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National Comprehensive Cancer Control Program (NCCCP) Workplan Instructions and Forms PPO 1 AO 1.1 EBI 1.1.1 Activities 1-5 EBI 1.1.2 Activities 1-5 EBI 1.1.3 Activities 1-5 AO 1.2 EBI 1.2.1 Activities 1-5 EBI 1.2.2 Activities 1-5 EBI 1.2.3 Activities 1-5 PPO 2 AO 2.1 EBI 2.1.1 Activitie s 1-5 EBI 2.1.2 Activitie s 1-5 EBI 2.1.3 Activitie s 1-5 PPO 3 AO 3.1 EBI 3.1.1 Activities 1-5 EBI 3.1.2 Activities 1-5 EBI 3.1.3 Activities 1-5 AO 3.2 EBI 3.2.1 Activities 1-5 EBI 3.2.2 Activities 1-5 EBI 3.2.3 Activities 1-5 AO 3.3 EBI 3.3.1 Activities 1-5 EBI 3.3.2 Activities 1-5 EBI 3.3.3 Activities 1-5

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Page 1: National comprehensive cancer control program … › ... › dp17-1701-ncccp-workplan-in… · Web viewActivity 5 – Program Monitoring and Evaluation: Type a brief description

National Comprehensive Cancer Control Program

(NCCCP)

Workplan Instructions and Forms

PPO

1

AO 1.1

EBI 1.1.1 Activities 1-5

EBI 1.1.2 Activities 1-5

EBI 1.1.3 Activities 1-5

AO 1.2

EBI 1.2.1 Activities 1-5

EBI 1.2.2 Activities 1-5

EBI 1.2.3 Activities 1-5

PPO

2

AO 2.1

EBI 2.1.1 Activities 1-5

EBI 2.1.2 Activities 1-5

EBI 2.1.3 Activities 1-5

PPO

3

AO 3.1

EBI 3.1.1 Activities 1-5

EBI 3.1.2 Activities 1-5

EBI 3.1.3 Activities 1-5

AO 3.2

EBI 3.2.1 Activities 1-5

EBI 3.2.2 Activities 1-5

EBI 3.2.3 Activities 1-5

AO 3.3

EBI 3.3.1 Activities 1-5

EBI 3.3.2 Activities 1-5

EBI 3.3.3 Activities 1-5

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This guidance document provides information on the optional workplan template developed for Program 2: National Comprehensive Cancer Control Program. The workplan will provide direction and guidance for the implementation of strategies 4: Environmental Approaches for Sustainable Cancer Control, 5: Community-Clinical Linkages to Aid Patient Support, and 6: Health Systems Changes. The workplan must include project period objectives (long-term objectives to attain over the life of the cooperative agreement) and annual objectives (short-term objectives that support the project period objectives) that are specific, measureable, achievable, realistic, and time-phased (SMART).

Navigating the Template

There are templates for NCCCP priority areas: emphasize primary prevention of cancer, facilitate screening and early detection of cancer, improve cancer survivors’ quality of life, and promote health equity as it relates to cancer control.

One template should be completed for each project period objective (PPO).

At minimum, applicants must have one PPO for each NCCCP priority area. Each PPO must have at least one annual objective (AO). Each AO must have evidence-based interventions (EBIs). Applicants are required to select 3 EBIs per priority area (primary prevention, screening and early detection of cancer, and improving quality of life of cancer survivors). Selected EBIs can be environmental approaches for sustainable cancer control; community-clinical linkages; or health systems changes. Each EBI must have activities that align with the five funding opportunity announcement (FOA) strategies (Program Collaboration, External Partnerships, Cancer Data and Surveillance, Implementation of EBIs, and Program Monitoring and Evaluation).

Per the FOA, applicants must ensure that at least one of the evidence-based strategies in each priority area addresses cancer-related disparities as evidenced by risk, incidence, and mortality. Regarding the workplan, these strategies will be documented in the Health Disparities template with separate PPOs and AOs to monitor and track program effort.

Developing the Workplan

The NCCCP Library of Indicators and Data Sources (LIDS) has been provided to help applicants develop their workplan. Follow these steps to complete the workplan templates—

Step 1: Complete the PPO

Choose the priority area. Select the cancer site or risk factor the priority area addresses. LIDS worksheets are categorized by priority area and cancer site or risk factor. From the appropriate LIDS table, select an indicator for your PPO. Select the Direction of Change, Unit of Measure, Baseline, and Target. Type your full PPO statement and LIDS indicator into the template.

NCCCP Workplan Instructions and Forms • Page 1 of 27

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Step 2: Complete the AO

Using the same LIDS table selected for the development of the PPO, choose an indicator for your AO. Select the Direction of Change, Unit of Measure, Baseline, and Target. Type your full AO statement and selected LIDS indicator into the template.

Step 3: Select the EBIs

Select the FOA Strategy (Environmental Approaches, Community-Clinical Linkages, or Health Systems Change). Go to the LIDS table and view the EBIs that are linked to the indicator you selected in step 2. Type the EBI your program intends to implement in the first program year in the Evidence-Based Intervention field.

Step 4: Enter the Activities

Activity 1 - Program Collaboration: Type a brief description of how your program will collaborate across NBCCEDP, National Program of Cancer Registries (NPCR), and other chronic disease prevention and health promotion programs to implement the selected EBI.

Activity 2 – External Partnerships: Type a brief description of how your program will convene, support, and sustain partnerships necessary to implement the selected EBI.

Activity 3 – Cancer Data and Surveillance: Type a brief description of how your program will use cancer risk factor and surveillance data to identify priorities and set baselines and targets specific to the selected EBI.

Activity 4 – Implementing the EBI: Type a brief description of key steps necessary to implement the selected EBI.

Activity 5 – Program Monitoring and Evaluation: Type a brief description of how your program will monitor the implementation of the selected EBI, including any quality improvement or evaluation efforts.

Repeat the steps for each PPO. Please note: programs can determine their maximum number of PPOs for each priority area.

NCCCP Workplan Instructions and Forms • Page 2 of 27

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Priority Area: Emphasize Primary Prevention of Cancer

Cancer Site or Risk Factor: Skin

Project Period Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 3 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 4 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-BasedEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-BasedEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership ActivityExternal Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 5 of 27

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Priority Area: Facilitate Screening and Early Detection of Cancer

Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 6 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 7 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 8 of 27

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Priority Area: Improve Cancer Survivors’ Quality of Life

Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 9 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 10 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 11 of 27

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Priority Area: Promote Health Equity As It Relates to Cancer Control

Cancer Site or Risk Factor: SkinPriority Type: Primary Prevention

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 12 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 13 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 14 of 27

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Additional Workplan Templates

Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 15 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 16 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 17 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 18 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 19 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 20 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 21 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 22 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 23 of 27

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Cancer Site or Risk Factor: SkinPriority Type: Primary Prevention

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 24 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 25 of 27

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Cancer Site or Risk Factor: Skin

Project Period Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

Annual Objective:      

Direction of Change: Increase Unit of Measure: Percent of Baseline:       Target:      

LIDS Indicator:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

FOA Strategy: Strategy 4: Environmental ApproachesEvidence-Based Intervention:      Program Collaboration Activity:      External Partnership Activity:      Cancer Data and Surveillance Activity:      Implementation of the Evidence-Based Intervention Activity:      Program Monitoring and Evaluation Activity:      

NCCCP Workplan Instructions and Forms • Page 26 of 27