifiableriskfactorsforobesity-andtobaccouseareresponsibleformuchoftheillness,suffering,anddeathrelatedtochronicdiseases.TheCommunitiesPuttingPreventiontoWork(CPPW)program,fundedinFY2009throughtheRecoveryAct,isnearingconclusion,withmostgranteeactivityhavingbeencompleted.Throughtheprogram,CDChasworkedwithawardrecipientsinall50states,theDistrictofColumbia,PuertoRico,andsixPacificIslandterritoriestoaddresschronicdiseaseriskfactors,includingobesityandtobaccouse.Theseeffortsareleadingtobroad,high-impact,sustainablehealthoutcomesforcommunitiesandstatesacrosstheNation.CPPWgrantsarelocally-driveninitiatives.Awardeesproposedandhavecarriedoutactivitiesthatbestmettheneedsoftheircitizensandaddressedchronicdiseaseburdenintheirrespectivecommunities.CDCprovidedresourcestosupportawardees'effortstocreatehealthyenvironmentsfortheirresidents.Amongtheactivitiesawardeescouldchoosetopursuetowardtheseends,itwaspermissibletoincludeinteractionwithpolicymakersandthepubliconlytotheextenttheinteractionwasconsistentwithapplicablelobbyingrestrictions.Federallawallowsmanyactivitiesthatarenotconsideredlobbyingandthatcommunityawardeesmaydecidetopursue.Forexample,awardeescouldusefundstodisseminateinformationaboutpublichealthproblemsandscience-basedsolutionsandtoimplementspecificprograms,suchasevidence-basededucationalmaterialsandmediaonthehealtheffectsofincreasingphysicalactivityordecreasingexposure
 
TheHonorableSusanCollinsPageTwotosecondhandsmoke.EngagementinthesekindsofactivitiesunderCPPWgrantsisconsistentwithapplicablegrantconditionsthatprohibiteduseofCDCfundsforlobbyingactivities,discussedbelow.IncreatingtheCPPWprogram,Congressrecognizedtheimportanceofevidence-based"programsdesignedtoreducechronicdiseases.OneofCDC'sobjectiveswastoprovideguidancetopotentialgranteesontherangeofeffectiveinterventionsontobacco,nutrition,andphysicalactivitythatwouldberesponsivetoCongressionalintent.
In
the"MAPPS(Media,Access,PointofDecisionInformation,Price,andSocialSupport
&
Services)InterventionsforCommunitiesPuttingPreventiontoWork",CDCprovidedanextensivemenuofinterventionsthathadbeenreviewedintheliterature,aswellasexpertsynthesesfrom
TheCommunityGuide
andotherpeer-reviewedsources,forgranteestouseindesigningstrategiesthataddressedcommunity-identifiedneeds.SomeoftheMAPPSinterventionsrelatedtonutritionandphysicalactivityarediscussedinmoredetailinanotherdocument,"NutritionandPhysicalActivityInformationforAmericanRecoveryandReinvestmentAct(RecoveryAct)CommunitiesPuttingPreventiontoWork".Thesedocuments,referencedinyourletter,wereuniquetotheCPPWprogramguidanceandhavenotbeenusedinotherCDCgrantguidance.TherearemanyeffectiveinterventionsintheliteratureandMAPPSthatinvolvearangeofactivities;however,itisimportanttonotethatindesigningspecificimplementationstrategiesandworkplans,granteesweresubjecttomultipleconditionsontheappropriateuseofCPPWfunding,asriotedbelow.UseofCDCfundsforlobbyingactivitiesbyCPPWgranteesandtheirsub-awardeeswasprohibitedundertheCDCgrantaward.HHSiscommittedtoensuringtheproperuseofappropriatedfunds,andtoensuringawardees'compliancewithallapplicableregulationsandstatutesrelatedtolobbyingactivities,suchasOfficeofManagementandBudget(OMB)CircularA;-122:CostPrinciplesforNon-ProfitOrganizations;OMBCircularA-87:CostPrinciplesforState,Local,andIndianTribalGovernments;andourownpolicyregardinglobbyingactivities.CDC'spolicyprohibitslobbyingatthefederal,state,andlocallevels.TheserestrictionsapplytoallCDCgrants,includingtheCPPWprogram.AllCDCawardeesareinformedatmultiplejuncturesaboutthefederallawsrelatingtouseoffederalfunds,includingapplicableanti-lobbyingprovisions.CDC's
AdditionalRequirement
12,
"LobbyingRestrictions"
(AR-12)(enclosed)statesCDC'spolicyprohibitingawardeesfromusinganyappropriatedfederalfundsfor"anyactivitydesignedtoinfluenceactioninregardtoaparticularpieceofpendinglegislation."ThislobbyingprohibitionwasincludedwithintherespectivefundingopportunityannouncementsfortheCPPWCommunities,StatesandTerritoriesprogramsandwasalsoincludedwithinthetermsandconditionstowhicheachawardeeagreedpriortoreceivingfederal"funds.CDC'spolicyonlobbyingbygrantees,asexpressedintheenclosedAR-12,hasbeeninplaceforoveradecade.
 
TheHonorableSusanCollinsPageThreeInadditiontomakingtheserestrictionspartofgrantawards,toensuregranteesunderstoodthelimitsonuseoftheawards,includinglimitsonapplicationoftheMAPPSstrategies,CDCstaffhasprovidednumerousremindersandconductedtrainingsforCPPWawardeesontheseprohibitions,includingthefollowing:•FundedCPPWcommunitieswereexplicitlyremindedoftheprohibitiononusingfederalfundsforlobbyingactivityduringanall-handsteleconferencepriortoacceptanceoftheirawardsonFebruary17,2010;•HHS'sOfficeofGeneralCounselreiteratedtheprohibitionsagainstlobbyingandemphasizedtherestrictionsimposedbyAR-12attheCPPWCommunitieskick-offmeetinginApril2010;•.CPPWStateandTerritoryawardeeswereremindedoftheprohibitiononusingfederalfundsforlobbyingactivityattrainingsessionsinMarch2010andJune2010aswellasattheawardees'FallInstitute2010andataMarch2011trainingsession;and•AllCPPWCommunityawardeeswereremindedoftheprohibitionduringtheCPPWAnnualTrainingheldinMarch2011.AmandatorymeetingforallprogrammanagersandprincipalinvestigatorswasheldinwhichtheprohibitionsoutlinedintheAR-12werediscussed.Inadditiontoeducatingawardees,CDCregularlymonitorsgranteeperformanceinordertoensurethatfederalfundsareusedeffectivelyandappropriately.CDCstaffinteractwithawardeeseverymonthtoensurethattheyareimplementingtheactivitiesandstrategiessetforthintheawardee'sworkplanandthatawardeesareadheringtoadministrativerequirements,includingprovisionsrelatingtolobbying.Inaddition,CDCstaffmonitorstheuseoffederalfundsbyawardeesusingtoolssuchasonsitereviewandriskmitigationplans.YouaskedaboutinstancesinwhichwehaveidentifiedCDCawardeesthathaveusedfederalfundstopayforlobbyingactivities.CDChasdeterminedthatoneCPPWawardee'sactionswerenotinfullcompliancewiththerestrictionsinAR-12.Specifically,CDCdeterminedthatstafffundedbyaCPPWgranttotheSouthCarolinaDepartmentofHealthhadtakenactionsincludingsendingemailmessagesandschedulingapresseventforthepurposeofgainingthesupportofcitycouncilmembersforaproposedsmoke-freeordinance.Inresponse,CDCdirectedtheawardeetoceaseallcurrentandfutureprohibitedactivity,disallowedthecoststheawardeeincurredinconductingsuchactivities($248),andrequiredeachoftheawardee'semployeesandcontractorstoattendadditionaltrainingonAR-12.Asnotedabove,CDCregularlyreviewstheactivitiesofthisandallothergranteesandtakesactionwhereappropriate.
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