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Task
<br />Activity
<br />Deliverables/Outcomes
<br />Due Date/Time Frame
<br />Payment Information
<br />#
<br />and/or Amount
<br />1 c
<br />PROGRAM ADMINISTRATION:
<br />Quarterly progress
<br />Year 4-FFY21:
<br />Reimbursement for
<br />Perform administrative duties related to
<br />reports to DOH via
<br />• January 17, 2022 (covering September 30,2021 -December30, 2021)
<br />actualcosts, not to
<br />LSPAN
<br />SharePoint site or email
<br />• April 15, 2022 (covering December 31, 2021 March 30, 2022)
<br />exceed total contract
<br />• July 15, 2022 (covering March 31, 2022 June 29, 2022)
<br />funding. See Program
<br />• October 17, 2022(covering June 30, 2022 -Se tember29, 2022
<br />Specific Requirements
<br />2a
<br />PROGRAM IMPLEMENTATION:
<br />Submit Work Plan to
<br />Draft due: Year 4-FFY21: March 25, 2022
<br />Reimbursement for
<br />Finalize Work Plan and Budget
<br />DOH contractmanager
<br />actualcosts, not to
<br />Workbook using DOH -provided
<br />via email
<br />Final due: Year 4 - FFY21: July 15, 2022
<br />exceed total contract
<br />templates.
<br />funding. See Program
<br />Specific Requirements
<br />2b
<br />PROGRAM IMPLEMENTATION:
<br />Quarterly progress
<br />Year 4-FFY21:
<br />Reimbursement for
<br />Implement finalized community work
<br />reports to DOH via
<br />• January 17, 2022 (covering September 30, 2021 -December 30, 202 1)
<br />actualcosts, not to
<br />plan focused on LSPAN that include:
<br />SharePoint site or email
<br />• April 15, 2022 (covering December 31, 2021 March 30, 2022)
<br />exceed totalcontract
<br />• Addressing at least two (2) state
<br />• July 15, 2022 (covering March 31, 2022 June 29, 2022)
<br />funding. See Program
<br />strategies required by this grant
<br />• October 17, 2022 (covering June 30, 2022-September29, 2022)
<br />Specific Requirements
<br />funding.
<br />• Achieving policy, systems, or
<br />environmental changes consistent
<br />with the strategies.
<br />• Identifying and reaching
<br />populations with health dis arities.
<br />2c
<br />PROGRAM IMPLEMENTATION:
<br />Report quarterly
<br />Year 4-FFY21:
<br />Reimbursement for
<br />Report quarterly expenditures using
<br />expenditures using
<br />• January 17, 2022 (covering September 30, 2021 -December 30, 202 1)
<br />actualcosts, not to
<br />DOH provided template.
<br />DOH -provided
<br />• April 15, 2022 (covering December 31, 2021 March 30, 2022)
<br />exceed totalcontract
<br />template.
<br />• July 15, 2022 (covering March 31, 2022 June 29, 2022)
<br />funding. See Program
<br />• October 17, 2022(covering June 30, 2022 -Se tember29, 2022
<br />Specific Requirements
<br />3
<br />PROGRAM EVALUATION:
<br />Quarterly progress
<br />Year 4-FFY21:
<br />Reimbursement for
<br />Participate in performance measure
<br />reports to DOH via
<br />• January 17, 2022 (covering September 30,2021 -December30, 2021)
<br />actualcosts, not to
<br />data collection and program evaluation
<br />SharePoint site or email
<br />• April 15, 2022 (covering December 31, 2021 March 30, 2022)
<br />exceed totalcontract
<br />activities in collaboration with DOH.
<br />• July 15, 2022 (covering March 31, 2022 June 29, 2022)
<br />funding. See Program
<br />• October 17, 2022 (covering June 30, 2022-September29, 2022)
<br />Specific Requirements
<br />4
<br />PROGRAM COMMUNICATION:
<br />Provide copies of any
<br />Year 4-FFY21:
<br />Reimbursement for
<br />Inform partners and public about
<br />relevant communication
<br />• January 17, 2022 (covering September 30, 2021 -December 30, 202 1)
<br />actualcosts, not to
<br />program successes and related best
<br />products with quarterly
<br />• April 15, 2022 (covering December 31, 2021 March 30, 2022)
<br />exceed totalcontract
<br />practices, including social media posts
<br />progress reports to
<br />• July 15, 2022 (covering March 31, 2022 June 29, 2022)
<br />funding. See Program
<br />andpublication.
<br />DOH via SharePoint
<br />• October 17, 2022 (covering June 30, 2022-September29, 2022)
<br />Specific Requirements
<br />site or email
<br />Year 4-FFY21:
<br />Write a success story related to LSPAN
<br />Draft due: July 1, 2022
<br />projects.
<br />One success story using
<br />Final due: July 29, 2022
<br />DOH -provided template
<br />Exhibit A, Statement of Work Page 2 of 3 Contract NumberCLH31015
<br />Template Created September 2021
<br />
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