HomeMy WebLinkAboutSTATE DPH-Hospital Preparedness Program-Local Emergency Medical Services Agency Support Funds LEMSA_A-23-212.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
O� 1$56 0 Telephone: (559)600-3529
FRV,t' Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
May 9, 2023
Present: 5- Supervisor Steve Brandau, Vice Chairman Nathan Magsig, Supervisor Buddy Mendes,
Supervisor Brian Pacheco, and Chairman Sal Quintero
Agenda No. 45. Public Health File ID: 23-0113
Re: Approve and authorize the Chairman to execute a retroactive revenue Agreement and related forms
with the California Department of Public Health for Hospital Preparedness Program-Local Emergency
Medical Services Agency Support funds, effective July 1, 2022 through June 30, 2027,total not to
exceed$322,730
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero
Agreement No. 23-212
County of Fresno Page 47
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Board Agenda Item 45
O 1856 O
FRE`'�
DATE: May 9, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Department of Public Health
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute a retroactive revenue Agreement and related forms
with the California Department of Public Health for Hospital Preparedness Program -Local
Emergency Medical Services Agency Support funds, effective July 1, 2022 through June 30, 2027,
total not to exceed $322,730.
There is no increase in Net County Cost associated with the recommended action, which will allow the
Department of Public Health (Department)to continue receiving non-competitive Federal and State
Hospital Preparedness Program (HPP)- Local Emergency Medical Services Agency(LEMSA) Support
funds from the California Department of Public Health (CDPH). The HPP-LEMSA Support Agreement
funds the Department's Emergency Medical Services (EMS) Program's support and assistance of the HPP
in Fresno, Kings, Madera, and Tulare Counties. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended action, the
Department's EMS Program would not receive any HPP funding for the HPP related assistance it provides
to the Fresno, Kings, Madera, and Tulare Counties' HPP operations and would need to reallocate funding
from another source to fully support the staff that provide this assistance.
RETROACTIVE AGREEMENT:
The recommended final and corrected revenue agreement was received from the CDPH on February 24,
2023, is retroactive to July 1, 2022, and is being brought to your Board in accordance with the agenda item
processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The FY 2022-23
maximum revenue amount of the recommended agreement is$64,546; $322,730 for the five year term.
The grant allocation is non-competitive and does not require matching funds. Sufficient appropriations and
estimated revenues are included in the Department's Org 5620 FY 2022-23 Adopted Budget and will be
included in future budget requests for the duration of the agreement. The recommended agreement
includes funding for full recovery of direct and indirect costs.
DISCUSSION:
Since 2002, the County has received HPP grant funding for EMS activities with the most recent grant
County of Fresno Page 1 File Number.23-0113
File Number:23-0113
agreement(A-17-417) having a term of July 1, 2017 through June 30, 2022. Fresno County's Department
of Public Health is the designated Local EMS Agency for Kings, Madera, and Tulare Counties and activities
include participation in program working groups and working with EMS providers and hospitals on
preparedness in the event of a large-scale incident. The recommended HPP-LEMSA Support Agreement
provides funding for the cost of the Department's Emergency Services Division to address several
objectives in each County's HPP, which include:
• coordinating healthcare partnerships;
• participating in medical/health operational area programs;
• attending state sponsored training;
• establishing continuity of operations plans for EMS; and,
• managing multi-casualty incidents and field treatment sites.
The scope of work received with the original agreement incorrectly included work components associated
with Public Health Emergency Preparedness (PHEP) and Pandemic Influenza planning. This has been
corrected to indicate the funding is only related to HPP-LEMSA activities.
The recommended agreement deviates from the County's standard indemnification language and requires
the County (and the County's contractors receiving this funding)to provide one-way indemnification to the
State, in performance of the agreement. Additionally, the recommended agreement contains a dispute
resolution procedure requiring both parties to first seek resolution of any dispute that may arise from the
agreement. The State may also terminate the agreement without cause upon providing the County with
30-day advanced written notice or immediately terminate the agreement for cause. The County can request
to terminate the agreement only if the State substantially fails to perform its responsibilities as provided for
within the agreement. This language is typically present in State grants. Consequently, the Department
has determined that its acceptance of the non-standard language is advantageous to the County, as the
State-grant is an essential funding source for DPH HPP-LEMSA related activities, without which the
continued provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #41, August 8, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Agreement with California Department of Public Health
CAO ANALYST:
Ron Alexander
County of Fresno Page 2 File Number.23-0113
Agreement No. 23-212
State of California — Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
2022-23 to 2026-27 CDC Public Health Emergency Preparedness (PHEP), State
General Fund (GF) Pandemic Influenza, ASPR Hospital Preparedness Program (HPP)
Funding
Awarded By
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter "Department"
TO
County of Fresno, hereinafter "Grantee"
Implementing the CDC Public Health Emergency Preparedness (PHEP), State General
Fund (GF) Pandemic Influenza, ASPR Hospital Preparedness Program (HPP),"
hereinafter "Project"
GRANT AGREEMENT NUMBER 22-10701
The Department awards this Grant and the Grantee accepts and agrees to use the Grant
funds as follows:
AUTHORITY: The Department has authority to grant funds for the Project under
the California Health and Safety Code, Sections 101315 to 101319.
PURPOSE: The Department shall award this Grant Agreement to and for the benefit of the
Grantee; the purpose of the Grant is to provide funding for public health and medical
emergency preparedness goals and objectives in accordance with the Centers for Disease
Control and Prevention (CDC) #5NU90TP922005-04-00 Public Health Emergency
Preparedness (PHEP), the Assistant Secretary for Preparedness and Response (ASPR)
Hospital Preparedness Program (HPP), State General Fund (GF) Pandemic Influenza, and
CDPH guidance.
GRANT AMOUNT: The maximum amount payable under this Grant Agreement shall not
exceed the amount of$322,730
TERM OF GRANT AGREEMENT: The term of the Grant shall begin on July 1, 2022 and
terminates on June 30, 2027. No funds may be requested or invoiced for services
performed or costs incurred after June 30, 2027.
PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will
be:
Page 1 of 3
State of California — Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
California Department of Public Health Grantee: County of Fresno
Attention: Nathan Blair Attention: Curtis Jack
1615 Capital Avenue 1221 Fulton Street
Sacramento, CA 95814 Fresno, CA 93721
(916) 650-6416 (559) 600-3387
nathan.blair@cdph.ca.gov cjack@fresnocountyca.gov
Direct all inquiries to the following representatives:
California Department of Public Health, Grantee: County of Fresno
Emergency Preparedness Office
Attention: Sarah Westerman Attention: Curtis Jack
1615 Capital Avenue 1221 Fulton Street
Sacramento, 95814 Fresno, CA 93721
(916) 650-6416 (559) 600-3387
sarah.westerman@cdph.ca.gov cjack@fresnocountyca.gov
All payments from CDPH to the Grantee; shall be sent to the following address:
Remittance Address
Grantee: County of Fresno
Attention: Cashier— DPH Business Office
P.O. Box 11800
Fresno, CA 93775
(559) 600-6415
dphboap@fresnocountyca.gov
Either party may make changes to the Project Representatives, or remittance address, by
giving a written notice to the other party, said changes shall not require an amendment to
this agreement but must be maintained as supporting documentation. Note: Remittance
address changes will require the Grantee to submit a completed CDPH 9083 Governmental
Entity Taxpayer ID Form or STD 204 Payee Data Record Form and the STD 205 Payee
Page 2 of 3
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
Data Supplement which can be requested through the CDPH Project Representatives for
processing.
STANDARD GRANT PROVISIONS. The Grantee must adhere to all Exhibits listed
and any subsequent revisions. The following Exhibits are attached hereto or attached by
reference and made a part of this Grant Agreement:
Exhibit A SCOPE OF WORK
Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS
Exhibit B Attachment 1 Advance Payment Provisions
Exhibit C STANDARD GRANT CONDITIONS
Exhibit D REQUEST FOR APPLICATIONS
Including all the requirements and attachments contained therein
Exhibit E ADDITIONAL PROVISIONS
Exhibit F FEDERAL TERMS AND CONDITIONS
GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and
conditions of this grant, including those stated in the Exhibits incorporated by reference
above. The Grantee(s) shall fulfill all assurances and commitments made in the application,
declarations, other accompanying documents, and written communications (e.g., e-mail,
correspondence) filed in support of the request for grant funding. The Grantee(s) shall
comply with and require its subgrantee's to comply with all applicable laws, policies, and
regulations.
IN WITNESS THEREOF, the parties have executed this Grant on the dates set forth below.
Executed By:
Date: 5—°1 -23
ATTEST: Sal Q me o, h 'rman of the Board of
BERNICE E.SEIDEL Supervl rs
Clerk of the Board of Supervisors County of Fresno
County of Fresno,State of California
1221 Fulton Street
By Deputy Fresno, CA 93
Date: S Z� o s��
�` Jeannie Oalarpe, Chi os 4P
4- Contracts Manageme ervices Section
California Department of Public Health
1616 Capitol Avenue, Suite 74.262
P.O. Box 997377, MS 1800- 1804
Sacramento, CA 95899-7377
Page 3 of 3
County of Fresno
22-10701
Exhibit A
Scope of Work
Hospital Preparedness Program (HPP)
HPP Capability 1: Foundation for Health Care and Medical Readiness
Objective: The community's health care organizations and other stakeholders—coordinated through a sustainable Health Care Coalition —have strong
relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.
Activities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Identify health care coalition members
® Objective 1: Establish and 6/30/27 2. Establish health care coalition governance
operationalize a health care coalition
(HCC) 3. Assess hazard vulnerabilities and risks
4. Assess regional health care resources
® Objective 2: Identify risk and needs 5. Prioritize resource gaps and mitigation strategies
® Objective 3: Develop a health care
6. Assess community planning for children, pregnant women, seniors, individuals with access
coalition preparedness plan and functional needs, including people with disabilities, and others with unique needs
7. Engage clinicians
® Objective 4: Train and prepare the 8. Engage community leaders
health care and medical workforce 9. Promote sustainability of HCC
10. Promote role-appropriate NIMS implementation
® Objective 5: Ensure preparedness is 11. Educate and train on identified preparedness and response gaps
sustainable 12. Plan and conduct coordinated exercises with HCC members and other response
organizations
Page 1 of 9
County of Fresno
22-10701
Exhibit A
Scope of Work
Hospital Preparedness Program (HPP)
HPP Capability 2: Health Care and Medical Response Coordination
Objective: Health care organizations, the HCC, their jurisdiction(s), and the state's/jurisdiction's ESF-8 lead agency plan and collaborate to share and analyze
information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.
Activities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Develop a health care coalition response plan
® Objective 1: Develop and coordinate 6/30/27 2. Develop information sharing procedures
health care organization and health care
coalition response plans 3. Communicate with the public during an emergency
4. Identify and coordinate resource needs during an emergency
® Objective 2: Utilize information 5. Coordinate an incident action planning during an emergency
sharing procedures and platforms 6. Communicate with health care providers, non-clinical staff, patients, and visitors during an
® Objective 3: Coordinate response emergency
strategy, resources, and communications
Page 2 of 9
County of Fresno
22-10701
Exhibit A
Scope of Work
Hospital Preparedness Program (HPP)
HPP Capability 3: Continuity of Health Care Service Delivery
Objective: Health care organizations, with support from the HCC and the state's/jurisdiction's ESF-8 lead agency, provide uninterrupted, optimal medical care to
all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for
patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.
Activities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Develop a health care organization continuity of operations plan
® Objective 2: Plan for continuity of 6/30/27 2. Assess supply chain integrity
operations
3. Assess and address equipment, supply, and pharmaceutical requirements
® Objective 3: Maintain access to non- 4. Develop and implement evacuation and relocation plans
personnel resources during an 5. Distribute resources required to protect the health care workforce
emergency 6. Train and exercise to promote responder safety and health
® Objective 6: Plan for and coordinate
health care evacuation and relocation
® Objective 5: Protect responder safety
and health
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County of Fresno
22-10701
Exhibit A
Scope of Work
Hospital Preparedness Program (HPP)
HPP Capability 4: Medical Surge
Objective: Health care organizations deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply.
The HCC, in collaboration with the state's/jurisdiction's ESF-8 lead agency, coordinates information and available resources for its members to maintain
conventional surge response. When an emergency overwhelms the HCC's collective resources, the HCC supports the health care delivery system's transition to
contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.
Activities to Support the Objective Timeline Evaluation/Deliverables
7/1/22—
® Objective 1: Plan for a medical surge 6/30/27 1. Incorporate medical surge planning into a health care organization emergency operations
® Objective 2: Respond to a medical
plan
surge 2. Incorporate medical surge into a health care coalition response plan
3. Implement emergency department and inpatient medical surge response
4. Develop an alternate care system
5. Provide pediatric care during a medical surge response
6. Provide surge management during a chemical or radiation emergency event
7. Provide burn care during a medical surge response
8. Enhance infections disease preparedness and surge response
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County of Fresno
22-10701
Exhibit A
Scope of Work
Public Health Emergency Preparedness (PHEP)
PHEP Domain 1: Strengthen Community Resilience
Objective: Community resilience is the ability of a community, through public health agencies, to develop, maintain, and utilize collaborative relationships among
government, private, and community organizations to develop and utilize shared plans for responding to and recovering from disasters and public health
emergencies.
Capabilities to Support the Domain Timeline Evaluation/Deliverables
7/1/22— 1. Determine the risks to the health of the jurisdiction
❑ Capability 1: Community 6/30/27 2. Ensure HPP coordination
preparedness
3. Plan for the whole community
❑ Capability 2: Community recovery 4. Focus on the tribal planning and engagement
5. Ensure emergency support function (ESF)cross-discipline coordination and partner and
stakeholder collaboration
6. Strengthen and implement plans through training and exercising
7. Obtain public comment and input
PHEP Domain 2: Strengthen Incident Management
Objective: Incident management is the ability to activate, coordinate and manage health and medical emergency operations throughout all phases of an incident
through use of a flexible and scalable incident command structure that is consistent with the Standardized Emergency Management System (SEMS)and the
National Incident Management System (NIMS).
Capabilities to Support the Domain Timeline Evaluation/Deliverables
7/1/22— 1. Activate and coordinate public health emergency operations
❑ Capability 3: Emergency operations 6/30/27
coordination
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County of Fresno
22-10701
Exhibit A
Scope of Work
Public Health Emergency Preparedness (PHEP)
PHEP Domain 3: Strengthen Information Management
Objective: Information management is the ability to develop and maintain systems and procedures that facilitate the communication of timely, accurate, and
accessible information, alerts, and warnings using a whole community approach. It also includes the ability to exchange health information and situational
awareness with federal, state, local, territorial, and tribal governments and partners.
Capabilities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Maintain situational awareness during incidents
❑ Capability 4: Emergency public 6/30/27 2. Coordinate information sharing
information and warning
3. Coordinate emergency information and warning
❑ Capability 6: Information sharing
PHEP Domain 4: Strengthen Countermeasures and Mitigation
Objective: Countermeasures and mitigation is the ability to distribute, dispense, and administer medical countermeasures (MCMs)to reduce morbidity and
mortality and to implement appropriate nonpharmaceutical and responder safety and health measures during response to a public health incident.
Capabilities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Develop and exercise plans for MCM distribution, dispensing, and vaccine administration
❑ Capability 8: Medical countermeasure 6/30/27 2. Maintain preparedness plans based on risks
dispensing and administration
3. Participate in ORRs and self-assessment
❑ Capability 9: Medical materiel 4. Submit updated MCM action plans
management and distribution 5. Update local distribution site survey
6. Coordinate nonpharmaceutical interventions (NPIs)
❑ Capability 11: Non pharmaceutical 7. Support the protection of responders' health and safety
interventions
❑ Capability 14: Responder safety and
health
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County of Fresno
22-10701
Exhibit A
Scope of Work
Public Health Emergency Preparedness (PHEP)
PHEP Domain 5: Strengthen Surge Management
Objective: Surge management is the ability to coordinate jurisdictional partners and stakeholders to ensure adequate public health, health care, and behavioral
services and resources are available during events that exceed the limits of the normal public health and medical infrastructure of an affected community. This
includes coordinating expansion of access to public health, health care and behavioral services; mobilizing medical and other volunteers as surge personnel;
conducting ongoing surveillance and public health assessments at congregate locations; and coordinating with organizations and agencies to provide fatality
management services.
Capabilities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Coordinate activities to manage public health and medical surge
❑ Capability 5: Fatality 6/30/27 2. Coordinate with public health, health care, mental/behavioral health, and human services
❑ Capability 7: Mass care needs during mass care operations
3. Coordinate with partners to address public health needs during fatality management
❑ Capability 10: Medical surge operations
4. Coordinate medical and other volunteers to support public health and medical surge
❑ Capability 15: Volunteer management 5. Support HPP medical surge planning
Page 7 of 9
County of Fresno
22-10701
Exhibit A
Scope of Work
Public Health Emergency Preparedness (PHEP)
PHEP Domain 6: Strengthen Biosurveillance
Objective: Biosurveillance is the ability to conduct rapid and accurate laboratory tests to identify biological, chemical, radiological, and nuclear agents; and the
ability to identify, discover, locate, and monitor-through active and passive surveillance -threats, disease agents, incidents, outbreaks, and adverse events, and
provide relevant information in a timely manner to stakeholders and the public.
Capabilities to Support the Objective Timeline Evaluation/Deliverables
7/1/22— 1. Conduct epidemiological surveillance and investigation
❑ Capability 12: Public health laboratory 6/30/72 2. Conduct laboratory testing
testing
❑ Capability 13: Public health
surveillance and epidemiological
investigation
Page 8 of 9
County of Fresno
22-10701
Exhibit A
Scope of Work
Pandemic Influenza Planning
Pandemic Influenza
Objective: Strengthen planning and response efforts in order to be prepared for an influenza Pandemic.
Activities to Support the Objective Timeline Evaluation/Deliverables
7/1/22 1. Up-to-date written policies and procedures in place to
❑ Function 1: Update and/or maintain a local Pandemic Influenza plan — ensure pandemic influenza readiness and response,
6/30/27
❑ Function 2: Maintain a surveillance system for reporting novel/variant influenza virus including LHD collaborative efforts with local and state
infections and influenza-associated deaths in children <18 years of age, and report data via partners, effective administration and documentation of
electronic or fax during the regular influenza season. vaccines, guidelines for prioritizing lab testing and
❑ Function 3: Maintain the ability to conduct case-based surveillance for influenza as distribution of materials to partners, document vaccine
requested by CDC and/or CDPH. For example, all cases, hospitalizations, ICU admissions, administration in the immunization registry, and
or deaths, and report those cases via electronic means or fax during a pandemic. procedures for communication to promote vaccine and
preventative measures.
❑ Function 4: Maintain the ability of the public health laboratory to type and subtype 2. Surveillance systems are maintained to ensure accurate
influenza A viruses and lineage type influenza B viruses (if the laboratory is capable of and timely documentation of novel/variant influenza virus
lineage type testing)for any cases tested for influenza by status of clinical severity (e.g.,
hospitalized ICU/severe cases, outpatients, and/or fatal cases) during both the regular infections, influenza-associated deaths in children and/or
influenza season and in a pandemic and report results to CDPH through established case-specific data requested by state and federal
reporting mechanisms. partners.
3. Local public health laboratories maintain capability and
❑ Function 5: Submit influenza positive specimens to the CDPH Viral and Rickettsia) capacity to type and subtype influenza viruses.
Diseases Laboratory (VRDL)for antiviral resistance testing, as provided by CDPH's
Immunization Branch, in accordance with the Association of Public Health Laboratories 4. Updated written procedures in place for monitoring
(APHL) Influenza Virologic Surveillance Right Size Roadmap. exposed persons exposed to avian or novel influenza
viruses, including laboratory testing and ensuring regular
❑ Function 6: Conduct active or passive monitoring for influenza-like illness among persons communication of activities and outcomes to state
exposed to avian or novel influenza viruses (e.g., persons exposed to poultry or other
animals infected with avian influenza on farms inside or outside of CA, persons exposed to partners.
humans with novel or variant influenza virus infections such as H7N9, H5N1, H3N2v, or 5. Conduct a mass vaccination clinic and complete an After-
H1N2v). Action Report/Improvement Plan (AAR/IP).
6. Implementation of processes for ensuring optimal
❑ Function 7: Conduct at least one mass vaccination clinic exercise and maximize utilization of influenza vaccines within local communities,
attendance in order to test and evaluate the mass vaccination capability and capacity.
including target populations such as persons with
❑ Function 8: In conjunction with the immunization coordinator, support efforts to intensify underlying medical conditions and/or school-aged
seasonal flu vaccination efforts to enhance pandemic influenza preparedness. children.
Page 9 of 9
County of Fresno
22-10701
Exhibit B
Budget Detail and Payment Provisions
1. Invoicing and Payment
A. Upon completion of project activities as provided in Exhibit A Grant
Application/Attachment 1 Grantee Written Modification, and upon receipt and approval
of the invoices, the State agrees to reimburse the Grantee for activities performed and
expenditures incurred in accordance with the total amount of this agreement.
B. Invoices shall include the Grant Number and shall be submitted electronically or in
triplicate not more frequently than monthly in arrears to:
California Department of Public Health
Emergency Preparedness Office
Attn: Local Management Unit
MS 7002
P.O. Box 997377
Sacramento, CA 95899-7377
C. HPP, PHEP, and Pan Flu Invoices shall:
1) Be prepared on Grantee letterhead. If invoices are not on produced letterhead
invoices must be signed by an authorized official, employee or agent certifying that
the expenditures claimed represent activities performed and are in accordance with
Exhibit A Grant Application under this Grant.
2) Bear the Grantee's name as shown on the Grant.
3) Identify the billing and/or performance period covered by the invoice.
4) Itemize costs for the billing period in the same or greater level of detail as indicated
in this Grant. Subject to the terms of this Grant, reimbursement may only be sought
for those costs and/or cost categories expressly identified as allowable and
approved by CDPH.
D. Amount awarded under this Grant is identified in the CDPH 1229 Grant Agreement.
2. Budget Contingency Clause
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent
years covered under this Agreement does not appropriate sufficient funds for the
program, this Agreement shall be of no further force and effect. In this event, the State
shall have no liability to pay any funds whatsoever to Grantee or to furnish any other
considerations under this Agreement and Grantee shall not be obligated to fulfill any
provisions of this Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State or offer an agreement amendment to Grantee to reflect the
reduced amount.
Page 1 of 2
County of Fresno
22-10701
Exhibit B
Budget Detail and Payment Provisions
3. Prompt Payment Clause
Payment will be made in accordance with, and within the time specified in, Government
Code Chapter 4.5, commencing with Section 927.
4. Advance Payments
A. Advance payments are subject to the provisions outlined in Exhibit B Attachment 1
entitled "Advance Payment Provisions".
B. Advance payments may be requested annually up to 25% of each annual budget by
submitting an invoice for the amount of the advance. Grantor must liquidate or offset
the amount of the advance with invoices before the end of each budget year/period.
Regular payments thereafter, may be requested not more frequently than once per
month in arrears.
C. If an amendment increases the annual budget total, CDPH may advance up to 25% of
any increase. If an amendment decreases the annual budget total, Grantor agrees to
remit to CDPH the appropriate pro-rata share of any funds already advanced and shall
do so within thirty (30) calendar days of receiving a re-payment request from CDPH.
D. Grantor agrees to remit any unexpended advance payment balance to CDPH within
forty-five (45) calendar days following the submission of the Grantee's final invoice.
5. Timely Submission of Final Invoice
A. A final undisputed invoice shall be submitted for payment no more than thirty (30)
calendar days following the expiration or termination date of this Grant, unless a later or
alternate deadline is agreed to in writing by the program grant manager. Said invoice
should be clearly marked "Final Invoice", indicating that all payment obligations of the
State under this Grant have ceased and that no further payments are due or
outstanding.
B. The State may, at its discretion, choose not to honor any delinquent final invoice if the
Grantee fails to obtain prior written State approval of an alternate final invoice
submission deadline.
6. Travel and Per Diem Reimbursement
Any reimbursement for necessary travel and per diem shall, unless otherwise specified in
this Agreement, be at the rates currently in effect, as established by the California
Department of Human Resources (Cal HR). If the Cal HR rates change during the term of
the Agreement, the new rates shall apply upon their effective date and no amendment to
this Agreement shall be necessary. No travel outside the State of California shall be
reimbursed without prior authorization from the CDPH. Verbal authorization should be
confirmed in writing. Written authorization may be in a form including fax or email
confirmation.
Page 2 of 2
County of Fresno
22-10701
Exhibit B, Attachment 1
Advance Payment Provisions
1. Advance Payment Authority and Limitation
A. Pursuant to Government Code Section 11019, CDPH may authorize one annual advance
payment each state fiscal year in an amount not to exceed twenty-five percent (25%) of the
Grantee's annual contract budget(s).
B. If the funding is increased by amendment in any year, CDPH may authorize subsequent
advance payments on those amounts provided said cumulative advances do not exceed
twenty-five percent (25%) of the Grantee's annual contract budget.
2. Conditions for Receiving an Advance Payment
No advance payment shall be issued until:
A. The Agreement has been approved and fully executed.
B. The Grantee has met CDPH advance payment eligibility requirements and has submitted
proof of eligibility as required by CDPH (i.e., proof of nonprofit status and need for advance
funds).
C. The Grantee has obtained a Commercial Blanket Fidelity Bond equal to or in excess of the
amount of the advanced funds. The California Department of Public Health shall be the loss
payee on said fidelity bond.
D. The prior year advance payment issued by the funding program under this Agreement, if
any, has been fully liquidated or repaid in full. At no time may the sum total of any advance
payment exceed 25% percent of the total annual Agreement amount.
3. Separate Bank Account/ Management of Funds
A. Advanced funds received from CDPH must be deposited in an account:
1) Managed by a bank or financial institution that is a member of the FDIC.
2) That is interest bearing.
3) Separate from other fund accounts of the Grantee.
B. Grantee must forward one set of bank signature cards for this account to the CDPH
Program Contract Manager assigned to this Agreement. One copy of any new signature
cards must be forwarded to the CDPH Program Grantee Manager whenever changes are
made to the persons named on the bank signature card within the term of the Agreement.
The bank signature cards must:
1) Be signed by one or more persons in the Grantee's organization who are authorized to
withdraw funds.
2) Indicate that Grantee withdrawals shall be by check only.
Grantee withdrawals do not require countersignature by CDPH.
Page 1 of 5
County of Fresno
22-10701
Exhibit B, Attachment 1
Advance Payment Provisions
3) Indicate that CDPH withdrawals shall be accompanied by a written CDPH directive and
be issued by check only and made payable to the California Department of Public
Health.
a. Said written directive from CDPH shall indicate the Grantee is in default of its
contractual obligations or indicate that cancellation or termination of the Agreement
is imminent or has been initiated.
b. CDPH withdrawals do not require countersignature by the Grantee.
C. The Grantee shall transmit to the CDPH Program Grant Manager a copy of an agreement
letter from the bank or financial institution in which the bank account is established, clearly
setting forth the special character of the account, the responsibilities of the bank thereunder,
and whether or not the account is interest bearing. The agreement letter should, at a
minimum, indicate:
1) CDPH Agreement number,
2) Name, address of bank or financial institution, and bank account number,
3) If the bank or financial institution is a member of the FDIC,
4) If the account is interest bearing,
5) That the purpose of the account is to only to receive and disburse monies advanced to
the Grantee by CDPH,
6) Grantee shall only make withdrawals by check,
7) Bank or financial institution agrees to take the following action upon receipt of a written
directive from the California Department of Public Health indicating the Agreement has
been or will be cancelled or terminated or that the Grantee is in default:
a. Withhold further withdrawals from the account by the Grantee and/or its designees,
and
b. Allow CDPH designees, named within the directive, to withdraw any and all funds in
the above referenced account by check made payable to the California Department
of Public Health.
8) Bank disclaimers if deemed appropriate such as the bank will not be responsible for
withdrawals meeting the above criteria and/or subsequent use of those funds.
D. Within thirty (30) calendar days of receiving an advance payment from CDPH, the Grantee
must:
1) Notify CDPH in writing that the advanced funds have been placed in an account meeting
the requirements stipulated in paragraph 3.A. above.
2) Submit copies of the account signature cards as indicated in paragraph 3.B. above.
3) Submit an agreement letter from the bank or financial institution clearly setting forth the
Page 2of5
County of Fresno
22-10701
Exhibit B, Attachment 1
Advance Payment Provisions
special character of the account as indicated in paragraph 3.C. above.
4. Fidelity Bond Requirements
A. The Grantee must obtain a Commercial Blanket Fidelity Bond equal to the amount of the
advanced funds.
B. The California Department of Public Health shall be the loss payee.
C. Said Bond shall be maintained until all advanced payments have been fully liquidated,
offset, or repaid to CDPH.
D. The Grantee shall submit proof of said documentation to CDPH, upon request.
5. Disbursement of Advanced Funds by CDPH
Advance payments issued by CDPH shall be made by check. Checks shall be payable to the
Grantee as named on Agreement and shall be marked "For Deposit Only".
6. Use of Advanced Funds
Advanced funds shall be used solely for the purpose of making payments for allowable costs
incurred under the terms and conditions of this Agreement.
7. Returning Interest Earned on Advanced Payments
A. Any interest accrued from funds advanced under this Agreement shall be identified and
returned to CDPH by or before:
1) June 30th of the fiscal year in which the advance was issued, or
2) Prior to the expiration or termination of said Agreement if the Agreement expires or is
terminated prior to June 30th.
B. Place the following information on the face of the interest warrant:
1) CDPH agreement#
2) Interest Earned on Advance Payment Account-- Fiscal Year / .
C. Label and address each interest warrant as follows:
California Department of Public Health
Emergency Preparedness Office
Attn: Local Management Unit
MS 7002
P.O. Box 997377
Sacramento, CA 95899-7377
The State, at its discretion, may designate an alternate department name and/or invoice
submission address. A change in the department name and/or invoice address shall be
accomplished via a written notice to the Grantee by the State and shall not require an
Page 3 of 5
County of Fresno
22-10701
Exhibit B, Attachment 1
Advance Payment Provisions
amendment to this Agreement.
8. Liquidation of Advanced Funds
A. Unless otherwise stipulated in this Agreement, advanced funds shall be liquidated:
1) No later than June 30th of the fiscal year in which the advance was issued, or
2) Prior to the expiration or termination date or at the time of termination if the Agreement
expires or is terminated prior to June 30tn
3) According to the repayment schedule that is determined by CDPH and confirmed in
writing to the Grantee.
B. If any advanced funds have not been liquidated upon completion or termination of this
Agreement, the balance thereof shall be:
1) Promptly paid by the Grantee to CDPH upon demand, or
2) Deducted from any sum otherwise due to the Grantee from CDPH, or
3) Deducted from any sum that may become due to the Grantee from CDPH.
9. Return / Repayment of Advanced Funds
A. The Grantee may, at any time, repay all or any part of the Advanced Payment.
B. CDPH may, at any time, demand full repayment of any unliquidated balance. Upon receipt
of such demand, The Grantee shall promptly repay the unliquidated balance.
10. Default Provisions
A. The State, without limiting any rights which it may otherwise have, may in its sole discretion,
and upon written notice to the Grantee, withhold further payments under this Agreement,
and/or demand immediate repayment of the unliquidated balance of any advance payment
hereunder, and/or withdraw all or any part of the advance payment balance in the identified
bank account, and/or terminate this Agreement upon occurrence of any of the following
events:
1) Termination of this Agreement.
2) A finding by CDPH that the Grantee:
a. Has failed to observe any of the covenants, conditions, or warranties of this exhibit,
b. Has failed to comply with any material provision of this Agreement,
c. Has failed to make satisfactory progress/performance in completion of the terms and
conditions of this Agreement,
d. Is in such unsatisfactory financial condition as to endanger performance of this
Agreement,
Page 4 of 5
County of Fresno
22-10701
Exhibit B, Attachment 1
Advance Payment Provisions
e. Has allocated resources for the performance of this Agreement that CDPH believes
are substantially exceeding the reasonable requirements for performance of this
Agreement,
f. Is delinquent in payment of taxes, subcontractors, or any other cost of performance
of this Agreement in the ordinary course of business.
B. Appointment of a trustee, receiver or liquidator for all or a substantial part of the Grantee's
property, or institution of bankruptcy, reorganization arrangement of liquidation proceedings
by or against the Grantee.
C. Service of any writ of attachment, levy, or execution or commencement of garnishment
proceedings.
D. The commission of an act of bankruptcy.
Page 5 of 5
County of Fresno
22-10701
Page 1 of 4
EXHIBIT C
STANDARD GRANT CONDITIONS
1. APPROVAL: This Grant is of no force or effect until signed by both parties and approved by
the Department of General Services, if required. The Grantee may not commence
performance until such approval has been obtained
2. AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless
made in writing, signed by the parties, and approved as required. No oral understanding or
Agreement not incorporated in the Grant is binding on any of the parties. In no case shall
the Department materially alter the scope of the Project set forth in Exhibit A.
3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part,
without the written consent of the Grant Manager in the form of a written amendment to the
Grant.
4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated
representative shall have the right to review and to copy any records and supporting
documentation pertaining to this Grant. Grantee agrees to maintain such records for a
possible audit for a minimum of three (3) years after final payment or completion of the
project funded with this Grant, unless a longer period of records retention is stipulated.
Grantee agrees to allow the auditor(s) access to such records during normal business hours
and to allow interviews of any employees who might reasonably have information related to
such records. Further, Grantee agrees to include a similar right of the State to audit records
and interview staff in any subcontract related to the project.
5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state
and/or federal conflict of interest laws.
6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or
corporation furnishing or supplying work services, materials, or supplies in connection with
the project, and from any and all claims and losses accruing or resulting to any person, firm
or corporation who may be injured or damaged by Grantee in the performance of any
activities related to the Project.
7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees
that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit
tracing of all grant funds to a level of expenditure adequate to establish that such funds have
not been used in violation of any applicable state or federal law, or the provisions of this
Grant. Grantee further agrees that it will maintain separate Project accounts in accordance
with generally accepted accounting principles.
8. GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with
the laws of the State of California.
County of Fresno
22-10701
Page 2 of 4
9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other
amounts (including any interest thereon) accruing to or received by the Grantee under this
Grant shall be paid by the Grantee to the Department, to the extent that they are properly
allocable to costs for which the Grantee has been reimbursed by the Department under this
Grant.
10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the
performance of the Project, shall act in an independent capacity and not as officers,
employees or agents of the Department.
11. MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least
twenty (20)working days before any public or media event publicizing the accomplishments
and/or results of the Project and provide the opportunity for attendance and participation by
Department's representatives.
12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any
rights or remedies for any third- party as a beneficiary of this Grant or the project.
13. NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any
events, developments or changes that could affect the completion of the project or the budget
approved for this Grant.
14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform
services under this Grant where such services are called for.
15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with
generally accepted accounting principles. Grantee further certifies that it will comply with the
following conditions for a grant award as set forth in the Request for Applications (Exhibit D)
and the Grant Application (Exhibit A).
A. Establish an official file for the Project which shall adequately document all
significant actions relative to the Project;
B. Establish separate accounts which will adequately and accurately depict all
amounts received and expended on this Project, including all grant funds received
under this Grant;
C. Establish separate accounts which will adequately depict all income received which
is attributable to the Project, especially including any income attributable to grant
funds disbursed under this Grant;
D. Establish an accounting system which will adequately depict final total costs of the
Project, including both direct and indirect costs; and,
E. Establish such accounts and maintain such records as may be necessary for the
state to fulfill federal reporting requirements, including any and all reporting
requirements under federal tax statutes or regulations.
16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any
disbursement under this Grant to pay for costs associated with any litigation between the
Grantee and the Department.
County of Fresno
22-10701
Page 3 of 4
17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings,
specifications, reports, computer programs, operating manuals, notes, and other written or
graphic work submitted under Exhibit A in the performance of the Project funded by this Grant
shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part,
any final form data and information received, collected, and developed under this Project,
subject to appropriate acknowledgment of credit to the Department for financial support.
Grantee shall not utilize the materials submitted to the Department (except data)for any profit
making venture or sell or grant rights to a third-party who intends to do so. The Department
has the right to use submitted data for all governmental purposes.
18. VENUE: (This provision does not apply to Local Governmental Entities)
The Department and Grantee agree that any action arising out of this Grant shall be filed and
maintained in the Superior Court, California. Grantee waives any existing sovereign immunity
for the purposes of this Grant, if applicable.
19. STATE-FUNDED RESEARCH GRANTS:
A. Grantee shall provide for free public access to any publication of a department-funded
invention or department-funded technology. Grantee further agrees to all terms and
conditions required by the California Taxpayer Access to Publicly Funded Research Act
(Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the
Government Code).
B. As a condition of receiving the research grant, Grantee agrees to the following terms and
conditions which are set forth in Government Code section 13989.6 ("Section 13989.E"):
1) Grantee is responsible for ensuring that any publishing or copyright agreements
concerning submitted manuscripts fully comply with Section 13989.6.
2) Grantees shall report to the Department the final disposition of the research grant,
including, but not limited to, if it was published, when it was published, where it was
published, when the 12-month time period expires, and where the manuscript will be
available for open access.
3) For a manuscript that is accepted for publication in a peer-reviewed journal, the
Grantee shall ensure that an electronic version of the peer-reviewed manuscript is
available to the department and on an appropriate publicly accessible database
approved by the Department, including, but not limited to, the University of California's
eScholarship Repository at the California Digital Library, PubMed Central, or the
California Digital Open Source Library, to be made publicly available not later than 12
months after the official date of publication. Manuscripts submitted to the California
Digital Open Source Library shall be exempt from the requirements in subdivision (b)
of Section 66408 of the Education Code. Grantee shall make reasonable efforts to
comply with this requirement by ensuring that their manuscript is accessible on an
approved publicly accessible database, and notifying the Department that the
manuscript is available on a department-approved database. If Grantee is unable to
ensure that their manuscript is accessible on an approved publicly accessible
database, Grantee may comply by providing the manuscript to the Department not
later than 12 months after the official date of publication.
County of Fresno
22-10701
Page 4 of 4
4) For publications other than those described inparagraph B.3 above„ including
meeting abstracts, Grantee shall comply by providing the manuscript to the
Department not later than 12 months after the official date of publication.
5) Grantee is authorized to use grant money for publication costs, including fees charged
by a publisher for color and page charges, or fees for digital distribution.
Exhibit D
Page 1
April 12, 2022
Authority:
Health and Safety Code Sections:
1 001 50-1 00236, 100250-100255, 100325-100950,
TO: All Local Public Health Emergency Preparedness Directors 101315-101319, 131000-131020,and 1 31 050-1 31 231
Government Code Sections:8574.48 and 8587.8-
RE: Request for Applications 8587.9
Public Health Emergency Preparedness Funding
California Code of Regulations,Titles 17 and 22
Dear Local Public Health Emergency Preparedness Director:
The California Department of Public Health (CDPH), Emergency Preparedness Office (EPO)
is pleased to announce the request for applications (RFA) for emergency preparedness for
public health and the health care coalition grants. This request for application includes the
following funding sources:
1. Centers for Disease Control and Prevention's (CDC) Public Health Emergency
Preparedness (PHEP);
2. Assistant Secretary for Preparedness and Response's (ASPR) Hospital Preparedness
Program (HPP); and
3. State General Fund Pandemic Influenza (GF Pan Flu).
Collectively, this funding is intended to enhance day-to-day response plans and prepare for
public health and/or medical emergencies. CDPH will enter into a five-year grant
agreement with Local Health Jurisdictions (LHJ) covering the period July 1, 2022 to June 30,
2027. LHJs can apply for each funding source, as applicable (see Attachment 2). Following
is a description of each funding source and their intended use.
CDC PHEP
PHEP funding is intended to build public health preparedness and response capabilities
nationwide. CDPH is providing PHEP funding to LHJs within California to build and
strengthen their abilities to effectively respond to a range of public health threats, including
infectious diseases, natural disasters, and biological, chemical, nuclear, and radiological
events. Preparedness activities funded with PHEP should specifically target the
development of emergency-ready public health departments that are flexible and
adaptable. For additional information, please visit the websife for CDC's State and Local
Readiness PHEP.
Exhibit D
Page 2
Lab
Public Health Laboratory funding is carved from PHEP funding to support local public
health laboratories to maintain their Laboratory Response Network (LRN-B) capability
to detect biological threats and emerging infectious diseases
CRI
Public Health Cities Readiness Initiative funding is intended to enhance
preparedness in large metropolitan public health jurisdictions, to effectively respond
to large public health emergencies needing life-saving medicines and medical
supplies. CRI funding is to develop, test, and maintain plans to quickly
receive medical countermeasures from the Strategic National Stockpile and
distribute them to local communities.
ASPR HPP
HPP funding is intended to improve capacity of the health care system to plan for and
respond to large-scale emergencies and disasters. CDPH is providing HPP funding to local
public health jurisdictions within California to development and sustain health care
coalitions (HCCs). HCCs consist of core members from health care, public health,
emergency medical services and emergency management organizations plus additional
members that support the health care delivery system. HCCs partner to prepare health
care systems to respond to emergencies and disasters, with an aim to improve patient
outcomes during disasters and to minimize the need for state and federal resources. For
additional information, please visit the websife for ASPR's HPP.
GF Pan Flu
GF Pan Flu funding is intended to enhance LHJs readiness to respond to an infectious
disease outbreak. GF Pan Flu funding compliments and supports PHEP and HPP funding
goals while expanding the planning, training, and exercising of mass vaccinations in
response to an infectious disease outbreak.
Funding:
Funding for the five-year grant period is approved on an annual basis. The funding
allocations for HPP are an estimate based on FY 2021-22 allocations as ASPR has not
released final allocations for FY 2022-23 (see Attachment 1). The total grant agreement will
be based on the allocations listed in Attachment 1 and multiplied by five years.
Funding of local public health jurisdictions is contingent on CDPH-EPO receiving federal and
State funds each fiscal year. CDPH-EPO will release local allocations and funding guidance
(see Attachment 4) along with FY 22-23 budget templates annually to local public health
jurisdictions for all emergency preparedness for public health and the health care delivery
system grants prior to the start of the next fiscal year.
Application Submission Requirements:
1. Complete and submit a Letter of Intent (Attachment 2) and Project Representative
information (Attachment 3) and email to.LHBTProq@cdph.ca.gov by April 19, 2022.
2. Complete an Application package, starting with Attachments 41-4M, as applicable, and
submit to CDPH at: LHBTPro_q@cdph.ca.gov by May 20, 2022.
Exhibit D
Page 3
Upon receipt of attachments 2 & 3, your assigned contract manager will finalize your grant
agreement and will send to your LHJ for review and approval. As a reminder, LHJs are not to
begin work under this RFA until there is a fully executed grant agreement.
We look forward to collaborating on these activities with your LHJ. EPO will host an
application webinar on April 19th and 20th, 2022 to go over the requirements and activities
of these funding sources. If you have any questions or need further clarification, please
reach out to your EPO Contract Manager.
Sincerely,
(Ac.c't-ah b�i
On behalf of
Melissa Relles
Assistant Deputy Director
Emergency Preparedness Office
California Department of Public Health
Attachments
Attachment 1: Local Allocation Tables
Attachment 2: Letter of Intent
Attachment 3: Project Representatives
Attachment 4: Funding Guidance:
A. PHEP Workplan
B. HPP Workplan
C. Pan Flu Workplan
D. Multi-County LEMSA Workplan
E. PHEP Budget (CRI & Lab)
F. HPP Budget
G. Pan Flu Budget
H. Budget Personnel Summary
I. Contact Information
J. Gov. Agency Taxpayer ID Form
K. Fiscal Corrective Action Plan (CAP)
L. Inventory Disposal Schedule
M. Lab Training & Assistance Application
cc: CCLHO and CHEAC
Exhibit D
Page 4
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Total Grant Summary
Local Health DRAFT HPP PHEP CRI Lab Pan Flu FY 22-23 Total
Department Allocation Allocation Allocation Allocation Allocation (all grants)
ALAMEDA $456,863 $0 $0 $0 $0 $456,863
ALAMEDA(minus Berkeley) $0 $886,064 $374,873 $0 $110,721 $1,371,658
ALPINE $125,115 $110,572 $0 $0 $60,037 $295,724
AMADOR $129,233 $128,838 $0 $0 $61,231 $319,302
BERKELEY $0 $168,847 $28,426 $0 $63,846 $261,119
BUTTE $159,987 $212,144 $0 $0 $66,676 $438,807
CALAVERAS $129,981 $132,698 $0 $0 $61,483 $324,162
COLUSA $123,844 $121,213 $0 $0 $60,733 $305,790
CONTRA COSTA $356,150 $691,535 $280,907 $0 $98,007 $1,426,599
DEL NORTE $111,690 $123,582 $0 $0 $60,888 $296,160
ELDORADO $164,137 $208,461 $47,561 $0 $66,435 $486,594
FRESNO $316,642 $627,440 $249,946 $281,933 $93,818 $1,569,779
GLENN $125,333 $124,958 $0 $0 $60,978 $311,269
HUMBOLDT $132,504 $175,948 $0 $281,933 $64,310 $654,695
IMPERIAL $162,268 $203,760 $0 $0 $66,128 $432,156
INYO $122,675 $119,356 $0 $0 $60,611 $302,642
KERN $308,139 $570,747 $0 $0 $90,113 $968,999
KINGS $141,527 $186,881 $0 $0 $65,025 $393,433
LAKE $119,100 $142,225 $0 $0 $62,106 $323,431
LASSEN $130,523 $123,896 $0 $0 $60,908 $315,327
LONG BEACH $0 $0 $0 $0 $75,407 $75,407
LOS ANGELES
(minus Long Beach & $0 $0 $0 $0 $370,662 $370,662
Pasadena)
MADERA $142,715 $189,870 $0 $0 $65,220 $397,805
MARIN $176,640 $239,916 $62,755 $0 $68,491 $547,802
MARIPOSA $127,041 $119,091 $0 $0 $60,594 $306,726
MENDOCINO $142,362 $153,681 $0 $0 $62,855 $358,898
MERCED $182,061 $253,555 $0 $0 $69,382 $504,998
MODOC $126,901 $114,783 $0 $0 $60,313 $301,997
MONO $121,619 $116,701 $0 $0 $60,438 $298,758
MONTEREY $212,6071 $330,405 $0 $0 $74,405 $617,417
Attachment 1-Local Allocation Tables 1 of 17
Exhibit D
Page 5
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Total Grant Summary
Local Health DRAFT HPP PHEP CRI Lab Pan Flu FY 22-23 Total
Department Allocation Allocation Allocation Allocation Allocation (all grants)
NAPA $152,573 $179,368 $0 $0 $64,534 $396,475
NEVADA $138,912 $159,122 $0 $0 $63,210 $361,244
ORANGE $756,790 $1,699,476 $767,786 $281,933 $163,882 $3,669,867
PASADENA $0 $0 $0 $0 $64,786 $64,786
PLACER $200,519 $314,114 $98,596 $0 $73,340 $686,569
PLUMAS $128,629 $119,130 $0 $0 $60,597 $308,356
RIVERSIDE $616,698 $1,347,028 $597,539 $0 $140,847 $2,702,112
SACRAMENTO $437,716 $896,740 $380,030 $281,933 $111,418 $2,107,837
SAN BENITO $137,726 $142,017 $15,465 $0 $62,092 $357,300
SAN BERNARDINO $516,858 $1,206,643 $529,727 $281,933 $131,672 $2,666,833
SAN DIEGO $789,169 $1,780,938 $807,137 $281,933 $169,206 $3,828,383
SAN FRANCISCO $300,290 $550,999 $213,022 $0 $88,822 $1,153,133
SAN JOAQUIN $281,964 $504,896 $0 $281,933 $85,809 $1,154,602
SAN LUIS OBISPO $179,324 $246,669 $0 $281,933 $68,932 $776,858
SAN MATEO $278,301 $495,678 $186,300 $0 $85,206 $1,045,485
SANTA BARBARA $213,379 $332,348 $0 $0 $74,532 $620,259
SANTA CLARA $512,470 $1,084,809 $470,876 $281,933 $123,710 $2,473,798
SANTA CRUZ $177,309 $241,600 $0 $0 $68,601 $487,510
SHASTA $155,005 $199,608 $0 $281,933 $65,856 $702,402
SIERRA $125,639 $111,607 $0 $0 $60,105 $297,351
SISKIYOU $128,268 $132,342 $0 $0 $61,460 $322,070
SOLANO $212,850 $331,015 $0 $0 $74,445 $618,310
SONOMA $222,001 $354,037 $0 $281,933 $75,949 $933,920
STANISLAUS $189,229 $390,204 $0 $0 $78,313 $657,746
SUTTER $139,678 $161,049 $0 $0 $63,336 $364,063
TEHAMA $132,479 $142,938 $0 $0 $62,153 $337,570
TRINITY $127,711 $116,822 $0 $0 $60,446 $304,979
TULARE $207,4731 $352,7901 $0 $281,9331 $75,8681 $918,064
TUOLUMNE $135,7111 $136,946 $0 $0 $61,7611 $334,418
Attachment 1-Local Allocation Tables 2 of 17
Exhibit D
Page 6
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Total Grant Summary
Local Health DRAFT HPP PHEP CRI Lab Pan Flu FY 22-23 Total
Department Allocation Allocation Allocation Allocation Allocation (all grants)
VENTURA $292,319 $530,947 $0 $0 $87,511 $910,777
YOLO $168,572 $219,619 $52,951 $0 $67,164 $508,306
YUBA $135,295 $150,021 $0 $0 $62,616 $347,932
Multi-County LEMSAs $280,635 $0 $0 $0 $0 $280,635
ab Training & Assistance $0 $0 $0 $406,500 $0 $406,500
TOTALS $13,019,153 $21,208,687 $5,163,897 $3,789,696 $4,960,000 $48,141.433
Attachment 1-Local Allocation Tables 3 of 17
Exhibit D
Page 7
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
DRAFT FY 22-23 HPP Allocations (Base: $125,000)
Local Health 21-22 22-23 Multi-County Multi-County Final 22-23
Department Population Allocation Allocation LEMSA LEMSA Allocation Change
Amount
ALAMEDA 1,656,591 $457,596 $456,863 $0 $456,863 -$733
ALPINE 1,135 $125,115 $125,227 $112 Mountain Valley EMS $125,115 $0
AMADOR 37,377 $129,245 $132,488 $3,255 Mountain Valley EMS $129,233 -$12
BUTTE 202,669 $161,248 $165,600 $5,613 Sierra-Sac Valley EMS $159,987 -$1,261
CALAVERAS 45,036 $129,921 $134,022 $4,041 Mountain Valley EMS $129,981 $60
COLUSA 22,248 $123,747 $129,457 $5,613 Sierra-Sac Valley EMS $123,844 $97
CONTRA COSTA 1,153,854 $354,628 $356,150 $0 $356,150 $1,522
DEL NORTE 26,949 $111,725 $130,399 $18,709 North Coast EMS $111,690 -$35
ELDORADO 195,362 $163,464 $164,137 $0 $164,137 $673
FRESNO 1,026,681 $314,678 $330,674 $14,032 Central California EMS $316,642 $1,964
GLENN 29,679 $125,240 $130,946 $5,613 Sierra-Sac Valley EMS $125,333 $93
HUMBOLDT 130,851 $132,826 $151,213 $18,709 North Coast EMS $132,504 -$322
IMPERIAL 186,034 $162,578 $162,268 $0 $162,268 -$310
INYO 18,563 $122,655 $128,719 $6,044 ICEMA $122,675 $20
KERN 914,193 $307,648 $308,139 $0 $308,139 $491
KINGS 152,543 $141,545 $155,559 $14,032 Central California EMS $141,527 -$18
LAKE 63,940 $119,039 $137,809 $18,709 North Coast EMS $119,100 $61
LASSEN 27,572 $130,739 $130,523 $0 $130,523 -$216
MADERA 158,474 $142,449 $156,747 $14,032 Central California EMS $142,715 $266
MARIN 257,774 $176,921 $176,640 $0 $176,640 -$281
MARIPOSA 18,037 $127,024 $128,613 $1,572 Mountain Valley EMS $127,041 $17
MENDOCINO 86,669 $142,507 $142,362 $0 $142,362 -$145
MERCED 284,836 $181,438 $182,061 $0 $182,061 $623
MODOC 9,491 $126,905 $126,901 $0 $126,901 -$4
MONO 13,295 $121,636 $127,663 $6,044 ICEMA $121,619 -$17
MONTEREY 437,318 $212,814 $212,607 $0 $212,607 -$207
Attachment 1-Local Allocation Tables 4 of 17
Exhibit D
Page 8
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
DRAFT FY 22-23 HPP Allocations (Base: $125,000)
Local Health 21-22 22-23 Multi-County Multi-County Final 22-23
Department Population Allocation Allocation LEMSA LEMSA Allocation Change
Amount
NAPA 137,637 $152,687 $152,573 $0 $152,573 -$114
NEVADA 97,466 $138,918 $144,525 $5,613 Sierra-Sac valley EMS $138,912 -$6
ORANGE 3,153,764 $760,862 $756,790 $0 $756,790 -$4,072
PLACER 404,994 $199,750 $206,132 $5,613 Sierra-Sac valley EMS $200,519 $769
PLUMAS 18,116 $128,635 $128,629 $0 $128,629 -$6
RIVERSIDE 2,454,453 $611,165 $616,698 $0 $616,698 $5,533
SACRAMENTO 1,561,014 $434,611 $437,716 $0 $437,716 $3,105
SAN BENITO 63,526 $137,412 $137,726 $0 $137,726 $314
SAN BERNARDINO 2,175,909 $515,019 $560,897 $44,039 ICEMA $516,858 $1,839
SAN DIEGO 3,315,404 $790,527 $789,171 $0 $789,169 -$1,358
SAN FRANCISCO 875,010 $303,717 $300,290 $0 $300,290 -$3,427
SAN JOAQUIN 783,534 $278,999 $281,964 ° l $281,964 $2,965
SAN LUIS OBISPO 271,172 $180,191 $179,324 $0 $179,324 -$867
SAN MATEO 765,245 $278,922 $278,301 $0 $278,301 -$621
SANTA BARBARA 441,172 $214,943 $213,379 $0 $213,379 -$1,564
SANTA CLARA 1,934,171 $515,550 $512,470 $0 $512,470 -$3,080
SANTA CRUZ 261,115 $178,992 _ $177,309 $0 $177,309 -$1,683
SHASTA 177,797 $154,829 $160,618 $5,613 Sierra-Sac valley EMS $155,005 $176
SIERRA 3,189 $125,637 $12 3,639 $0 $125,639 $2
SISKIYOU 44,330 $128,238 $133,881 $5,613 Sierra-Sac valley EMS $128,268 $30
SOLANO 438,527 $212,631 $212,850 $0 $212,850 $219
SONOMA 484,207 .223,133 $222,001 $0 $222,001 -$1,132
STANISLAUS 555.968 $188,871 $236,376 $47,147 Mountain valley EMS $189,229 $358
SUTTER 1 1,289 $139,443 $145,291 $5,613 Sierra-Sac valley EMS $139,678 $235
TEHAMA 65,354 $132,352 $138,092 $57613 Sierra-Sac Valley EMS $132,479 $127
TRINITY 13,535 $127,697 $127,711 $0 $127,711 $14
TULARE 481,7331 $206,513 1 $221,505 $147032 Central California EMS $207,473 $960
TUOLUMNE 53,4651 $135,932 1 $135,711 $0 $135,711 -$221
Attachment 1-Local Allocation Tables 5 of 17
Exhibit D
Page 9
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
DRAFT FY 22-23 HPP Allocations (Base: $125,000)
Local Health 21-22 22-23 Multi-County Multi-County Final 22-23
Department Population Allocation Allocation LEMSA LEMSA Allocation Change
Amount
VENTURA 835,223 $292,785 $292,319 $0 $292,319 -$466
YOLO 217,5001 $169,133 $168,572 $0 $168,572 -$561
YUBA 79,4071 $135,091 $140,908 $5,613 Sierra-sac Valley EMS $135-29F $204
TOTALSI 29,422,3971 12,738,516 13,019,155 280,635 $12,738,518
Population 29,422,397 Multi-County LEMSA Allocation Total
Local HPP Allocation $13,019,153 DRAFT Central California EMS $56,127
Local Base Allocation $125,000 Mountain Valley EMS $56,127
Sierra-Sac Valley EMS $56,127
North Coast EMS $56,127
ICEMA $56,127
Total $280,635
Attachment 1-Local Allocation Tables 6 of 17
Exhibit D
Page 10
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 PHEP Allocations (Base: $110,000)
Local Health Population 21-22 22-23 Final 22-23 Change
Department Allocation Allocation Allocation
ALAMEDA(minus Berkeley) 1,539,830 $898,389 $886,064 $886,064 -12,325
ALPINE 1,135 $110,585 $110,572 $110,572 -13
AMADOR 37,377 $129,185 $128,838 $128,838 -347
BERKELEY 116,761 $172,419 $168,847 $168,847 -3,572
BUTTE 202,669 $217,083 $212,144 $212,144 -4,939
CALAVERAS 45,036 $132,926 $132,698 $132,698 -228
COLUSA 22,248 $121,153 $121,213 $121,213 60
CONTRA COSTA 1,153,854 $697,407 $691,535 $691,535 -5,872
DEL NORTE 26,949 $123,900 $123,582 $123,582 -318
EL DORADO 195,362 $208,393 $208,461 $208,461 68
FRESNO 1,026,681 $631,106 $627,440 $627,440 -3,666
GLENN 29,679 $124,971 $124,958 $124,958 -13
HUMBOLDT 130,851 $177,879 $175,948 $175,948 -1,931
IMPERIAL 186,034 $206,127 $203,760 $203,760 -2,367
INYO 18,563 $119,463 $119,356 $119,356 -107
KERN 914,193 $577,229 $570,747 $570,747 -6,482
KINGS 152,543 $188,219 $186,881 $186,881 -1,338
LAKE 63,940 $142,610 $142,225 $142,225 -385
LASSEN 27,572 $124,682 $123,896 $123,896 -786
MADERA 158,474 $190,530 $189,870 $189,870 -660
MARIN 257,774 $242,818 $239,916 $239,916 -2,902
MARIPOSA 18,037 $119,200 $119,091 $119,091 -109
MENDOCINO 86,669 $154,783 $153,681 $153,681 -1,102
MERCED 284,836 $254,372 $253,555 $253,555 -817
MODOC 9,491 $114,873 $114,783 $114,783 -90
MONO 13,295 $116,856 $116,701 $116,701 -155
MONTEREY 437,3181 $334,6351 $330,4051 $330,405 -4,230
Attachment 1-Local Allocation Tobles 7 of 17
Exhibit D
Page 11
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 PHEP Allocations (Base: $110,000)
Local Health Population 21-22 22-23 Final 22-23 Change
Department Allocation Allocation Allocation
NAPA 137,637 $180,825 $179,368 $179,368 -1,457
NEVADA 97,466 $159,961 $159,122 $159,122 -839
ORANGE 3,153,764 $1,736,591 $1,699,476 $1,699,476 -37,115
PLACER 404,994 $315,574 $314,114 $314,114 -1,460
PLUMAS 18,116 $119,298 $119,130 $119,130 -168
RIVERSIDE 2,454,453 $1,353,650 $1,347,028 $1,347,028 -6,622
SACRAMENTO 1,561,014 $902,010 $896,740 $896,740 -5,270
SAN BENITO 63,526 $141,751 $142,017 $142,017 266
SAN BERNARDINO 2,175,909 $1,220,355 $1,206,643 $1,206,643 -13,712
SAN DIEGO 3,315,404 $1,812,475 $1,780,941 $1,780,938 -31,537
SAN FRANCISCO 875,010 $567,173 $550,999 $550,999 -16,174
SAN JOAQUIN 783,534 $503,942 $504,896 $504,896 954
SAN LUIS OBISPO 271,172 $251,184 $246,669 $246,669 -4,515
SAN MATEO 765,245 $503,745 $495,678 $495,678 -8,067
SANTA BARBARA 441,172 $340,082 $332,348 $332,348 -7,734
SANTA CLARA 1,934,171 $1,109,058 $1,084,809 $1,084,809 -24,249
SANTA CRUZ 261,115 $248,115 $241,600 $241,600 -6,515
SHASTA 177,797 $200,663 $199,608 $199,608 -1,055
SIERRA 3,189 $111,630 $111,607 $111,607 -23
SISKIYOU 44,330 $132,640 $132,342 $132,342 -298
SOLANO 438,527 $334,167 $331,015 $331,015 -3,152
SONOMA 484,207 $361,031 $354,037 $354,037 -6,994
STANISLAUS 555,968 $393,992 $390,204 $390,204 -3,788
SUTTER 101,289 $161,303 $161,049 $161,049 -254
TEHAMA 65,354 $143,164 $142,938 $142,938 -226
TRINITY 13,535 $116,899 $116,822 $116,822 -77
TULARE 481,733 $354,410 $352,790 $352,790 -1,620
TUOLUMNE 53,465 $137,964 $136,946 $136,946 -1,018
Attachment 1-Local Allocation Tables 8 of 17
Exhibit D
Page 12
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 PHEP Allocations (Base: $110,000)
Local Health Population 21-22 22-23 Final 22-23 Change
Department Allocation Allocation Allocation
VENTURA 835,223 $539,207 $530,947 $530,947 -8,260
YOLO 217,500 $222,895 $219,619 $219,619 -3,276
YUBA 79,4071 $150,1701 $150,0211 $150,021 -149
TOTALS 29,422,3971 $21,457,7171 $21,208,6901 $21,208,687
Population 29,422,397
Local PHEP Allocation $24,998,383
Local Lab $3,789,696
TOTAL Local PHEP
Allocation (less Lab) $21,208,687
Local Base Allocation 1 $110,000
Attachment 1-Local Allocation Tables 9 of 17
Exhibit D
Page 13
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 CRI Allocations
Local Health 21-22 22-23 Final 22-23
Department Population Allocation Allocation Allocation change
ALAMEDA(minus Berkeley) 1,539,830 $331,121 $374,873 $374,873 43,752
BERKELEY 116,761 $26,216 $28,426 $28,426 Z210
CONTRA COSTA 1,153,854 $246,709 $280,907 $280,907 34,198
EL DORADO 195,362 $41,325 $47,561 $47,561 6,236
FRESNO 1,026,681 $218,863 $249,946 $249,946 31,083
MARIN 257,774 $55,783 $62,755 $62,755 6,972
ORANGE 3,153,764 $683,164 $767,786 $767,786 84,622
PLACER 404,994 $86,341 $98,596 $98,596 12,255
RIVERSIDE 2,454,453 $522,330 $597,539 $597,539 75,209
SACRAMENTO 1,561,014 $332,642 $380,030 $380,030 47,388
SAN BENITO 63,526 $13,336 $15,465 $15,465 Z129
SAN BERNARDINO 2,175,909 $466,346 $529,727 $529,727 63,381
SAN DIEGO 3,315,404 $715,035 $807,138 $807,137 92,102
SAN FRANCISCO 875,010 $192,012 $213,022 $213,022 21,010
SAN MATEO 765,245 $165,372 $186,300 $186,300 20,928
SANTA CLARA 1,934,171 $419,602 $470,876 $470,876 51,274
YOLO 1217,5001 $47,4161 $52,9511 $52,9511 5,535
TOTALS1 21,211,2521 $4,563,6131 $5,163,8981 $5,163,897
Population I 21,211,252
Local CRI Allocation j $5,163,897
Attachment 1-Local Allocation Tables 10 of 17
Exhibit D
Page 14
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Lab Allocations
Local Health 22-23 22-23 Lab 22-23 Lab Final 22-23
Department Allocation Trainee Assistance Allocation
FRESNO $281,933 $0 $0 $281,933
HUMBOLDT $281,933 $0 $0 $281,933
ORANGE $281,933 $0 $0 $281,933
SACRAMENTO $281,933 $0 $0 $281,933
SAN BERNARDINO $281,933 $0 $0 $281,933
SAN DIEGO $281,933 $0 $0 $281,933
SAN JOAQUIN $281,933 $0 $0 $281,933
SAN LUIS OBISPO $281,933 $0 $0 $281,933
SANTA CLARA $281,933 $0 $0 $281,933
SHASTA $281,933 $0 $0 $281,933
SONOMA $281,933 $0 $0 $281,933
TULARE $281,933 $0 $0 $281,933
TOTALS $3,383,1961 $0.001 $0.001 $3,383,196
Pending Allocation
Local LRN-B Labs 12
Local Lab Allocation $3,383,196
*Lab Trainee & Assist. $406,500 $406,500
TOTAL Labj $3,789,696
'Lab Trainee and Assistance funds to train microbiologist.
1)Allocated during application approval process.
2) Refer to Local Funding Guidance,Attachment for Lab Trainee and Assistance.
Attachment 1-Local Allocation Tables 11 of 17
Exhibit D
Page 15
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Pan Flu Allocations (Base: $60,000)
Local Health Population Final 22-23
Department Allocation
ALAMEDA(minus Berkeley) 1,539,830 $110,721
ALPINE 1,135 $60,037
AMADOR 37,377 $61,231
BERKELEY 116,761 $63,846
BUTTE 202,669 $66,676
CALAVERAS 45,036 $61,483
COLUSA 22,248 $60,733
CONTRA COSTA 1,153,854 $98,007
DEL NORTE 26,949 $60,888
EL DORADO 195,362 $66,435
FRESNO 1,026,681 $93,818
GLENN 29,679 $60,978
HUMBOLDT 130,851 $64,310
IMPERIAL 186,034 $66,128
INYO 18,563 $60,611
KERN 914,193 $90,113
KINGS 152,543 $65,025
LAKE 63,940 $62,106
LASSEN 27,572 $60,908
LONG BEACH 467,730 $75,407
LOS ANGELES
(minus Long Beach&Pasadena) 9,431,422 $370,662
MADERA 158,474 $65,220
MARIN 257,774 $68,491
MARIPOSA 18,037 $60,594
MENDOCINO 86,669 $62,855
MERCED 284,836 $69,382
MODOC 9,491 $60,313
MONO 1 13,2951 $60,438
MONTEREY 1 437,3181 $74,405
Attachment 1-Local Allocation Tables 12 of 17
Exhibit D
Page 16
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Pan Flu Allocations (Base: $60,000)
Local Health Population Final 22-23
Department Allocation
NAPA 137,637 $64,534
NEVADA 97,466 $63,210
ORANGE 3,153,764 $163,882
PASADENA 145,306 $64,786
PLACER 404,994 $73,340
PLUMAS 18,116 $60,597
RIVERSIDE 2,454,453 $140,847
SACRAMENTO 1,561,014 $111,418
SAN BENITO 63,526 $62,092
SAN BERNARDINO 2,175,909 $131,672
SAN DIEGO 3,315,404 $169,206
SAN FRANCISCO 875,010 $88,822
SAN JOAQUIN 783,534 $85,809
SAN LUIS OBISPO 271,172 $68,932
SAN MATEO 765,245 $85,206
SANTA BARBARA 441,172 $74,532
SANTA CLARA 1,934,171 $123,710
SANTA CRUZ 261,115 $68,601
SHASTA 177,797 $65,856
SIERRA 3,189 $60,105
SISKIYOU 44,330 $61,460
SOLANO 438,527 $74,445
SONOMA 484,207 $75,949
STANISLAUS 555,968 $78,313
SUTTER 101,289 $63,336
TEHAMA 65,354 $62,153
TRINITY 13,535 $60,446
TULARE 481,733 $75,868
TUOLUMNE 53,465 $61,761
Attachment 1-Local Allocation Tables 13 of 17
Exhibit D
Page 17
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
FY 22-23 Pan Flu Allocations (Base: $60,000)
Local Health Population Final 22-23
Department Allocation
VENTURA 835,223 $87,511
YOLO 217,500 $67,164
YUBA 79,407 $62,616
TOTALS 39,466,855 $4,960,000
Population 39,466,855
Pan Flu Allocation $4,960,000
Base Allocation $60,000
Attachment 1-Local Allocation Tables 14 of 17
Exhibit D
Page 18
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
CA Department of Finance
Population Estimates
Report E-1
Released: January 1, 2021
Local Health 22-23
Department Population
ALAMEDA 1,656,591
ALAMEDA(minus Berkeley) 1,539,830
ALPINE 1,135
AMADOR 37,377
BERKELEY 116,761
BUTTE 202,669
CALAVERAS 45,036
COLUSA 22,248
CONTRA COSTA 1,153,854
DEL NORTE 26,949
ELDORADO 195,362
FRESNO 1,026,681
GLENN 29,679
HUMBOLDT 130,851
IMPERIAL 186,034
INYO 18,563
KERN 914,193
KINGS 152,543
LAKE 63,940
LASSEN 27,572
LONG BEACH 467,730
LOS ANGELES 9,431,422
(minus Long Beach&Pasadena)
MADERA 158,474
MARIN 257,774
MARIPOSA 18,037
MENDOCINO 86,669
MERCED 284,836
MODOC 9,491
MONO 13,295
MONTEREY 1 437,318
Attachment 1-Local Allocation Tables 15 of 17
Exhibit D
Page 19
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
CA Department of Finance
Population Estimates
Report E-1
Released: January 1, 2021
Local Health 22-23
Department Population
NAPA 137,637
NEVADA 97,466
ORANGE 3,153,764
PASADENA 145,306
PLACER 404,994
PLUMAS 18,116
RIVERSIDE 2,454,453
SACRAMENTO 1,561,014
SAN BENITO 63,526
SAN BERNARDINO 2,175,909
SAN DIEGO 3,315,404
SAN FRANCISCO 875,010
SAN JOAQUIN 783,534
SAN LUIS OBISPO 271,172
SAN MATEO 765,245
SANTA BARBARA 441,172
SANTA CLARA 1,934,171
SANTA CRUZ 261,115
SHASTA 177,797
SIERRA 3,189
SISKIYOU 44,330
SOLANO 438,527
SONOMA 484,207
STANISLAUS 555,968
SUTTER 101,289
TEHAMA 65,354
TRINITY 13,535
TULARE 481,733
TUOLUMNE 53,465
Attachment 1-Local Allocation Tables 16 of 17
Exhibit D
Page 20
California Department of Public Health FY 2022-23 Local Grant Allocations Attachment 1 v1
Emergency Preparedness Office Grant Period: 01/07/2022 to 06/30/2023
CA Department of Finance
Population Estimates
Report E-1
Released: January 1, 2021
Local Health 22-23
Department Population
VENTURA 835,223
YOLO 217,500
YUBA 79,407
TOTALI 39,466,855
California 39,466,855
Attachment 1-Local Allocation Tables 17 of 17
Exhibit D
Letter of Intent Page 21
Emergency Preparedness Office
Public Health and Medical Emergency Preparedness Program
Local Implementing Agency Funding Application
Fiscal Years (FY) FY 2022-23 through FY 2026-27
(July 1, 2022 to June 30, 2027)
Complete and email this form by 4:00pm April 19, 2022 to: LHBTProg(a-_)cdph.ca.gov
Emergency Preparedness Office
California Department of Public Health
1) Please complete the fields below for your Agency:
Project Representative: C
Title:
Agency:
Address:
Telephone:
Email:
2) Please check the boxes below that indicate the funding source your Agency will apply.
a) Public Health Emergency Preparedness (PHEP)
b) Hospital Preparedness Program (HPP)
c) Pandemic Influenza (Pan Flu)
d) PHEP & Cities Readiness Initiative (CRI)
e) PHEP & Laboratory (Lab)
f) PHEP, CRI & Lab
3) Please complete the fields below in order to expedite processing your agreement.
Does your Agency require a board resolution for a new agreement?
When are your scheduled board meeting dates between May and
September 2022?
Does your Agency require the contract be in hand to get on the Agenda?
When do you need the contract? (i.e. two weeks before, one month
before, etc.)
4) By signing below,your Agency agrees to prepare the required documents for this funding
application.
Signature of Project Director or Designee Date
Printed name
Exhibit D
Attachment 3 Page 22
PROJECT REPRESENTATIVES The Project Representatives during the term of this agreement will be:
California Department of Public Health Grantee:
Name:
Address:
City, ZIP:
Phone:
Email:
Direct all inquiries to the following representatives:
California Department of Public Health Grantee:
FName:
Address:
City, ZIP:
Phone:
[Email:
All payments from CDPH to the Grantee; shall be sent to the following address:
Remittance Address
Grantee:
Attention:
Address:
City, ZIP:
Phone:
Email:
Exhibit D
Page 23
Attachment 4
Fiscal Year (FY) 2022 — 2027
Funding Guidance
Public Health and Health Care Coalition Emergency Preparedness Guidance
California Department of Public Health
Emergency Preparedness Office
Emergency Preparedness Office
California Department of Public Health
1615 Capitol Avenue, Suite 73.516
PO Box 997377, MS 7204
Sacramento, CA 95899
California Dcpartmcnt of
PublicHealth
This material was produced by the California Department of Public Health's Emergency
Preparedness Office with funding from the CDC, ASPR and California as Pandemic Influenza.
This document contains both Federal and State dates and requirements that are subject to
change due to emergency response efforts. Notification of such changes will be provided upon
receipt.
Exhibit D
Page 24
TIMELINE
DATE ACTIVITY
April 12, 2022 Funding Application Package release
April 19, 2022 Letter of Intent (Attachment 2) and Project
Representative information (Attachment 3)
April 19 & 20, 2022 Application Webinar, all LHD call
May 20, 2022 Application Package
June 2022 Application Approval Letter
July 1, 2022 Five-Year Grant Agreement begins
Application Package Checklist
ApplicationDocument Completed
All Grants
Annual Single Audit of FY 21-22
Budget Personnel Summary FY 22-23 (Attachment H)
Contact Information FY 22-23 (Attachment 1)
Gov. Agency Taxpayer ID Form (Attachment J)
Public Health Emergency Preparedness (PHEP)
PHEP Workplan FY 22-23 (Attachment A)
PHEP Budget FY 22-23 (Attachment E)
Hospital Preparedness Program (HPP)
HPP Workplan FY 22-23 (Attachment B)
HPP Budget FY 22-23 (Attachment F)
Pandemic Influenza (Pan Flu)
Pan Flu Workplan FY 22-23 (Attachment C)
Pan Flu Budget FY 22-23 (Attachment G)
Cities Readiness Initiative (CRI) Jurisdictions
PHEP CRI Budget FY 22-23 (Attachment E)
Laboratory Response Network — Biological (LRN-B) Jurisdictions
PHEP Lab Budget FY 22-23 (Attachment E)
Multi-County LEMSA Jurisdictions
Multi-County LEMSA Workplan FY 22-23 (Attachment D)
IF Applicable
Fiscal Corrective Action Plan (CAP) (Attachment K)
Inventory Disposal Schedule FY 22-23 (Attachment L)
Lab Training & Assistance Application FY 22-23 (Attachment M)
Application funding is subject to change at any time because of changes in Federal
or State program funding amendments.
Exhibit D
Page 25
Contents
A. Introduction ................................................................................................................4
B. Funding Authorization ................................................................................................4
1. Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI)
Act ............................................................................................................................4
a) PHEP............................................................................................................ 5
b) HPP.............................................................................................................. 6
c) Pan Flu ......................................................................................................... 6
C. General Information ................................................................................................... 7
1. Funding Objective................................................................................................. 7
2. Funding Amount................................................................................................... 7
3. Eligibility ............................................................................................................... 7
D. Grant Agreement Award Process .............................................................................. 8
E. Application Instructions.............................................................................................. 8
1. Intent to Apply....................................................................................................... 8
2. Application Webinar.............................................................................................. 8
3. Submission of Application .................................................................................... 9
4. Required Application Documents ......................................................................... 9
5. FY Allocations..................................................................................................... 10
a) Local Emergency Medical Services Agency (LEMSA) Allocations ............. 10
b) Cities Readiness Initiative (CRI)................................................................. 10
c) Local Laboratory Response Network — Biological (LRN-B) ........................ 11
6. If Applicable........................................................................................................ 12
7. Application Questions......................................................................................... 12
F. Funding Requirements............................................................................................. 12
a) Capabilities Planning Guides...................................................................... 12
b) Emergency Preparedness Training Workshop (EPTW) ............................. 12
c) Inventory..................................................................................................... 13
d) Mid-Year and Year End Reporting.............................................................. 13
e) Performance Measures .............................................................................. 13
f) Site Visits.................................................................................................... 13
g) Statewide Medical Health Exercise (SWMHE) ........................................... 14
G. Additional Information .............................................................................................. 14
H. Audit......................................................................................................................... 14
I. Continuation Guidance ............................................................................................ 14
Exhibit D
Page 26
A. Introduction
The Emergency Preparedness Office (EPO) of the California Department of Public Health
(CDPH) is soliciting applications from all Local Health Departments (LHDs) to provide public
health and medical emergency preparedness funding for LHDs to plan, train, exercise and
improve local public health and medical emergency response and recovery from a disaster.
Funding sources include: the Centers for Disease Control and Prevention (CDC), for Public
Health Emergency Preparedness (PHEP) planning, Cities Readiness Initiative (CRI), and
Laboratory (Lab); the Assistant Secretary for Preparedness & Response (ASPR) for Hospital
Preparedness Program (HPP) planning; and the State of California for Pandemic Influenza (Pan
Flu) planning.
This application begins the process by which CDPH-EPO will prepare a five-year agreement.
The CDPH-EPO authority for these grant agreements is vested in the California Health and
Safety Code, Sections 100150-100236, 100250-100255, 100325-100950, 101315, 101319,
131000-131020, and 131050-131231; Government Code, Sections 8574.48 and 8587.8-8587.9;
and California Code of Regulations, Titles 17 and 22. The services in this grant agreement are
identified as 100% local assistance funding in our agency's budget and meet the conditions of
State Contracting Manual 3.17.
The budget period (BP) for all funding streams begins on July 1st and ends on June 301" of each
Fiscal Year (FY). The funding streams included in this Guidance are listed below:
• Public Health Emergency Preparedness (PHEP)
o Cities Readiness Initiative (PHEP CRI)
o Laboratory (PHEP Lab)
• Hospital Preparedness Program (HPP)
• Pandemic Influenza (Pan Flu)
B. Funding Authorization
1 . Pandemic and All-Hazards Preparedness and Advancing Innovation
(PAHPAI) Act
The PAHPAI Act reauthorizes, revises, and establishes several programs and entities relating to
public health emergency preparedness and response. Language from the PAHPAI Act
reauthorizing PHEP and HPP programs is as follows:
TITLE 11--IMPROVING PREPAREDNESS AND RESPONSE
(Sec. 201) This section reauthorizes through FY2023 and revises the Public Health
Emergency Preparedness cooperative-agreement program administered by the Centers
Exhibit D
Page 27
for Disease Control and Prevention (CDC) to include evaluations using evidence-based
benchmarks and objective standards.
(Sec. 202) This section reauthorizes through FY2023 and revises the Hospital
Preparedness Program administered by the Office of the Assistant Secretary for
Preparedness and Response (ASPR) to require applicants for cooperative agreements
under the program to describe the applicant's approach for coordinating services and
integrating health data.
a) PHEP
• Awarding Agency: Department of Health and Human Services, Centers for Disease
Control and Prevention (CDC)
• Funding Authority Section 319C-1 of the Public Health Service (PHS) Act (title 47
United States Code (USC) 247d-3a), as amended.
• Award Recipient: California Department of Public Health
• Catalog of Federal Domestic Assistance (CFDA) Number: 93.069 — Public Health
Emergency preparedness
• Assistance Type: Cooperative Agreement
• BP3 Grant Number: 5 NU90TP922005-03-00, Award Date: 04/26/2021
• Federal Award Identification Number (FAIN): NU90TP922005
• BP3 Notice of Funding Opportunity (NOFO) Number: CDC-RFA-TP19-1901
• Title of Project: Public Health Emergency Preparedness (PHEP) Cooperative Agreement
• Project Period: From 07/01/2019 through 06/30/2024
• PHEP Federal Project Description: The Public Health Emergency Preparedness and
Response Capabilities: National Standards of State, Local, Tribal, and Territorial Public
Health describes the 15 capability standards for PHEP recipients to strengthen during
the 2019-2024 performance period. The capability standards inform the PHEP logic
model, which is a high-level description of the PHEP program's general approach that
displays "if-then" relationships between the program's strategies, activities, and
outcomes. The logic model also highlights priority strategies and activities, provides
examples of consequent outputs, and characterizes the intended outcomes that will
result from building jurisdictional capabilities.
PHEP recipients are expected to show measurable progress toward achieving the short-
term and long-term outcomes during this five-year performance period. CDC will use its
PHEP Operational Readiness Review (ORR) Reporting and Tracking System (PORTS)
evaluation process to measure PHEP recipient progress in achieving desired outcomes.
Subject to the availability of funding, CDC may introduce future projects that support
advanced development of key public health preparedness capabilities in high population
cities during the 2019-2024 performance period. This future project may support high
Exhibit D
Page 28
population cities with identifying gaps and strengthening chemical and radiological
preparedness.
b) HPP
• Awarding Agency: Department of Health and Human Services, Assistant Secretary for
Preparedness & Response (ASPR)
• Funding Authority: Section 319C-2 of the Public Health Services (PHS) Act (title 42
United States Code (USC) 247d-3b), as amended.
Section 311 of the PHS Act (title 42 USC 243), subject to available funding and other
requirements and limitations
• Award Recipient: California Department of Public Health
• Catalog of Federal Domestic Assistance (CFDA) Number: 93.889 — National
Bioterrorism Hospital Preparedness
• Assistance Type: Formula Grant
• BP2 Grant Number: 5 U3REP190564-02-00
• Federal Award Identification Number (FAIN): U3REP190564
• BP3 Funding Opportunity Announcement (FOA) Number: EP-U3R-19-001
• Title of Project: Hospital Preparedness Program Cooperative Agreement
• Project Period: From 07/01/2019 through 06/30/2024
• HPP Federal Project Description: ASPR's HPP funding is to strengthen and enhance the
acute care medical surge capacity through the maintenance and growth of strong Health
Care Coalitions (HCCs) within each HPP-funded state, territory, freely associated state,
and locality. HPP funds are to build acute care medical surge capacity by ensuring that
HPP recipients focus on objectives and activities that advance progress toward meeting
the goals of the four capabilities detailed in the 2017-2022 Health Care Preparedness
and Response Capabilities and document progress in establishing or maintaining
response-ready health care systems through strong HCCs.
c) Pan Flu
Match to federal funding, authorized by the annual California Budget Act
PROGRAM AUTHORITY 4040-Public Health Emergency Preparedness: Health and Safety
Code, Sections 100150-100236, 100250-100255, 100325-100950, 101315, 101319,
131000-131020, and 131050-131231; Government Code, Sections 8574.48 and 8587.8-
8587.9; and California Code of Regulations, Titles 17 and 22.
4040010 - Emergency Preparedness
The Public Health Emergency Preparedness program coordinates preparedness and
response activities for all public health emergencies, including natural disasters, acts of
terrorism, and pandemic diseases. The program plans and supports surge capacity in the
Exhibit D
Page 29
medical care and public health systems to meet needs during emergencies. The program
also administers federal and state funds that support Public Health emergency
preparedness activities.
C. General Information
1 . Funding Objective
CDPH-EPO is issuing a funding application request to Local Health Departments or their
designated entity for a five-year grant period from July 1, 2022, to June 30, 2027. CDPH-EPO
funds PHEP, HPP, Pan Flu, CRI and Lab to LHDs to complete service delivery within their
jurisdiction, and to promote planning and preparedness for a response to all public health and
medical emergencies, including natural disasters, acts of terrorism, and infectious diseases. The
local emergency preparedness program plans shall support surge capacity in public health
systems and the health care delivery system to meet the needs during emergencies.
The objective is to award funding for work with PHEP, HPP, Pan Flu, CRI and Lab eligible
LHDs. Successful applicants will use jurisdictional hazard and vulnerability assessments,
exercises, and real events to assess gaps, and develop improvement plans to inform and
galvanize process improvement. Improvements and updates should be at least every three
years and used to inform policy, processes, training and exercising needed to be ready for a
public health and/or medical emergency that threats the public's health and the stability of the
health care delivery system with a long-term goal of sustaining readiness.
2. Funding Amount
CDPH-EPO will award approximately $48M each FY dependent upon the annual Federal
Continuation Guidance and State award. Attachment 1 is the DRAFT Local Allocation table for
FY 2022-23 for each LHJ by funding stream. Each FY CDPH-EPO will release the annual Local
Allocation table along with State Continuation Guidance based on federal funding authority and
State awards. Refer to Continuation Guidance for additional information.
3. Eligibility
Applicants must be a California Local Health Department or Agency or a Local Health
Department's designated entity, from here on referred to as Local Health Jurisdiction (LHJ) that
meets all the criteria below:
i. Operate within the county they authorize to serve,
ii. Provide proof of non-profit status as part of the response to the Funding Application
Request (for example, a copy of your signed 501(c) (3) IRS form),
iii. Address public health and/or medical emergency preparedness and response planning
and implementation and sustainment,
iv. Follow the California Public Health and Medical Emergency Operations Manual (EOM),
California's Standardized Emergency Management System (SEMS) and the National
Incident Management System (NIMS).
Exhibit D
Page 30
v. Demonstrate experience or capacity to provide public health and/or medical emergency
preparedness and response planning and implementation to the jurisdiction,
vi. Collaborate and coordinate with public health and medical emergency preparedness
response partners and stakeholders representing the diverse assets, diverse populations
in order to meet the public health and medical emergency preparedness and response
needs of community, including addressing and promoting the following efforts: tribal
engagement, at-risk populations and health equity, and
vii. Possess the capacity to adhere to the agreement, fiscal and program reporting
requirements of CDPH-EPO, CDC and ASPR.
D. Grant Agreement Award Process
Awarded Grant Agreements will be executed by June 30, 2022, for work to begin on July 1,
2022. CDPH-EPO reserves the right to fund any or none of the applications submitted.
Awards will be made to LHJs, whose applications are determined to be technically complete
and whose professional qualifications and experience meet the terms of the Funding Application
Package. The selection process may include a request for additional information to support the
application. In addition, telephone interviews and/or site visits may take place between the
selection processes, grant agreement negotiations, and grant agreement award dates.
E. Application Instructions
1 . Intent to Apply
Prospective applicants who intend to apply are required to indicate their intention to apply,
by submitting the Letter of Intent and Project Representatives. Failure to submit the
mandatory, non-binding Letter of Intent will result in application rejection. The mandatory
Letter of Intent is non-binding and prospective applicants are not required to apply merely
because a Letter of Intent is submitted.
Submitting a Mandatory, Non-Binding Letter of Intent & Project Representatives
The mandatory, non-binding Letter of Intent and Project Representatives must be received by
4:00 pm (PST) on April 19, 2022. Submit the Letter of Intent via email. Email Subject Line:
Letter of Intent for Funding Application FY 2022-2027 to LHBTProg(a-).cdph.ca.gov and cc your
Contract Manager.
2. Application Webinar
An Application Webinar will be scheduled in April 19 & 20, 2022. The purpose of the webinar is
to review the information in this Funding Application Package and answer any questions
applicants have regarding the application process.
Exhibit D
Page 31
3. Submission of Application
Submit all required application documents to LHBTProgQCDPH.ca.gov, and cc your
Contract Manager, with an email subject line: LHJ Name Application documents, in the
body of the email list all the attachments included. Application documents 414M are due
not later than May 20, 2022.
CDPH-EPO reserves the right to reject any or all applications and/or cancel the grant
agreement made under this Funding Application Package. Acceptance of an application
is subject to negotiations of an agreement between CDPH-EPO and the applicant.
All materials submitted in response to this Funding Application Package will become the
property of CDPH-EPO at the time the application is received. All applicants agree that in
applying, they authorize CDPH-EPO to verify any or all claimed information.
All applications must be complete when submitted. CDPH-EPO reserves the right to contact
applicants during any application evaluation phase to clarify the content of the application and
request changes.
Application will be considered as a representation that:
i. The LHJ and any subcontractor(s) have carefully investigated all conditions which
affect, now and in the future, the performance of the work covered by the application,
ii. The LHJ and any subcontractor(s) are fully informed concerning the conditions to be
encountered, quantity and quality of work to be performed, and
iii. The LHJ and any subcontractor(s) are familiar with all Federal and State laws that affect
the work to be conducted and the persons employed in the work.
Information, Addenda, or Changes
If any clarifications or modifications to this Funding Application Package are necessary,
all questions and answers, addenda, or changes will be communicated to the applicant
from LHBTProgC@cdph.ca.gov. It is the responsibility of applicants to request to join
CDPH-EPO emergency preparedness email distribution lists and keep their contact
information up to date.
4. Required Application Documents
Complete and submit the required application documents for FY 2022-23. All required
application documents for a complete application are included in the checklist on page 2
and detailed below. LHJs work plans and budgets for the current FY will be incorporated
into the applicant's five-year agreement.
There are four Workplans; one for each grant (PHEP, HPP and Pan Flu) and one for the
Multi-County Local Emergency Medical Services Agencies (MCLEMSA). All local
applicants must complete and submit a workplan for each applicable funding stream
indicated in Attachment 2 (Letter of Intent). Workplan Instructions are included in
Appendix C, this appendix will be updated each FY and be included in the annual
Continuation Guidance.
0 Attachment A: PHEP Workplan FY 22-23
Exhibit D
Page 32
• Attachment B: HPP Workplan FY 22-23
• Attachment C: Pan Flu Workplan FY 22-23
• Attachment D: Multi-County LEMSA Workplan FY 22-23
The budget period for all application funding streams is July 1 to June 30. All budgets are based
on the annual allocations for the upcoming FY, use Attachment I — DRAFT Local Allocation
tables. Budget Instructions are outlined in Appendix A, this appendix will be updated each FY
and be included in the annual Continuation Guidance.
• Attachment E: PHEP Budget FY 22-23
• Attachment F: HPP Budget FY 22-23
• Attachment G: Pan Flu Budget FY 22-23
• Attachment E: PHEP CRI Budget FY 22-23
• Attachment E: PHEP Lab Budget FY 22-23
• Attachment H: Budget Personnel Summary FY 22-23
5. FY Allocations
The DRAFT allocation tables for PHEP, PHEP CRI, PHEP Lab, HPP and Pan Flu funding are
listed in Attachment 1, will be updated each FY, and be included in the annual Continuation
Guidance.
a) Local Emergency Medical Services Agency (LEMSA) Allocations
Local Entities receiving HPP funding will fund their jurisdiction's single county LEMSA at
$43,175. There are 25 LHJs that share a LEMSA, the five multi-county LEMSAs contract
directly with CDPH-EPO, are required to complete the same workplan activities as the single
county LEMSAs, multi-county LEMSAs complete Attachment D.
b) Cities Readiness Initiative (CRI)
California has sixteen LHJs outside of Los Angeles County designated as a CRI jurisdiction.
California's higher risk Metropolitan Statistical Areas (MSAs) are Los Angeles-Long Beach-
Anaheim, San Diego-Carlsbad, and San Francisco-Oakland-Hayward. *City of Berkeley
receives CRI funding; it is not counted as a separate CRI jurisdiction by the CDC. CRI LHJs
complete Attachment E (PHEP Budget).
California CRI — Local Entities
Alameda Orange San Diego
*City of Berkeley Placer San Francisco
Contra Costa Riverside San Mateo
El Dorado Sacramento Santa Clara
Fresno San Benito Yolo
Marin San Bernardino
Exhibit D
Page 33
c) Local Laboratory Response Network— Biological (LRN-B)
Fourteen of California's public health labs are designated as LRN-B Reference Public Health
Laboratories, see table below. *Twelve LRN-B Reference Public Health Laboratories are
allocated $281,933 of PHEP funding each year. LRN-B LHJs complete Attachment E (PHEP
Budget).
LRN-113 Reference Public Health Laboratories
California Department of Public *Sacramento *Santa Clara
Health
*Fresno *San Bernardino *Shasta
*Humboldt *San Diego *Sonoma
Los Angeles *San Joaquin *Tulare
*Orange *San Luis Obispo
An Annual Single Audit for the previous fiscal year, must be provided annually. The Annual
Single Audit is reviewed and provided to CDPH's internal audits program prior to the applicant's
audit. The Single Audit applies to state, local government, and nonprofit recipients. Single Audit
must be submitted to the Federal Audit Clearinghouse (FAC), and to any Federal agency who
specifically requests it. Federal guidelines require recipients to submit the documents no more
than 30 days after the auditor issues its report or 9 months after the final day of the audit period,
whichever comes first. Refer to https://www.ecfr.gov/cqi-bin/text-idx?node=sp2.1.200.f. All
LHJs must provide their Annual Single Audit, if the audit is not available at the time the
Application Package is due, please provide a letter from your health officer or fiscal officer
stating when the Annual Single Audit will be provided. All LHJs provide their Single Audit for the
previous FY.
• Annual Single Audit of FY 21-22
Current contact information for the emergency preparedness and response programs in LHJs
must be submitted and kept up to date throughout the fiscal year. Complete and submit Contact
Information, Attachment I. All LHJs complete Attachment I
• Attachment I - Contact Information FY 22-23
Government Agency Taxpayer ID form, CDPH9083, is used to confirm applicant's payment
address each fiscal year for Quarter 1 payments and future invoice reimbursements. Applicants
must include this form each FY. All LHJs complete Attachment J.
0 Attachment J: Government Agency Taxpayer ID form
Exhibit D
Page 34
6. If Applicable
A Health Officer Letter is required when the Local Health Department or Agency designates
another entity to perform the programmatic and fiscal duties during the five-year agreement.
• Health Officer Letter
Local Public Health Laboratories designated as a Laboratory Response Network— Biological
(LRN-B) are eligible to apply for additional funding to support Microbiologist training. For more
information on how to apply for the PHEP Laboratory Training and Assistance funds, refer to
Attachment M.
• Attachment M: PHEP Lab Training and Assistance application
The Inventory Disposal Schedule, Attachment L, is used to report any single piece of equipment
with a value of$5,000 or more that was disposed of during the fiscal year.
Attachment L: Inventory Disposal Schedule
If the Local Entity has any outstanding audit finding(s) from prior years, a Fiscal CAP is required
for each fiscal year when the audit finding(s) are unresolved.
• Attachment K: Fiscal Corrective Action Plan
7. Application Questions
Submit all application questions or concerns to LHBTProg(a)_CDPH.ca.gov, and cc your
Contract Manager, with an email subject line: LHJ Name Application Question, in the
body of the email include your question, or outline your concerns and attach any relevant
documents.
F. Funding Requirements
Each FY applicants are required to complete the following activities.
a) Capabilities Planning Guides
LHJs are required to complete the Public Health and Health Care Capabilities Planning Guides
(CPGs). The CPG data are a point in time self-assessment of current preparedness abilities,
used to identify gaps and guide planned activities for the upcoming FY. CDPH-EPO will provide
the CPG questions and instructions on completing and submitting the CPG responses in the
second quarter of each FY.
b) Emergency Preparedness Training Workshop (EPTW)
All LHJ Program Coordinators are required to attend the annual CDPH-EPO Emergency
Preparedness Training Workshop (EPTW). Each FY EPTW will notify all LHJs via email and
provide a link to the EPTW website with the dates, location, registration fee, agenda, and other
details. CDPH-EPO encourages Local Entity staff, HPP Healthcare Partners, Healthcare
Coalition partners, local Office of Emergency Services and Local Emergency Medical Services
(LEMSA) staff to attend the EPTW.
Exhibit D
Page 35
c) Inventory
All LHJs must maintain a list of equipment and/or property purchased with federal and State
funds for emergency planning and preparedness. LHJs must include both major and minor
equipment and/or property on their inventory list and follow the Code of Federal Regulations
(CFR) for purchasing and disposing of equipment and/or property if purchased with federal
funds. LHJs will be required to complete federal documentation of purchases and disposals of
equipment and/or property that costs $5,00 or more, to CDPH-EPO.
i. Major equipment/property: A tangible or intangible item having a base unit cost of$5,000
or more with a life expectancy of one (1) year or more and is either furnished by CDPH
or the cost is reimbursed through this Agreement. Software and videos are examples
of intangible items that meet this definition.
ii. Minor equipment/property: A tangible item having a base unit cost of less than $5,000
with a life expectancy of one (1) year or more and is either furnished by CDPH or the
cost is reimbursed through this Agreement.
d) Mid-Year and Year End Reporting
Each FY programmatic and fiscal progress reports are due for all funding streams to CDPH-
EPO twice a year at mid-year and end of year. The programmatic progress report is included
within the Workplans and the instructions for completing the report section are within the Work
Plan Instructions. The progress expenditure report templates and instructions will be provided
via email prior to the due dates.
Due Dates:
• Mid-Year Reports (all): January 31, 2023
• Year End Work Plan Progress Reports: July 30, 2023
• Year End Expenditure Report Approval: 10 days after the approval of a Local Entity' Final
Invoice
Submit all Progress Reports via email to LHBTProgCa cdph.ca.gov and copy your assigned
Project Officer and Contract Manager.
e) Performance Measures
All LHJs may be required to submit federal and State performance measures for each funding
stream. LHJs will be informed of what performance measures apply, by funding stream within
the Local Work Plans and/or via email. In addition, LHJs may be requested to submit additional
data and documents during the five-year agreement as required by the federal funding authority
and/or CDPH-EPO.
f) Site Visits
CDPH-EPO Project Officers and Contract Managers will conduct annual site visits of all LHJs or
their designated entities to review progress on grant deliverables and activities and provide
technical assistance. Site visits are an opportunity for LHJs to share best practices, trainings,
exercises, and other events demonstrating grant progress, as well as discuss any challenges or
Exhibit D
Page 36
barriers. Annual site visits may be virtual or in-person, depending on state and/or local
restrictions.
g) Statewide Medical Health Exercise (SWMHE)
All LHJs must participate in the annual Statewide Medical and Health Exercise (SWMHE). Each
FY SWMHE will notify all LHJs via email and provide a link to the SWMHE website with the
dates, incident, location(s), capabilities being tested, and other details. LHJs should utilize their
participation in this exercise to complete multiple exercise requirements and encourage
participation from all members of their Health Care Coalition, LEMSA and OES.
G.Additional Information
Additional information to assist LHJs with their application, managing and reporting progress.
i. Appendix A- Budget Instructions
Instructions on how to complete the budget templates, include expanded authority (carry-
forward) funds and budget revisions.
ii. Appendix B - What's Allowable Matrix
Guide to items that are allowable to purchase by budget category and purpose.
iii. Appendix C - Work Plan Instructions
Instructions on how to complete the work plan templates, including progress reporting.
H. Audit
All funding is subject to an audit by CDPH's Internal Audits program for each FY funding was
received. CDPH-EPO assesses the risk of each LHJ based on their ability to meet deliverable
deadlines, provide complete and accurate reports, appropriately budget and expend their funds.
The assessment is utilized by CDPH's Internal Audits program to determine the type of audit,
desktop or onsite, to be performed. CDPH's Internal Audits aims to perform a fiscal audit on all
federal funds for each LHJ at least once during a three-year period.
I. Continuation Guidance
Successive fiscal years applicants will receive an annual Continuation Guidance which will
include updated federal and State funding requirements, and the annual allocation for the
upcoming fiscal year. Updated application documents, per the checklist on page 2, must be
completed and submitted each successive fiscal year upon request during the five-year
agreement. All LHJs will receive an email notification prior to the upcoming FY providing the
annual Continuation Guidance, the annual allocations, updates to the Local work plan activities
and deliverables and updates from Federal and State.
Exhibit D
Page 37
Attachment A
Date:
!)CDPH
California Department of Public Health
Emergency Preparedness Office
FY 2022-23 to FY 2026-27
Local Health Department Work Plan for
Public Health Emergency Preparedness (PHEP)
[Local Entity Name]
Region:
Population size:
Attachment A-PHEP Workplan,Cover
Exhibit D
Page 38
PHEP Requirements Attachment A
This is a short list of requirements for the Public Health Emergency Preparedness (PHEP) funding.
Instruction
Please use the drop down menus in each "box" and select an option.
Requirement
Use the drop down to indicate the year the requirement was or will be completed.
Conduct a public health full Jurisdictional Risk Assessment (JRA) must be completed at least
once every five years (rolling five years).
See Domain 1, Domain Activity 1.1
Exercises
Use the drop down to indicate the year the exercise was or will be completed.
DRILL: Facility setup must be completed once a year.
See Domain 4, Domain Activity 1.1-1.2 for more information.
DRILL: Staff notification and assembly must be completed once a year.
See Domain 4, Domain Activity 1.1-1.2 for more information.
DRILL: Site activation must be completed once a year.
See Domain 4, Domain Activity 1.1-1.2 for more information.
TABLE TOP: Anthrax must be complete at least once every five years (rolling five years).
See Domain 4, Domain Activity 1.4 for more information.
TABLE TOP: Pandemic influenza must be completed at least once every five years (rolling five years).
See Domain 4, Domain Activity 1.3 for more information.
FULL-SCALE: Pandemic influenza, for the critical work force, at least once every five years (rolling five years).
See Domain 4, Domain Activity 1.3 for more information.
]FULL-SCALE: Joint PHEP-HPP exercise at least once every five years (rolling five years).
See Domain 1, Domain Activity 2.2 for more information
FULL-SCALE: Anthrax dispensing exercise at least once every five years (rolling five years). MSAs only.
See Domain 4, Domain Activity 1.4 for more information.
Attachment A-PHEP Workplan,Requirements 1 of 3
Exhibit D
Page 39
PHEP Requirements Attachment A
AAR/IP
Submission with each incident of a functional and full-scale exercise each year.
EPTW
Attend the Emergency Preparedness Training Workshop (EPTW) each year.
MYTEP
Multi-year Training and Exercise Plan (MYTEP) that specifies at least two years of trainings and exercises, must be updated
each year. MYTEP should address the needs and priorities identified in previous AARs/lps and demonstrate coordination with
partners and stakeholders.
Plans
Use the drop down to indicate the activity that will occur for the plan in the FY.
Develop and maintain current version of the following plans (may be included as annexes or components in larger plans).
Listed plans are referenced throughout this work plan.
Listed plans must be reviewed, updated and signed by the respective partners at least once every three years and made
available for review prior to site visits.
All hazards preparedness and response plan.
See Domain 1, Domain Activity 6.1 for more information.
Infectious disease response plan.
See Domain 1, Domain Activity 6.1 for more information.
Pandemic influenza plan.
See Domain 1, Domain Activity 6.1 for more information.
]Medical countermeasure distribution and dispensing plans.
See Domain 1, Domain Activity 6.1 for more information.
Continuity of operations (COOP) plans.
See Domain 1, Domain Activity 6.1 and Domain 6, Activity 2.7 for more information.
]Chemical, biological, radiological, and nuclear (CBRN) threat response plans.
See Domain 1, Domain Activity 6.1 for more information.
]Plan(s) that support the volunteer recruitment and management.
See Domain 5, Activity 4.2 for more information.
Attachment A-PHEP Workplan,Requirements 2 of 3
Exhibit D
PHEP Domain 1 Attachment Aage 40
Strengthen Community Resilience
[Local Entity Name]
Domain 1: Strengthen Community Resilience
Description: Community resilience is the ability of a community, through public health agencies, to develop, maintain, and utilize
collaborative relationships among government, private, and community organizations to develop and utilize shared
plans for responding to and recovering from disasters and public health emergencies.
11 Known Gaps:
Capability 1: lCommunity Preparedness
Capability 2: lCommunity Recovery
z Classify Activity: Are you Building or Sustaining this Domain?
Outcomes: 1 Analyze JRA results to determine strategic priorities, identify program gaps, and prioritize preparedness investments.
2 Develop a comprehensive whole-community approach to preparedness management.
3 Have a comprehensive preparedness program including a whole community approach and engaged ESF partners.
4 Create a progressive, multiyear training and exercise program with increasingly complex exercises to improve operational readiness across multiple hazards.
3 FY 2022-23 3 FY 2023-24
Domain Activity 1: Determine the Risks to the Health of the Jurisdiction FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will collaborate in conjunction with stakeholders, partners and tribal entities
to complete a JRA once every 5 years (FY 2019-2024), to identify potential
hazards, vulnerabilities, and risks within the community that relate to the public
health, medical, and mental/behavioral health systems and the access and
functional needs of at-risk individuals.
FY 21-22 Continue to work on this activity and deliverable and report.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 7
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 1, Activity 2
PHEP Capabilities Guide pages 20-22
Activities 2
3
4
Functions used to guide your planned activities
7Cap—ability 1, F1 Determine the risks to the health of the jurisdiction.
Outputs from the planned activities
1 Complete a JRA once within the 5-year period (FY 2019-2024).
(Activity 1)
Outputs 2
3
4
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 1 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 41
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 2: Ensure HPP Coordination FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
(HPP Coordination occurs throughout PHEP, not limited to the activities below.) Activity Type Completion Activity Type Completion
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will continue assessing risk, planning, coordinating, and exercising with
HPP counterparts, including HCC's.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide HPP Coordination.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide HPP Coordination.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 7-8
FY 2019-20 Local PHEP Work Plan, multiple locations, key word search HPP
and HCC.
PHEP Capabilities Guide, multiple locations, key word search HPP and HCC.
FY 22-23 HPP Workplan, Capability 2, Phase 3, Objective 3, Activity 2.2
2 LHD's will plan and participate in at least one joint exercise with HPP and
emergency management at least once in every 5 year period (currently 2019-
2024). LHDs can meet this requirement with a functional exercise, full scale
exercise, or real incident.
Recommend meeting multiple program requirements with this exercise or real
incident, by including PHEP, HPP, MCM, CRI and other exercise requirements.
FY 21-22 Continue to work on this activity and deliverable and report.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDPH Statewide Medical & Health Exercise,
https://www.cdph.ca.gov/Programs/EPO/Pages/swmhe.aspx
CDC NoFO PHEP CDC RFA TP19-1901, page 7-8, 38-41
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 4, Activity 2
PHEP Capabilities Guide, Capability 3, Skills & Training
FY 21-22 HPP Workplan, Capability 1, Phase 3, Objective 4, Activity 3.1
Activities 3
4
5
Functions used to guide your planned activities
1 Capability 1, F3 Coordinate with partners and share information through
community social networks.
2 Capability 1, F4 Coordinate training and provide guidance to support community
involvement with preparedness efforts.
Outputs from the planned activities
1 Coordinated planning and preparedness activities with HPP/HCC partners.
(Activity 1)
2 Develop or assist in the development of an AAR/IP within 90 days of the
exercise or real event. (Activity 2)
3 Share with all appropriate stakeholders or verify sharing of finalized AAR/IP.
(Activity 2)
4 FY 22-23 Complete CDPH survey of top improvements identified in FY 21-22.
(Activity 2)
Outputs 5
6
7
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 2 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 42
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 3: Plan for the Whole Community FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will have procedures in place to identify individuals with access and
functional needs that may be at risk of being disproportionately impacted by
incidents with public health consequences. LHDs can use the CMIST framework
to update and maintain procedures to identify at-risk populations disproportionally
impacted by incidents or events as defined in the CMIST framework.
Communication; Maintaining Health; Independence; Support, Safety and Self-
determination; Transportation (CMIST).
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 8
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 4, Activity 2
PHEP Capabilities Guide, page 20
FY 22-23 HPP Workplan, Capability 1, Phase 1, Objective 2, Activity 4.4
2 LHDs, in coordination with HPP, will continue to encourage participation of social
services including faith based partners, child service providers, community based
organizations, mental/behavioral health organizations in community
preparedness planning to address needs during an emergency in the jurisdiction.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 8-9
FY 2019-20 Local PHEP Work Plan, Capability 1, Functions 1-4
PHEP Capabilities Guide, multiple locations, key word search social services,
faith based, child services, community, and mental/behavioral health
FY 22-23 HPP Workplan, Capability 1, Phase 1, Objective 2, Activity 4.4
3 Identify LHD's role in family reunification.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 9
FY 2019-20 Local PHEP Work Plan, Capability 1, Functions 2, Activity 1
PHEP Capabilities Guide, multiple locations, key word search family reunification
Activities 4
5
6
Attachment A -PHEP Workplan, PHEP Domainl Page 3 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 43
Strengthen Community Resilience
Functions used to guide your planned activities
1 Capability 1, F1 Determine the risks to the health of the jurisdiction.
2 Capability 1, F2 Strengthen community partnerships to support public health
preparedness.
3 Capability 1, F3 Coordinate with partners and share information through
community social networks.
4 Capability 1, F4 Coordinate training and provide guidance to support community
involvement with preparedness efforts.
5 Capability 2, F1 Identify and monitor community recovery needs.
6 Capability 2, F2 Support recovery operations for public health and related
systems for the community
Outputs from the planned activities
1 Document procedures that identify at-risk populations and those individuals with
access and functional needs that may be disproportionately impacted. (Activity 1)
2 Document partners and stakeholders. (Activity 2)
3 Document role and responsibility in family reunification. (Activity 3)
Outputs 4
5
6
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 4 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 44
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 4: Focus on Tribal Planning and Engagement FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHD's should engage with federally recognized Native American Tribal entities for
emergency preparedness planning and response activities. LHD's whose
boundaries include tribal reservations and tribal communities will attempt to
engage with federally recognized American Indian tribes for emergency
preparedness planning and response activities.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide tribal engagement.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide tribal engagement.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 9-10
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 2, Activity 7
PHEP Capabilities Guide, multiple locations, key word search Tribal, Tribes, and
native
FY 22-23 HPP Workplan, Capability 1, Phase 1, Objective 5, Activity 3.1
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 1, F2 Strengthen community partnerships to support public health
preparedness.
2 Capability 1, F3 Coordinate with partners and share information through
community social networks.
3 Capability 1, F4 Coordinate training and provide guidance to support community
involvement with preparedness efforts.
Out uts from the planned activities
1 Document engagement efforts on Tribal planning (Activity 1)
2 In person meeting or attempt(s) to have an in person meeting. (Activity 1)
3 Fy, 20 T Utilize new engagement techniques, as needed, based on lessons
learned during COVID-19. (Activity 1)
Outputs 4
5
6
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 5 of 18
Exhibit D
PHEP Domain 1 Attachment Aage45
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 5: Ensure Emergency Support Function (ESF) Cross-Discipline Coordination FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
and Partner and Stakeholder Collaboration Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs, in coordination with HPP, will continue to encourage participation of
government agencies and stakeholders with an ESF role including the MHOAC,
RDMHS, emergency management, EMS, behavioral/mental health,
environmental health, organizations serving older adults, and education and child
care systems.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating this process.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating this process.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 10
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 3, Activity 3
PHEP Capabilities Guide, multiple locations, key word search ESF, Partner and
Stakeholder.
CDPH training on Environmental Health Training in Emergency Response
(ENTER) is available, contact:Allison.Wilder@cdph.ca.gov
FY 22-23 HPP Workplan, Capability 2, Objective 1, Activity 2.1 - 2.3
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 1, F3 Coordinate with partners and share information through
community social networks.
2 Capability 2, F2 Support recovery operations for public health and related
systems for the community
Outputs from the planned activities
1 Identify and document partners and stakeholders with a role in ESF 8 (Activity 1)
2 Gy, Y 21 22 Update and maintain ESF 8 list of partners and stakeholders. (Activity
1)
Outputs 3
4
5
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 6 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 46
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 6: Strengthen and Implement Plans through Training and Exercising FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will develop and maintain training and exercise plans for building and/or
sustaining public health preparedness and response capability.
-All-hazards preparedness and response plan
-Infectious disease response plan
-Pandemic Influenza plan
-Medical countermeasures distribution and dispensing plans
-Continuity of operations plans (COOP)
-Chemical, biological, radiological, and nuclear (CBRN)threat response plans
- Plans that support the Emergency System for Advance Registration of
Volunteer Health Professionals (ESAR-VHP) or volunteer management plan
-Communications plan
Plans must be reviewed, and updated at least every 3 years.
FY 21-22 Continue to work on this activity and deliverable and report. Utilize
COVID-19 and other response activities, AAR(s) and IP(s) to update
preparedness and response plans. Use the PHEP Capabilities Guide for a list of
stakeholders to include in planning process.
FY 22-23 Continue to work on this activity and deliverable and report. Utilize
COVID-19 and other response activities, AAR(s) and IP(s) to update
preparedness and response plans. Use the PHEP Capabilities Guide for a list of
stakeholders to include in planning process.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 11-12
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 2, Activity 5
PHEP Capabilities Guide, multiple locations, key word search the plans listed
above.
FY 2019-20, thru to 2022-2023 Pan Flu Workplan.
2 LHDs will participate in the Emergency Preparedness Training Workshop
(EPTW).
Develop and provide multiyear training and exercise plans (MYTEPS) that specify
at least two years of trainings and exercises. The MYTEP should address the
needs and priorities identified in previous AARs/IPs; demonstrate coordination
with applicable entities, partners, and stakeholders; and describe methods to
leverage and allocate resources to the maximum extent possible.
FY 20-21 EPTW canceled.
FY 21-22 EPTW canceled.
FY 22-23 EPTW will be held in the spring.
FY 21-22 MYTEP(s) developed based on lessons learned from previous year.
FY 22-23 MYTEP(s) developed based on lessons learned from previous year.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 11
FY 2019-20 Local PHEP Work Plan, Capability 1, Functions 4, Activity 1
PHEP Capabilities Guide, multiple locations, key word search multi-year, train,
exercise, after-action, and improvement plan.
FY 22-23 HPP Workplan, Capability 1, Phase 2, Objective 4, Activity 2.2
3 LHDs will develop evaluative processes to review, revise, and maintain plans
based on the resulting priorities, needs, findings, and corrective actions of
exercises, real incidents, trainings, and assessments. These processes must be
used to develop and inform AARs/IPs.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 11-12
FY 2019-20 Local PHEP Work Plan, Capability 1, Functions 4, Activity 1
PHEP Capabilities Guide, multiple locations, key word search multi-year, train,
exercise, after-action, and improvement plan
Activities 4
5
6
Attachment A -PHEP Workplan, PHEP Domainl Page 7 of 18
Exhibit D
PHEP Domain 1 Attachment Aage 47
Strengthen Community Resilience
Functions used to guide your planned activities
1 Capability 1, F1 Determine the risks to the health of the jurisdiction.
2 Capability 1, F4 Coordinate training and provide guidance to support community
involvement with preparedness efforts.
3 Capability 2, F2 Support recovery operations for public health and related
systems for the community
Out uts from the planned activities
1 Develop MYTEPs that specify at least two years of training and exercises.
(Activity 2)
2 Document evaluation and improvement planning. (Activity 3)
3 Coordinate training and exercise implementation with partners and stakeholders.
(Activity 1)
4 Develop and maintain plans appropriately. (Activity 1)
Outputs 5
6
7
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 8 of 18
Exhibit D
PHEP Domain 1 Attachment Aage48
Strengthen Community Resilience
3 FY 2022-23 3 FY 2023-24
Domain Activity 7: Obtain Public Comment and Input FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will share with stakeholders and community partners public health
emergency preparedness and response plans as appropriate for input.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide obtaining input and comment.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide obtaining input and comment.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 12
FY 2019-20 Local PHEP Work Plan, Capability 1, Function 2, Activity 5;
Capability 2, Function 3, Activity 1
PHEP Capabilities Guide, multiple locations, key word search public input.
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 1, F2 Strengthen community partnerships to support public health
preparedness.
Outputs from the planned activities
1 Document stakeholder and community partner input. (Activity 1)
Outputs 2
3
4
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domainl Page 9 of 18
Exhibit D
PHEP Domain 2 Attachment A age 49
Strengthen Incident Management
[Local Entity Name]
Domain 2: IStrengthen Incident Management
Description: Incident management is the ability to activate,coordinate and manage health and medical emergency operations
throughout all phases of an incident through use of a flexible and scalable incident command structure that is
consistent with the Standardized Emergency Management System(SEMS)and the National Incident Management
System(NIMS).
t Known Gaps:
Capability 3: Emergency
Operations
Coordination
2 Classify Activity: Are you Building or Sustaining this Domain?
Outcomes: 11 Continuity of emergency operations throughout the response and recovery of a public health incident.
3
Domain Activity 1: Activate and Coordinate Public Health Emergency Operations FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Activity Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will update and maintain procedures for activating,operating,
managing,and staffing the public health emergency operations center.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 12-13
FY 2019-20 Local PHEP Work Plan,Capability 3,Function 1,Activities 1,4;
Function 2,Activity 3
PHEP Capabilities Guide pages 34-41
2 LHDs will train response staff,formal and/or informal,in the EOM,SEMS,
NIMS and EOC/DOC section speck processes.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide staff training on incident
management.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide staff training on incident
management.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 12-14
FY 2019-20 Local PHEP Work Plan,Capability 3,Function 1,Activities 2-5;
Function 2,Activities 2&4;Function 4,Activities 1-4
PHEP Capabilities Guide pages 12-41
FY 22-23 HPP Workplan,Capability 1,Phase 2,Objective 4,Activity 1.1
3 LHDs will update the EOC/DOC medical health personnel responder list.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 12-14
FY 2019-20 Local PHEP Work Plan,Capability 3,Function 1,Activity 2;
Function 2,Activity 1
PHEP Capabilities Guide pages 12-41
4 LHDs will have a plan for demobilization to return to"ready state"of
operations.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities,as appropriate,to inform and guide updating the demobilization
process.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 12-14
FY 2019-20 Local PHEP Work Plan,Capability 3,Function 5,Activities 1-3
PHEP Capabilities Guide pages 41-42
Activities 5
6
7
Attachment A-PHEP Workplan,PHEP Domain2 Page 1 of 4
Exhlblt D
PHEP Domain 2 Attachment Rage so
Strengthen Incident Management
Functions used to guide lour planned activities
1 Capability 3,F1 Conduct preliminary assessment to determine the need for
activation of public health emergency operations.
2 Capability 3,F2 Activate public health emergency operations.
3 Capability 3,F3 Develop and maintain an incident response strategy.
4 Capability 3,F4 Manage and maintain the public health response.
5 Capability 3,F5 Demobilize and evaluate public health emergency operations.
Outputs from the planned activities
1 Trained staff on updated policies and procedures for activating,operating,and
managing emergency response and recovery. (Activity 2)
2 FY Y21-92 LHDs will have updated operation center procedures.(Activity 1)
3 F".Y 21 22 Current list of staff trained to work in the EOC/DOC.(Activity 3)
4 F".Y 21—«Update Demobilization Plan.(Activity 4)
Outputs 5
6
7
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domain2 Page 2 of 4
Exhibit D
PHEP Domain 3 Attachment'page 51
Strengthen Information Management
[Local Entity Name]
Domain 3: IStrengthen Information Management
Description: Information management is the ability to develop and maintain systems and procedures that facilitate the communication of
timely,accurate,and accessible information,alerts,and warnings using a whole community approach.It also includes the
ability to exchange health information and situational awareness with federal,state,local,territorial,and tribal governments and
partners.
t Known Gaps:
Capability 4: Emergency
Public Information
and Warning
Capability 6: Information
Sharing
s Classify Activity: Are you Building or Sustaining this Domain?
Outcomes: 1 Establish a standardized system for information sharing which will assess situational awareness and create a common operating picture.
2 Have access to a standardized joint information system to develop,coordinate,disseminate timely and accurate information alerts,warnings,and notification
to the public including at risk populations..
Attachment A-PHEP Warkplan,PHEP Domain3 Page 1 of 8
Exhlblt D
PHEP Domain 3 Attachment ppage 52
Strengthen Information Management
Domain Activity 1: Maintain Situational Awareness during Incidents FY 2022-23 Estimated a MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes FY 2024-25
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier Activity
Activities 1 LHDs will establish a common operating picture,that facilitates coordinated
information sharing among all public health,health care and necessary
partners and stakeholders,for example environmental health.This includes
state,local,tribal,and the region and their respective preparedness
programs,public health laboratories,communicable disease programs and
programs addressing health care-acquired infections.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 16
FY 2019-20 Local PHEP Work Plan,Capability 6,Function 2,Activities 1,
2,10
PHEP Capabilities Guide pages 62-69
2 LHDs will sustain a program that facilitates coordinated information sharing
among all public health,health care,and necessary partners and
stakeholders.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide information sharing
processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide information sharing
processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 16
FY 2019-20 Local PHEP Work Plan,Capability 6,Function 1,Activities 1-
2;Function 2,Activities 3-7
PHEP Capabilities Guide pages 62-69
Activities 3
4
5
Functions used to guide our planned activities
1 Capability 6,F1 Identify stakeholders that should be incorporated into
information flow and define information sharing needs.
2 Capability 6,F2 Identify and develop guidance standards and systems for
information exchange.
3 Capability 6,F3 Exchange information to determine a common operating
picture.
Outputs from the planned activities
1 Have or have access to a tool that collects information to create situational
awareness in a common operating picture.Provide documentation of
utilizing the information tool during real world incident,exercise,and/or
planned event.
2 F",Y 21 22 LHD staff trained on information sharing process.
Outputs 3
4
5
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domain3 Page 2 of 8
Exhlblt D
PHEP Domain 3 Attachment/gage 53
Strengthen Information Management
Domain Activity 2: Coordinate Information Sharing FY 2022-23 Estimated a MY Report s YE Report Notes FY 2023-24 Estimated a MY Report 5 YE Report Notes FY 2024-25
Activity Type Completion Activity Type Completion Activity
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status Primary Barrier Type
Activities 1 LHDs will have or have access to communication systems that maintain or
improve reliable,resilient,interoperable and redundant information and
communication systems and platforms,including those for bed availability,
EMDS data,and patient tracking,and provide access to HCC members
and other partners and stakeholders.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
coordination.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
coordination.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 16-17
FY 2019-20 Local PHEP Work Plan,Capability 6,Function 2,Activities 5,
6,8,9;Function 3,Activities 6,7
PHEP Capabilities Guide pages 62-69
FY 22-23 HPP Workplan,Capability 2,Phase 1,Objective 2,Activity 1.2-
1.3
2 LHDs will provide situational awareness information to MHOAC program,
during emergency response operations and as requested.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
sharing techniques.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
sharing techniques.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 16-17
FY 2019-20 Local PHEP Work Plan,Capability 6,Function 3,Activities 3
PHEP Capabilities Guide pages 62-69
3 LHDs will utilize the California Health Alert Network(CAHAN)to share
emergent public health and medical threats.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
sharing processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating information
sharing processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 16-17
FY 2019-20 Local PHEP Work Plan,Capability 6,CAHAN
PHEP Capabilities Guide pages 62-69
Activities 4
5
6
Functions used to guide our planned activities
1 Capability 6,F1 Identify stakeholders that should be incorporated into
information flow and define information sharing needs.
2 Capability 6,F2 Identify and develop guidance standards and systems for
information exchange.
3 Capability 6,F3 Exchange information to determine a common operating
picture.
Outputs from the planned activities
1 Provide Documentation showing use of communication systems during real
life incident,exercise,and/or event.(Activity 1)
2 Provide flash report and situation reports to your MHOAC Program,during
real events or exercises as needed.(Activity 2)
3 LHDs will maintain participation in the Cafrfomia Health Alert Network and
participate in all contact drills.(Activity 3)
Outputs 4
5
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domain3 Page 3 of 8
Exhlblt D
PHEP Domain 3 Attachment/gage 54
Strengthen Information Management
3
Domain Activity 3: Coordinate Emergency Information and Warning FY 2022-23 Estimated 4 MY Repoli s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes FY 2024-25
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier Activity
Activities 1 LHDs will,in coordination with HCC,develop,and disseminate information,
alerts,warnings,and notifications to the public.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 17
FY 2019-20 Local PHEP Work Plan,Capability 4,Function 1,Activities 1
&4;Function 5,Activities 1-3
PHEP Capabilities Guide pages 43-51
FY 22-23 HPP Workplan,Capability 2,Phase 3,Objective 3,Activity 3.3
2 LHDs have or have access to a Communications Plan that utilizes crisis
and emergency risk communication(CERC)principles,including PIO roles,
responsibility,and trainings,and the joint information system activation
criteria.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-
19 activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 17
FY 2019-20 Local PHEP Work Plan,Capability 4,Function 2,Activities 1-
2;Function 3,Activity 1
PHEP Capabilities Guide pages 43-51
Activities 3
4
Functions used to guide our planned activities
1 Capability 4,F1 Activate the emergency public information system
2 Capability 4,F2 Determine the need for a Joint Information System
3 Capability 4,F3 Establish and participate in information system operations
4 Capability 4,F4 Establish avenues for public interaction and information
exchange
Capability 4,F5 Issue public information,alerts,warnings,and notifications
5 Capability 6,F2 Identify and develop guidance standards and systems for
information exchange.
6 Capability 6,F3 Exchange information to determine a common operating
picture.
Outputs from the planned activities
1 LHDs will have or have access to message templates based on Jurisdiction
Risk Assessment(JRA)as appropriate.(Activity 1)
2 Documentation of crisis communication elements identified in exercises,
real world incidents and or planned events.(Activity 2)
Outputs 3
4
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domain3 Page 4 of 8
Exhibit D
Page 55
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
[Local Entity Name]
Domain 4: IStrengthen Countermeasures and Mitigation
Description: Countermeasures and mitigation is the ability to distribute,dispense,and administer medical countermeasures(MCMs)to reduce
morbidity and mortality and to implement appropriate nonpharmaceutical and responder safety and health measures during
response to a public health incident.
i Known Gaps:
Capability 8: Medical Countermeasure
Dispensing and
Administration
Capability 9: Medical Materiel
Management and
Distribution
Capability 11: Nonpharmaceutical
Interventions
Capability 14: Responder Safety and
Health
z Classify Activity: Are you Building or Sustaining this Domain?
Outcomes: 1 Continuity of emergency operations management for emergency or incident requiring MCM dispensing/distribution.
2 Before,during,and after an incident,ensure the safety and health of responders.
3 Timely implementation of public health intervention and control measures.
AttachmentA-PHEP Workplan,PHEP Domain4 Page 1 of 9
Exhibit D
Page M
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
s s FY 2023-24
Domain Activity 1: Develop and Exercise Plans for MCM Distribution,Dispensing,and Vaccine FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Administration Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will develop and submit distribution drills;Site activation,staff call down,and
pick list.
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output waived.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 18
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 4
PHEP Capabilities Guide pages 80-90
2 LHDs will develop and submit dispensing drills;Facility set up,staff notification and
assembly,and site activation.
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output waived.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFATPI9-1901,page 18
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 4
PHEP Capabilities Guide pages 80-90
3 LHDs will conduct pandemic influenza exercise;TTX,functional,and full scale if
applicable.
FY 20-21 May use COVID-19 to meet the Activity and Output.
FY 21-22 May use COVID-19 to meet the Activity and Output.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 18
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 4
PHEP Capabilities Guide pages 80-90
FY 2019-20,thru to 2022-2023 Pan Flu Workplan,Objective 7
FY 21-22 HPP Workplan,Capability 4,Phase 3,Objective 2,Activity 9.10
4 LHDs(CRI)will conduct anthrax exercises;TTX,full scale if applicable
FY 20-21 May use COVID-19 to meet the Activity and Output.
FY 21-22 May use COVID-19 to meet the Activity and Output.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 18
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 4
PHEP Capabilities Guide pages 80-90
FY 22-23 HPP Workplan Capability 3,Phase 2,Objective 5,Activity 2.2
5 LHDs will conduct annual CHEMPACK lrainings and exercises,e.g.,meetings,drills,
workshop,TTX,functional or full-scale with appropriate partners.
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output waived.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 18
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 4
PHEP Capabilities Guide pages 80-90
FY 22-23 HPP Workplan Capability 3,Phase 2,Objective 5,Activity 2.2
Activities 6
7
8
AttachmentA-PHEP Workplan,PHEP Domoin4 Page 2 of 9
Exhibit D
Page 57
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
Functions used to guide your planned activities
1 Capability 8,F1 Determine medical countermeasures dispensing/administration
strategies.
2 Capability 8,F2 Receive medical countermeasures to be dispensed/administered.
3 Capability 8,F3 Activate medical countermeasure dispensing/administration
operations.
4 Capability 8,F4 Dispense/administer medical countermeasures to targeted
population(s).
5 Capability 8,F5 Report adverse events.
Outputs from the planned activities
1 Implement corrective action plan(s)or improvement plan(s),based on exercise or real
event.
2 Verified site and staff contact list,as a result of submitted exercises and drills.(Activity
1)
3 Complete PHEP reporting requirements.
4 rv�:2 Prepared for MCM activation.
Outputs 5
6
7
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domain4 Page 3 of 9
Exhibit D
Page 55
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
3 3
Domain Activity 2: Maintain Preparedness Plans Based on Risks FY 2022.23 Estimated 4 MY Report s YE Report Notes FY 2023.24 Estimated 4 MY Report s YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will review and update MCM plans e.g.,bioterror and emerging infectious
disease.
FY 20-21 Option to reduce or pause Activity and Output.
FY 21-22 Option to reduce or pause Activity and Output.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating of plans.
Reference:
FY 2020-21 Local PHEP Work Plan,Domain 1,Domain Activity 6
CDC NoFO PHEP CDC RFA TP19-1901,page 19-20
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 1,Activity 2
PHEP Capabilities Guide pages 80-84
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.3
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 8,F1 Determine medical countermeasure dispensing/administration
strategies.
Outputs from the planned activities
1 Implement corrective action plan(s)or improvement plan(s),based on exercise or real
event.
Outputs 2
3
4
Notes 1
2
3
AttochmentA-PHEP Workplan,PHEP Domain4 Page 4 of 9
Exhibit D
Page 59
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
s s FY 2023-24
Domain Activity 3: Participate in ORRs and Self Assessment FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs(CRI)will participate in bi-annual review with CDPH and DSLR.
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output Waived.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 22-23
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 6
PHEP Capabilities Guide pages 80-91
2 LHDs(CRI)will complete .training for the new
ORR self assessment system(PORTS).
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output waived.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 22-23
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 6
PHEP Capabilities Guide pages 80-91
Activities 3
4
5
Functions used to guide your planned activities
1 Capability 8
Outputs from the planned activities
1 Compete ORR assessment-Complete PORTS Training for new assessment system.
(Activity 2)
2 Complete CRI reporting requirements.
Outputs 3
4
5
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domain4 Page 5 of 9
Exhibit D
Page 60
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
s s FY 2023-24
Domain Activity 4: Submit Updated MCM Action Plans FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status I Primary Barrier Status Primary Barrier
Activities 1 LHDs(CRI)will submit MCM action plans at the end of 01 and Q3.
FY 20-21 Option to reduce or pause Activity and Output.
FY 21-22 Option to reduce or pause Activity and Output.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 8,Function 2,Activities 1-3;Function
4,Activities 1,4.
PHEP Capabilities Guide pages 80-91
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.3
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 8,F2 Receive medical countermeasures to be dispensed/administered.
2 Capability 8,F4 Dispense/administer medical countermeasures to targeted
populations.
Outputs from the planned activities
1 Submitted MCM action plan.(Activity 1)
Outputs 2
3
4
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domoin4 Page 6 of 9
Exhibit D
Page 61
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
s s FY 2023-24
Domain Activity 5: Update Local Distribution Site Survey FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will review inventory tracking process.
FY 20-21 Option to reduce or pause Activity and Output.
FY 21-22 Option to reduce or pause Activity and Output.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating inventory processes.
Reference:
CDC NoFO PHEP CDC RFATPI9-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 9,Function 1,Activities 1.
PHEP Capabilities Guide pages 92-97
2 LHDs will train staff on inventory tracking process.
FY 21-22 Continue to work on this activity and deliverable.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFATPI9-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 9,Function 1,Activities 6.
PHEP Capabilities Guide pages 92-97
3 LHDs will complete and submit CDPH LDS data sheet.
FY 20-21 Activity and Output waived.
FY 21-22 Activity and Output waived.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFATP19-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 9,Function 1,Activities 1-6.
PHEP Capabilities Guide pages 92-97
Activities 4
5
6
Functions used to uide our tanned activities
1 Capability 9,F1 Direct and activate medical materiel management and distribution.
Outputs from the planned activities
1 Trained inventory management staff.(Activity 2
2 Submitted CDPH LDS data sheet.(Activity3)
3 c".Y:21-22 Submit inventory list to CDPH by June 30 each FY.
Outputs 4
5
6
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domoin4 Page 7 of 9
Exhibit D
Page 62
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
s s FY 2023-24
Domain Activity 6: Coordinate Nonpharmaceutical Interventions(NPIs) FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will coordinate with stakeholders/partners to define procedures,triggers and
necessary authorizations to implement NPIs.
FY 21-22 Continue to work on this activity and deliverable.Utilize COVID-19 activities,
as appropriate,to inform and guide updating NPI procedures.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating NPI procedures.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 24
FY 2019-20 Local PHEP Work Plan,Capability 11,Function 1,Activities 1-2;
Function 2,Activity 1.
PHEP Capabilities Guide pages 112-119
FY 22-23 HPP Workplan,Capability 4,Phase 1 and Phase 3,Surge Annexes
(Infectious Disease,Burn Surge,Radiation,and Chemical)
Activities 2
3
4
Functions used to guide your planned activities
1 Capability 11,F1 Engage partners and identify factors that impact nonpharmaceutical
interventions.
2 Capability 11,F2 Determine nonpharmaceutical interventions.
Outputs from the plannad activities
1 LHDs will have a reviewed and revised isolated quarantine plan and/or NPI plans and
policies.(Activity 1)
Outputs 2
3
4
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domoin4 Page 8 of 9
Exhibit D
Page 63
PHEP Domain 4 Attachment A
Strengthen Countermeasures and Mitigation
3 3 FY 2023-24
Domain Activity 7: Support the Protection of Responders Health and Safety FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 Determine exposure prevention measures(e.g.decontamination,evacuation
strategies).
FY 21-22 Continue to work on this activity and deliverable.Utilize COVID-19 activities,
as appropriate,to inform and guide updating exposure processes.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating exposure processes.
References:
FY 22-23 HPP Workplan,Capability 3,Phase 1,Objective 6,Activity 1.1
2 LHD to assist,train,or provide resources necessary to protect public health first
responders,critical workforce personnel,and critical infrastructure workforce from
hazards during a public health response and recovery.
FY 21-22 Continue to work on this activity and deliverable.Utilize COVID-19 activities,
as appropriate,to inform and guide updating training on responder safety and health
processes.
FY 22-23 Continue to work on this activity and deliverable.Utilize COVID-19
activities,as appropriate,to inform and guide updating training on responder safety
and health processes.
References:
FY 22-23 HPP Workplan,Capability 3,Phase 2,Objective 5,Activity 2.2
Activities 3
4
5
Functions used to guide your planned activities
1 Capability 14,F1 Identify responder safety and health risks.
2 Capability 14,F2 Identify risk-specific responder safety and health training.
Outputs from the planned activities
1 Documentation of trained staff on PPE,MCM,workplace violence,psychological first
aid,other resources specific to an emergency that would protect responders. (Activity
2)
2 LHDs has updated and reviewed all policies,plans,and procedures related to
responder health and safety.(Activity 1)
Outputs 3
4
5
Notes 1
2
3
AttachmentA-PHEP Workplan,PHEP Domain4 Page 9 of 9
Exhill D
PHEP Domain 5 Attachment A Page 64
Strengthen Surge Management
Domain 5: Strengthen Surge Management
Description: Surge management is the ability to coordinate jurisdictional partners and stakeholders to ensure adequate public health,health care,and
behavioral services and resources are available during events that exceed the limits of the normal public health and medical infrastructure of
an affected community.This includes coordinating expansion of access to public health,health care and behavioral services;mobilizing
medical and other volunteers as surge personnel;conducting ongoing surveillance and public health assessments at congregate locations;
and coordinating with organizations and agencies to provide fatality management services.
i Known Gaps:
Capability 5: Fatality Management
Capability 7: Mass Care
Capability 10: Medical Surge
Capability 15: Volunteer
Management
z Classify Activity: Are you Building or Sustaining this Domain?
Outcomes: 1 Efficient coordination of activities to manage public health and medical surge.
2 Optimal coordination of public health,health care,mental/behavioral health,environmental health,and human services needs during mass care operations
3 Improved partnerships to address public health needs during fatality management operations
4 Timely coordination and support from volunteers during a medical surge response
Attachment A-PHEP Workplon,PHEP Domain5 Page 1 of 7
Exhibit D
PHEP Domain 5 Attachment A Page 65
Strengthen Surge Management
3TY 2022-233 - 5
Domain Activity 1: Coordinate Activities to Manage Public Health and Medical Surge FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes FY 2024-25 Estimated 4 MY Report
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Completion Status rimary Barri
Activities 1 LHDs will maintain MHOAC procedures for engaging the health care system and HCC to
collect,provide,and receive information to create a shared situational awareness and
common operating picture.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities.
as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 10,Function 1,Activities 1-6.
PHEP Capabilities Guide pages 92-97
FY 22-23 HPP Workplan,Capability 2,Phase 1,Objective 1,Activity 2.1 and 2.2
FY 22-23 HPP Workplan,Capability 1.Phase 1,Objective 2,Activity 2.3
2 LHDs will have or have access to procedures in place to support family reunification.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 10,Function 3,Activities 3.
PHEP Capabilities Guide pages 109-110
3 LHDs will have plans in place that clearly define the public health roles and
responsibilities during surge operations and outline procedures on how public health will
engage the health care system to provide and receive situational awareness through the
surge event.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 23-24
FY 2019-20 Local PHEP Work Plan,Capability 10,Function 1,Activities 1.
PHEP Capabilities Guide pages 109-110
FY 22-23 HPP Workplan,Capability 2,Phase 1,Objective 1,Activity 2.2
Activities 4
5
6
Functions used to guide our planned activities
1 Capability 10,F1 Assess the nature and scope of the incident.
2 Ca abili 10, Su ort'urisdictional medical surge operations.
Outputs from the Warmed activities
1 Updated procedures or processes for supporting family reunification.
(Activity 2)
2 Updated written plans that identify PH's role and responsibilities during surge operations.
(Activity 3)
3FY:21:22 MHOAC procedures updated based on Improvement Plans.(Activity 1)
Outputs 4
5
6
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domain5 Page 2 of 7
Exhibit D
PHEP Domain 5 Attachment A Page es
Strengthen Surge Management
3 3 - 5
Domain Activity 2: Coordinate Public Health,Health Care,McMallBehavioral Health,and Human FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes FY 2024-25 Estimated 4 MY Report
Services Needs during Mass Care Operations Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Completion Status rimary Barri
Activities 1 LHDs will maintain their identified support roles during mass care operations.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating public health's role.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating public health's role.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 26
FY 2019-20 Local PHEP Work Plan,Capability 7,Function 1,Activity 1
PHEP Capabilities Guide pages 70-79
2 LHDs should support family reunification,including any special considerations for
children as part of their demobilization mass care operations procedures.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating this process.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating this process.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 26
FY 2019-20 Local PHEP Work Plan,Capability 7,Function 4,Activity 3
PHEP Capabilities Guide pages 70-79
Activities 3
4
5
Functions used to guide our planned activities
61 ca abilit 7,F1 Determine public health role in mass care operations.
Outputs from the planned activities
1 Maintained procedures that identify PH's support role during mass care operations in
coordination with partners.(Activity 1)
2 Updated procedures or processes for the support of family reunification during
demobilization.(Activity 2)
Outputs 3
4
5
Notes 1
2
3
Attachment A-PHEP Workplan,PHEP Domoin5 Page 3 of 7
Exhill D
PHEP Domain 5 Attachment A Page 67
Strengthen Surge Management
0 - 3 - 5
Domain Activity 3: Coordinate with Partners to Address Public Health Needs during Fatality FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes FY 2024-25 Estimated 4 MY Report
Management Operations Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Completion Status rimary Barri
Activities 1 LHDs will define public health's role in fatality management.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide fatality management partners.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide fatality management partners.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 26-27
FY 2019-20 Local PHEP Work Plan,Capability 5,Function 1,Activity 2
PHEP Capabilities Guide pages 52-55
2 LHDs will maintain ability to provide recommendations for hazardous speck fatality
situations.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating recommendations.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating recommendations.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901,page 26-27
FY 2019-20 Local PHEP Work Plan,Capability 5,Function 2,Activities 1-2
PHEP Capabilities Guide pages 55-58
Activities 3
4
Functions used to guide your planned activities
1 Capability 5,F1 Determine the public health agency role in fatality management
2 Capability 5,F2 Identify and facilitate access to public health resources to support
fatality management operations
Out uts from the plarmed activities
1 Updated procedures that contain the collection and analysis of incident data.
2 Documentation of Crisis Communication elements identified in exercises,real world
incidents and or planned events.
Outputs 3
4
Notes 1
2
3
Attachment -PHEP Workplan,PHEP Domains Page 4 of 7
Exhill D
PHEP Domain 5 Attachment A Page es
Strengthen Surge Management
3 3 - 5
Domain Activity 4: Coordinate Medical and Other Volunteers to Support Public Health and Medical FY 2022-23 Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated 4 MY Report s YE Report Notes FY 2024-25 Estimated 4 MY Report
Surge Activity Type Completion Activity Type Completion Activity Completion
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status Primary Barrier Status rimary Barri
Activities 1 LHDs will maintain,test/train the Disaster Healthcare Volunteer system(ESAR-VHP)to
register and verify credentials of medical volunteers.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating volunteer processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating volunteer processes.
Reference:
FY 21-22 HPP Workplan,Capability 4,Phase 3,Objective 2,Activity 1.1
2 LHDs will develop,refine or maintain written plans that identify the public health role(s)
and responsibilities in supporting volunteer management operations.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating public health's role.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19 activities,
as appropriate,to inform and guide updating public health's role.
Reference:
FY 22-23 HPP Workp/an,Capability 4,Phase 1,Objective 1,Activity 3.3
Activities 3
4
5
Functions used to utde our planned activities
1 Capabili 15,Ft Recruit,coordinate and train volunteers.
Out uts from the plarm activities
1 Up-to-date DHV system which includes licensed healthcare professionals.(Activity 1)
2 Updated written plans that identify the PH role and responsibilities in supporting volunteer
operations.(Activity 2)
Outputs 3
4
Notes 1
2
3
Attachment -PHEP Workplan,PHEP Domoin5 Page 5 of 7
Exhill D
PHEP Domain 5 Attachment A Page ss
Strengthen Surge Management
3 0 - 5
Required by State Support HPP Medical Surge Planning FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated a MY Report 5 YE Report Notes FY 2024-25 Estimated 4 MY Report
Activity 1: Activity Type Completion Activity Type Completion Activity Completion
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status Primary Barrier Type Status rimary Barri
Activities 1 FY 21-22 LHDs will assist and provide subject matter expertise to the Hospital
Preparedness Program's(HPP)development of their Health Care Coalition(HCC)level
Response Plan Annex on Infectious Disease Surge. Utilize existing LHD Pandemic
Influenza plan for Infectious Disease.Refer to the PHEP Capabilities Guide for a list of
stakeholders to include in planning process.
FY 22-23 Continue to assist in the maintenance,testing and updating of the HCC
Infectious Disease Surge Annex.
References:
CDC NoFO PHEP CDC RFA TP19-1901,page 11-12
FY 2019-20 Local PHEP Work Plan,Capability 1,Function 2,Activity 5
PHEP Capabilities Guide,multiple locations,key word search the plan.
FY 2019-20,2020-21 and 2021-2022 Pan Flu Workplan.
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.6
2 FY 21-22 LHDs will assist and provide subject matter expertise to the Hospital
Preparedness Program's(HPP)development of their Health Care Coalition(HCC)level
Response Plan Annex on Burn Surge. Refer to the PHEP Capabilities Guide for a list of
stakeholders to include in planning process.
FY 22-23 Continue to assist in the maintenance,testing and updating of the HCC Burn
Surge Annex.
References:
CDC NoFO PHEP CDC RFA TP19-1901,page 11-12
FY 2019-20 Local PHEP Work Plan,Capability 1,Function 2,Activity 5
PHEP Capabilities Guide,multiple locations,key word search the plan.
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.5
3 FY 21-22 LHDs will assist and provide subject matter expertise to the Hospital
Preparedness Program's(HPP)development of their Health Care Coalition(HCC)level
Response Plan Annex on Radiation Surge. Refer to the PHEP Capabilities Guide for a
list of stakeholders to include in planning process.
FY 22-23 Continue to assist in the development of the HCC Radiation Surge Annex.
References:
CDC NoFO PHEP CDC RFA TP19-1901,page 11-12
FY 2019-20 Local PHEP Work Plan,Capability 1,Function 2,Activity 5
PHEP Capabilities Guide,multiple locations,key word search the plan.
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.7
CDPH training on Environmental Health Training in Emergency Response(EHTER)is
available,contact:Allison.Wilder@cdph.ca.gov
4 FY 21-22 LHDs will assist and provide subject matter expertise to the Hospital
Preparedness Program's(HPP)development of their Health Care Coalition(HCC)level
Response Plan Annex on Chemical Surge. Refer to the PHEP Capabilities Guide for a
list of stakeholders to include in planning process.
FY 22-23 Continue to assist in the development of the HCC Chemical Surge Annex.
References:
CDC NoFO PHEP CDC RFA TP19-1901,page 11-12
FY 2019-20 Local PHEP Work Plan,Capability 1,Function 2,Activity 5
PHEP Capabilities Guide,multiple locations,key word search the plan.
FY 22-23 HPP Workplan,Capability 4,Phase 1,Objective 1,Activity 3.8
CDPH training on Environmental Health Training in Emergency Response(ENTER)is
available,contact:Allison.Wilder@cdph.ca.gov
5 FY 21-22 LHDs will review the State's Crisis Standards of Care guidelines.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
ht tps://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%2ODoc ument%2OLibraty/COVI
D-19/Califomia%20SARS-Co V-2%2OCrisis%2OCare%2OGuidelines%20-
June%208%202020.pdf
6 FY 21-22 LHDs will participate in the Statewide Medical Health Exercise of Crisis
Standards of Care,date to be announced.
FY 21-22 This activity was waived.
FY 22-23 LHDs will participate in the Statewide Medical Health Exercise of Crisis
Standards of Care,date to be announced.
Reference:
CDPH Statewide Medical 6 Health Exercise,
https://www.cdph.ca.gov/Programs/EPO1Pages1swmhe.aspx
Activities 7
8
9
Functions used to uide our tanned activities
1 Ca abili 10,F3 Support Jurisdictional medical surge operations.
Out uts from the plarm activities
1 FY 21-29 LHD Infectious Disease plan utilized by HCC.(Activity 1)
2 Pi!21 22 LHD provide subject matter expertise to HCCs development of their Burn
Surge Annex.(Activity 2)
3 FY 21=LHD provide subject matter expertise to HCCs development of their Radiation
Surge Annex.(Activity 3)
Attachment A-PHEP Workplan,PHEP Domain5 Page 6 of 7
Exhibit D
PHEP Domain 6 Attachment Aage 70
Strengthen Biosurveillance
[Local Entity Name]
Domain 6: Strengthen Biosurveillance
Description: Biosurveillance is the ability to conduct rapid and accurate laboratory tests to identify biological, chemical, radiological, and
nuclear agents; and the ability to identify, discover, locate, and monitor-through active and passive surveillance - threats,
disease agents, incidents, outbreaks, and adverse events, and provide relevant information in a timely manner to
stakeholders and the public.
11 Known Gaps:
Capability 12: Public Health
Laboratory Testing
Capability 13: Public Health
Surveillance and
Epidemiological
Investigation
s Classify Activity: jAre you Building or Sustaining this Domain?
Outcomes: 11 Maintain full ability to conduct rapid and accurate laboratory tests to identify biological agents.
2 Maintain full ability to collect and analyze data for surveillance and epidemiological investigation.
Attachment A -PHEP Workplan, PHEP Domain6 Page 1 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 71
Strengthen Biosurveillance
3 FY 2022-23 3 FY 2023-24
Domain Activity 1: Conduct Epidemiological Surveillance and Investigation FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report 5 YE Report Notes
Activity Type Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status Primary Barrier Status Primary Barrier
Activities 1 LHDs will continue to develop, maintain, support, and strengthen surveillance
and detection systems and epidemiological processes.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
Pan Flu Work Plan, utilize immunization registry for epidemiological
surveillance
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 1, Activities 1, 2
& 9.
PHEP Capabilities Guide pages 128-137
2 Collaborate to enhance essential surveillance systems. LHDs should
enhance the public health information system workforce and advance
electronic information exchange.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating surveillance
processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating surveillance
processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 1, Activities 3,
4, 5, 6.
PHEP Capabilities Guide pages 128-137
3 LHDs will identify and have access to personnel trained to manage and
monitor routine jurisdictional surveillance, and epidemiological investigation
systems, and support surge requirements in response to threats.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide surveillance personnel training.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide surveillance personnel training.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 2, Activity 7.
PHEP Capabilities Guide pages 128-137
Attachment A -PHEP Workplan, PHEP Domain6 Page 2 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 72
Strengthen Biosurveillance
4 LHDs will have a process in place to establish partnerships, conduct
investigations, and share information with other governmental agencies,
partners, and organizations.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 1, Activities 7,
Function 2, Activities 2 & 3.
PHEP Capabilities Guide pages 128-137
5 LHDs will evaluate effectiveness of public health surveillance and
epidemiological investigation processes and systems.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes and
systems.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating processes and
systems.
6 LHDs whose jurisdictional border is shared with Mexico, will conduct border
health surveillance activities.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating surveillance
processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 1, Activity 7.
PHEP Capabilities Guide paaes 128-137
7 LHDs will implement process(es)for using poison control center data for
public health surveillance.
FY 21-22 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 1, Activity 8.
PHEP Capabilities Guide pages 128-137
For more details regarding how Poison Control can assist please contact
SEHeard@CalPoison.org.
Attachment A -PHEP Workplan, PHEP Domain6 Page 3 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 73
Strengthen Biosurveillance
8 LHDs will maintain access to electronic death registration (EDR) systems.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating this processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating this processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 27-30
FY 2019-20 Local PHEP Work Plan, Capability 13, Function 3, Activity 2.
PHEP Capabilities Guide pages 128-137
Activities 9
10
11
Functions used to guide your planned activities
1 Capability 13, F1 Conduct or support public health surveillance.
2 Capability 13, F2 Conduct public health surveillance and epidemiological
investigations.
3 Capability 13, F3 Recommend, monitor and analyze mitigation actions.
Capability 13, F4 Improve public health surveillance and epidemiological
investigation systems.
Outputs from the planned activities
1 Documentation of surveillance and detection systems. (Activity 1)
2 Documentation of access to trained personnel. (Activity 3)
3 Documentation of evaluation of effectiveness. (Activity 5)
4 Documentation of processes for partnering with poison control. (Activity 7)
5 Fy,�z Enhanced early detection of potential public health threats. (Activity
2)
6 Fy,�2 LHDs that have border points of entry, enhanced early detection of
potential public health threats entering the State.
(Activity 6)
Outputs 7
8
9
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domain6 Page 4 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 74
Strengthen Biosurveillance
3 FY 2022-23 3 FY 2023-24
Domain Activity 2: Conduct Laboratory Testing FY 2022-23 Estimated Notes FY 2023-24 Estimated Notes
Activity Type Completion Activity Type Completion
Reference: 4 MY Report 5 YE Report 4 MY Report 5 YE Report
Pan Flu Work Plan Status Primary Barrier Status Primary Barrier Status Primary Barrier Status Primary Barrier
Activities 1 LHDs, whose jurisdiction includes a LRN-B Lab, will meet LRN-B proficiency
testing (PT) requirements. This is a PHEP Benchmark.
FY 21-22 Continue to work on this activity and deliverable.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activities 1 &
4.
PHEP Capabilities Guide pages 120-127
2 LHDs, whose jurisdiction includes a LRN-B Lab, will meet or sustain standard
reference laboratory requirements as appropriate.
FY 21-22 Continue to work on this activity and deliverable.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activities 1 &
4.
PHEP Capabilities Guide pages 120-127
3 LHDs, whose jurisdiction includes a LRN-B Lab, should have the ability to
expeditiously transport, test and report threat samples with 24 hours.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activities 4 &
12.
PHEP Capabilities Guide pages 120-127
4 LHDs, whose jurisdiction includes a LRN-B Lab, will ensure there are
established partnerships and processes for addressing joint investigations of
intentional public health threats or incidents between the appropriate
authorities.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 5.
PHEP Capabilities Guide pages 120-127
5 LHDs, whose jurisdiction includes a LRN-B Lab, must maintain a list of
sentinel laboratories with current contact information and engage sentinel
laboratories utilizing contact drills to support the detection of emerging
infectious diseases (EIDs).
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 10.
PHEP Capabilities Guide pages 120-127
Attachment A -PHEP Workplan, PHEP Domain6 Page 5 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 75
Strengthen Biosurveillance
6 Maintain staffing and equipment requirements. LHDs, whose jurisdiction
includes a LRN-B Lab, must ensure the LRN-B standard laboratory checklist
requirements are met.
FY 21-22 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 9.
7 LHDs, whose jurisdiction includes a public health lab, will maintain a current
laboratory COOP plan to ensure the ability to conduct ongoing testing for
routine and emerging public health threats and exercise their laboratory
COOP plan at least once every five years.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating the COOP.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 7.
PHEP Capabilities Guide pages 120-127
8 LHDs, whose jurisdiction includes a public health lab, will maintain
certification for packaging and shipping.
FY 21-22 Continue to work on this activity and deliverable.
FY 22-23 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 11.
PHEP Capabilities Guide pages 120-127
9 LHDs, whose jurisdiction includes a public health lab, will maintain lab
workforce for surge capacity, preventative maintenance agreements and
standard laboratory checklist requirements for staffing and equipment.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating lab staffing.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating lab staffing.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 9.
PHEP Capabilities Guide pages 120-127
10 LHDs, whose jurisdiction includes a public health lab, will continue to submit
data to CaIREDIE.
FY 21-22 Continue to work on this activity and deliverable.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
FY 2019-20 Local PHEP Work Plan, Capability 12, Function 1, Activity 9.
PHEP Capabilities Guide pages 120-127
11 LHDs, without a public health lab, will maintain a contract with a local public
health lab for testing, packaging, shipping and coordination of sample
transport.
FY 21-22 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
FY 22-23 Continue to work on this activity and deliverable. Utilize COVID-19
activities, as appropriate, to inform and guide updating these processes.
Reference:
CDC NoFO PHEP CDC RFA TP19-1901, page 30-35
PHEP Capabilities Guide pages 120-127
Activities 12
13
14
Attachment A -PHEP Workplan, PHEP Domain6 Page 6 of 13
Exhibit D
PHEP Domain 6 Attachment Aage 76
Strengthen Biosurveillance
Functions used to guide your planned activities
1 Capability 12, F1 Conduct laboratory testing and report results.
2 Capability 12, F2 Enhance laboratory communications and coordination.
3 Capability 12, F3 Support training and outreach.
Out uts from the planned activities
1 Maintain a local public health lab or contract with a local public health lab for
testing, packaging, shipping and coordination of sample transport.
2 Maintain CDC Federal Select Agents Program (FSAP) certification for select
agent testing as appropriate.
3 Maintain packaging and shipping certifications. (Activity 8)
4 Contract or MOU with a public health lab. (Activity 11)
5 Public Health labs maintain and/or update the COOP. (Activity 7)
6 Maintain staffing and equipment as appropriate. (Activity 6)
7 Fez LRN-B Lab maintained.
8 Fy,--22 Enhanced coordination with appropriate authorities. (Activity 4)
9 Fy, Y 21 22 A process for maintaining lab functionality during a surge. (Activity
9)
10 �y,--�-�A process for submitting data to CaIREDIE. (Activity 10)
11 Fez Sentinel laboratories current contacts and contact drills. (Activity 5)
Outputs 12
13
14
Notes 1
2
3
Attachment A -PHEP Workplan, PHEP Domain6 Page 7 of 13
Exhibit D
Page 77
Attachment A
Application Definitions
Known Gaps
Known Gaps Enter gaps identified from jurisdictional Capabilities Planning Guide (CPGs) survey, trainings, exercises, real events,
after action reports and/or improvement plans that you want to resolve during the fiscal year.
Classify Activity'
Sustain A capability is built and ready for an emergency and/or disaster. Sustainment is working through the preparedness cycle;
train, exercise, evaluate and improve in order to retain the ability and improve based on current jurisdictional hazards.
Build A capability is incomplete. Building activities include research, development, identifying key partners and stakeholders,
establishing relationships, defining roles, responsibilities, draft, public comment, etc..
Fiscal Year (FY) Activity
Plan/Develop Strategic and operational planning establishes priorities, identifies expected levels of performance and capability
requirements, provides the standard for assessing capabilities and helps stakeholders learn their roles. The planning
elements identify what an organization's Standard Operating Procedures (SOPs) or Emergency Operations Plans (EOPs)
should include for ensuring that contingencies are in place for delivering the capability during a large-scale disaster.
Organize/Equip Organizing and equipping include identifying what competencies and skill sets people should possess and ensuring an
organization has the correct personnel. Additionally, it includes identifying and acquiring standard equipment an
organization may need to use in times of emergency.
Train Training with the knowledge, skills, and abilities needed to perform key tasks required during a specific emergency
situation.
Exercise Exercises enable entities to identify strengths and incorporate them within best practices to sustain and enhance existing
capabilities. They also provide an objective assessment of gaps and shortfalls within plans, policies and procedures to
address areas for improvement prior to a real-world incident. Exercises help clarify roles and responsibilities among
different entities, improve inter-agency coordination and communications and identify needed resources and
opportunities for improvement.
Evaluate/Improve Quality improvement thru after action Reports (AARs), collecting lessons learned, develop improvement plans, and track
corrective actions to address gaps and deficiencies identified in exercises or real-world events to continuously improve
and strengthen preparedness.
Updating Modernize, make current and/or include the most recent information.
Not Applicable Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
Estimated Completion
This fiscal year by Q2 The activity will be complete by the end of the second quarter of the fiscal year.
This fiscal year by Q4 The activity will be complete by the end of the fourth quarter of the fiscal year.
Continuous The activity occurs throughout the year.
Out year Not working on the activity this fiscal year, it will be addressed in the future.
Exhibit D
Page 78
Attachment A
Reporting
Status "
Complete The Activity has been fully executed/in place to satisfy all requirements.
In progress, on schedule This Activity is work in progress and will be completed by the Estimated Completion time.
In progress, off schedule This Activity is work in progress and will be not be completed/late by the Estimated Completion time.
Not Started No work has been done on this Activity.
Canceled This activity will not be finished/completed this FY.
Primary Barrier`
None No barriers to completing this Activity and corresponding Outputs.
Lack of Funding In sufficient funding to complete this Activity and corresponding Outputs.
Lack of Personnel In sufficient staff or subject matter experts to complete this Activity and corresponding Outputs.
Administrative Jurisdictional administrative processes delayed and/or pushed back the the next FY this Activity.
Time Constraint Various factors limited the amount of time needed to complete this Activity. A few example, deadlines, workload, and resc
Waiting on EPO Waiting on EPO to provide materials, resources or guidelines that impedes completion of this Activity.
Real Event Jurisdiction
Other, provide in the Notes
section. Add additional information in the Notes section of this Activity.
Exhibit D
Page 79
Attachment B
Date:
OCDPH
California Department of Public Health
Emergency Preparedness Office
FY 2022-23 to FY 2026-27
Local Health Department Work Plan for
Hospital Preparedness Program (HPP)
and the Health Care Coalition
[Local Entity Name]
Region:
Population size:
Attachment B - HPP Workplan DRAFT, Cover
Exhibit D
Page 80
Attachment B
[Local Entity Name]
This is a short list that includes requirements, a checklist and clarifications for the Hospital Preparedness Program (HPP) funding.
This list is not exhaustive, HCCs are required to study the HPP Capability Guide and HPP Performance Measures and therein
HPP Performance Measures Implementation Guides
Link: https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hpp-pmi-guidance-2017.pdf
Link: https://www.phe.gov/Preparedness/planning/hpp/reports/pmi-guidance-2019-2023/Pages/default.aspx
Pages 90-96 in the 2019-2023 HPP Performance Measures Implementation Guide contain a crosswalk of
performance measures to HPP Workplan activities.
Opp-
HPP Capability Guide
Link: htt s: www. he. ov Pre aredness in h orts D ments 2017-2022-healthcare- r-ca ablities. df
HPP Coalition Assessment Tool (C4011h,
HPP Performance Measures ar orted in the Coalition Assessment Tool (CAT) and to CDPH. CDPH will utilize information in the
CAT to meet CDPH's require HPP reporting. CDPH will require HCCs to provide required deliverables and data that are not
contained in the CAT. If you ed to update your CAT point of contact and access, use the email provided below.
Link: htt s: HPPCAT. s. ov
Email: CAT@HHS.gov VP
Attachment B - HPP Workplan DRAFT, Requirements
Exhibit D
Page 81
Attachment B
Requirement
HPP-PHEP-EMA Joint Exercise: Select from the dropdown menu the year of the exercise. This exercise must be
a standalone functional or full scale joint exercise once every five years (rolling five years). This exercise must
include a surge of patients into the health care system. FY 2021-22 HPP Funding Opportunity Announcement,
page 16.
Pediatric Surge Care Annex, Exercise: Select from the dropdown menu the year of the exercise. This exercise
must be completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop or discussion exercise
format. See Capability 4, Phase 3, Objective 2, Activity 4.6.
Radiation Emergency Surge Annex, Exercise: Select from the dropdown menu the year of the exercise if selected
over the Chemical Emergency Surge Annex exercise. This exercise must be completed within five-years (FY 2019-
20 to FY 2023-24) via a real event, tabletop or discussion exercise format. See Capability 4, Phase 3, Objective 2,
Activity 5.7.
Or (Radiation or Chemical Exercise)
Chemical Emergency Surge Annex, Exercise: Select from the dropdown menu the year of the exercise if selected
over the Radiation Emergency Surge Annex exercise. This exercise must be completed within five-years (FY 2019-
20 to FY 2023-24) via a real event, tabletop or discussion exercise format. See Capability 4, Phase 3, Objective 2,
Activity 5.8.
Burn Surge Annex, Exercise: Select from the dropdown menu the year of the exercise. This exercise must be
completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop or discussion exercise format.
See Capability 4, Phase 3, Objective 2, Activity 6.9.
Infectious Disease Preparedness and Surge Annex, Exercise: Select from the dropdown menu the year of the
exercise. This exercise must be completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop
or discussion exercise format. See Capability 4, Phase 3, Objective 2, Activity 9.10
FY 2022-23 Participate in State Wide Medical Health Exercise of Crisis Standards of Care CONOPS. See Capability 4, Phase
3, Objective 1, Activity 3.1.
Attachment B- HPP Workplan DRAFT, Requirements
Exhibit D
Page 82
Attachment B
Provide a current inventory: Select which quarter to provide the list of all HCC resources purchased in the
previous fiscal year that would be utilized during an exercise or real event each year to CDPH. State Site
Visit/State Audit requirement.
Checklist
Performance Measure 4: Complete HCC member updates, in CDPH template by the due date.
Performance Measure 6: Other Exercise Requirements within the CAT, Exercise Tool report exercise dates and
complete a datasheet for all required exercises.
Performance Measure 9: Complete Jurisdictional Risk Assessment Survey provided by CDPH by the due date.
Performance Measure 10: After Action Reporting (AAR) and Improvement Planning (IP) Matrix, complete within
the CAT within the Exercise Tool.
Performance Measures 12 & 13: Redundant Communications Drills 1 & 2, enter data into the CAT. The second
drill must be six months after the first.
Capability Assessments must be completed within the CAT before the end of year due date.
Performance Measure HPP-PHEP J.1, Information Sharing: Report Essential Elements of Information (EEls),
situation reporting, to CDPH as requested during exercises and real events.
CAHAN Communication Drills, quarterly.
Disaster Health Volunteers (DHV) Program must be maintained annually. See Capability 4, Phase 3, Objective 2,
Activity 1.1
Attachment B- HPP Workplan DRAFT, Requirements
Exhibit D
Page 83
Attachment B
Clarifications
Performance Measure 22: This is a Hospital performance measure collected by the Emergency Medical Services for
Children (EMSC). This should align with your Pediatric Surge Annex.
Performance Measure HPP-PHEP J.2, Volunteers: This is a State level performance measure.
Performance Measures 23-28: Annual Hospital Surge Test (HST) in the CAT within the Exercise Tool. Only complete
if, you have a hospital that is in a Frontier and Remote Area (FAR) level four. https://www.ers.usda.gov/data-
products/frontier-and-remote-area-codes/
HCC Exercise with an FCC to participate in the NDMS patient movement in the CAT within the Exercise Tool. Only
complete if, you have a Federal Coordination Center (FCC) in your jurisdiction. https:Hasprtracie.hhs.gov/technical-
resources/resource/5622/national-disaster-medical-system-federal-coordinating-center-guide
If there is a difference between the Performance Measures and HPP Funding Opportunity Announcement (FOA), the
most current requirement is listed in this work plan, at this point in time it is based on the Performance Measures
Implementation Guide 2019-2023.
Attachment B- HPP Workplan DRAFT, Requirements
Exhibit D
Page 84
Attachment B
[Local Entity Name]
Capability 1: Foundation for Health Care and Medical Readiness
Goal: The community's health care organizations and other stakeholders — coordinated through a sustainable Hee
have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, train
managing resources.
11 Known Gaps:
z Classify Activity: I Are you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepare 3 FY 2022-23
Objective 1 Establish and Operationalize a Health Care Coalition (HCC) FY 2022-23
Activity Type
Activity 2 Identify HCC Members
1 1HCCs will annually provide a listing of all core members and additional coalition
members. EPO will provide a template with instructions and a due date in Q1.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 46
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 11-12
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 31 page 11-12
2019-2023 HPP Performance Measures Implementation Guidance
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 85
Attachment B
2 Core HCC members should be represented at all HCC meetings, virtually or in-
person. Core members should sign all HCC-related documentation and
participate in all HCC exercises.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 46
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 1
2017-2022 health Care Preparedness and Response Capabilities, page 11-12
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 31 4 and 5, page 11-16
2019-2023 HPP Performance Measures Implementation Guidance
Activity 3 Establish HCC Governance
3 HCCs will maintain engagement with the Clinical Advisor. Include this position in
your HPP Budget.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 48-49
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 7 and 8
2017-2022 health Care Preparedness and Response Capabilities, page 11-12
Coalition Assessment Tool (CAT): httpsJIHPPCAT.hhs.gov
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 86
Attachment B
4 HCCs will continue to maintain a HCC Readiness and Response Coordinator.
Include this position in your HPP Budget.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 48-49
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 7 and 9
2017-2022 health Care Preparedness and Response Capabilities, page 11-12
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activities 5
6
7
Outputs from the planned activities
1 Provide a listing of all core and additional coalition members in Q1 (Activity 2.1).
2 Provide an agenda and sign-in sheets from HCC meetings and trainings (Activity
2.2).
Outputs 3
4
5
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 87
Attachment B
3 2022-23
Objective 2 Identify Risks and Needs FY 2022-23
Activity Type
Activity 1 Assess Hazard Vulnerability and Risks
1 HCCs will continue to annually update their Hazard Vulnerability Assessment
(HVA).
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 49-50
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 3
2017-2022 Health Care Preparedness and Response Capabilities, page 13-14
ASPR TRACIE: https://asprtracie.hhs.gov/technical-resources/3/hazard-
vulnerability-risk-assessment/1
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
2 HCC funded projects must go toward a risk(s) identified in the HVA, identified
gap(s), and/or corrective actions. Utilize "Known Gaps" at the beginning of each
Capability in this work plan. Upload work plan and budget into the CAT 30 days
after award.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 49
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 5, 10
2017-2022 Health Care Preparedness and Response Capabilities, page 13-14
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activity 2 Assess Regional Health Care Resources
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 88
Attachment B
3 HCCs will continue to annually update and maintain a resource inventory
assessment to identify health care resources and services at the jurisdictional
level and have available for the RDMHS.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 50
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 4
2017-2022 Health Care Preparedness and Response Capabilities, page 14-15
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 1, Activity 1
Activity 4 Assess Community Planning for Children, Pregnant Women, Seniors,
Individuals with Access and Functional Needs, People with Disabilities, and
Others with Unique Needs
4 HCCs will continue to annually assess community planning for at risk populations.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 50-51
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 15
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 3, Activity 1 and Activity 2
Activities 5
6
7
Outputs from the planned activities
1 HCCs will have an updated HVA by June 30 (Activity 1.1).
2 HCCs will have HPP Work Plan and Budget into the CAT within 30 days of award
(Activity 1.2).
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 89
Attachment B
3 HCCs will have an updated inventory list available upon request (Activity 2).
Outputs 4
5
6
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 90
Attachment B
3 2022-23
Objective 3 Develop a HCC Preparedness Plan FY 2022-23
Activity Type
Activity 1 Same as above.
1 HCCs will continue to update and maintain their Preparedness Plan.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 51-52
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 1, Activity 6
2017-2022 Health Care Preparedness and Response Capabilities, page 17-18
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 4, page 13-14
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activities 2
3
4
Outputs from the planned activities
1 HCCs will have an updated Preparedness Plan by June 30 (Activity 1).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 91
Attachment B
3
Objective 5 Ensure Preparedness is Sustainable FY 2022-23
Activity Type
Activity 3 Engage Clinicians
1 HCCs will continue to engage health care executives, clinicians, community
leaders, and tribal representatives in debriefs/hot washes.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 52-53
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 5, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 23-24
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 4, Activity 1
Activity 4 Engage Community Leaders
2 HCCs will continue to engage community leaders, organizations, and the media in
exercises to promote resilience of the entire community.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 52-53
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 5, Activities 1-2
2017-2022 Health Care Preparedness and Response Capabilities, page 23-24
Activity 5 Promote Sustainability of HCC
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 92
Attachment B
3 HCCs will continue to promote sustainability of HCC by considering cost share
with other organizations with similar requirements and leverage group buying
power.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 53-54
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 5, Activities 1 and 3
2017-2022 Health Care Preparedness and Response Capabilities, page 24
Activities 4
5
6
Outputs from the planned activities
1 HCCs will provide documentation of engagement (Activity 3.1 & Activity 4.2).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 93
Attachment B
CHASE 2: Train and 3 FY 2022-23
Objective 4 Train and Prepare the Health Care and Medical Workforce FY 2022-23
Activity Type
Activity 1 Promote Role-Appropriate NIMS Implementation
1 HCCs will continue to promote role-appropriate National Incident Management
System (NIMS) and Standardized Emergency Management System (SEMS)
trainings.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 54
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 4, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 19
Activity 2 Educate and Train on Identified Preparedness and Response Gaps
2 HCCs will continue to provide trainings based on risks, resource gaps,
deliverables and corrective actions. HCCs will upload a list of planned training
activities within 30 days of award.
FY 20-21 Waived.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 54
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 4, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 19
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 2
FY 21-22 PHEP Workplan Domain 2, Domain Activity 1, Activity 2
Activities 3
4
5
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 94
Attachment B
Outputs from the planned activities
1 HCCs will upload a list of planned training activities within 30 days of award
(Activity 2.2).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 95
Attachment B
PHASE 3: Exercise and Respond 3 FY 2022-23
Objective 4 Train and Prepare the Health Care and Medical Work Force FY 2022-23
Activity Type
Activity 3 Plan and Conduct Coordinated Exercises with HCC Members and Other
Response Organizations
1 HPP, PHEP and all HCCs will participate in the annual Statewide Medical Health
Exercise (SWMHE).
FY 20-21 Canceled.
FY 21-22 Canceled.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 55
FY 2019-20 Local HPP Work Plan, Capability 1, Objective 4, Activity 3 and 5
2017-2022 Health Care Preparedness and Response Capabilities, page 20-21
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 2, Activity 2
Activities 2
3
4
Outputs from the planned activities
1 HCCs will provide after action reports (AARs) and improvement plans (IPs)
(Activity3.1).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 96
Attachment B
filth Care Coalition —
iing, exercising, and
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 97
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 98
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page 99
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier I Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page100
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page101
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 1
Exhibit D
Page102
Attachment B
[Local Entity Name]
Capability 2: Health Care and Medical Response Coordination
Goal: Health care organizations, the HCC, their jurisdiction(s), and the state's/jurisdiction's ESF-8 lead agency
collaborate to share and analyze information, manage and share resources, and coordinate strategies to
care to all populations during emergencies and planned events.
11 Known Gaps:
2 Classify Activity: Are you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepwe 3 FY 2022-23
Objective 1 Develop and Coordinate Health Care Organization and HCC Response Plans FY 2022-23
Activity Type
Activity 2 Develop a HCC Response Plan
1 1HCCs, in coordination with PHEP, will review and update their Response Plan
annually and upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 56-57
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 1, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 27-28
2017-2022 Hospital Preparedness Program, Performance Measures, Performance
Measure 5, page 15-16
Coalition Assessment Tool (CAT): httpsJIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 5, Activity 1
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 1, Activity 1
2019-2023 HPP Performance Measures Implementation Guidance
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page103
Attachment B
2 HCCs, in coordination with PHEP, will update and maintain current operational roles,
situational awareness, information sharing and resource management in their
Response Plan annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 57
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 1, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 27-28
2017-2022 Hospital Preparedness Program, Performance Measures, Performance
Measure 5, page 15-16
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 5, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 1, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 1, Activity 3
2019-2023 HPP Performance Measures Implementation Guidance
3 HCCs will continue to participate with PHEP to update and maintain the jurisdictions
All Hazards Preparedness and Response Plan annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 57
2017-2022 Health Care Preparedness and Response Capabilities, page 27-28
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 5, Activity 1
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
2019-2023 HPP Performance Measures Implementation Guidance
Activities 4
5
6
Outputs from the planned activities
1 1 HCCs will have an updated Response Plan by June 30 (Activity 2.1, 2.2, 2.3).
Outputs 2
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page104
Attachment B
3 FY 2022-23
Objective 2 Utilize Information Sharing Processes and Platforms FY 2022-23
Activity Type
Activity 1 Develop Information Sharing Procedures
1 HCCs will continue to update their essential elements of information (EEls) in their
Response Plan, annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 58
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 2, Activities 3 and 5
2017-2022 Health Care Preparedness and Response Capabilities, page 28
2019-2023 HPP Performance Measures Implementation Guidance
2 HCCs, in coordination with PHEP, will annually maintain ability to access timely,
relevant, and actionable information about their members during emergencies by-
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 58
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 2, Activities 1-2
2017-2022 Health Care Preparedness and Response Capabilities, page 28-29
FY 21-22 PHEP Workplan, Domain 3, Domain Activity 2, Activity 1
FY 21-22 Pan Flu Workplan, Objective 3
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page105
Attachment B
3 HCCs will identify reliable, resilient, interoperable, and redundant information and
communication systems and platforms, including those for bed availability and
patient tracking, and provide access to HCC members and other stakeholders.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 58
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 2, Activities 1-2
2017-2022 Health Care Preparedness and Response Capabilities, page 29
FY 21-22 PHEP Workplan, Domain 3, Domain Activity 2, Activity 1
FY 21-22 Pan Flu Workplan, Objective 3
2019-2023 HPP Performance Measures Implementation Guidance
Activities 4
5
6
Outputs from the planned activities
1 HCCs Response Plan will include updated EEls annually (Activity 1.1).
2 HCCs will have proof of participation in information sharing exercises (Activity 1.3).
Outputs 3
4
5
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page106
Attachment B
PHASE 2: Train and Equip 3 FY 2022-23
Objective 3 Coordinate Response Strategy, Resources, and Communications FY 2022-23
Activity Type
Activity 4 Communicate with the Public During an Emergency
1 IHCCs, in coordination with PHEP, will provide public information officer (PIO) training
to those who are designated to act in that capacity during an emergency and for
HCC members in need of such training, annually by june 30 2022. This training
should include Crisis and Emergency Risk Communication (CERC) training.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 59
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 3, Activities 4
2017-2022 Health Care Preparedness and Response Capabilities, page 31
Activities 2
3
4
Outputs from the planned activities
1 HCCs will provide a list of participants and an agenda for each completed training
(Activity 4).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page107
Attachment B
PHASE 3: Exercise and Respond 3 FY 2022-23
Objective 3 Coordinate Response Strategy, Resources, and Communications FY 2022-23
Activity Type
Activity 1 Identify and Coordinate Resource Needs during an Emergency
1 1HCCs will continue to share information and coordination activities with HCC
members, and HCC members will have access to information sharing platforms,
annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 59
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 3, Activities 3
2017-2022 Health Care Preparedness and Response Capabilities, page 29-31
Activity 2 Coordinate Incident Action Planning During an Emergency
2 HCCs, in coordination with PHEP, will continue to maintain the ability to coordinate
incident action planning during a real event/exercise as reflected in applicable plans,
annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 59
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 3, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 30
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 2, Activity 1
Activity 3 Communicate with Health Care Providers, Non-Clinical Staff, Patients, and
Visitors during an Emergency.
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page108
Attachment B
3 HCCs will assist their members with developing the ability to rapidly alert and notify
their employees, patients and visitors to provide situational awareness, protect their
health and safety and facilitate provider-to-provider communication annually by juRe-
30,2022.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60
FY 2019-20 Local HPP Work Plan, Capability 2, Objective 3, Activity 3
2017-2022 Health Care P
preparedness and Response Capabilities, page 30-31
FY 21-22 PHEP Workplan, Domain 3, Domain Activity 3, Activity 1
FY 21-22 Pan Flu Workplan, Objective 3
Activities 4
5
6
Outputs from the planned activities
1 HCCs will provide a copy of an incident action plan upon request (Activity 2.2).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page109
Attachment B
plan and
deliver medical
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page110
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page111
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page112
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, Capability 2
Exhibit D
Page113
Attachment B
[Local Entity Name]
Capability 3: Continuity of Health Care Service Delivery
Goal: Health care organizations, with support from the HCC and the state's/jurisdiction's ESF-8 lead agenc,
uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care
Health care workers are well-trained, well-educated, and well-equipped to care for patients during em
Simultaneous response and recovery operations result in a return to normal or, ideally, improved ope
11 Known Gaps:
z Classify Activity: IAre you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepare 3 FY 2022-23
Objective 2 Plan for Continuity of Operations FY 2022-23
Activity Type
Activity 2 Develop a HCC Continuity of Operations Pan
1 HCCs will support Health Care Organizations in development or maintenance of
their continuity of operations plan (COOP) by January 30, 2022, thereafter
annually. The HCO plans will inform the HCC COOP.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page114
Attachment B
2 HCCs will develop or maintain a coalition COOP annually by june 30 2022 and
upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 34
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activities 3
4
5
Outputs from the planned activities
1 HCCs will submit a COOP plan into the CAT (Activity 2.2).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page115
Attachment B
37772022-23
Objective 3: Maintain Access to Non-Personnel Resources During an Emergency FY 2022-23
Activity Type
Activity 1 Assess Supply Chain Integrity
1 HCCs will continue to assess supply chain integrity by developing a vendor
management process to address limited supply ordering for all HCC members
and neighboring HCCs in an emergency. HCCs will share with neighboring HCCs
annually byp�0, 2022 and upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 62
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 3, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 35
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activity 2 Assess and Address Equipment, Supply and Pharmaceutical Requirements
2 HCCs will continue to assess and address equipment, supply, and
pharmaceutical requirements annually, and update inventory list. Inventory
management program protocol for all cached materials will be updated annually
and uploaded into the CAT within 30 days after award.
rY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 62-63
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 3, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 36-7
Coalition Assessment Tool (CAT): https:IIHPPCAT.hhs.gov
Activities 3
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page116
Attachment B
4
5
Outputs from the planned activities
1 HCCs will upload a vendor management process into the CAT (Activity 1.1).
2 HCCs will upload an inventory management program protocol into the CAT
(Activity 1.2).
Outputs 3
4
5
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page117
Attachment B
3
Objective 6 Plan for Health Care Evacuation and Relocation FY 2022-23
Activity Type
Activity 1 Develop and Implement Evacuation and Relocation Plans
1 HCCs will continue to support HCC member's development or maintenance of
their evacuation, transportation and relocation plans, annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 63
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 3, Activity 2
2017-2022 Health Care Preparedness and Response Capabilities, page 40-42
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 7, Activity 1
Activities 2
3
Outputs from the planned activities
1 HCCs will provide upon request meeting minutes and best practices (Activity 1.1).
Outputs 2
3
4
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page118
Attachment B
PHASE 2: Train and Equip 3 FY 2022-23
Objective 5: Protect Responder Safety and Health FY 2022-23
Activity Type
Activity 1 Distribute Resources Required to Protect the Health Care Workforce
1 HCCs will annually support and promote regional PPE procurement, update
inventory list, and include/update this process in the HCC Preparedness Plan.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 65
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 5
2017-2022 Health Care Preparedness and Response Capabilities, page 36-37
Activity 2 Train and Exercise to Promote Responder Safety and Health
2 HCCs, in coordination with PHEP, will continue to annually make available
training opportunities to HCC members to promote responder safety and health.
Include such trainings in the HCC training plan.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 65
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 5
2017-2022 Health Care Preparedness and Response Capabilities, page 38-40
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 1, Activity 4 and Activity 6
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 7, Activity 2
Activities 3
4
5
Outputs from the planned activities
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page119
Attachment B
1 HCCs will provide a list of participants and an agenda for each completed training
(Activity 2.2).
2 HCCs will provide MCM dispensing plans reflecting the HCCs role (Activity 2.1).
Outputs 3
4
5
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page120
Attachment B
y, provide
infrastructure.
ergencies.
rations.
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page121
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Activity Type Completion
Status Primary Barrier Status Primary Barrier Status
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page122
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page123
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion Status
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page124
Attachment B
3
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report Notes
Primary Barrier Status Primary Barrier 25 d I Status mary Bari Status Imary Bar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page125
Attachment B
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report Notes
Primary Barrier Status Primary Barrier 25 d I Status Imary Bari Status Imary Bar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page126
Attachment B
3 FY 2025-26 3 FY 2026-27
FY 2025- Estimate a MY Report 5 YE Report INotes FY 2026- Esti mat a MY Report 5 YE Report
26 d Stat—us—Fm—aryBarl Status ImaryBarl 27 ed I Status hYr—yBarl Status InaryBar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page127
Attachment B
3 3 FY 2026-27
FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE Report
26 d 27 ed
Activity Completi Status mart' Bar Status mart' Bar Activity Complet Status ary Bar Status ary Bar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page128
Attachment B
3 3
r
Y 2025- Estimate a MY Report 5 YE Report INotes FY 2026- Esti mat a MY Report 5 YE Report
26 d Stat—us—Fm—aryBarl Status ImaryBarl 27 ed I Status jn7r—yBarj Status InaryBar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page129
Attachment B
3 FY 2025-26 3 FY 2026-27
FY 2025- Estimate a MY Report 5 YE Report INotes FY 2026- Esti mat a MY Report 5 YE Report
26 d Stat—us—Fm—aryBarl Status ImaryBarl 27 ed I Status hYr—yBarl Status InaryBar
Attachment B - HPP Workplan DRAFT, Capability 3
Exhibit D
Page130
Attachment B
[Local Entity Name]
Capability 4: Medical Surge
Goal: Health care organizations deliver timely and efficient care to their patients even when the demand for health
exceeds available supply. The HCC, in collaboration with the state's/jurisdiction's ESF-8 lead agency, coord
and available resources for its members to maintain conventional surge response. When an emergency ovE
HCC's collective resources, the HCC supports the health care delivery system's transition to contingency ar
response and promotes a timely return to conventional standards of care as soon as possible.
11 Known Gaps:
z Classify Activity: I Are you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepare 4 d' 3 FY 2022-23
Objective 1 PI Ndical Surge FY 2022-23
A k Activity Type
Activity 1 Incorporate Medi I Surge Planning into Health Care Organization
Emergency Operations Plan
1 HCC members will continue to work together to manage staffing resources
including volunteers within hospitals and other health care settings, and
include/update annually such strategy in preparedness and response plans.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 66-67
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 11
2017-2022 Health Care Preparedness and Response Capabilities, page 45
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page131
Attachment B
2 HCCs will continue to serve as planning resources and subject matter experts to
PHEP program and LHDs as they develop or augment existing response plans,
annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 70
2017-2022 Health Care Preparedness and Response Capabilities, page 47-48
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 2, Activity 1
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 4, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 4, Activity 2
3 FY 21-22 HCCs will develop complementary coalition-level annexes to their base
medical surge/trauma mass casualty Response Plan to manage a large number
of casualties with specific needs. Consider regional plans.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 70-74
2017-2022 Health Care Preparedness and Response Capabilities, page 51
2019-2023 HPP Performance Measures Implementation Guidance
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page132
Attachment B
4 HCCs will continue to maintain and update their Pediatric Surge Annex of their
Response Plan, annually. Updates will be uploaded into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 71
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 5
2017-2022 Health Care Preparedness and Response Capabilities, page 51
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page133
Attachment B
5 Develop an Infectious Disease Surge or Burn Surge Annex to HCC Response
Plan by June 2021.
If selected over an Infectious Disease Surge Annex, HCCs will develop their Burn
Surge Annex of their Response Plan, a draft is due April 1, 2021, and the final by
June 30, 2021 and upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 71
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 6
2017-2022 Health Care Preparedness and Response Capabilities, page 52
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 5, Required by State Activity 1, Activity 2
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page134
Attachment B
6 Develop an Infectious Disease Surge or Burn Surge Annex to HCC Response
Plan by June 2022.
If a Burn Surge Annex was not selected and developed, HCCs will develop their
Infectious Disease Surge Annex of their Response Plan, a draft is due April 1,
2022, and the final by June 30, 2022 and upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 72
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 7
2017-2022 Health Care Preparedness and Response Capabilities, page 53-54
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 Pan Flu Workplan, Objective 1
FY 21-22 PHEP Workplan, Domain 5, Required by State Activity 1, Activity 1
7 HCCs will develop their Radiation Surge Annex of their Response Plan, a draft is
due April 1, 2023, and the final by June 30, 2023 and uploaded into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 73
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 8
2017-2022 Health Care Preparedness and Response Capabilities, page 51-52
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Required by State Activity 1, Activity 3
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page135
Attachment B
8 HCCs will develop their Chemical Surge Annex of their Response Plan, a draft is
due April 1, 2024, and the final by June 30, 2024 and uploaded into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 73-74
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 9
2017-2022 Health Care Preparedness and Response Capabilities, page 51-52
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Required by State Activity 1, Activity 4
9 HCCs will continue to coordinate with the PHEP program and CDPH for
integrating crisis care elements into their Response plans annually by june 30,
2022 and upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 76
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 3
2017-2022 Health Care Preparedness and Response Capabilities, page 47-51
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 4, Domain Activity 1, Activity 3
Activities 10
11
12
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page136
Attachment B
Outputs from the planned activities
1 HCCs use the Disaster Healthcare Volunteer (DHV) program (Activity 1.1).
2 HCCs will provide upon request Medical Response Corps (MRC) engagement
activities (Activity 1.1).
3 HCCs will upload their Pediatric Surge Annex into the CAT (Activity 3.5).
4 HCCs will upload their Burn or Infectious Disease Surge Annex into the CAT
(Activity 3.6).
5 HCCs will uploaded their Radiation Surge Annex into the CAT (Activity 3.7).
6 HCCs will have upload their Chemical Surge Annex into the CAT (Activity 3.8).
7 HCCs will update their Response to include Crisis Care elements (Activity 3.9).
Outputs 8
9
10
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page137
Attachment B
PHASE 3: Exercise and Respond 3 FY 2022-23
Objective 1: Plan for a Medical Surge FY 2022-23
Activity Type
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
1 HCCs will participate in the SWMHE to validate CDPH's Crisis Standards of Care
CONOPS in FY 2022-23.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 77
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 1, Activity 4
2017-2022 Health Care Preparedness and Response Capabilities, page 47-51
2 HCCs will complete a redundant communications drill twice a year and enter the
data into the CAT. These drills must be six months apart.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 59
2017-2022 Health Care Preparedness and Response Capabilities, page 29
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 12 and 13, page 28-31
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
2019-2023 HPP Performance Measures Implementation Guidance
Activities 3
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page138
Attachment B
4
5
Outputs from the planned activities
1 HCCs will participate in the SWMHE (Activity 3.1).
2 HCCs will input data from redundant communications drill into the CAT (Activity
3.2).
Outputs 3
4
5
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page139
Attachment B
3 FY 2022-23
Objective 2: Respond to a Medical Surge FY 2022-23
Activity Type
Activity 1 Implement Emergency Department and Inpatient Medical Surge Response
1 HCCs, in coordination with PHEP, will incorporate the use of volunteers, Disaster
Healthcare Volunteer (DHV) system, to support a medical surge response during
training, drills and exercises, annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 77
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 13
2017-2022 Health Care Preparedness and Response Capabilities, page 48-49
FY 21-22 PHEP Workplan, Domain 1, Domain Activity 6, Activity 1
FY 21-22 PHEP Workplan, Domain 5, Domain Activity 4, Activity 1
2019-2023 HPP Performance Measures Implementation Guide
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page140
Attachment B
2 HCCs will conduct a Coalition Surge Test (CST) annually, results entered into the
CAT.
FY 20-21 Waived.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 14
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 14-21, page 32-49
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
2019-2023 HPP Performance Measures Implementation Guidance
3 HCCs will complete the Surge Estimator Tool by March 31, 2022 and March 31,
2024 to support determination of their surge capacity. Only hospitals that
provide emergency services are to be included. Data to be entered into the
CAT.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 78
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page141
Attachment B
Activity 3 Develop an Alternate Care System
4 HCCs, in collaboration with CDPH, LHDs and emergency management, will
develop and/or maintain an alternate care system annually by 'may �30, and
upload into the CAT.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 78-79
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 3
2017-2022 Health Care Preparedness and Response Capabilities, page 50-51
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
5 HCCs, in coordination with PHEP, will continue to provide subject matter
expertise to LHDs, for providing medical care to sheltered and/or congregate
locations during an incident.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 79
2017-2022 Health Care Preparedness and Response Capabilities, page 50-51
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
Activity 4 Provide Pediatric Care During a Medical Surge Response
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page142
Attachment B
6 HCCs will test/exercise their Pediatric Surge Care Annex during a medical surge
response or tabletop/discussion exercise format. Completed and upload
results/data into the CAT by the end of the five-year project period (FY 2019-20
to FY 2023-24).
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-WR-19-001, pages 79
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 4
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page143
Attachment B
Activity 5 Provide Surge Management During a Chemical or Radiation Emergency
Event
7 HCCs will test/exercise their Radiation Emergency Surge Annex, if chosen over
the Chemical Emergency Surge Annex exercise, during a medical surge or
tabletop/discussion exercise format, by june 30 2023 and upload the
results/data into the CAT by the end of the five-year project period (FY 2019-20
to FY 2023-24).
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-WR-19-001, pages 79
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 5
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
8 HCCs will test/exercise their Chemical Emergency Surge Annex, if chosen over
the Radiation Emergency Surge Annex exercise, during a medical surge or
tabletop/discussion exercise format, by june 30 2024 and upload the
results/data into the CAT by the end of the five-year project period (FY 2019-20
to FY 2023-24).
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-WR-19-001, pages 79
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 6
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
Activity 6 Provide Burn Care During a Medical Surge Response
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page144
Attachment B
g if a Burn Surge ARRex was seleGted and deyeleped HCCs will test/exercise their
Burn Care Surge Annex during a medical surge or tabletop/discussion exercise
format, by iWRe 30 and upload the results/data into the CAT by the end of
the five-year project period (FY 2019-20 to FY 2023-24).
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-WR-19-001, pages 79
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 7
Coalition Assessment Tool (CAT): https.IIHPPCAT.hhs.gov
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page145
Attachment B
Activity 9 Enhance Infectious Disease Preparedness and Surge Response
10 If on Infectious disease Surge Annex was se'eGterd aR d ldeyel pe'de HCCs will
test/exercise their Infectious Disease Preparedness and Surge Annex during a
medical surge or tabletop/discussion exercise format, by une 30,�zz and
upload the results/data into the CAT by the end of the five-year project period (FY
2019-20 to FY 2023-24).
FY 21-22 Continue to work on this activity and deliverable and report. HCCs may
utilize COVID-19 response to meet this deliverable. A data sheet will need to be
completed.
Reference:
ASPR HPP FOA EP-WR-19-001, pages 80
FY 2019-20 Local HPP Work Plan, Capability 4, Objective 2, Activity 10
Coalition Assessment Tool (CAT): httpsJIHPPCAT.hhs.gov
FY 21-22 Pan Flu Workplan, Objective 1 and Objective 7
Activities 11
12
13
Outputs from the planned activities
1 HCCs will use the Disaster Healthcare Volunteer (DHV) program (Activity 1.1).
2 HCCs will provide upon request Medical Response Corps (MRC) engagement
activities (Activity 1.1).
3 HCCs will input data from CST into the CAT (Activity 1.2).
4 HCCs will input data from Surge Estimator Tool into the CAT (Activity 1.3).
5 HCCs will provide their tele/virtual medicine policy (Activity 3.4).
6 HCCs will provide their policy for establishing an alternate care site (Activity 3.4).
7 HCCs will provide after action reports (AARs) and improvement plans (IPs)
(Activities 4.6, 5.7, 5.8, 6.9, 9.10)
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page146
Attachment B
i care services
inates information
�rwhelms the
id crisis surge
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24
Completion Status Primary Barrier Status Primary Barrier Activity Type
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page147
Attachment B
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24
Completion Status Primary Barrier Status Primary Barrier Activity Type
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page148
Attachment B
3
Estimated 4 MY Report s YE Report Notes FY 2023-24
Completion Status Primary Barrier Status Primary Barrier Activity Type
Attachment B - HPP Workplan DRAFT, Capability 4
Exhibit D
Page149
Attachment B
[Local Entity Name]
Capability 4: Medical Surge
Goal: Health care organizations deliver timely and efficient care to their patients even when the demand for f
services exceeds available supply. The HCC, in collaboration with the state's/jurisdiction's ESF-8 lead
coordinates information and available resources for its members to maintain conventional surge respor
emergency overwhelms the HCC's collective resources, the HCC supports the health care delivery sys
contingency and crisis surge response and promotes a timely return to conventional standards of care
possible.
11 Known Gaps:
z Classify Activity: Are you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepare -,do 3 FY 2022-23
Objective 1 Plan for a Medical Surge FY 2022-23
V* P Activity Type
Activity 2 Incorporate Medical Surge Planning into Emergency Medical Services
Emergency Operation Plan
1 EMS plans should incorporate disaster related dispatch, response, mutual aid
and regional coordination, pre-hospital triage and treatment, transportation,
supplies and equipment.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-47
Attachment B- HPP Workplan DRAFT, LEMSA
Exhibit D
Page150
Attachment B
2 EMS will work collaboratively with the LHD to identify a local initiative or project to
meet local needs and delineate the LEMSA role from the LHD role.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
3 EMS will continue to participate in the review and update of the HCC Response
Plan, to maintain the patient transportation process from, the field, to hospital, to
interfacility, and to the region.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
4 EMS will continue to review and update information sharing protocols with HCC
members, corroborate member needs and incorporate the process in the HCC
Response Plan.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
Activities 5
6
7
Outputs from the planned activities
Attachment B- HPP Workplan DRAFT, LEMSA
Exhibit D
Page151
Attachment B
1 HCCs will provide the EMS plans upon request (Activity 2.1).
2 HCCs will provide a documentation of roles and responsibilities for local initiative
or project (Activity 2.2).
3 HCCs will provide a copy of the EMS transportation protocols upon request
(Activity 3.3).
4
5
Outputs 6
7
8
Notes 1
2
3
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page152
Attachment B
PHASE 2: Train and Equip 3 FY 2022-23
Objective 2: Respond to a Medical Surge FY 2022-23
Activity Type
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
1 EMS will continue to provide training to HCC members on plans, policies and
procedures for regional transportation of a patient(s) with a suspected and/or
confirmed highly infectious disease.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
2 EMS will continue to provide training to HCC members on plans, policies and
procedures for transitioning to a disaster response.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
Activities 3
4
5
Outputs from the planned activities
1 HCCs will provide upon request their patient movement plan, and patient
tracking/reunification plan (Activity 3.1).
2 HCCs will provide a list of participants and an agenda for each completed training
(Activity 3.2).
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page153
Attachment B
PHASE 3: Exercise and Respond 3 FY 2022-23
Objective 2: Respond to a Medical Surge FY 2022-23
Activity Type
Activity 3 Incorporate Medical Surge into HCC Response Plan
1 EMS will participate in the Coalition Surge Test (CST) annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
2019-2023 HPP Performance Measures Implementation Guidance
2 EMS will complete a redundant communications drill twice a year with their HCC.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page154
Attachment B
3 EMS will participate in the annual SWMHE.
FY 20-21 Canceled.
FY 21-22 Canceled.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
4 EMS will participate in the SWMHE to validate the CDPH's Crisis Standards of
Care CONOPS in FY 2022-23.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
Activities 5
6
7
Outputs from the planned activities
1 HCCs will provide after action reports (AARs) and improvement plans (IPs)
(Activities 3.1-3.4).
Outputs 2
3
4
Notes 1
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page155
Attachment B
iealth care
agency,
ise. When an
tem's transition to
as soon as
3 FY 2023-24
Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page156
Attachment B
3 FY 2023-24
Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page157
Attachment B
3 FY 2023-24
Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page158
Attachment B
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page159
Attachment B
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page160
Attachment B
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report s YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page161
Attachment B
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page162
Attachment B
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page163
Attachment B
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment B - HPP Workplan DRAFT, LEMSA
Exhibit D
Page164
Attachment B
Application
Known Gaps
Known Gaps
Classify Activity
Sustain
Build
Fiscal Year (FY) Activity
Plan/Develop
Organize/Equip
Train
Exercise
Evaluate/Improve
Updating
Not Applicable
Estimated Completion
This fiscal year by Q2
This fiscal year by Q4
Continuous
Out year
Not Applicable
Reporting
Status
Complete
In progress, on schedule
Attachment B- HPP Workplan DRAFT, Definitions
Exhibit D
Page165
Attachment B
In progress, off schedule
Not Started
Canceled
Primary Barrier "
None
Lack of Funding
Lack of Personnel
Administrative
Time Constraint
Waiting on EPO
Real Event
Other, provide in the Notes
section.
Attachment B- HPP Workplan DRAFT, Definitions
Exhibit D
Page166
Attachment B
Definitions
Enter gaps identified from jurisdictional Capabilities Planning Guide (CPGs) survey, trainings, exercises,
real events, after action reports and/or improvement plans that you want to resolve during the fiscal
A capability is built and ready for an emergency and/or disaster. Sustainment is working through the
preparedness cycle; train, exercise, evaluate and improve in order to retain the ability and improve
based on current jurisdictional hazards.
A capability is incomplete. Building activities include research, development, identifying key partners
and stakeholders, establishing relationships, defining roles, responsibilities, draft, public comment, etc..
Strategic and operational planning establishes priorities, identifies expected levels of performance and
capability requirements, provides the standard for assessing capabilities and helps stakeholders learn
their roles. The planning elements identify what an organization's Standard Operating Procedures
(SOPs) or Emergency Operations Plans (EOPs) should include for ensuring that contingencies are in
place for delivering the capability during a large-scale disaster.
Organizing and equipping include identifying what competencies and skill sets people should possess
and ensuring an organization has the correct personnel. Additionally, it includes identifying and
acquiring standard equipment an organization may need to use in times of emergency.
Training with the knowledge, skills, and abilities needed to perform key tasks required during a specific
emergency situation.
Exercises enable entities to identify strengths and incorporate them within best practices to sustain and
enhance existing capabilities. They also provide an objective assessment of gaps and shortfalls within
plans, policies and procedures to address areas for improvement prior to a real-world incident.
Exercises help clarify roles and responsibilities among different entities, improve inter-agency
coordination and communications and identify needed resources and opportunities for improvement.
Quality improvement thru after action Reports (AARs), collecting lessons learned, develop improvement
plans, and track corrective actions to address gaps and deficiencies identified in exercises or real-world
events to continuously improve and strengthen preparedness.
Modernize, make current and/or include the most recent information.
Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
The activity will be complete by the end of the second quarter of the fiscal year.
The activity will be complete by the end of the fourth quarter of the fiscal year.
The activity occurs throughout the year.
Not working on the activity this fiscal year, it will be addressed in the future.
Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
The Activity has been fully executed/in place to satisfy all requirements.
This Activity is work in progress and will be completed by the Estimated Completion time.
Attachment B- HPP Workplan DRAFT, Definitions
Exhibit D
Page167
Attachment B
This Activity is work in progress and will be not be completed/late by the Estimated Completion time.
No work has been done on this Activity.
This activity will not be finished/completed this FY.
No barriers to completing this Activity and corresponding Outputs.
In sufficient funding to complete this Activity and corresponding Outputs.
In sufficient staff or subject matter experts to complete this Activity and corresponding Outputs.
Jurisdictional administrative processes delayed and/or pushed back the the next FY this Activity.
Various factors limited the amount of time needed to complete this Activity. A few example, deadlines, w
Waiting on EPO to provide materials, resources or guidelines that impedes completion of this Activity.
Jurisdiction
Add additional information in the Notes section of this Activity.
Attachment B- HPP Workplan DRAFT, Definitions
Exhibit D
Page168
Attachment B
Annual Region I less than 200,000
FY 2022-23 Region II between 200,000 and
FY 2023-24 Region III greater than 700,000
FY 2024-25 Region IV
FY 2025-26 Region V Q2
FY 2026-27 Region VI Q3
Multiple Regions Q4
Attachment B- HPP Workplan DRAFT, Definitions
Exhibit D
Page169
Attachment C
Date:
!)CDPH
California Department of Public Health
Emergency Preparedness Office
FY 2022-23 to FY 2026-27
Local Health Department Work Plan for
Pandemic Influenza (Pan Flu)
[Local Entity Name]
Region:
Population size:
Attachment C-Pan Flu Workplan,Cover
Exhibit D
Pandemic Influenza Attachment FGge 170
[Local Entity Name]
Description: Strengthen planning and response efforts in order to be prepared for an influenza Pandemic.
11 Known Gaps:
s Classify Activity: Are you Building or Sustaining influenza planning?
Outcomes: 1 Up-to-date written policies and procedures in place to ensure pandemic influenza readiness and response, including LHD
collaborative efforts with local and state partners, effective administration and documentation of vaccines, guidelines for prioritizing
lab testing and distribution of materials to partners, document vaccine administration in the immunization registry, and procedures for
communication to promote vaccine and preventative measures.
2 Surveillance systems are maintained to ensure accurate and timely documentation of novel/variant influenza virus infections,
influenza-associated deaths in children and/or case-specific data requested by state and federal partners.
3 Local public health laboratories maintain capability and capacity to type and subtype influenza viruses.
4 Updated written procedures in place for monitoring exposed persons exposed to avian or novel influenza viruses, including
laboratory testing and ensuring regular communication of activities and outcomes to state partners.
5 Conduct a mass vaccination clinic and complete an After Action Report/Improvement Plan (AAR/IP).
6 Implementation of processes for ensuring optimal utilization of influenza vaccines within local communities, including target
populations such as persons with underlying medical conditions and/or school-aged children.
Attachment C-Pan Flu Workplan,Pan Flu Page 1 of 20
Exhibit D
Pandemic Influenza Attachment FGge 171
3 FY 2022-23 3 FY 2023-24
Objective 1 Update and/or maintain a local Pandemic Influenza Plan FY 2022-23 Estimated Notes FY 2023-24 Estimated
Activity Type Completion Activity Type Completion
Reference:
PHEP Work Plan, Domain 1, Activity 6: Strengthen and Implement Plans
PHEP Work Plan, Domain 4, Activity 1: Develop and Exercise Plans for MCM
Distribution, Dispensing and Vaccine Administration
PHEP Work Plan, Domain 4, Activity 2: Maintain Preparedness Plans Based on
Risks
FY 21-22 HPP Workplan, Capability 4, Phase 1, Objective 1, Activity 2.6
FY 21-22 HPP Workplan, Capability 4, Phase 3, Objective 2, Activity 9.10 4 MY Report s YE Report 4 MY Report
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 Protocol describing how the LHD will work with local partners and health care
coalitions to address pandemic influenza preparedness and response.
FY 21-22 Continue to work on this activity and deliverable and report.
FY 22-23 Continue to work on this activity and deliverable and report.
2 Update procedure for how LHD will ensure appropriate staff are prepared to order
and receive pandemic influenza vaccines, administer vaccine and document
pandemic vaccine administration in the immunization registry within 14 days.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDPH's Immunization Program:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/immunize.aspx
California Immunization Registry (CAIR): http://cairweb.org/
https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/immunization bra
nch/SDIR.html
http://www.myhealthyfutures.org/
3 Update plan for how LHD will identify and vaccinate likely target populations,
including Tier 1 through Tier 3 critical workforce and occupational groups.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDC's Roadmap to Implementing Pandemic Influenza Vaccination of Critical
Workforce. https://www.cdc.gov/flu/pandemic-resources/pdf/roadmap_panflu.pdf
References:
FY 21-22 HPP Workplan, Capability 4, Phase 1, Objective 1, Activity 2.6
FY 21-22 HPP Workplan, Capability 4, Phase 3, Objective 2, Activity 9.10
4 Update plans for disseminating CDPH/LHD guidelines for prioritization of influenza
laboratory testing to public and private laboratories, healthcare facilities and
providers, and other key healthcare partners within the jurisdiction during both the
regular influenza season and in a pandemic.
FY 22-23 Continue to work on this activity and deliverable and report.
5 Update procedures for preparedness and response communications, including
outreach and educational efforts to promote vaccine and prevention measures and
coordinating these efforts and messaging with key partners in the community.
FY 22-23 Continue to work on this activity and deliverable and report.
6 Annually provide, and keep updated, the name and contact information for the
LHD's Pandemic Influenza Coordinator or position responsible for ensuring
completion of Pan Flu Work Plan activities and deliverables.
FY 22-23 Continue to work on this activity and deliverable and report.
Activities 7
8
9
Attachment C-Pan Flu Workplan,Pan Flu Page 2 of 20
Exhibit D
Pandemic Influenza Attachment FGge 172
Outputs from the planned activities
1 Updated process for engaging local partners and stakeholders in influenza
pandemic planning and preparedness.
2 Updated vaccine administration and immunization registry process including
documentation.
3 Updated plan for vaccination plan for target populations and critical workforce.
4 Updated plans for prioritizing lab testing.
5 Updated communication procedures.
6 Pan Flu Coordinator contact is current.
Outputs 7
8
9
Notes 1
2
3
Attachment C-Pan Flu Workplan,Pan Flu Page 3 of 20
Exhibit D
Pandemic Influenza AttachmentFGge 173
3 FY 2022-23 3 FY 2023-24
Objective 2 Maintain a surveillance system for reporting novel/variant influenza virus FY 2022-23 Estimated Notes FY 2023-24 Estimated
infections and influenza-associated deaths in children <18 years of age, and Activity Type Completion Activity Type Completion
report data via electronic or fax during the regular influenza season.
Reference:
PHEP Work Plan, Domain 3, Activity 2: Coordinate Information Sharing
PHEP Work Plan, Domain 6, Activity 1: Conduct Epidemiological Surveillance 4 MY Report s YE Report 4 MY Report
CDC NoFO PHEP CDC RFA TP19-1901, page 16-17, 25-26 and 28-29
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 LHDs will report influenza-associated deaths in persons <18 years of age to CDPH
within two weeks of death.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDPH Influenza guidance:
https://www.cdph.ca.gov/Programs/CID/DCDC/pages/immunization/influenza.aspx
CDPH Influenza recommendations:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Im
munization/InfluenzaGuidance.pdf
2 LHDs will submit completed case report forms to CDPH for influenza-associated
deaths in persons <18 years of age within two months of death.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
Refer to references in Activity 1, above.
3 LHDs will utilize immunization registry for epidemiological surveillance.
FY 22-23 Continue to work on this activity and deliverable and report.
Activities 4
5
6
Outputs from the planned activities
1 Updated surveillance systems that provide accurate and timely data of
novel/variant influenza virus infections and associated deaths.
2 Updated process for reporting of influenza associated deaths in person <18 years
of age.
3 Updated process to provide data requested by State and Federal partners.
Outputs 4
5
6
Notes 1
2
3
Attachment C-Pon Flu Workplon,Pon Flu Page 4 of 20
Exhibit D
Pandemic Influenza AttachmentFGge 174
3 FY 2022-23 3 FY 2023-24
Objective 3 Maintain the ability to conduct case-based surveillance for influenza as FY 2022-23 Estimated Notes FY 2023-24 Estimated
requested by CDC and/or CDPH. For example, all cases, hospitalizations, ICU Activity Type Completion Activity Type Completion
admissions, or deaths, and report those cases via electronic means or fax
during a pandemic.
Reference:
PHEP Work Plan, Domain 3, Activity 2: Coordinate Information Sharing
PHEP Work Plan, Domain 6, Activity 1: Conduct Epidemiological Surveillance
FY 20-21 HPP Workplan, Capability 2, Phase 1, Objective 2, Activity 1.2 and 1.3
FY 20-21 HPP Workplan, Capability 2, Phase 3, Objective 3, Activity 3.3
CDC NoFO PHEP CDC RFA TP19-1901, page 16-17, 25-26 and 28-29 4 MY Report s YE Report 4 MY Report
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 Submit completed case report forms for persons with novel or variant influenza
infections to CDPH within three days of confirmation.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDPH Influenza guidance:
https://www.cdph.ca.gov/Programs/CID/DCDC/pages/immunization/influenza.aspx
CDPH Influenza recommendations:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Im
munization/InfluenzaGuidance.pdf
2 Report and submit completed case report forms for pandemic-associated influenza
cases within the timeframe specified by CDPH during an influenza pandemic.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
Refer to references in Activity 1, above.
3 LHDs will utilize immunization registry for epidemiological surveillance.
FY 22-23 Continue to work on this activity and deliverable and report.
Activities 4
5
6
Outputs from the planned activities
1 Updated case based surveillance systems that provide accurate and timely data of
novel/variant influenza virus infections and associated deaths.
2 Updated process to provide data requested by State and Federal partners.
Outputs 3
4
5
Notes 1
2
3
Attachment C-Pon Flu Workplon,Pon Flu Page 5 of 20
Exhibit D
Pandemic Influenza AttachmentFGge 175
3 FY 2022-23 3 FY 2023-24
Objective 4 Counties with a Public Health Laboratory FY 2022-23 Estimated Notes FY 2023-24 Estimated
Maintain the ability of the public health laboratory to type and subtype Activity Type Completion Activity Type Completion
influenza A viruses and lineage type influenza B viruses (if the laboratory is
capable of lineage type testing) for any cases tested for influenza by status of
clinical severity (e.g., hospitalized ICU/severe cases, outpatients, and/or fatal
cases) during both the regular influenza season and in a pandemic and report
results to CDPH through established reporting mechanisms.
4 MY Report 5 YE Report 4 MY Report
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 LHD's will maintain laboratory testing capability for influenza A/B typing and Flu A
subtyping/Flu B lineage typing by rRT-PCR AND satisfactorily pass influenza
proficiency testing requirements two times/year.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
PHEP Work Plan, Domain 6 Biosurveillance
CDPH Influenza guidance:
https://www.cdph.ca.gov/Programs/CID/DCDC/pages/immunization/influenza.aspx
Activities 2
3
4
Outputs from the planned activities
1 Maintained laboratory testing capability for influenza.
2 Satisfactorily pass influenza proficiency testing requirements two times a year.
Outputs 3
4
5
Notes 1
2
3
Attachment C-Pon Flu Workplon,Pon Flu Page 6 of 20
Exhibit D
Pandemic Influenza AttachmentFGge 176
3 FY 2022-23 3 FY 2023-24
Objective 5 Counties with a Public Health Laboratory FY 2022-23 Estimated Notes FY 2023-24 Estimated
Submit influenza positive specimens to the CDPH Viral and Rickettsial Activity Type Completion Activity Type Completion
Diseases Laboratory (VRDL) for antiviral resistance testing, as provided by
CDPH's Immunization Branch, in accordance with the Association of Public
Health Laboratories (APHL) Influenza Virologic Surveillance Right Size
Roadmap.
Reference:
CDPH Immunization Branch:
https://www.cdph.ca.go v/Programs/CID/DCDC/Pages/immunize.aspx
APHL Influenza Virologic Surveillance Right Size Roadmap:
www.aphl.org/aboutAPHUpublications/Documents/ID_Jul y2013_lnfluenza-
Virologic-Surveillance-Right-Size-Roadmap.pdf
4 MY Report 5 YE Report 4 MY Report
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 Immediately notify CDPH-VRDL of any Unsubtypeable or Inconclusive results that
show a cycle threshold (Ct) value for Flu A <_ 35.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
CDPH Viral and Rickettsial Disease Laboratory:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/V
RDL_Influenza Info.pdf
Activities 2
3
4
Outputs from the planned activities
1 Routine immediate notification to CDPH-VRDL of any Unsubtypeable or
Inconclusive results that show a cycle threshold (Ct) value for Flu A <_ 35.
Outputs 2
3
4
Notes 1
2
3
Attachment C-Pon Flu Workplon,Pon Flu Page 7 of 20
Exhibit D
Pandemic Influenza Attachment FGge 177
3 FY 2022-23 3 FY 2023-24
Objective 6 Conduct active or passive monitoring for influenza-like illness among persons FY 2022-23 Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated 4 MY Report
exposed to avian or novel influenza viruses (e.g., persons exposed to poultry Activity Type Completion Activity Type Completion
or other animals infected with avian influenza on farms inside or outside of
CA, persons exposed to humans with novel or variant influenza virus
infections such as H7N9, H5N1, H3N2v, or H1 N2v).
Reference:
CDPH Influenza guidance:
https://www.cdph.ca.gov/Programs/CID/DCDC/pages/immunization/influenza.aspx
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 Update and maintain procedures for monitoring persons exposed to avian or novel
influenza viruses.
FY 22-23 Continue to work on this activity and deliverable and report.
2 Report monitoring activities and outcomes to CDPH electronically or via fax.
FY 22-23 Continue to work on this activity and deliverable and report.
3 Obtain specimens, from symptomatic persons being monitored for exposure to
avian or novel influenza viruses, for testing at a public health laboratory and
forward unsubtypable and indeterminate subtype specimens to VRDL for
confirmatory testing at CDC.
FY 22-23 Continue to work on this activity and deliverable and report.
Activities 4
5
6
Outputs from the planned activities
1 Updated procedures for monitoring exposed persons, including laboratory testing,
and ensuring regular communication of activities and outcomes to State partners.
Outputs 2
3
4
Notes 1
2
3
Attachment C-Pan Flu Workplan,Pan Flu Page 8 of 20
Exhibit D
Pandemic Influenza Attachment FGge 178
3 FY 2022-23 3 FY 2023-24
Objective 7 Conduct at least one mass vaccination clinic exercise and maximize FY 2022-23 Estimated Notes FY 2023-24 Estimated
attendance in order to test and evaluate the mass vaccination capability and Activity Type Completion Activity Type Completion
capacity.
Reference:
PHEP Work Plan, Requirements
CDC NoFO PHEP CDC RFA TP19-1901, exercise requirements on page 39 4 MY Report s YE Report 4 MY Report
FY 21-22 HPP Workplan, Capability 4, Phase 3, Objective 2, Activity 9.10
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 LHDs will identify high risk and priority target groups, including low income
populations, in order to conduct outreach and provide educational materials, to
increase attendance at the mass vaccination clinic exercise.
FY 22-23 Continue to work on this activity and deliverable and report.
2 LHDs will coordinate with the CDPH Immunization Branch to order and receive
State purchased flu vaccine for mass vaccination clinic exercise.
FY 22-23 Continue to work on this activity and deliverable and report.
(If LHDs need additional doses or would like to offer other vaccines, contact
CDPH's Immunization Branch.)
3 LHDs will plan and conduct your mass vaccination clinic exercise in coordination
with your Public Health Emergency Preparedness (PHEP) and Immunization
programs. Utilize improvements plans from previous exercises after action reports
(AARs) to fill gaps identified and improve the process.
FY 22-23 Continue to work on this activity and deliverable and report.
4 LHDs will enter into the immunization registry (within 14 days) all vaccine doses
administered during the mass vaccination clinic exercise.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
California Immunization Registry (CAIR): http://cairweb.org/
5 LHDs will in coordination with your Public Health Emergency Preparedness (PHEP)
and Immunization programs, complete an after action report (AAR) including an
improvement plan (IP) after the exercise.
FY 22-23 Continue to work on this activity and deliverable and report.
Activities 6
7
8
Outputs from the planned activities
1 Completed a mass vaccination exercise.
2 Completed a AAR and IP.
Outputs 3
4
5
Notes 1
2
3
Attachment C-Pan Flu Workplan,Pan Flu Page 9 of 20
Exhibit D
Pandemic Influenza Attachment FGge 179
3 FY 2022-23 3 FY 2023-24
Objective 8 In conjunction with the immunization coordinator, support efforts to intensify FY 2022-23 Estimated Notes FY 2023-24 Estimated
seasonal flu vaccination efforts to enhance pandemic influenza preparedness. Activity Type Completion Activity Type Completion
4 MY Report 5 YE Report 4 MY Report
Status Primary Barrier Status Primary Barrier Status Primary Barrier Status
Activities 1 Support the LHD immunization program to enter/record all doses of seasonal
influenza vaccine administered by the LHD (in clinics or in LHD offices) in the
immunization registry. Data should be recorded within 14 days of administration.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
California Immunization Registry (CAIR): http://Cairweb.orgl
https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/immunization bra
nch/SDIR.html
http://www.myhealthyfutures.org/
2 Support the LHD immunization program to ensure all state-purchased (VFC, 317 or
State) seasonal influenza vaccines shared with and administered by local partners
are documented in the immunization registry within 14 days of administration.
FY 22-23 Continue to work on this activity and deliverable and report.
Reference:
California Immunization Registry (CAIR): http://cairweb.org/
https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/immunization bra
nch/SDIR.html
http://www.myhealthyfutures.org/
3 Promote increased seasonal influenza vaccine within the community, including
target populations and school-aged children.
FY 22-23 Continue to work on this activity and deliverable and report.
4 Suggested Activity: Increase immunization of school-aged children as part of mass
vaccination clinics.
Activities 5
6
7
Outputs from the planned activities
1 Implementation of processes for ensuring optimal utilization of influenza vaccines
within local communities, including target populations such as persons with
underlying medical conditions and/or school-aged children.
Outputs 2
3
4
Notes 1
2
3
Attachment C-Pan Flu Workplan,Pan Flu Page 10 of 20
Exhibit D
Page180
Application Definitions
Known Gaps
Known Gaps Enter gaps identified from jurisdictional Capabilities Planning Guide (CPGs) survey, trainings, exercises, real events,
after action reports and/or improvement plans that you want to resolve during the fiscal year.
Classify Activity'
Sustain A capability is built and ready for an emergency and/or disaster. Sustainment is working through the preparedness cycle;
train, exercise, evaluate and improve in order to retain the ability and improve based on current jurisdictional hazards.
Build A capability is incomplete. Building activities include research, development, identifying key partners and stakeholders,
establishing relationships, defining roles, responsibilities, draft, public comment, etc..
Fiscal Year (FY) Activity
Plan/Develop Strategic and operational planning establishes priorities, identifies expected levels of performance and capability
requirements, provides the standard for assessing capabilities and helps stakeholders learn their roles. The planning
elements identify what an organization's Standard Operating Procedures (SOPs) or Emergency Operations Plans (EOPs)
should include for ensuring that contingencies are in place for delivering the capability during a large-scale disaster.
Organize/Equip Organizing and equipping include identifying what competencies and skill sets people should possess and ensuring an
organization has the correct personnel. Additionally, it includes identifying and acquiring standard equipment an
organization may need to use in times of emergency.
Train Training with the knowledge, skills, and abilities needed to perform key tasks required during a specific emergency
situation.
Exercise Exercises enable entities to identify strengths and incorporate them within best practices to sustain and enhance existing
capabilities. They also provide an objective assessment of gaps and shortfalls within plans, policies and procedures to
address areas for improvement prior to a real-world incident. Exercises help clarify roles and responsibilities among
different entities, improve inter-agency coordination and communications and identify needed resources and
opportunities for improvement.
Evaluate/Improve Quality improvement thru after action Reports (AARs), collecting lessons learned, develop improvement plans, and track
corrective actions to address gaps and deficiencies identified in exercises or real-world events to continuously improve
and strengthen preparedness.
Updating Modernize, make current and/or include the most recent information.
Not Applicable Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
Estimated Completion
This fiscal year by Q2 The activity will be complete by the end of the second quarter of the fiscal year.
This fiscal year by Q4 The activity will be complete by the end of the fourth quarter of the fiscal year.
Continuous The activity occurs throughout the year.
Out year Not working on the activity this fiscal year, it will be addressed in the future.
Exhibit D
Page181
Reporting
Status "
Complete The Activity has been fully executed/in place to satisfy all requirements.
In progress, on schedule This Activity is work in progress and will be completed by the Estimated Completion time.
In progress, off schedule This Activity is work in progress and will be not be completed/late by the Estimated Completion time.
Not Started No work has been done on this Activity.
Canceled This activity will not be finished/completed this FY.
Primary Barrier`
None No barriers to completing this Activity and corresponding Outputs.
Lack of Funding In sufficient funding to complete this Activity and corresponding Outputs.
Lack of Personnel In sufficient staff or subject matter experts to complete this Activity and corresponding Outputs.
Administrative Jurisdictional administrative processes delayed and/or pushed back the the next FY this Activity.
Time Constraint Various factors limited the amount of time needed to complete this Activity. A few example, deadlines, workload, and resc
Waiting on EPO Waiting on EPO to provide materials, resources or guidelines that impedes completion of this Activity.
Real Event Jurisdiction
Other, provide in the Notes
section. Add additional information in the Notes section of this Activity.
Exhibit D
Page182
Attachment D
Date:
OCDPH
California Department of Public Health
Emergency Preparedness Office
FY 2022-23 to FY 2026-27
Local Health Department Work Plan for
Hospital Preparedness Program (HPP)
and the Health Car C li n I
A01111%
[Local Entity Name]
Region:
Population size:
Attachment D- Multi-County LEMSA Workplan DRAFT, Cover
Exhibit D
Page183
Attachment D
[Local Entity Name]
This is a short list that includes requirements, a checklist and clarifications for the Hospital Preparedness Program (HPP) funding.
This list is not exhaustive, HCCs are required to study the HPP Capability Guide and HPP Performance Measures and therein
HPP Performance Measures Implementation Guides
Link: https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hpp-pmi-guidance-2017.pdf
Link: https://www.phe.gov/Preparedness/planning/hpp/reports/pnabguidance-2019-2023/Pages/default.aspx
Pages 90-96 in the 2019-2023 HPP Performance Measures Implementation Guide contain a crosswalk of
performance measures to HPP Workplan activities.
HPP Capability Guide
Link: https://www.phe.gov/Preparedness/r)la pninNp)colrts/Documents/2017-2022-healthcare-pr-capablities.pdf
41% Is
HPP Coalition Assessment Tool (CAT)
HPP Performance Measures are reported in the Coalition Assessment Tool (CAT) and to CDPH. CDPH will utilize information in the
CAT to meet CDPH's required HPP reporting. CDPH will require HCCs to provide required deliverables and data that are not
contained in the CAT. If you need to update your CAT point of contact and access, use the email provided below.
Link: https://HPPCAT.hhs.gov
Email: CAT@HHS.gov
Attachment D- Multi-County LEMSA Workplan DRAFT, Requirements
Exhibit D
Page184
Attachment D
Requirement
HPP-PHEP-EMA Joint Exercise: Select from the dropdown menu the year of the exercise. This exercise must be
a standalone functional or full scale joint exercise once every five years (rolling five years). This exercise must
include a surge of patients into the health care system. FY 2021-22 HPP Funding Opportunity Announcement,
page 16.
Pediatric Surge Care Annex, Exercise: Select from the dropdown menu the year of the exercise. This exercise
must be completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop or discussion exercise
format. See Capability 4, Phase 3, Objective 2, Activity 4.6.
Radiation Emergency Surge Annex, Exercise: Select from the dropdown menu the year of the exercise if selected
over the Chemical Emergency Surge Annex exercise. This exercise must be completed within five-years (FY 2019-
20 to FY 2023-24) via a real event, tabletop or discussion exercise format. See Capability 4, Phase 3, Objective 2,
Activity 5.7.
or (Radiation or Chemical Exercise)
Chemical Emergency Surge Annex, Exercise: Select from the dropdown menu the year of the exercise if selected
over the Radiation Emergency Surge Annex exercise. This exercise must be completed within five-years (FY 2019-
20 to FY 2023-24) via a real event, tabletop or discussion exercise format. See Capability 4, Phase 3, Objective 2,
Activity 5.8.
Burn Surge Annex, Exercise: Select from the dropdown menu the year of the exercise. This exercise must be
completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop or discussion exercise format.
See Capability 4, Phase 3, Objective 2, Activity 6.9.
Infectious Disease Preparedness and Surge Annex, Exercise: Select from the dropdown menu the year of the
exercise. This exercise must be completed within five-years (FY 2019-20 to FY 2023-24) via a real event, tabletop
or discussion exercise format. See Capability 4, Phase 3, Objective 2, Activity 9.10
FY 2022-23 Participate in State Wide Medical Health Exercise of Crisis Standards of Care CONOPS. See Capability 4, Phase
3, Objective 1, Activity 3.1.
Attachment D- Multi-County LEMSA Workplan DRAFT, Requirements
Exhibit D
Page185
Attachment D
Provide a current inventory: Select which quarter to provide the list of all HCC resources purchased in the
previous fiscal year that would be utilized during an exercise or real event each year to CDPH. State Site
Visit/State Audit requirement.
Checklist
Performance Measure 4: Complete HCC member updates, in CDPH template by the due date.
Performance Measure 6: Other Exercise Requirements within the CAT, Exercise Tool report exercise dates and
complete a datasheet for all required exercises.
Performance Measure 9: Complete Jurisdictional Risk Assessment Survey provided by CDPH by the due date.
Performance Measure 10: After Action Reporting (AAR) and Improvement Planning (IP) Matrix, complete within
the CAT within the Exercise Tool.
Performance Measures 12 & 13: Redundant Communications Drills 1 & 2, enter data into the CAT. The second
drill must be six months after the first.
Capability Assessments must be completed within the CAT before the end of year due date.
Performance Measure HPP-PHEP J.1, Information Sharing: Report Essential Elements of Information (EEls),
situation reporting, to CDPH as requested during exercises and real events.
CAHAN Communication Drills, quarterly.
Disaster Health Volunteers (DHV) Program must be maintained annually. See Capability 4, Phase 3, Objective 2,
Activity 1.1
Attachment D- Multi-County LEMSA Workplan DRAFT, Requirements
Exhibit D
Page186
Attachment D
Clarifications
Performance Measure 22: This is a Hospital performance measure collected by the Emergency Medical Services for
Children (EMSC). This should align with your Pediatric Surge Annex.
Performance Measure HPP-PHEP J.2, Volunteers: This is a State level performance measure.
Performance Measures 23-28: Annual Hospital Surge Test (HST) in the CAT within the Exercise Tool. Only complete
if, you have a hospital that is in a Frontier and Remote Area (FAR) level four. https://www.ers.usda.gov/data-
products/frontier-and-remote-area-codes/
HCC Exercise with an FCC to participate in the NDMS patient movement in the CAT within the Exercise Tool. Only
complete if, you have a Federal Coordination Center (FCC) in your jurisdiction. https:Hasprtracie.hhs.gov/technical-
resources/resource/5622/national-disaster-medical-system-federal-coordinating-center-guide
If there is a difference between the Performance Measures and HPP Funding Opportunity Announcement (FOA), the
most current requirement is listed in this work plan, at this point in time it is based on the Performance Measures
Implementation Guide 2019-2023.
Attachment D- Multi-County LEMSA Workplan DRAFT, Requirements
Exhibit D
Page187
Attachment D
[Local Entity Name]
Capability 4: Medical Surge
Goal: Health care organizations deliver timely and efficient care to their patients even when the demand for f
services exceeds available supply. The HCC, in collaboration with the state's/jurisdiction's ESF-8 lead
coordinates information and available resources for its members to maintain conventional surge respor
emergency overwhelms the HCC's collective resources, the HCC supports the health care delivery sys
contingency and crisis surge response and promotes a timely return to conventional standards of care
possible.
11 Known Gaps:
z Classify Activity: Are you Building or Sustaining this Capability?
PHASE 1 : Plan and Prepare -,do 3 FY 2022-23
Objective 1 Plan for a Medical Surge FY 2022-23
V* P Activity Type
Activity 2 Incorporate Medical Surge Planning into Emergency Medical Services
Emergency Operation Plan
1 EMS plans should incorporate disaster related dispatch, response, mutual aid
and regional coordination, pre-hospital triage and treatment, transportation,
supplies and equipment.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-47
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page188
Attachment D
2 EMS will work collaboratively with the LHD to identify a local initiative or project to
meet local needs and delineate the LEMSA role from the LHD role.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
3 EMS will continue to participate in the review and update of the HCC Response
Plan, to maintain the patient transportation process from, the field, to hospital, to
interfacility, and to the region.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
4 EMS will continue to review and update information sharing protocols with HCC
members, corroborate member needs and incorporate the process in the HCC
Response Plan.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
Activities 5
6
7
Outputs from the planned activities
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page189
Attachment D
1 HCCs will provide the EMS plans upon request (Activity 2.1).
2 HCCs will provide a documentation of roles and responsibilities for local initiative
or project (Activity 2.2).
3 HCCs will provide a copy of the EMS transportation protocols upon request
(Activity 3.3).
4
5
Outputs 6
7
8
Notes 1
2
3
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page190
Attachment D
PHASE 2: Train and Equip 3 FY 2022-23
Objective 2: Respond to a Medical Surge FY 2022-23
Activity Type
Activity 3 Incorporate Medical Surge Planning into HCC Response Plan
1 EMS will continue to provide training to HCC members on plans, policies and
procedures for regional transportation of a patient(s) with a suspected and/or
confirmed highly infectious disease.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
2 EMS will continue to provide training to HCC members on plans, policies and
procedures for transitioning to a disaster response.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
Activities 3
4
5
Outputs from the planned activities
1 HCCs will provide upon request their patient movement plan, and patient
tracking/reunification plan (Activity 3.1).
2 HCCs will provide a list of participants and an agenda for each completed training
(Activity 3.2).
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page191
Attachment D
PHASE 3: Exercise and Respond 3 FY 2022-23
Objective 2: Respond to a Medical Surge FY 2022-23
Activity Type
Activity 3 Incorporate Medical Surge into HCC Response Plan
1 EMS will participate in the Coalition Surge Test (CST) annually.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 68-76
FY 2019-20 Local HPP Work Plan, Capability 4, LEMSA
2017-2022 Health Care Preparedness and Response Capabilities, page 46-48
2019-2023 HPP Performance Measures Implementation Guidance
2 EMS will complete a redundant communications drill twice a year with their HCC.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page192
Attachment D
3 EMS will participate in the annual SWMHE.
FY 20-21 Canceled.
FY 21-22 Canceled.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
4 EMS will participate in the SWMHE to validate the CDPH's Crisis Standards of
Care CONOPS in FY 2022-23.
FY 21-22 Continue to work on this activity and deliverable and report.
Reference:
ASPR HPP FOA EP-U3R-19-001, pages 60-61
FY 2019-20 Local HPP Work Plan, Capability 3, Objective 2, Activity 1
2017-2022 Health Care Preparedness and Response Capabilities, page 34
2017-2022 Hospital Preparedness Program, Performance Measures,
Performance Measure 5, page 15-16
Activities 5
6
7
Outputs from the planned activities
1 HCCs will provide after action reports (AARs) and improvement plans (IPs)
(Activities 3.1-3.4).
Outputs 2
3
4
Notes 1
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page193
Attachment D
iealth care
agency,
ise. When an
tem's transition to
as soon as
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page194
Attachment D
3 FY 2023-24
Estimated 4 MY Report s YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page195
Attachment D
3 FY 2023-24
Estimated 4 MY Report 5 YE Report Notes FY 2023-24 Estimated
Completion Status Primary Barrier Status Primary Barrier Activity Type Completion
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page196
Attachment D
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page197
Attachment D
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page198
Attachment D
s FY 2024-25
4 MY Report 5 YE Report Notes FY 2024- Estimate 4 MY Report 5 YE Report
Status Primary Barrier Status Primary Barrier 25 d Status mary Bar Status Imary Bar
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page199
Attachment D
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page 200
Attachment D
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page 201
Attachment D
3 FY 2025-26 3 FY 2026-27
Notes FY 2025- Estimate a MY Report 5 YE Report Notes FY 2026- Estimat a MY Report 5 YE F
26 d Status Imary Bar Status Imary Bar 27 ed Status ary Bar Status
Attachment D- Multi-County LEMSA Workplan DRAFT, LEMSA
Exhibit D
Page 202
Attachment D
Application
Known Gaps
Known Gaps
Classify Activity
Sustain
Build
Fiscal Year (FY) Activity
Plan/Develop
Organize/Equip
Train
Exercise
Evaluate/Improve
Updating
Not Applicable
Estimated Completion
This fiscal year by Q2
This fiscal year by Q4
Continuous
Out year
Not Applicable
Reporting
Status
Complete
In progress, on schedule
Attachment D- Multi-County LEMSA Workplan DRAFT, Definitions
Exhibit D
Page 203
Attachment D
In progress, off schedule
Not Started
Canceled
Primary Barrier "
None
Lack of Funding
Lack of Personnel
Administrative
Time Constraint
Waiting on EPO
Real Event
Other, provide in the Notes
section.
Attachment D- Multi-County LEMSA Workplan DRAFT, Definitions
Exhibit D
Page 204
Attachment D
Definitions
Enter gaps identified from jurisdictional Capabilities Planning Guide (CPGs) survey, trainings, exercises,
real events, after action reports and/or improvement plans that you want to resolve during the fiscal
A capability is built and ready for an emergency and/or disaster. Sustainment is working through the
preparedness cycle; train, exercise, evaluate and improve in order to retain the ability and improve
based on current jurisdictional hazards.
A capability is incomplete. Building activities include research, development, identifying key partners
and stakeholders, establishing relationships, defining roles, responsibilities, draft, public comment, etc..
Strategic and operational planning establishes priorities, identifies expected levels of performance and
capability requirements, provides the standard for assessing capabilities and helps stakeholders learn
their roles. The planning elements identify what an organization's Standard Operating Procedures
(SOPs) or Emergency Operations Plans (EOPs) should include for ensuring that contingencies are in
place for delivering the capability during a large-scale disaster.
Organizing and equipping include identifying what competencies and skill sets people should possess
and ensuring an organization has the correct personnel. Additionally, it includes identifying and
acquiring standard equipment an organization may need to use in times of emergency.
Training with the knowledge, skills, and abilities needed to perform key tasks required during a specific
emergency situation.
Exercises enable entities to identify strengths and incorporate them within best practices to sustain and
enhance existing capabilities. They also provide an objective assessment of gaps and shortfalls within
plans, policies and procedures to address areas for improvement prior to a real-world incident.
Exercises help clarify roles and responsibilities among different entities, improve inter-agency
coordination and communications and identify needed resources and opportunities for improvement.
Quality improvement thru after action Reports (AARs), collecting lessons learned, develop improvement
plans, and track corrective actions to address gaps and deficiencies identified in exercises or real-world
events to continuously improve and strengthen preparedness.
Modernize, make current and/or include the most recent information.
Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
The activity will be complete by the end of the second quarter of the fiscal year.
The activity will be complete by the end of the fourth quarter of the fiscal year.
The activity occurs throughout the year.
Not working on the activity this fiscal year, it will be addressed in the future.
Does not apply my jurisdiction. For example, a Public Health Lab, non CRI etc.
The Activity has been fully executed/in place to satisfy all requirements.
This Activity is work in progress and will be completed by the Estimated Completion time.
Attachment D- Multi-County LEMSA Workplan DRAFT, Definitions
Exhibit D
Page 205
Attachment D
This Activity is work in progress and will be not be completed/late by the Estimated Completion time.
No work has been done on this Activity.
This activity will not be finished/completed this FY.
No barriers to completing this Activity and corresponding Outputs.
In sufficient funding to complete this Activity and corresponding Outputs.
In sufficient staff or subject matter experts to complete this Activity and corresponding Outputs.
Jurisdictional administrative processes delayed and/or pushed back the the next FY this Activity.
Various factors limited the amount of time needed to complete this Activity. A few example, deadlines, w
Waiting on EPO to provide materials, resources or guidelines that impedes completion of this Activity.
Jurisdiction
Add additional information in the Notes section of this Activity.
Attachment D- Multi-County LEMSA Workplan DRAFT, Definitions
Exhibit D
Page 206
Attachment D
Annual Region I less than 200,000
FY 2022-23 Region II between 200,000 and
FY 2023-24 Region III greater than 700,000
FY 2024-25 Region IV
FY 2025-26 Region V Q2
FY 2026-27 Region VI Q3
Multiple Regions Q4
Attachment D- Multi-County LEMSA Workplan DRAFT, Definitions
Exhibit D
Page 207
PHEP Budget Attachment E
1) 2) Date:
3) Entity Name:
4) FY 22-23 Allocation
5) Indirect Cost based on:
6) Personnel Costs Rate:
Direct Costs Rate:
Budget Category Total % Allocation
Personnel $0.00 0%
Fringe $0.00 0%
Operating Expenses $0.00 0%
Equipment $0.00 0%
In State Travel $0.00 0%
Out of State Travel $0.00 0%
Subcontracts $0.00 0%
Other Costs $0.00 0%
Total Direct $0.00 0%
Total Indirect Cost $0.00
Total Budget $0.00
Balance $0.00
Attachment E-PHEP Budget 1 of 1
Exhibit D
Page 208
PHEP Budget Attachment E
0
Personnel
UID 1) Position and ° 3)Time 4)Annual 5)Annual 7) Domain
Individual 2) FTE / (months) SalaryFringe Salary Cost Fringe Cost Cost 6) Domain Activity8) Budget Justification Fringe
PP101 $0.00 $0.00 0.00 0.00 0.00 0
PP102 $0.00 $0.00 0.00 0.00 0.00 0
PP103 $0.00 $0.00 0.00 0.00 0.00 0
PP104 $0.00 $0.00 0.00 0.00 0.00 0
PP105 $0.00 $0.00 0.00 0.00 0.00 0
PP106 $0.00 $0.00 0.00 0.00 0.00 0
PP107 $0.00 $0.00 0.00 0.00 0.00 0
PP108 $0.00 $0.00 0.00 0.00 0.00 0
PP109 $0.00 $0.00 0.00 0.00 0.00 0
PP110 $0.00 $0.00 0.00 0.00 0.00 0
Personnel 0.00 0.00 $0.00 $0.0 $0.00 $0.00 $0.00 0.0%
FTE Time Salary Fringe Total Personnel Fringe %
Operating Expenses
UID 3) Domain
1) Item 2) Domain 4)Cost 5) Budget Justification
Activity
POE101 $0.00
POE102 $0.00
POE103 $0.00
POE104 $0.00
POE105 $0.00
POE106 $0.00
POE107 $0.00
POE108 $0.00
POE109 $0.00
POE110 $0.00
OE111 $0.00
OE112 $0.00
OE113 $0.00
OE114 $0.00
OE115 $0.00
$0.00
Total Operating Expenses
Equipment (Major)
UID 3) Domain
1) Item 2) Domain 4)Qty 5) Unit Price Cost 6) Budget Justification
Activity
PE 101 $0.00 0.00
PE 102 $0.00 0.00
PE 103 I I I 1 1 $0.00 0.00
Attachment E-PHEP Budget 1 of 6
Exhibit D
Page 209
PHEP Budget Attachment E
0
PE104 $0.00 0.00
PE105 $0.00 0.00
PE 106 $0.00 0.00
PE107 $0.00 0.00
PE108 $0.00 0.00
PE 109 $0.00 0.00
PE 110 $0.00 0.00
$0.00
Total Equipment
Attachment E-PHEP Budget 2 of 6
Exhibit D
Page 210
PHEP Budget Attachment E
0
In State Travel
UID 3) Domain
1)Travel Name 2) Domain 4) Cost 5) Budget Justification
Activity
PT101 $0.00
PT102 $0.00
PT103 $0.00
PT104 $0.00
PT105 $0.00
PT106 $0.00
PT107 $0.00
PT108 $0.00
PT109 $0.00
PT110 $0.00
$0.00
Total In State Travel
Out of State Travel
UID 3) Domain
1)Travel Name 2) Domain 4) Cost 5) Budget Justification
Activity
POST101 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST10 $0.00
POST11 C $0.00
$0.00
Total Out of State Travel
Subcontracts
UID 4) Domain
1) Contract Name 2) FTE 3) Domain 5) Cost 6) Budget Justification
Activity
PS 101 $0.00
PS 102 $0.00
PS 103 $0.00
PS 104 $0.00
PS 105 $0.00
PS 106 $0.00
PS 107 $0.00
PS 108 $0.00
PS 109 $0.00
PS110 $0.00
Attachment E-PHEP Budget 3 of 6
Exhibit D
Page 211
PHEP Budget Attachment E
0
UID 3) Domain
1)Software and Licenses 2) Domain Activity4) Cost 5) Budget Justification
P0101 $0.00
P0102 $0.00
P0103 $0.00
P0104 $0.00
P0105 $0.00
P0106 $0.00
P0107 $0.00
P0108 $0.00
P0109 $0.00
P0110 $0.00
Software and Licenses an nr
1)Training and Conference Registrations
P0131 $0.00
P0132 $0.00
P0133 $0.00
P0134 $0.00
P0135 $0.00
P0136 $0.00
P0137 $0.00
P0138 $0.00
P0139 $0.00
P0140 $0.00
Training and Conference Registrations $0.00
1)Training and Exercise Materials
P0161 $0.00
P0162 $0.00
P0163 $0.00
P0164 $0.00
P0165 $0.00
P0166 $0.00
P0167 $0.00
P0168 $0.00
P0169 $0.00
P0170 $0.00
Training and Exercise Materials
1) Maintenance Agreements
P0191 $0.00
P0192 $0.00
P0193 $0.00
P0194 $0.00
P0195 $0.00
Attachment E-PHEP Budget 5 of 6
Exhibit D
Page 212
PHEP Budget Attachment E
0
P0196 $0.00
P0197 $0.00
P0198 $0.00
P0199 $0.00
P0200 $0.00
Maintenance AgreementF $0.00
$0.00
Total Other
Total Direct $0.00
Total Indirect $0.00
Total $0.00
Attachment E-PHEP Budget 6 of 6
Exhibit D
Page 213
HPP Budget Attachment F
1) HPP Budget 2) Date:
3) Entity Name:
4) FY 22-23 Allocation
5) Indirect Cost based on:
6) Personnel Costs Rate:
Direct Costs Rate:
Budget Category Total % Allocation
Personnel $0.00 0%
Fringe $0.00 0%
Operating Expenses $0.00 0%
Equipment $0.00 0%
In State Travel $0.00 0%
Out of State Travel $0.00 0%
Subcontracts $0.00 0%
Other Costs $0.00 0%
Total Direct $0.00 0%
Total Indirect Cost $0.00
Total Budget $0.00
Balance $0.00
Attachment F-HPP Budget DRAFT 1 of 18
Exhibit D
Page 214
HPP Budget Attachment F
Personnel
UID 1) Position and ) y g
2) FTE % 3)Time 4)Annual 5 Annual Salary Fringe Cost
Individual (months) Salary Fringe Cost Cost
HP101 $0.00 $0.00 0.00 0.00 0.00
HP102 $0.00 $0.00 0.00 0.00 0.00
HP103 $0.00 $0.00 0.00 0.00 0.00
HP104 $0.00 $0.00 0.00 0.00 0.00
HP105 $0.00 $0.00 0.00 0.00 0.00
HP106 $0.00 $0.00 0.00 0.00 0.00
HP107 $0.00 $0.00 0.00 0.00 0.00
HP108 $0.00 $0.00 0.00 0.00 0.00
HP109 $0.00 $0.00 0.00 0.00 0.00
HP110 $0.00 $0.00 0.00 0.00 0.00
HP111 $0.00 $0.00 0.00 0.00 0.00
HP112 $0.00 $0.00 0.00 0.00 0.00
HP113 $0.00 $0.00 0.00 0.00 0.00
HP114 $0.00 $0.00 0.00 0.00 0.00
HP115 $0.00 $0.00 0.00 0.00 0.00
Personnel 0.00 0.00 $0.00 $0.00 $0.00
FTE Time Salary Fringe Total Personnel
Operating Expenses
UID
1) Item 2) Capability 3)Objective 4) Cost
HOE101 $0.00
HOE102 $0.00
HOE103 $0.00
HOE104 $0.00
HOE105 $0.00
HOE106 $0.00
HOE107 $0.00
Attachment F-HPP Budget DRAFT 2 of 18
Exhibit D
Page 215
HPP Budget Attachment F
0
HOE108 $0.00
HOE109 $0.00
HOE110 $0.00
HOE111 $0.00
HOE112 $0.00
HOE113 $0.00
HOE114 $0.00
HOE115 $0.00
$0.00
Total Operatinc
Attachment F-HPP Budget DRAFT 3 of 18
Exhibit D
Page 216
HPP Budget Attachment F
0
Equipment (Major)
UID
1) Item 2) Capability 3)Objective 4)Qty 5) Unit Price Cost
HE101 $0.00 0.00
H E 102 $0.00 0.00
HE103 $0.00 0.00
H E 104 $0.00 0.00
HE105 $0.00 0.00
H E 106 $0.00 0.00
HE107 $0.00 0.00
HE108 $0.00 0.00
HE109 $0.00 0.00
HE110 $0.00 0.00
$0.00
Total Equipmei
In State Travel
UID
1)Travel Name 2) Capability 3)Objective 4) Cost
HT101 $0.00
HT102 $0.00
HT103 $0.00
HT104 $0.00
HT105 $0.00
HT106 $0.00
HT107 $0.00
HT108 $0.00
HT109 $0.00
HT110 $0.00
$0.00
Total In State T
Out of State Travel
UID
1)Travel Name 2) Capability 3)Objective 4) Cost
Attachment F-HPP Budget DRAFT 4 of 18
Exhibit D
Page 217
HPP Budget Attachment F
0
HOST101 $0.00
HOST102 $0.00
HOST103 $0.00
HOST104 $0.00
HOST105 $0.00
HOST106 $0.00
HOST107 $0.00
HOST108 $0.00
HOST109 $0.00
HOST110 $0.00
$0.00
Total Out of St;
Attachment F-HPP Budget DRAFT 5 of 18
Exhibit D
Page 218
HPP Budget Attachment F
0
Subcontracts
UID
1)Contract Name 2) FTE 3) Capability 4)Objective 5) Cost
HS101 $0.00
HS102 $0.00
HS103 $0.00
HS104 $0.00
HS105 $0.00
HS106 $0.00
HS107 $0.00
HS108 $0.00
HS109 $0.00
HS110 $0.00
$0.00
Total Subcontr
Other
UID
1)Software and Licenses 2) Capability 3)Objective 4) Cost
H0101 $0.00
H0102 $0.00
H0103 $0.00
H0104 $0.00
H0105 $0.00
H0106 $0.00
H0107 $0.00
H0108 $0.00
H0109 $0.00
H0110 $0.00
Software and Licenses $0.00
1)Training and Conference Registrations 2) Capability 3)Objective 4) Cost
H0131 $0.00
H0132 $0.00
H0133 $0.00
Attachment F-HPP Budget DRAFT 6 of 18
Exhibit D
Page 219
HPP Budget Attachment F
0
H0134 $0.00
H0135 $0.00
H0136 $0.00
H0137 $0.00
H0138 $0.00
H0139 $0.00
HO140 $0.00
Training and Conference Registrations $0.00
Attachment F-HPP Budget DRAFT 7 of 18
Exhibit D
Page 220
HPP Budget Attachment F
1)Training and Exercise Materials 2) Capability 3)Objective 4) Cost
H0161 $0.00
H0162 $0.00
H0163 $0.00
H0164 $0.00
H0165 $0.00
H0166 $0.00
H0167 $0.00
H0168 $0.00
H0169 $0.00
H0170 $0.00
Training and Exercise Materials $0.00
Maintenance Agreements 2) Capability 3)Objective 4) Cost
H0191 $0.00
H0192 $0.00
H0193 $0.00
H0194 $0.00
H0195 $0.00
H0196 $0.00
H0197 $0.00
H0198 $0.00
H0199 $0.00
H0200 $0.00
Maintenance Agreements
$0.00
Total Other
Total Direct $0.00
Total Indirect $0.00
Total $0.00
Attachment F-HPP Budget DRAFT 8 of 18
Exhibit D
Page 221
HPP Budget Attachment F
6) Capability 7) Objective 8) Budget Justification Fringe %
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
I
5) Budget Justification 6) Facility
Attachment F-HPP Budget DRAFT 10 of 18
Exhibit D
Page 222
HPP Budget Attachment F
6) Budget Justification 7) Facility
nt
5) Budget Justification 6) Facility
ravel
15) Budget Justification 6) Facility
Attachment F-HPP Budget DRAFT 12 of 18
Exhibit D
Page 223
HPP Budget Attachment F
ate Travel
Attachment F-HPP Budget DRAFT 13 of 18
Exhibit D
Page 224
HPP Budget Attachment F
5) Budget Justification & Facility 6) Facility
acts
5) Budget Justification & Facility 6) Facility
5) Budget Justification & Facility 6) Facility
Attachment F-HPP Budget DRAFT 14 of 18
Exhibit D
Page 225
HPP Budget Attachment F
Attachment F-HPP Budget DRAFT 15 of 18
Exhibit D
Page 226
HPP Budget Attachment F
5) Budget Justification & Facility 6) Facility
5) Budget Justification & Facility 6) Facility
Attachment F-HPP Budget DRAFT 16 of 18
Exhibit D
Page 227
HPP Budget Attachment F
Facilities
UID Facility Name UID Facility Name
A AV
B AW
C AX
D AY
E AZ
F BA
G BB
H BC
I BD
J BE
K BF
L BG
M BH
N BI
O BJ
P BK
Q BL
R BM
S BN
T BO
U BP
V BQ
W BR
X BS
Y BT
Z BU
AA BV
AB BW
AC BX
AD BY
AE BZ
AF CA
AG CB
AH CC
Al CD
AJ C E
AK CF
AL CG
AM CH
AN CI
AO CJ
AP CK
AQ CL
AR CM
AS CN
AT CO
AU CP
Attachment F-HPP Budget DRAFT 18 of 18
Exhibit D
Page 228
Pan Flu Budget Attachment G
1) Pan Flu 2) Date:
3) Entity Name:
4) FY 22-23 Allcoation
5) Indirect Cost based on:
6) Personnel Costs Rate:
Direct Costs Rate:
Budget Category Total % Allocation
Personnel $0.00 0%
Fringe $0.00 0%
Operating Expenses $0.00 0%
Equipment $0.00 0%
In State Travel $0.00 0%
Out of State Travel $0.00 0%
Subcontracts $0.00 0%
Other Costs $0.00 0%
Total Direct $0.00 0%
Total Indirect Cost $0.00
Total Budget $0.00
Balance $0.00
Attachment G-Pan Flu Budget 1 of 1
Exhibit D
Page 229
Pan Flu Budget Attachment G
Personnel
UID
1) Position and Individual 2) FTE % 3)Time 4)Annual 5)Annual Salary Cost Fringe Cost
(months) Salary Fringe
FP101 $0.00 $0.00 0.00 0.00
FP102 $0.00 $0.00 0.00 0.00
FP103 $0.00 $0.00 0.00 0.00
FP104 $0.00 $0.00 0.00 0.00
FP105 $0.00 $0.00 0.00 0.00
FP106 $0.00 $0.00 0.00 0.00
FP107 $0.00 $0.00 0.00 0.00
FP108 $0.00 $0.00 0.00 0.00
FP109 $0.00 $0.00 0.00 0.00
FP110 $0.00 $0.00 0.00 0.00
FP111 $0.00 $0.00 0.00 0.00
FP112 $0.00 $0.00 0.00 0.00
FP113 $0.00 $0.00 0.00 0.00
FP114 $0.00 $0.00 0.00 0.00
FP115 $0.00 $0.00 0.00 0.00
Personnel 0.00 0.00 $0.00 $0.00
FTE Time Salary Fringe
Operating Expenses
UID
1) Item 2) Objective 3)Activity
FOE101
FOE102
FOE103
FOE104
FOE105
FOE106
FOE107
FOE108
FOE109
Attachment G-Pan Flu Budget 1 of 12
Exhibit D
Page 230
Pan Flu Budget Attachment G
Equipment (Major)
UID 1) Item 2) Objective 3)Activity 4)Qty 5) Unit Price
FE101 $0.00
FE102 $0.00
FE103 $0.00
FE104 $0.00
FE105 $0.00
FE106 $0.00
FE107 $0.00
FE108 $0.00
FE109 $0.00
FE110 $0.00
In State Travel
UID
1)Travel Name 2) Objective 3)Activity
FT101
FT102
FT103
FT104
FT105
FT106
FT107
FT108
FT109
FT110
Attachment G-Pan Flu Budget 3 of 12
Exhibit D
Page 231
Pan Flu Budget Attachment G
0
Out of State Travel
UID
1)Travel Name 2) Objective 3)Activity
FOST101
FOST102
FOST103
FOST104
FOST105
FOST106
FOST107
FOST108
FOST109
FOST110
Subcontracts
UID 1) Contract Name 2) FTE 3) Objective 4)Activit
FS101
FS102
FS103
FS104
FS105
FS106
FS107
FS108
FS109
FS110
Attachment G-Pan Flu Budget 4 of 12
Exhibit D
Page 232
Pan Flu Budget Attachment G
0
Other
UID
1)Software and Licenses 2) Objective 3)Activity
F0101
F0102
F0103
F0104
F0105
F0106
F0107
F0108
F0109
F0110
Software and Licenses
1)Training and Conference Registrations 2) Objective 3)Activity
F0131
F0132
F0133
F0134
F0135
F0136
F0137
F0138
F0139
F0140
Training and Conference Registrations
Attachment G-Pan Flu Budget 5 of 12
Exhibit D
Page 233
Pan Flu Budget Attachment G
1)Training and Exercise Materials 2) Objective 3)Activity
F0161
F0162
F0163
F0164
F0165
F0166
F0167
F0168
F0169
F0170
Training and Exercise Materials
1) Maintenance Agreements 2) Objective 3)Activity
F0191
F0192
F0193
F0194
F0195
F0196
F0197
F0198
F0199
F0200
Maintenance Agreements
Total Direct
Total Indirect
Total
Attachment G-Pan Flu Budget 6 of 12
Exhibit D
Page 234
Pan Flu Budget Attachment G
Fringe %
Cost 6)Objective 7)Activity s) Budget Justification
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
$0.00 0.0%
Total Personnel Fringe %
4)Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Attachment G-Pan Flu Budget 7 of 12
Exhibit D
Page 235
Pan Flu Budget Attachment G
Cost 6) Budget Justification
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
Total Equipment
4)Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total In State Travel
Attachment G-Pan Flu Budget 9 of 12
Exhibit D
Page 236
Pan Flu Budget Attachment G
4)Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Out of State Travel
5) Cost 6) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Subcontracts
Attachment G-Pan Flu Budget 10 of 12
Exhibit D
Page 237
Pan Flu Budget Attachment G
4)Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
4) Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.0{
Attachment G-Pan Flu Budget 11 of 12
Exhibit D
Page 238
Pan Flu Budget Attachment G
4) Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
4) Cost 5) Budget Justification
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
-*u.VL
$0.00
Total Other
$0.00
$0.00
$0.00
Attachment G-Pan Flu Budget 12 of 12
Exhibit D
Page 239
Budget Personnel Summary Attachment H
4)Annual
FTE Percentage and Time (Months) Salary 5) Salary
2)PHEP 3)PHEP 2)LABS 3)LABS 2) CRI Time 3) CRI 2)HPP Time 3)HPP 2) Pan Flu 3)Pan Flu (does not Revision
UID 1)TITLE/NAME Time (mo) FTE % Time (mo) FTE % (mo) FTE % (mo) FTE % Time (mo) FTE % TOTAL include Fringe) (mm/dd/yy)
PS101 0.00%
PS 102 0.00%
PS103 0.00%
PS 104 0.00%
PS 105 0.00%
PS 106 0.00%
PS 107 0.00%
PS 108 0.00%
PS 109 0.00%
PS110 0.00%
PS111 0.00%
PS112 0.00%
PS113 0.00%
PS114 0.00%
PS115 0.00%
PS116 0.00%
PS117 0.00%
PS118 0.00%
PS119 0.00%
PS 120 0.00%
Totals 0.00% 0.00% 0.00% 0.00% 0.00%
oa oaFFrP7— lotalllanFlu
1 1 1
EPO Use Only 10.00% 10.00% 10.00%
Attachment H-Budget Personnel Summary 1 of 1
Exhibit D
Page 240
Local Entity Contact Information Attachment I
Local Entity Name
Pandemic Influenza (Pan Flu)
Pan Flu Positions IName Address Telephone Number E-mail Address
Pandemic Influenza Coordinator
Fiscal Contact
Public Health Emergency Preparedness (PHEP)
PHEP Positions Name Address Telephone Number E-mail Address
Health Officer
Health Executive
PHEP Coordinator
SNS Coordinator
Epidemiologist
MHOAC (Primary)
MHOAC (Alternate)
Lab Director
Lab Emergency Contact
CAHAN Coordinator (Primary)
CAHAN Coordinator (Alternate)
Statewide Exercise Coordinator
Fiscal Contact
Public Information Officer (PIO)
Hospital Preparedness Program
HCC Name
HCC County(ies)
HPP Positions Name Address Telephone Number E-mail Address
HPP Coordinator
Coalition Coordinator
LEMSA Coordinator
MHOAC (Primary)
MHOAC (Alternate)
CAHAN Coordinator (Primary)
CAHAN Coordinator (Alternate)
Statewide Exercise Coordinator
Fiscal Contact
DHV Coordinator
Attachment I-Contact Information 1 of 1
Exhibit D
Page 241
State of California-Health and Human Services Agency California Department of Public Health
1616 Capitol Ave., Suite 74.262
P.O. Box 997377, MS 1800
Sacramento, CA 95899-7377
Submit www.cdi)h.ca.aov
GOVERNMENT AGENCY TAXPAYER ID FORM
The principal purpose of the information provided is to establish the unique identification of the government entity.
Instructions:You may submit one form for the principal government agency and all subsidiaries sharing the same TIN.Subsidiaries with a
different TIN must submit a separate form. Fields bordered in red are required. Please print the form to sign prior to submittal. You may
email the form to: GovSuppliers@cdph.ca.gov or fax it to(916) 650-0100, or mail it to the address above.
Principal
Government
Agency Name
Remit-To
Address (Street
or PO Box)
City: State: Zip Code+4:
Government City ❑ County Federal
Type: ❑ Special District ❑ Federal doyer
epl fication
Other(Specify) Number
(FEIN)
List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same
FEIN and receives payment from the State of California.
FI$Cal ID# Dept/Division/Unit Complete
(if known) Name Address
FI$Cal ID# Dept/Division/Unit Complete
(if known) Name Address
FI$Cal ID# Dept/Division/Unit Complete
(if known) Name Address
FI$Cal ID# Dept/Division/Unit Complete
(if known) Name Address
Contact Person Title
Phone number E-mail address
Signature F Date
CDPH 9083(1/18)
Exhibit D
Page 242
California Department of Public Health
Emergency Preparedness Office (EPO)
Corrective Action Plan (CAP) Preparation Instructions
General Instructions: The instructions below have been prepared to assist you in developing your Corrective
Action Plan (CAP)for the findings that were made during your Audit. The Final Audit Report was issued to
you by the California Department of Public Health, Office of Compliance--Grant Compliance Unit(GCU),
which disclosed findings that require corrective action and were stated in terms of"recommendations" by the
auditor(s) in the Final Audit Report. These preparation instructions will apply both to the Hospital
Preparedness (HPP) and the Public Health Emergency Preparedness (PHEP) Program audits. Each audit
finding must be addressed separately.
Your CAP must be prepared and completed using the Final Audit Report. List all findings made using the CAP
template provided in this document. The draft CAP must be submitted to EPO for review and approval no
later than thirty(30) days after receipt of the CAP template and instructions. Audit findings must be resolved
no later than six (6) months after receiving the Final Audit Report. Extensions to this deadline may be granted
by your Contract Manager on a case-by-case basis.
CAP Template Completion Instructions
Upon receipt of these instructions and template, it is recommended that you save a copy of the template to
your hard-drive to simplify preparation and for future reference.
COUNTY: (insert County name)
Implementation Schedule Date: Enter the date, month, and year you intend to "activate" CAP activities.
Please keep in mind that all activities must be completed/resolved within six (6) months from the date the
Final Audit Report was issued. This date may be an estimate of the date of implementation.
Program (PHEP/HPP): A CAP must be prepared for each audited program that had fiscal findings. Please
note a separate CAP is required for each audited program; this template includes a tab for each program.
Audit Period FY: Indicate the fiscal year for which the audit was conducted. If the audit included a grant
period that was extended, the fiscal year should be displayed as follows: FY 2018/19-20. The month and date
are not required in this block.
Contact Information: Enter current contact information for the person who is responsible for tracking CAP
activities.
Audit Information: Complete the first three (3) columns using the information within the Final Audit Report.
Once those columns have been finalized, you will then complete the remaining columns to ensure that your
CAP will not be returned as incomplete. If you are unable to locate the Final Audit Report, you may contact
your Contract Manager and request an additional copy.
Audit Category: Listed as the sub-header for each finding, such as "Finding #1 -Sub-contract not provided to
CDPH," "Finding #2 -Trust Fund", "Finding #3 ........ etc. These sub-headers are listed in the report's
"Executive Summary" and as the sub-headers in the "Findings and Recommendations" section of the Audit
Report. For each finding that includes an auditor recommendation, place this sub-heading in the "Audit
Category" column exactly as indicated in the Final Audit Report.
Attachment K-Fiscal Corrective Action Plan(CAP) 1
Exhibit D
Page 243
Finding: For each finding that includes an auditor recommendation, summarize the auditor's discussion in this
section. In summarizing, do not change the context of the finding, but briefly discuss the auditor's disclosure
of the finding. At the end of the discussion, provide the page number in the Final Audit Report where the
finding is listed. Copying the "Condition" of the report finding will suffice as a summary for the CAP Finding.
Audit Recommendation: Each finding that requires corrective action will include an auditor recommendation
for resolution indicated by an underlined sub-heading entitled "Recommendation"for each finding of the
report. Summarize this recommendation as appropriate and place the summary in the "Audit
Recommendation" block. Generally, copying the "Recommendation"of each report finding is the easiest and
most accurate answer for the CAP's "Audit Recommendation"column.
Corrective Action Taken: The County must provide a detailed, yet concise discussion of the intended
action(s) either planned, underway, or completed to resolve this specific finding. The discussion must
differentiate between actions completed, contemplated, or not completed. Additionally, the County must
provide a clear discussion regarding the measures taken to assure that this finding will not recur in the future
with subsequent CDPH/EPO-funded programs/grants. Source and/or confirming documentation must be
maintained and made available upon CDPH/EPO and CDPH/GCU request.
Estimated Completion Date: Insert the date the County anticipates this specific finding will be resolved. The
date should be realistic and flexible as it reflects how difficult or less so it is to resolve the finding. Extensions
of this estimated completion date may be requested through the County's EPO Contract Manager. Approvals
will be determined on a case-by-case basis. EPO determinations are final.
Actual Completion Date: Insert the date the finding has been resolved. This block is left empty until an
updated CAP is submitted to the EPO Contract Manager for review and approval. This block is only
completed once and within the allotted six-month audit resolution period. Assure source documentation is
maintained on each finding to confirm that the finding has been resolved. In order for the CAP to be accepted
as complete, there must be a completion date.
Finding Resolved (Yes/No): This block reflects whether the finding has been completely resolved or not;
future updates will be required until the finding is resolved. "Yes" is meant to convey that the finding has been
resolved within the estimated or actual completion date. A"No" response conveys that the finding remains an
open item within the County's CAP and further reporting will be required. Any additional time needed to
resolve and report efforts of resolving the finding must be requested in writing to the EPO Contract Manager
representing the County's region.
Reporting Requirements for Unresolved Audit Findings: Counties with unresolved audit findings must use this
CAP template to provide written audit resolution updates to CDPH/EPO Contract Managers during scheduled
mid-year and year-end reporting periods. In some instances, these reporting requirements may be sooner,
depending on the County's due date for the mid-year and year-end progress reports. Should there be a
variance between required program reporting and CAP updates, consult with your Contract Manager
concerning a modified update reporting schedule. This reporting requirement will become an additional
reporting requirement for future CDC and HPP grant award periods. All audit findings are reportable activities
until the finding is resolved.
Submission of CAPs for Review and Approval: CAPs will be submitted via email to your CDPH/EPO Contract
Manager- Local Emergency Preparedness Section.
Please direct all questions regarding the CAP to your Contract Manager
Attachment K-Fiscal Corrective Action Plan(CAP) 2
Exhibit D
Page 244
California Department of Public Health
Emergency Preparedness Office(EPO)
Corrective Action Plan
COUNTY:
Implementation Schedule Date: Program: PHEP Audit Period: FY
CONTACT INFORMATION
Contact Name & Position: Contact Organization: Address:
Phone Number: Email Address:
Audit Estimated Actual Finding
Category Finding Audit Recommendation Corrective Action Taken Completion Completion Resolved
Date Date (YES/NO)
Attachment K- Fiscal Corrective Action Plan (CAP) 3
Exhibit D
Page 245
California Department of Public Health
Emergency Preparedness Office(EPO)
Corrective Action Plan
COUNTY:
Implementation Schedule Date: Program: HPP Audit Period: FY
CONTACT INFORMATION
Contact Name & Position: Contact Organization: Address:
Phone Number: Email Address:
Audit Estimated Actual Finding
Category Finding Audit Recommendation Corrective Action Taken Completion Completion Resolved
Date Date (YES/NO)
Attachment K- Fiscal Corrective Action Plan (CAP) 4
Exhibit D
Pacie 246
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3.PRIME CONTRACT NUMBER 4.SUBCONTRACTOR/PURCHASE ORDER NUMBER �5.CONTRACT TYPE �6.TERM DOCKET NUMBER �7.TOTAL LINE ITEMS 8.TOTAL ACQUISITION COST
9a.CAGE CODE 9b.PRIME CONTRACTOR(Point of Contact) 10a.CAGE CODE 10b.SUBCONTRACTOR(Point of Contact)
9c.STREET ADDRESS 10c.STREET ADDRESS
9d.CITY,STATE,AND ZIP CODE 10d.CITY,STATE,AND ZIP CODE
11a.LOCATION OF PROPERTY 11b.POINT OF CONTACT FOR PROPERTY 12.PRODUCT COVERED BY CONTRACT/ORDER
Z
W W�Lu J O w LL Z 18.GOVERNMENT PART OR o W 21. UNIT 22. COST
13. ITEM M2UW 2 ¢ acnO o 20. 23.CONTRACTOR'S
14. ITEM DESCRIPTION L6zu)Q- o � 0 pco DRAWING NUMBER AND REVISION Z 0 OF
NUMBER w2w O QUANTITY OFFER
>wz(.) cd g Oz a V U NUMBER OU U MEASURE UNIT TOTAL
OLLO¢ p ~ (a) (b)
0 U
24a.SIGNATURE OF CONTRACTOR SUBMITTING SCHEDULE 24b.NAME OF CONTRACTOR SUBMITTING SCHEDULE 24c.TITLE 24d.DATE
AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1428 (REV. 1/2016)
PREVIOUS EDITION IS NOT USABLE Prescribed by GSA-FAR(48 CFR)53.245(e)and 53.249(b)
Exhibit D
Page 247
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Exhibit D
Page 248
Laboratory Training and Assistance Application
Laboratory training and assistance awards for Public Health Emergency Preparedness
(PHEP) must be submitted to CDPH Emergency Preparedness Office (EPO) by
May 20, 2022 via email to LHBTProg(a-)-cdph.ca.gov cc: katya.ledin(@cdph.ca.gov and
CAPHLD.documents(a)_gmail.com. EPO, in conjunction with the California Association of
Public Health Laboratory Directors Executive Committee (CAPHLD EC) and the Office
of the State Public Health Laboratory Director (OSPHLD) shall process all received
applications. The CAPHLD EC recommendations for funding will be made to EPO who
administer the agreement and funding for this award.
There is $406,500 available in laboratory (lab) training awards to Local Health
Department (LHD) Reference and Sentinel Labs for training of Public Health
Microbiologists (PHM). Refer to Funding Guidance for a list of labs. The funding
available breaks down as follows:
• Lab Training Funds of $30,000 each, only 12 available
• Lab Training Assistance of $15,500 each, only 3 available
Lab Training Funds
This funding is in support of PHM trainees and limited training supplies. The application
criteria are:
• Each LHD lab's trainee applicant must be approved by CDPH Laboratory Field
Services (LFS)
• The applicant LHD lab must be approved by CDPH LFS for PHM training, and
• The LHD lab providing the PHM training and applying for the funds must provide
a training schedule that is within the Federal budgeting cycle of July 1, 2022 to
June 30, 2023.
Applying
To apply for the Lab Training Funds complete and submit the documents below to the
Emergency Preparedness Office (EPO) via email to LHBTProq�cdph.ca.gov cc:
katya.ledin cdph.ca.gov and CAPHLD.documents(a gmail.com.
The email must contain the following:
Email Subject: County Name FY22-23 PHEP Application — Lab Training & Assistance
Attachments:
1. Letter to EPO — see page 3, complete highlighted text
2. Current Public Health Microbiologist Trainee certificate/license, or LFS Trainee
Support Letter— see example page 4, LFS completes
Exhibit D
Page 249
3. Training Schedule — LHD document
Awards
Notification of Lab Training funds award approval will be sent to the LHD and LHD Lab.
If the number of applications exceeds the number of awards, CAPHLD EC will make a
recommendation to EPO based on the number of funds requested, lab needs,
participation in training with other approved labs and history of successful training.
Lab Training Assistance
This funding is to assist with PHM training and may be used to backfill local staff
released for training PHM or to hire experts to do PHM training and for materials and
supplies needed for PHM training. The application criteria are:
• The applicant LHD lab must have at least one PHM Lab Training funds applicant,
• The applicant LHD lab must be approved by CDPH LFS for PHM training,
• The applicant LHD lab must have an agreement with at least two other approved
labs to participate jointly in PHM training,
• The applicant LHD lab must submit the attached lab PHM Lab Training Funds
application.
Applying
To apply for Lab Training Assistance the LHD lab must be applying for Lab Training
funds and complete and submit the documents below to the Emergency Preparedness
Office (EPO) via email to LHBTProgC@_cdph.ca.gov cc: katya.ledin _cdph.ca.gov, and
CAPHLD.documents angmail.com.
The email must contain the following:
Email Subject: County Name FY 22-23 PHEP Application — Lab Training & Assistance
Attachments:
1. Complete steps 1 - 3 of the Lab Training Funds application
2. Two Support Letters (minimum) — see example page 5, complete highlighted text
Awards
Notification of Lab Training Assistance award approval will be sent to the LHD and LHD
Lab. If the number of applications exceeds the number of awards, CAPHLD EC will
make a recommendation to EPO based on the number of funds requested, lab needs,
participation in training with other approved labs and history of successful training.
Exhibit D
Page 250
Applicant LHD Letter Head
Date
Department of Public Health
Emergency Preparedness Office
Attention: Local Emergency Preparedness Section
MS 7002
P.O. Box 997377
Sacramento, CA 95899-7377
RE: APPLICATION FOR LABORATORY TRAINING FUNDS
This is our formal request for one laboratory training grant award in the amount of
$30,000 for a Public Health Microbiologist trainee. The name of the trainee is trainee
First & Last name; who is qualified and interested in the position.
The training will be conducted in the LHD Name LHD Public Health Laboratory from
Month Date, Year to Month Date, Year.
Enclosed with this letter is the Laboratory Field Services (LFS) approval letter or current
Public Health Microbiologist Trainee (PMT) certificate/license for our proposed trainee,
and a tentative training schedule is attached with this application.
Sincerely,
First & Last Name
Title (Laboratory Manager/Director, Assistant Director or Bioterrorism Coordinator
LHD Name LHD Department of Public Health
Address 1
Address 2
City, State Zip
encl.
Cc:
LHD Emergency Preparedness Coordinator(s)
LHD Health Officer (optional)
Exhibit D
Page 251
EXAMPLE
Will be on CDPH Letter Head
Date
Trainee First & Last Name
Trainee Address 1
Trainee Address 2
Trainee City, State Zip
RE: PUBLIC HEALTH MICROBIOLOGIST TRAINEE SUPPORT LETTER
FROM: LABORATORY FIELD SERVICES
❑ You have been approved as a Public Health Microbiologist Trainee.
❑ You will need 26 weeks of training in an approved public health training laboratory.
❑ You may qualify for some reduction of the 26 weeks training period based upon your clinical
laboratory experience when verified. Specific evaluation of your experienced will be made if
you are being considered for an appointment to a training program.
❑ You should make copies of this letter and forward a copy, along with a cover letter and your
resume, to the approved public health training laboratories where you may wish to apply for
a trainee position.
❑ Before we can approve your application to take the certification examination, it must be
determined that your experience is at least equivalent to the required training for admission
to this examination. We will be contacting your current and former employers to ascertain
the nature and extent of your laboratory experience.
❑ You have been approved to take the state examination for certification as a Public Health
Microbiologist.
❑ You have been issued a temporary certificate. It is valid until the date of expiration which
appears on the certificates upper left corner or until the results of the examination are
known.
❑ The temporary certification becomes in valid should you fail the examination.
❑ The next scheduled state examination for certification as a Public Health Microbiologist will
be held as listed in the enclosed schedule.
❑ Enclosures.
Exhibit D
Page 252
SAMPLE
Support LHD(s) Letter Head
Date
Department of Public Health
Emergency Preparedness Office
Attention: Local Emergency Preparedness Section
MS 7002
P.O. Box 997377
Sacramento, CA 95899-7377
RE: SUPPORT LETTER FOR LABORATORY TRAINING ASSISTANCE
This letter is our formal support of the Applying LHD Name LHD Public Health
Laboratory's Public Health Microbiologist training. Applying LHD Name LHD Public
Health Laboratory is one of the laboratories involved in the joint training and has a
dedicated history of training microbiologists. We continue to support the Public Health
Microbiologist (PHM) training programs of our partners which play an important role in
alleviating the shortage of PHMs in the State of California. This training helps maintain
staff competency and laboratory capabilities and keep up with advances in the field of
public health microbiology.
Sincerely,
First & Last Name
Title (Laboratory Manager/Director, Assistant Director or Bioterrorism Coordinator)
LHD Name LHD Department of Public Health
Address 1
Address 2
City, State Zip
County of Fresno
22-10701
Page 1 of 5
Exhibit E
Additional Provisions
1. Cancellation / Termination
A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days
advance written notice to the Grantee.
B. CDPH reserves the right to cancel or terminate this Grant immediately for cause.
The Grantee may submit a written request to terminate this Grant only if CDPH
substantially fails to perform its responsibilities as provided herein.
C. The term "for cause" shall mean that the Grantee fails to meet the terms, conditions,
and/or responsibilities of this agreement. Causes for termination include, but are not
limited to the following occurrences:
1) If the Grantee knowingly furnishes any statement, representation, warranty, or
certification in connection with the agreement, which representation is materially
false, deceptive, incorrect, or incomplete.
2) If the Grantee fails to perform any material requirement of this Grant or defaults
in performance of this agreement.
3) If the Grantee files for bankruptcy, or if CDPH determines that the Grantee
becomes financially incapable of completing this agreement.
D. Grant termination or cancellation shall be effective as of the date indicated in
CDPH's notification to the Grantee. The notice shall stipulate any final performance,
invoicing or payment requirements.
E. In the event of early termination or cancellation, the Grantee shall be entitled to
compensation for services performed satisfactorily under this agreement and
expenses incurred up to the date of cancellation and any non-cancelable obligations
incurred in support of this Grant.
F. In the event of termination, and at the request of CDPH, the Grantee shall furnish
copies of all proposals, specifications, designs, procedures, layouts, copy, and other
materials related to the services or deliverables provided under this Grant, whether
finished or in progress on the termination date.
G. The Grantee will not be entitled to reimbursement for any expenses incurred for
services and deliverables pursuant to this agreement after the effective date of
termination.
H. Upon receipt of notification of termination of this Grant, and except as otherwise
specified by CDPH, the Grantee shall:
Page 1 of 5
County of Fresno
22-10701
Page 2 of 5
Exhibit E
Additional Provisions
1) Place no further order or subgrants for materials, services, or facilities.
2) Settle all outstanding liabilities and all claims arising out of such termination of
orders and subgrants.
3) Upon the effective date of termination of the Grant and the payment by CDPH of
all items properly changeable to CDPH hereunder, Grantee shall transfer, assign
and make available to CDPH all property and materials belonging to CDPH, all
rights and claims to any and all reservations, grants, and arrangements with
owners of media/PR materials, or others, and shall make available to CDPH all
written information regarding CDPH's media/PR materials, and no extra
compensation is to be paid to Grantee for its services.
4) Take such action as may be necessary, or as CDPH may specify, to protect and
preserve any property related to this agreement which is in the possession of the
Grantee and in which CDPH has or may acquire an interest.
I. CDPH may, at its discretion, require the Grantee to cease performance of certain
components of the Scope of Work as designated by CDPH and complete
performance of other components prior to the termination date of the Grant.
2. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the
Grantee, subgrants, or employees, officers and directors of the Grantee or
subgrants. Thus, CDPH reserves the right to determine, at its sole discretion,
whether any information, assertion or claim received from any source indicates the
existence of a real or apparent conflict of interest; and, if a conflict is found to exist,
to require the Grantee to submit additional information or a plan for resolving the
conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Grantee or any of its subgrants, or any employee, officer,
or director of the Grantee or any subgrant or has an interest, financial or
otherwise, whereby the use or disclosure of information obtained while
performing services under the grant would allow for private or personal benefit or
for any purpose that is contrary to the goals and objectives of the grant.
2) An instance where the Grantee's or any subgrant's employees, officers, or
directors use their positions for purposes that are, or give the appearance of
being, motivated by a desire for private gain for themselves or others, such as
those with whom they have family, business or other ties.
Page 2 of 5
County of Fresno
22-10701
Page 3 of 5
Exhibit E
Additional Provisions
C. If CDPH is or becomes aware of a known or suspected conflict of interest, the
Grantee will be given an opportunity to submit additional information or to resolve
the conflict. A Grantee with a suspected conflict of interest will have five (5) working
days from the date of notification of the conflict by CDPH to provide complete
information regarding the suspected conflict. If a conflict of interest is determined to
exist by CDPH and cannot be resolved to the satisfaction of CDPH, the conflict will
be grounds for terminating the grant. CDPH may, at its discretion upon receipt of a
written request from the Grantee, authorize an extension of the timeline indicated
herein.
3. Dispute Resolution Process
A. A Grantee grievance exists whenever there is a dispute arising from CDPH's action
in the administration of an agreement. If there is a dispute or grievance between the
Grantee and CDPH, the Grantee must seek resolution using the procedure outlined
below.
1) The Grantee should first informally discuss the problem with the CDPH Program
Grant Manager. If the problem cannot be resolved informally, the Grantee shall
direct its grievance together with any evidence, in writing, to the program Branch
Chief. The grievance shall state the issues in dispute, the legal authority or other
basis for the Grantee's position and the remedy sought. The Branch Chief shall
render a decision within ten (10) working days after receipt of the written
grievance from the Grantee. The Branch Chief shall respond in writing to the
Grantee indicating the decision and reasons therefore. If the Grantee disagrees
with the Branch Chief's decision, the Grantee may appeal to the second level.
2) When appealing to the second level, the Grantee must prepare an appeal
indicating the reasons for disagreement with Branch Chief's decision. The
Grantee shall include with the appeal a copy of the Grantee's original statement
of dispute along with any supporting evidence and a copy of the Branch Chief's
decision. The appeal shall be addressed to the Deputy Director of the division in
which the branch is organized within ten (10) working days from receipt of the
Branch Chief's decision. The Deputy Director of the division in which the branch
is organized or his/her designee shall meet with the Grantee to review the issues
raised. A written decision signed by the Deputy Director of the division in which
the branch is organized or his/her designee shall be directed to the Grantee
within twenty (20) working days of receipt of the Grantee's second level appeal.
B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in
which the branch is organized or his/her designee, the Grantee shall follow the
procedures set forth in Division 25.1 (commencing with Section 38050) of the Health
and Safety Code and the regulations adopted thereunder. (Title 1, Division 2,
Chapter 2, Article 3 (commencing with Section 1140) of the California Code of
Regulations).
Page 3 of 5
County of Fresno
22-10701
Page 4 of 5
Exhibit E
Additional Provisions
C. Disputes arising out of an audit, examination of an agreement or other action not
covered by subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the
California Code of Regulations, and for which no procedures for appeal are provided
in statute, regulation or the Agreement, shall be handled in accordance with the
procedures identified in Sections 51016 through 51047, Title 22, California Code of
Regulations.
D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal
correspondence shall be directed to the CDPH Grant Manager.
E. There are organizational differences within CDPH's funding programs and the
management levels identified in this dispute resolution provision may not apply in
every contractual situation. When a grievance is received and organizational
differences exist, the Grantee shall be notified in writing by the CDPH Grant
Manager of the level, name, and/or title of the appropriate management official that
is responsible for issuing a decision at a given level.
4. Executive Order N-6-22 - Economic Sanctions
On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the
EO) regarding Economic Sanctions against Russia and Russian entities and
individuals. "Economic Sanctions" refers to sanctions imposed by the U.S.
government in response to Russia's actions in Ukraine, as well as any sanctions
imposed under state law. The EO directs state agencies to terminate contracts with,
and to refrain from entering any new contracts with, individuals or entities that are
determined to be a target of Economic Sanctions. Accordingly, should the State
determine Grantee is a target of Economic Sanctions or is conducting prohibited
transactions with sanctioned individuals or entities, that shall be grounds for
termination of this Agreement. The State shall provide Grantee advance written
notice of such termination, allowing Grantee at least 30 calendar days to provide a
written response. Termination shall be at the sole discretion of the State.
Prior to awarding and executing grant, the State shall conduct its due diligence to
determine if the proposed awardee is a named individual or entity on federal and
any state Economic Sanctions lists. If the proposed awardee is listed, the State shall
refrain from entering into the Grant. Resources for locating names of sanctioned
individuals and entities are available on the DGS Office of Legal Services' webpage:
Ukraine-Russia (ca.gov).
If this Agreement is valued at $5 million or more, upon execution the State will send
a separate notification outlining additional requirements specified under the EO.
Compliance with this Economic Sanctions imposed in response to Russia's actions
in Ukraine is required, including with respect to, but not limited to, the federal
Page 4 of 5
County of Fresno
22-10701
Page 5 of 5
Exhibit E
Additional Provisions
executive orders identified in the EO and the sanctions identified on the U.S.
Department of the Treasury website (https:Hhome.treasury.gov/policy-
issues/financial-sanctions/sanctionsprograms-and-country-information/ukraine-
russia-related-sanctions). Failure to comply may result in the termination of this
Agreement.
Page 5 of 5
California Department of Public Health
County of Fresno
Exhibit F
22-10701
Exhibit F
Federal Terms and Conditions
(For Federally Funded Grant Agreements)
This exhibit contains provisions that require strict adherence to various contracting laws and
policies.
Index of Special Terms and Conditions
1. Federal Funds
2. Federal Equal Employment Opportunity Requirements
3. Debarment and Suspension Certification
4. Covenant Against Contingent Fees
5. Lobbying Restrictions and Disclosure Certification
6. Additional Restrictions
7. Human Subjects Use Requirments
8. Audit and Record Retention
9. Federal Requirements
CDPH(rev. 12-21) Page 1 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
1. Federal Funds
(Applicable only to that portion of an agreement funded in part or whole with federal funds.)
a. It is mutually understood between the parties that this Agreement may have been written
before ascertaining the availability of congressional appropriation of funds, for the mutual
benefit of both parties, in order to avoid program and fiscal delays which would occur if
the Agreement were executed after that determination was made.
b. This Agreement is valid and enforceable only if sufficient funds are made available to the
State by the United States Government for the fiscal years covered by the term of this
Agreement. In addition, this Agreement is subject to any additional restrictions,
limitations, or conditions enacted by the Congress or any statute enacted by the Congress
which may affect the provisions, terms or funding of this Agreement in any manner.
c. It is mutually agreed that if the Congress does not appropriate sufficient funds for the
program, this Agreement shall be amended to reflect any reduction in funds.
d. CDPH has the option to invalidate or cancel the Agreement with 30-days advance written
notice or to amend the Agreement to reflect any reduction in funds.
2. Federal Equal Opportunity Requirements
(Applicable to all federally funded grants entered into by the California Department of Public
Health (CDPH) formerly known as California Department of Health Services (CDHS).)
a. The Grantee will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, national origin, physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era. The Grantee
will take affirmative action to ensure that qualified applicants are employed, and that
employees are treated during employment, without regard to their race, color, religion,
sex, national origin, physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the
following: employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and career
development opportunities and selection for training, including apprenticeship. The
Grantee agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the Federal Government or CDPH, setting forth
the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of
1973 and the affirmative action clause required by the Vietnam Era Veterans'
Readjustment Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the
Grantee's obligation under the law to take affirmative action to employ and advance in
employment qualified applicants without discrimination based on their race, color, religion,
sex, national origin physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era and the rights of applicants and employees.
b. The Grantee will, in all solicitations or advancements for employees placed by or on behalf
of the Grantee, state that all qualified applicants will receive consideration for employment
CDPH(rev. 12-21) Page 2 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
without regard to race, color, religion, sex, national origin physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era.
c. The Grantee will send to each labor union or representative of workers with which it has
a collective bargaining agreement or other contract or understanding a notice, to be
provided by the Federal Government or the State, advising the labor union or workers'
representative of the Grantee's commitments under the provisions herein and shall post
copies of the notice in conspicuous places available to employees and applicants for
employment.
d. The Grantee will comply with all provisions of and furnish all information and reports
required by Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Era
Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212) and of the Federal
Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending
Executive Order 11246 Relating to Equal Employment Opportunity,' and as
supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract
Compliance Programs, Equal Employment Opportunity, Department of Labor," and of the
rules, regulations, and relevant orders of the Secretary of Labor.
e. The Grantee will furnish all information and reports required by Federal Executive Order
No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation
at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor," and the Rehabilitation Act of 1973, and
by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and
will permit access to its books, records, and accounts by the State and its designated
representatives and the Secretary of Labor for purposes of investigation to ascertain
compliance with such rules, regulations, and orders.
f. In the event of the Grantee's noncompliance with the requirements of the provisions
herein or with any federal rules, regulations, or orders which are referenced herein, this
Agreement may be cancelled, terminated, or suspended in whole or in part and the
Grantee may be declared ineligible for further federal and state contracts in accordance
with procedures authorized in Federal Executive Order No. 11246 as amended and such
other sanctions may be imposed and remedies invoked as provided in Federal Executive
Order No. 11246 as amended, including by Executive Order 11375, `Amending Executive
Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by
regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs,
Equal Employment Opportunity, Department of Labor," or by rule, regulation, or order of
the Secretary of Labor, or as otherwise provided by law.
g. The Grantee will include the provisions of Paragraphs a through g in every subcontract
or purchase order unless exempted by rules, regulations, or orders of the Secretary of
Labor issued pursuant to Federal Executive Order No. 11246 as amended, including by
Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal
Employment Opportunity,` and as supplemented by regulation at 41 CFR part 60, "Office
of the Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor," or Section 503 of the Rehabilitation Act of 1973 or(38 U.S.C. 4212)
of the Vietnam Era Veteran's Readjustment Assistance Act, so that such provisions will
be binding upon each subgrantee or vendor. The Grantee will take such action with
CDPH(rev. 12-21) Page 3 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
respect to any subcontract or purchase order as the Director of the Office of Federal
Contract Compliance Programs or CDPH may direct as a means of enforcing such
provisions including sanctions for noncompliance provided, however, that in the event the
Grantee becomes involved in, or is threatened with litigation by a subgrantee or vendor
as a result of such direction by CDPH, the Grantee may request in writing to CDPH, who,
in turn, may request the United States to enter into such litigation to protect the interests
of the State and of the United States.
3. Debarment and Suspension Certification
a. By signing this Grant, the Grantee agrees to comply with applicable federal suspension
and debarment regulations including, but not limited to 7 CFR Part 3017, 45 CFR 76, 40
CFR 32 or 34 CFR 85.
b. By signing this Grant, the Grantee certifies to the best of its knowledge and belief, that it
and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any federal department or agency;
(2) Have not within a three-year period preceding this application/proposal/agreement
been convicted of or had a civil judgment rendered against them for commission of
fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) transaction or contract under a public
transaction; violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making
false statements, or receiving stolen property;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State or local) with commission of any of the offenses
enumerated in Paragraph b(2) herein; and
(4) Have not within a three-year period preceding this application/proposal/agreement
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(5) Shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under federal regulations (i.e., 48 CFR part 9, subpart 9.4),
debarred, suspended, declared ineligible, or voluntarily excluded from participation in
such transaction, unless authorized by the State.
(6) Will include a clause entitled, "Debarment and Suspension Certification" that
essentially sets forth the provisions herein, in all lower tier covered transactions and
in all solicitations for lower tier covered transactions.
c. If the Grantee is unable to certify to any of the statements in this certification, the Grantee
shall submit an explanation to the CDPH Program Contract Manager.
d. The terms and definitions herein have the meanings set out in the Definitions and
Coverage sections of the rules implementing Federal Executive Order 12549.
CDPH(rev. 12-21) Page 4 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
e. If the Grantee knowingly violates this certification, in addition to other remedies available
to the Federal Government, the CDPH may terminate this Agreement for cause or default.
4. Covenant Against Contingent Fees
The Grantee warrants that no person or selling agency has been employed or retained to
solicit/secure this Grant upon an agreement of understanding for a commission, percentage,
brokerage, or contingent fee, except bona fide employees or bona fide established
commercial or selling agencies retained by the Grantee for the purpose of securing business.
For breach or violation of this warranty, CDPH shall have the right to annul this Grant without
liability or in its discretion to deduct from the Grant price or consideration, or otherwise
recover, the full amount of such commission, percentage, and brokerage or contingent fee.
5. Lobbying Restrictions and Disclosure Certification
(Applicable to federally funded grants in excess of $100,000 per Section 1352 of the 31,
U.S.C.)
a. Certification and Disclosure Requirements
(1) Each person (or recipient)who requests or receives a grant, subgrant, which is subject
to Section 1352 of the 31, U.S.C., and which exceeds $100,000 at any tier, shall file
a certification (in the form set forth in Attachment 1, consisting of one page, entitled
"Certification Regarding Lobbying")that the recipient has not made, and will not make,
any payment prohibited by Paragraph b of this provision.
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2, entitled
"Standard Form-LLL `disclosure of Lobbying Activities"') if such recipient has made or
has agreed to make any payment using nonappropriated funds (to include profits from
any covered federal action) in connection with a grant or any extension or amendment
of that grant, which would be prohibited under Paragraph b of this provision if paid for
with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in which
there occurs any event that requires disclosure or that materially affect the accuracy
of the information contained in any disclosure form previously filed by such person
under Paragraph a(2) herein. An event that materially affects the accuracy of the
information reported includes:
(a) A cumulative increase of $25,000 or more in the amount paid or expected to be
paid for influencing or attempting to influence a covered federal action;
(b) A change in the person(s) or individuals(s) influencing or attempting to influence a
covered federal action; or
(c) A change in the officer(s), employee(s), or member(s) contacted for the purpose
of influencing or attempting to influence a covered federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in
CDPH(rev. 12-21) Page 5 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
Paragraph a(1) of this provision a grant or subgrant exceeding $100,000 at any tier
under a grant shall file a certification, and a disclosure form, if required, to the next tier
above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier until
received by the person referred to in Paragraph a(1) of this provision. That person
shall forward all disclosure forms to CDPH Program Contract Manager.
b. Prohibition
Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may be
expended by the recipient of a federal contract or agreement, grant, loan, or cooperative
agreement to pay any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with any of the following covered
federal actions: the awarding of any federal contract or agreement, the making of any
federal grant, the making of any federal loan, entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification of any federal
contract or agreement, grant, loan, or cooperative agreement.
6. Additional Restrictions
Grantee shall comply with the restrictions under Division F, Title V, Section 503 of the
Consolidated Appropriations Act, 2012 (H.R. 2055), which provides that:
"SEC. 503.(a) No part of any appropriation contained in this Act or transferred pursuant
to section 4002 of Public Law 111-148 shall be used, other than for normal and
recognized executive-legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic
communication, radio, television, or video presentation designed to support or defeat the
enactment of legislation before the Congress or any State or local legislature or legislative
body, except in presentation to the Congress or any State or local legislature itself, or
designed to support or defeat any proposed or pending regulation, administrative action,
or order issued by the executive branch of any State or local government, except in
presentation to the executive branch of any State or local government itself.
(b) No part of any appropriation contained in this Act or transferred pursuant to section
4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient, related to any activity designed to
influence the enactment of legislation, appropriations, regulation, administrative action, or
Executive order proposed or pending before the Congress or any State government,
State legislature or local legislature or legislative body, other than for normal and
recognized executive-legislative relationships or participation by an agency or officer of a
State, local or tribal government in policymaking and administrative processes within the
executive branch of that government.
(c) The prohibitions in subsections (a) and (b) shall include any activity to advocate or
promote any proposed, pending or future Federal, State or local tax increase, or any
proposed, pending, or future requirement or restriction on any legal consumer product,
including its sale or marketing, including but not limited to the advocacy or promotion of
gun control."
CDPH(rev. 12-21) Page 6 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
7. Human Subjects Use Requirements
(Applicable only to federally funded agreements in which performance, directly or through a
subgrantee/subaward, includes any tests or examination of materials derived from the human
body.)
By signing this Agreement, Grantee agrees that if any performance under this Agreement or
any subcontract or subagreement includes any tests or examination of materials derived from
the human body for the purpose of providing information, diagnosis, prevention, treatment or
assessment of disease, impairment, or health of a human being, all locations at which such
examinations are performed shall meet the requirements of 42 U.S.C. Section 263a (CLIA)
and the regulations thereunder.
8. Audit and Record Retention
(Applicable to agreements in excess of $10,000.)
a. The Grantee shall maintain books, records, documents, and other evidence, accounting
procedures and practices, sufficient to properly reflect all direct and indirect costs of
whatever nature claimed to have been incurred in the performance of this Agreement,
including any matching costs and expenses. The foregoing constitutes "records" for the
purpose of this provision.
b. The Grantee's facility or office or such part thereof as may be engaged in the performance
of this Agreement and his/her records shall be subject at all reasonable times to
inspection, audit, and reproduction.
c. Grantee agrees that CDPH, the Bureau of State Audits, or their designated
representatives including the Comptroller General of the United States shall have the right
to review and to copy any records and supporting documentation pertaining to the
performance of this Agreement. Grantee agrees to allow the auditor(s) access to such
records during normal business hours and to allow interviews of any employees who
might reasonably have information related to such records. Further, the Grantee agrees
to include a similar right of the State to audit records and interview staff in any subgrantee
related to performance of this Agreement. (GC 8546.7, CCR Title 2, Section 1896).
d. The Grantee shall preserve and make available his/her records (1) for a period of three
years from the date of final payment under this Agreement, and (2)for such longer period,
if any, as is required by applicable statute, by any other provision of this Agreement, or
by subparagraphs (1) or (2) below.
(1) If this Agreement is completely or partially terminated, the records relating to the work
terminated shall be preserved and made available for a period of three years from the
date of any resulting final settlement.
(2) If any litigation, claim, negotiation, audit, or other action involving the records has been
started before the expiration of the three-year period, the records shall be retained
until completion of the action and resolution of all issues which arise from it, or until
the end of the regular three-year period, whichever is later.
CDPH(rev. 12-21) Page 7 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
f. The Grantee may, at its discretion, following receipt of final payment under this
Agreement, reduce its accounts, books and records related to this Agreement to
electoronic data storage device. Upon request by an authorized representative to inspect,
audit or obtain copies of said records, the Grantee and/or Subgrantee must supply or
make available applicable devices, hardware, and/or software necessary to view, copy
and/or print said records.
9. Federal Requirements
Grantee agrees to comply with and shall require all subgrantee's, if any, to comply with
all applicable Federal requirements including but not limited to the United States Code,
the Code of Federal Regulations, the Funding Opportunity Announcement, the Notice of
Award, the funding agreement, and any memoranda or letter regarding the applicable
Federal requirements.
CDPH(rev. 12-21) Page 8 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
Attachment 1
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the making, awarding or entering into of this Federal
contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of this Federal contract, grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency of the
United States Government, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract, grant, or
cooperative agreement, the undersigned shall complete and submit Standard Form LLL,
"Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subGrantees, subgrants, and contracts
under grants and cooperative agreements) of$100,000 or more, and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
County of Fresno Sal Quintero
Name of Grantee Printed Name of Person Signing for Grantee
22-10701
Contract/ Grant Number Sig at re of erson Signing for Grantee
Chairman of the Board of Supervisors
Date Title ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
After execution by or on behalf of Grantee, please return to: County of Fresno,State of California
BY Deputy
CDPH(rev. 12-21) Page 9 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
California Department of Public Health
Program
P.O. Box 997377, MS XXX
Sacramento, CA 95899-XXXX
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
CDPH(rev. 12-21) Page 10 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
Attachment 2
CERTIFICATION REGARDING LOBBYING
Approved by OMB Complete this form to disclose lobbying
activities pursuant to 31 U.S.C. 13520348-0046
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
[ ] a. contract [ ]I a. bid/offer/application [ ] a. initial filing
b. grant b. initial award b. material change
c. cooperative c. post-award For Material Change Only:
agreement
d. loan Year quarter
e. loan guarantee
f. loan insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter
Name
and Address of Prime:
❑ Prime ❑ Subawardee
Tier , if known:
6. Federal Department/Agency 7. Federal Program Name/Description:
8. Federal Action Number, if known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying b. Individuals Performing Services (including
Registrant address if different from 10a.
(If individual, last name, first name, MI): (Last name, First name, MI):
11.Information requested through this form
is authorized by title 31 U.S.C. section Signature:
1352. This disclosure of lobbying
activities is a material representation of Print Name:
fact upon which reliance was placed by Title:
the tier above when this transaction was Telephone No.: Date:
made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352.
This information will be available for
public inspection. required disclosure
shall be subject to a not more than
$100,000 for each such failure.
Federal Use Only Authorized for Local Reproduction
Standard Form-LLL (Rev. 7-97)
CDPH(rev. 12-21) Page 11 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal
recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous
filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or
agreement to make payment to any lobbying entity for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with a covered Federal action. Complete all items
that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured
to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a
material change to the information previously reported, enter the year and quarter in which the
change occurred. Enter the date of the last previously submitted report by this reporting entity
for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include
Congressional District, if known. Check the appropriate classification of the reporting entity that
designates if it is, or expects to be a prime or subaward recipient. Identify the tier of the
subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are
not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name,
address, city, State and zip code of the prime Federal recipient. Include Congressional District,
if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least
one organizational level below agency name, if known. For example, Department of
Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known,
enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative
agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified
in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant
announcement number; the contract, grant, or loan award number; the application/proposal
control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal
agency, enter the Federal amount of the award/loan commitment for the prime entity identified
in item 4 or 5.
CDPH(rev. 12-21) Page 12 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
10.(a) Enter the full name, address, city, State and zip code of the lobbying registrant under the
Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to
influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services and include full address if
different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11.The certifying official shall sign and date the form, print his/her name, title, and telephone
number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid
OMB Control Number.The valid OMB control number for this information collection is OMB No.0348-0046. Public reporting burden for this collection
of information is estimated to average 10 minutes per response, including time for reviewing instructions,searching existing data sources, gathering
and maintaining the data needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project(0348-0046),Washington,DC 20503.
CDPH(rev. 12-21) Page 13 of 13
California Department of Public Health
Name/No.: 2022-23 to 2026-27 CDC Public Health Emergency Preparedness
(PHEP), State General Fund (GF) Pandemic Influenza, ASPR Hospital
Preparedness Program (HPP) funding for LEMSA program (Grant Agreement
No. 22-10701)
HPP
Fund/Subclass: 0080/17360
Organization #: 1160
Revenue Account #: 4380