Emergency Medical Services for Children Demonstration Grants

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Emergency Medical Services for Children Demonstration Grants

AGENCY: Health Resources and Services Administration HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The HRSA in collaboration with the National Highway Traffic

Safety Administration (NHTSA) announces that applications will be

accepted for fiscal year (FY) 1996 funds for grants authorized under

section 1910 of the PHS Act. These discretionary grants will be made to

States or accredited schools of medicine to support projects for the

expansion and improvement of emergency medical services for children

(EMSC). Within the HRSA, EMSC grants are administered by the Maternal

and Child Health Bureau (MCHB).

This program announcement is subject to the appropriation of funds.

Applicants are advised that this program announcement is a contingency

action being taken to assure that should funds become available for

this purpose, they can be awarded in a timely fashion consistent with

the needs of the program as well as to provide for even distribution of

funds throughout the fiscal year. At this time, given a continuing

resolution and the absence of FY 1996 appropriations for the EMSC

program, the amount of available funding for this specific grant

program cannot be estimated.

The NHTSA participated with the MCHB in developing program

priorities for the EMSC program for FY 1996. The NHTSA will share the

Federal monitoring responsibilities for EMSC awards made during FY 1996

and will continue to provide ongoing technical assistance and

consultation in regard to the required collaboration/linkages between

applicants and their Highway Safety Offices and Emergency Medical

Services Agencies for the State(s). Grantees funded under this program

are expected to work collaboratively with the State agency or agencies

administering the Maternal and Child Health (MCH) and the Children with

Special Health Needs (CSHN) programs under the MCH Services Block

Grant, Title V of the Social Security Act (42 U.S.C. 701).

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The PHS is committed to achieving the health promotion and disease

prevention objectives of Healthy People 2000, a PHS led national

activity for setting priority areas. The EMSC grant program will

directly address the Healthy People 2000 objectives related to

emergency medical services and trauma systems linking prehospital,

hospital, and rehabilitation services in order to prevent trauma deaths

and long-term disability. Potential applicants may obtain a copy of

Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or Healthy

People 2000 (Summary Report: Stock No. 017-001-00473-1) through the

Superintendent of Documents, Government Printing Office, Washington,

D.C. 20402-9325 (telephone, (202) 783-3238).

The PHS strongly encourages all grant recipients to provide a

smoke-free workplace and promote the non-use of all tobacco products.

In addition, Public Law 103-227, the Pro-Children Act of 1994,

prohibits smoking in certain facilities (or in some cases, any portion

of a facility) in which regular or routine education, library, day

care, health care or early childhood development services are provided

to children.

ADDRESSES: Grant applications for Emergency Medical Services for

Children Demonstration Grants (Revised PHS form #5161-1, approved under

OMB #0937-0189) must be obtained from and submitted to: Grants

Management Branch, Maternal and Child Health Bureau, HRSA, Room 18-12,

Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, Attn:

EMSC, telephone 301-443-1440. You must obtain application materials in

the mail.

Federal Register notices and application guidance for MCHB programs

are available on the World Wide Web via the Internet at address: http:/

/www.os.dhhs.gov/hrsa/mchb. Click on the file name you want to download

to your computer. It will be saved as a self-extracting (Macintosh or)

Wordperfect 5.1 file. To decompress the file once it is downloaded,

type in the file name followed by a . The file will expand to a

Wordperfect 5.1 file. If you have difficulty accessing the MCHB Home

Page via the Internet and need technical assistance, please contact

Linda L. Schneider at 301-443-0767 or ``[email protected]''.

DATES: The application deadline date is April 26, 1996. Competing

applications will be considered to be on time if they are either

received on or before the deadline date or postmarked on or before the

deadline date and received in time for orderly processing. Applicants

should request a legibly dated receipt from a commercial carrier or the

U.S. Postal Service, or obtain a legibly dated U.S. Postal Service

postmark. Private metered postmarks will not be accepted as proof of

timely mailing.

Late competing applications or those sent to an address other than

specified in the ADDRESSES section will be returned to the applicant.

FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic

information from MCHB should be directed to Jean Athey, Ph.D., or Mark

E. Nehring, D.M.D., M.P.H., Division of Maternal, Infant, Child and

Adolescent Health, Maternal and Child Health Bureau, Health Resources

and Services Administration, Room 18A-39, Parklawn Building, 5600

Fishers Lane, Rockville, Maryland 20857, telephone (301) 443-4026.

Requests for technical or programmatic information from NHTSA should be

directed to Garry Criddle, R.N., CDR, USCG/USPHS, Department of

Transportation, NHTSA EMS Division, NTS-42, 400 Seventh Street SW.,

Washington, DC 20590, telephone (202) 366-5440. Requests for

information concerning business management issues should be directed

to: Maria Carter, Grants Management Specialist, Grants Management

Branch, Maternal and Child Health Bureau, at the address listed in the

ADDRESS section above.

The EMSC program funds three national EMSC resource centers that

are available to provide technical assistance and support to

applicants, particularly in the areas of: (1) understanding EMSC

terminology; (2) developing a manageable approach to EMSC

implementation; (3) obtaining local support for the grant application

process; (4) facilitating development of community linkages for a

collaborative effort; (5) identifying products of previously-funded

EMSC projects of interest to potential applicants; (6) offering advice

on grant writing; and (7) data collection and analysis. Applicants may

contact: James Seidel, M.D., Ph.D., or Deborah Henderson, R.N., M.A.,

National EMSC Resource Alliance, Research and Education Institute,

Harbor/UCLA Medical Center, 1001 West Carson Street, Suite S, Torrance,

CA 90502, telephone 310 328-0720; or Jane Ball, R.N., Dr. P.H., EMSC

National Resource Center, Children's National Medical Center, Emergency

Trauma Services, 111 Michigan Ave., N.W., Washington, DC 20010,

telephone 202 745-5188; or J. Michael Dean, M.D., National EMSC Data

Analysis Resource Center, University of Utah School of Medicine, 309

Park Building, Salt Lake City, UT 84112, telephone (801) 588-2360.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

The Emergency Medical Services for Children statute (Section 1910

of the PHS Act, as amended) establishes a program of two-year grants to

States, through a State-designated agency, or to accredited medical

schools within States, for projects for the expansion and improvement

of emergency medical services for children who need treatment for

trauma or critical illness. For purposes of this grant program, the

term ``State'' includes the 50 States, the District of Columbia, the

Commonwealth of Puerto Rico, the Virgin Islands, the Northern Mariana

Islands, Guam, American Samoa, the Republic of Palau, the Republic of

the Marshall Islands, and the Federated States of Micronesia. The term

``school of medicine'' is defined as having the same meaning as set

forth in Section 799(1)(A) of the PHS Act (42 U.S.C. 295p(1)(A)).

``Accredited'' in this context has the same meaning as set forth in

section 799(1)(E) of the PHS Act (42 U.S.C. 295p(1)(E)). It is the

intent of this grant program to stimulate further development or

expansion of ongoing efforts in the States to reduce the problems of

life-threatening pediatric trauma and critical illness. The Department

does not intend to award grants which would duplicate grants previously

funded under the Emergency Medical Services Systems Act of 1972 or

which would be used simply to increase the availability of emergency

medical services funds allotted to the State under the Preventive

Health Services Block Grant.

Funding Categories

There will be three categories of competition for funding this

year: State planning grants, State systems grants, and targeted issue

grants. States may apply for only one of the first two categories, but

are not restricted in applying for the last category.

Category (1): State Planning Grants

Planning grants are intended for States that have never received an

EMSC grant and that are not at a stage of readiness to initiate a full-

scale implementation project. States (or medical schools within those

States) that have not received prior EMSC implementation grants are the

only applicants eligible for this category. Planning grants are

designed to enable a State to assess needs and develop a strategy to

begin to address those needs.

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Funds may be used to hire staff to assist in the assessment of EMSC

needs of the State; obtain technical assistance from national, State,

regional or local resources; help formulate a State plan for the

integration of EMSC services into the existing State EMS plan; and plan

a more comprehensive grant proposal based upon a needs assessment

performed during the planning grant project period. A comprehensive

approach, addressing physical, psychological, and social aspects of

EMSC along the continuum of care, should be reflected. An ongoing

working relationship with Federal EMSC program staff and resource

center staff, beginning with the initiation of a planning grant

application, is desirable. The project period is for one year only.

Category (2): State Systems Grants

This category of grants has two subcategories: implementation

grants and system enhancement grants. For both subcategories, proposals

are sought which include strategies and/or models to ensure that

pediatric emergency care is family centered. ``Family centered''

includes the following key elements: maximum possible involvement of

families in all phases of the EMSC continuum of care; clear and

continuous communication between family members and the emergency care

team; attention to the psychological needs of all family members;

cultural competence of providers; consumer (parental) involvement in

planning and needs assessment; organizational support for the formation

of parent involvement groups; and ongoing partnerships with such

groups.

Applications will not be accepted for both planning grants and

state systems grants simultaneously from the same State.

Subcategory (A): Implementation Grants

Implementation grants will improve the capacity of a State's

Emergency Medical Services program to address the particular needs of

children. Implementation grants are used to assist States in

integrating research-based knowledge and state-of-the-art systems

development approaches into the existing State EMS, MCH and CSHN

systems, using the experience and products of previous EMSC grantees.

The program components of these grants should reflect the goals of the

MCHB/NHTSA Five Year Plan for EMSC. This plan outlines the direction of

the EMSC program and identifies specific objectives for the program. It

builds on the 1993 report for EMSC conducted by a blue ribbon Institute

of Medicine panel. The plan will be included with the application kit.

Depending upon the appropriation of funds, project periods are up to

two years. For this competition, we intend to fund applications from

States (and medical schools within those States) that have not as yet

received support, or that have received only partial support under this

program as part of a regional alliance. This means that approved

applications from States (and medical schools within those States) with

no or very limited prior EMSC program support will be funded before

approved applications from outside this group.

Subcategory (B): System Enhancement Grants

System enhancement grants will fund activities that represent the

next logical step or steps to take in institutionalizing EMSC

activities within the State EMS, MCH and CSHN systems and achieving

program goals outlined in this announcement. The program components of

these grants should reflect the goals and objectives of the MCHB/NHTSA

Five Year Plan for EMSC. For example, funding might be used to improve

linkages between local and regional or State agencies, to develop

pediatric standards for a region, or to assure effective field triage

of the child in physical or emotional crisis to appropriate facilities

and/or other resources. Activities implemented under prior EMSC program

funding but not completed or made self-sustaining during the original

implementation project period will not be considered suitable. States

that have previously received EMSC funds may apply for a system

enhancement grant, as long as they will not also be receiving

continuation funding for a State implementation grant during the

project period of the systems enhancement grant.

Category (3): Targeted Issues Grants

The third funding category is that of targeted issues grants on

topics of importance to EMSC. Targeted issues grants are intended to

address specific, focused issues related to the development of EMSC

capacity. Proposals under this category must have a well-conceived

methodology for evaluation of the impact of the activity. The EMSC Five

Year Plan identifies several activities judged to be appropriate for

support through targeted issues grants for FY 1996. They include the

following:

1. Cost-Benefit Analyses Related to EMSC

Very limited information is available on the costs related to

different aspects of EMSC, and yet such information is critical to

decision making. Projects in this category may include topics such as

the following:

Analyses of the impact of insurance, managed care, and

Federal and/or State health care financing policies and protocols on

pediatric emergency medical services.

Analyses of the impact of differing reimbursement policies

in contiguous jurisdictions on pediatric patients.

Assessment of the marginal incremental cost of different

approaches to improving EMSC.

Evaluation of the cost-effectiveness of different EMSC

program configurations (such as different approaches to medical

control, categorization, and regionalization).

2. Risk-Taking Behaviors of Children and Adolescents

Emergency department health professionals are uniquely positioned

to provide interventions to reduce the incidence of repeated episodes

when treating a child or adolescent for an injury or medical condition

(e.g., noncompliant child or adolescent with a chronic condition, such

as diabetes) resulting from risk-taking behavior. Projects in this

category can be directed to development and evaluation of materials and

strategies for emergency departments in one or more of the following

areas:

Unintentional injury prevention.

Violence or suicide prevention.

Integration of mental health services with preventive

interventions (injury or medical).

3. Care of Children With Special Health Needs (CSHN)

An organized system of emergency care is needed for children who

have special health care needs (children who are respirator dependent,

children with tracheostomies, indwelling (broviac) catheters, gastric

tubes, etc.) on discharge from acute care settings. Projects in this

category can be directed to one or more of the following:

Development, implementation and evaluation of educational

or training programs for families.

Development, implementation, and evaluation of educational

or training programs for health care providers (e.g., prehospital,

emergency department, school nurses. etc.).

Evaluation of models for comprehensive discharge planning.

Development and evaluation of model injury prevention

programs for CSHN.

Projects in this category must demonstrate collaboration and

linkages

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among EMS and CSHN agencies, as well as families and other agencies and

organizations, as appropriate (e.g., schools).

4. EMSC-Related Models for Improving the Care of Culturally Diverse

Populations

In emergencies, health care providers are often required to meet

the needs of linguistically, culturally and ethnically diverse children

and families, but little training is provided in this area. Projects in

this category can be directed to one or more of the following:

Development, implementation and evaluation of education

and training programs in cultural sensitivity for prehospital

providers, nurses, and physicians.

Development (or translation), implementation, and

evaluation of discharge, injury prevention and health care materials

for low literacy populations and for culturally and/or ethnically

diverse populations.

Projects in this category must demonstrate collaboration and

linkages among EMS or MCH agencies, acute care facilities, and

ethnically-oriented community organizations and agencies to assure

sensitivity to ethnic and cultural issues.

5. Children's Emergencies in Disasters

Local, regional, and State disaster plans typically do not address

the training and equipment necessary to meet the special needs of

children in disasters. Projects in this category should address one or

more of the seven recommendations identified in the September 21-22,

1995, Workshop on Children's Emergencies in Disasters, co-sponsored by

the Maternal and Child Health Bureau, the Federal Emergency Management

Agency, and the Substance Abuse and Mental Health Services

Administration (a copy of these recommendations is included in the

application kit). Examples of projects appropriate for this category

include the following:

Development of a strategy to integrate pediatrics into

existing disaster plans, in particular focusing on the following

components: Training, equipment, psychosocial support, system access

and cost reimbursement, shelter services, and mitigation.

Identification of key data to be collected, collection,

and analysis of data on children's health and mental health needs in

disasters.

Proposals may be submitted on emerging issues that are not included

in the above list. However, any such proposal must demonstrate

relevance to the EMSC Five Year Plan and must make a persuasive

argument that the issue is particularly critical. The justification

provided should clearly link the activities in the application with the

Plan's objectives. Current targeted issues grantees may apply for one

additional year of funding.

Prospective applicants are urged to contact EMSC program staff well

in advance of submitting their formal applications, so that the work of

proposal development can be avoided if the proposed project is

inappropriate for submission in this category.

Special Concerns

HRSA's Maternal and Child Health Bureau places special emphasis on

improving service delivery to women, children and youth from

communities with limited access to comprehensive care. In order to

assure access and cultural competence, it is expected that projects

will involve individuals from the populations to be served in the

planning and implementation of the project. The Bureau's intent is to

ensure that project interventions are responsive to the cultural and

linguistic needs of special populations, that services are accessible

to consumers, and that the broadest possible representation of

culturally distinct and historically underrepresented groups is

supported through programs and projects sponsored by the MCHB. This

same special emphasis applies to improving service delivery to children

with special health care needs.

In keeping with the goals of advancing the development of human

potential, strengthening the Nation's capacity to provide high quality

education by broadening participation in MCHB programs of institutions

that may have perspectives uniquely reflecting the Nation's cultural

and linguistic diversity, and increasing opportunities for all

Americans to participate in and benefit from Federal public health

programs, HRSA will place a funding priority on projects from

Historically Black Colleges and Universities (HBCU) or Hispanic Serving

Institutions (HSI) in all categories and subcategories in this notice

for which applications from academic institutions are encouraged. This

is in conformity with the Federal Government's policies in support of

White House Initiatives on Historically Black Colleges and Universities

(Executive Order 12876) and Educational Excellence for Hispanic

Americans (Executive Order 12900). An approved proposal from a HBCU or

HSI will receive a 0.5 point favorable adjustment of the priority score

in a 4 point range before funding decisions are made.

Evaluation Protocol

A maternal and child health discretionary grant project, including

any project awarded as part of the Emergency Medical Services for

Children Demonstration Grants program, is expected to incorporate a

carefully designed and well planned evaluation protocol capable of

demonstrating and documenting measurable progress toward achieving the

project's stated goals. The protocol should be based on a clear

rationale relating the grant activities, the project goals, and the

evaluation measures. Wherever possible, the measurements of progress

toward goals should focus on health outcome indicators, rather than on

intermediate measures such as process or outputs. A project lacking a

complete and well-conceived evaluation protocol as part of the planned

activities will not be funded.

Public Comment

If time permits, comments from the public will be accepted on the

categories, priorities, and preferences described in this notice.

Public comments received too late for consideration this year will be

considered in the development of program categories, priorities, or

preferences for FY 1997. Members of the public should submit any

comments to: Chief, Grants Management Branch, MCHB, at the address

listed in the ADDRESS section.

Project Review and Funding

The Department will review applications in the preceding funding

categories as competing applications and will fund those which, in the

Department's view, are consistent with the statutory purpose of the

program, with particular attention to children from culturally distinct

populations and children with special health care needs; and that best

meet the purposes of the EMSC program and address achievement of

applicable Healthy People 2000 objectives related to emergency medical

services and trauma systems.

Review Criteria

The review of applications will take into consideration the

following criteria:

For Category (1) State Planning Grants:

--Evidence of the State's commitment to improve pediatric emergency

care services and to continue with EMSC program implementation.

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--The adequacy of the applicant's proposed method to identify problems

and conduct a needs assessment.

--Evidence of the applicant's understanding of obstacles to EMSC

activity in the past, and the completeness of proposed strategies to

overcome these obstacles.

--The adequacy of the applicant's proposed planning process for

improving EMSC.

--The soundness of the methods the applicant will use to: (1) recruit,

select and assemble appropriate participants, including members of

culturally distinct populations, with demonstrated expertise and

experience in EMS; trauma systems; child health issues; and emergency

care for children; and (2) obtain input from potential consumers (i.e.,

families) of a State EMSC plan.

--Reasonableness of the proposed budget, soundness of the arrangements

for fiscal management, effectiveness of use of personnel, and

likelihood of project completion within the proposed grant period.

For Categories (2) and (3) State Systems and Targeted

Issues Grants:

--The appropriateness of project objectives and outcomes in relation to

the specific nature of the problems identified by the applicant.

--The adequacy of the proposed methodology for achieving project goals

and objectives.

--The soundness of the plan for evaluating progress in achieving

project objectives and outcomes.

--The adequacy of the plan for organizing and carrying out the project.

--The qualifications and experience of the Project Director and

proposed staff.

--The reasonableness of the proposed budget and soundness of the

arrangements for fiscal management.

--The extent to which the project gives special emphasis to the issues

identified in the Special Concerns section of this notice.

For Category (2) State Systems Grants only, the following

additional criteria:

--The adequacy of the applicant's understanding of the problem of

pediatric trauma and critical illness in the grant locale, including

the special problems of (a) children with special health needs (CSHN)

and their families; and (b) minority children and families (including

Native Americans, Native Hawaiians, and Alaska Natives).

--The extent to which the applicant will employ products and expertise

of EMSC programs from other States, especially of current and former

grantees of the Federal EMSC program.

--The adequacy with which the applicant addresses institutionalization

of the proposed project.

--The extent to which the applicant demonstrates the involvement and

participation of consumers (e.g., families) and parent advocacy groups

in planning, needs assessment, and project implementation.

--The extent to which the applicant demonstrates a multi-disciplinary

approach to EMSC system development, including providers at all levels

(e.g., physicians, nurses, emergency medical technicians, social

workers and others appropriate to project activities).

--Evidence that the applicant will collaborate and coordinate with

other participants in the EMSC continuum, e.g., the State EMS agency;

the State MCH/CSHN agency; the State Highway Safety Office; other

relevant State agencies; tribal nations; state and local professional

organizations; private sector voluntary organizations; business

organizations; hospital organizations; and any other ongoing Federally-

funded projects in EMS, injury prevention, and rural health.

--The adequacy of the applicant's plan to integrate pediatric emergency

care into the primary care delivery system.

For Category (3) Targeted Issues Grants only, the following

additional criteria:

--The relevance of the proposed project to the MCHB/NHTSA Five Year

Plan for EMSC.

Eligible Applicants

No more than one grant under this program will be made in any State

(to a State or a school of medicine in the State) in any fiscal year.

Applications for funding will be accepted from States and accredited

schools of medicine. Applications which involve more than a single

State will also be accepted. In developing the proposed project,

applicants must seek the participation and support of local or regional

trauma centers and other interested entities within the State, such as

local government and health and medical organizations in the private

sector. If the applicant is a school of medicine, the application must

be endorsed by the State. The State's endorsement must acknowledge that

the applicant has consulted with the State and that the State has been

assured that the applicant will work with the State on the proposed

project.

Any State (or medical school within that State) may apply for any

category or subcategory of grant, subject to the following

considerations based on equitable geographic distribution of EMSC

funds, differences in purpose among EMSC grant categories, and

variation among States in EMSC program progress:

For Category (1) Planning Grants, States (or medical

schools within those States) that have received prior EMSC state

systems grants may not apply for a planning grant.

For Category (2)(A) Implementation Grants, applications

from States (and medical schools within those States) that have not

previously received EMSC program funds, or that have received only

partial support under this program as part of a regional alliance, will

receive preference for funding in this subcategory. This means that

approved applications from States (and medical schools within those

States) with no or very limited prior EMSC program support will be

funded ahead of approved applications from outside this group.

For Category (2)(B) System Enhancement Grants, States (and

medical schools within those States) that have previously received EMSC

funds may apply for a system enhancement grant, as long as they will

not also be receiving implementation funds during the project period of

the system enhancement grant. States that have not previously received

EMSC funds are advised to apply first for implementation category

funds.

For Category (3) Targeted Issues Grants, eligibility is

not affected by previous receipt of other EMSC funding. Applications

will not be considered for both Category (1) State Planning Grants and

Category (2) State Systems Grants simultaneously from the same State.

Funding of an application for a planning grant or for a Category (2)(A)

implementation grant bars a State from future competitions for that

category or subcategory.

Allowable Costs

The HRSA may support reasonable and necessary costs of EMSC

Demonstration Grant projects within the scope of approved projects.

Allowable costs may include salaries, equipment and supplies, travel,

contracts, consultants, and others, as well as indirect costs as

negotiated and certified. The HRSA adheres to administrative standards

reflected in the Code of Federal Regulations, 45 CFR Part 92 and 45 CFR

Part 74.

[[Page 8297]]

Public Health System Reporting Requirements

This program is subject to the Public Health System Reporting

Requirements (approved under OMB No. 0937-0195). Under these

requirements, community-based nongovernmental applicants must prepare

and submit a Public Health System Impact Statement (PHSIS). The PHSIS

is intended to provide information to State and local health officials

to keep them apprised of proposed health services grant applications

submitted by community-based nongovernmental organizations within their

jurisdictions. Community-based non-governmental applicants are required

to submit the following information to the head of the appropriate

State and local health agencies in the area(s) to be impacted no later

than the Federal application receipt due date:

(a) A copy of the face page of the application (SF 424).

(b) A summary of the project (PHSIS), not to exceed one page, which

provides:

(1) A description of the population to be served.

(2) A summary of the services to be provided.

(3) A description of the coordination planned with the appropriate

State or local health agencies.

The project abstract may be used in lieu of the one-page PHSIS, if

the applicant is required to submit a PHSIS.

Executive Order 12372

This program has been determined to be a program which is subject

to the provisions of Executive Order 12372 concerning intergovernmental

review of Federal programs by appropriate health planning agencies, as

implemented by 45 CFR Part 100. Executive Order 12372 allows States the

option of setting up a system for reviewing applications from within

their States for assistance under certain Federal programs. The

application packages to be made available under this notice will

contain a listing of States which have chosen to set up such a review

system and will provide a single point of contact (SPOC) in the States

for review. Applicants (other than federally-recognized Indian tribal

governments) should contact their State SPOCs as early as possible to

alert them to the prospective applications and receive any necessary

instructions on the State process. For proposed projects serving more

than one State, the applicant is advised to contact the SPOC of each

affected State. The due date for State process recommendations is 60

days after the application deadline for new and competing awards. The

granting agency does not guarantee to ``accommodate or explain'' for

State process recommendations it receives after that date. (See Part

148, Intergovernmental Review of PHS Programs under Executive Order

12372 and 45 CFR Part 100 for a description of the review process and

requirements).

The OMB Catalog of Federal Domestic Assistance number is 93.127.

Dated: February 27, 1996.

Ciro V. Sumaya,

Administrator.

[FR Doc. 96-4860 Filed 3-1-96; 8:45 am]

BILLING CODE 4160-15-P