Research and Demonstration Programs in Surveillance, Prevention, and Control of Healthcare-Associated Infections and Antimicrobial Resistant Infections

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Announcement Number 789]

Research and Demonstration Programs in Surveillance, Prevention,

and Control of Healthcare-Associated Infections and Antimicrobial

Resistant Infections

Introduction

The Centers for Disease Control and Prevention (CDC) announces the

availability of fiscal year (FY) 1997 funds to provide assistance for

cooperative agreements to develop research and demonstration programs

in the surveillance, prevention, and control of healthcare-associated

infections and antimicrobial resistant infection.

CDC is committed to achieving the health promotion and disease

prevention objectives of Healthy People 2000, a national activity to

reduce morbidity and mortality and improve the quality of life. This

announcement is related to the priority area of Immunization and

Infectious Diseases. (For ordering a copy of Healthy People 2000, see

the section Where to Obtain Additional Information.)

Authority

This program is authorized under Section(s) 301 [42 U.S.C. 241] and

317(k)(2) [42 U.S.C. 247b(k)(2)] of the Public Health Service Act, as

amended.

Smoke-Free Workplace

CDC strongly encourages all grant recipients to provide a smoke-

free workplace and to promote the nonuse of all tobacco products, and

Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in

certain facilities that receive Federal funds in which education,

library, day care, health care, and early childhood development

services are provided to children.

Eligible Applicants

Applications may be submitted by public and private nonprofit

health care delivery systems and organizations. Thus, universities,

colleges, research institutions, hospitals, other public and private

non-profit organizations are eligible to apply.

Note: Effective January 1, 1996, Public law 104-65 states that

an organization described in section 501(c)(4) of the Internal

Revenue Code of 1986 which engages in lobbying activities shall not

be eligible for the receipt of Federal funds constituting an award,

grant (cooperative agreement), contract, loan, or any other form.

Availability of Funds

Approximately $700,000 will be available in Fiscal Year 1997 to

fund 2 to 3 cooperative agreements. The award is expected to begin on

or about September 29, 1997, for a 12-month budget period within a

project period of up to 3 years. The funding estimate is subject to

change. Continuation awards within the project period will be made on

the basis of satisfactory progress and the availability of funds. There

are no matching or cost participation requirements; however, the

applicant's anticipated contribution to the overall program costs, if

any, should be provided in the application.

Restrictions on Lobbying

Applicants should be aware of restrictions on the use of Department

of Health and Human Services (HHS) funds for lobbying of Federal or

State legislative bodies. Under the provisions of 31 U.S.C. Section

1352 (which has been in effect since December 23, 1989), recipients

(and their subtier contractors) are prohibited from using appropriated

Federal funds (other than profits from a Federal contract) for lobbying

Congress or any Federal agency in connection with the award of a

particular contract, grant, cooperative agreement, or loan. This

includes grants/cooperative agreements that, in whole or in part,

involve conferences for which Federal funds cannot be used directly or

indirectly to encourage participants to lobby or to instruct

participants on how to lobby.

In addition, the FY 1997 Departments of Labor, HHS, and Education,

and Related Agencies Appropriations Act, which became effective October

1, 1996, expressly prohibits the use of 1997 appropriated funds for

indirect or ``grass roots'' lobbying efforts that are designed to

support or defeat legislation pending before State legislatures.

Section 503 of this new law, as enacted by the Omnibus Consolidated

Appropriations Act, 1997, Division A, Title I, Section 101(e), Pub. L.

No. 104-208 (September 30, 1996), provides as follows:

Sec. 503: (a) No part of any appropriation contained in this Act

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, radio, television, or video presentation designed to

support or defeat legislation pending before the Congress, . . . except

in presentation to the Congress or any State legislative body itself.

(b) No part of any appropriation contained in this Act 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 legislation or appropriations pending before the Congress or

any State legislature.

Background

Nosocomial, or hospital-acquired, infections occur at a rate of 5

to 10 per hundred admissions in U.S. hospitals. An estimated 30,000

patients die each year as a direct result of nosocomial bloodstream

infection. Furthermore, many nosocomial infections are associated with

an extended length of stay, substantial morbidity, and prolonged

therapy. It has been estimated that nosocomial infections have a direct

cost of $5 billion to $10 billion annually in this country.

Purpose

The purpose of these cooperative agreements is to provide

assistance in establishing centers of excellence for research and

demonstration to improve the surveillance, prevention, and control of

healthcare-associated infections and antimicrobial resistant

infections. For purposes of this program announcement, centers of

excellence in the surveillance, prevention, and control of healthcare-

associated infections and antimicrobial resistant infections are

defined as those recipients who are successfully conducting the

activities delineated below. Thus, recipients will establish centers by

developing programs with three components: (1) program to conduct

research and demonstrate academic leadership in healthcare epidemiology

and infection control; (2) program to adapt and implement infection

control and healthcare epidemiology practice across the full range of

settings in an integrated health care delivery model; (3) program to

conduct training of healthcare epidemiologists and infection control

practitioners that utilizes quality

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management and outcomes management methods and practices.

These programs may be developed sequentially or at the same time;

however, the research program must be developed during the first year

of the program and the program to adapt practice to integrated delivery

models must be developed no later than during the second year of multi-

year projects. It is not required that all three components be fully

operational at the end of the three-year project period; however, clear

progress toward completion of all three components should be

demonstrable by the end of year three of multi-year programs.

These centers are intended to conduct research in and demonstrate

the application of infection surveillance, prevention, and control

principles and methods in health care delivery systems encompassing the

fullest range of settings, including, but not limited to acute

inpatient care, long term and chronic care, ambulatory care, ambulatory

surgical care, and home health care, with an emphasis on adaptations

relevant to populations of patients whose health care is provided by

managed care organizations. They are also intended to conduct training

in healthcare epidemiology. Component programs should demonstrate

activities directed toward the three principal goals of infection

control and healthcare epidemiology: (1) protection of patients from

adverse health events; (2) protection of health care workers from

occupationally-acquired illness; and (3) research to identify risk

factors for infection and develop interventions to ameliorate those

risk factors and prevent infections in a cost-effective manner.

The specific objectives of this cooperative agreement program are:

1. To study the effectiveness of traditional hospital-based

infection control methods and practice in integrated health care

delivery systems.

2. To improve and enhance existing methods by developing and

studying innovative approaches to infection surveillance, prevention,

and control that will maximize effectiveness in integrated health care

delivery systems.

3. To develop and study innovative approaches to using new

management information systems for the surveillance of antimicrobial

resistance and monitoring of the use of antimicrobial agents.

4. To develop and study improved evaluation methodologies to assess

the effectiveness of prevention and control methods for healthcare-

associated infections and antimicrobial resistant infections.

5. To develop and study innovative approaches for training of

infection control practitioners and hospital epidemiologists that

include the techniques and practices of quality management and outcomes

management.

6. To foster collaborative relationships between the demonstration

program center and CDC.

Program Requirements

In conducting activities to achieve the purpose of this program,

the recipient shall be responsible for conducting activities under A,

below and CDC shall be responsible for conducting activities under B,

below.

A. Recipient Activities

1. Program in research.

a. Recipient will assess the relationship between nurse-to-patient

ratios in intensive care units (ICUs) and the risk of bloodstream

infections (BSI) in ICU patients.

b. Recipient will study clinical performance indicator systems and

outcomes measures for infectious diseases and infection control

practice based on surveillance methods used in the National Nosocomial

Infections Surveillance (NNIS), and compare these to other types of

outcome indicators in use in hospitals and integrated delivery systems,

such as those based on data obtained from insurance claims and medical

records coding.

2. Program to adapt and implement infection control and

epidemiologic practice in integrated health care delivery systems.

Recipient will identify infection control issues in the major areas of

nosocomial infection control (antimicrobial resistant infections,

bloodstream infections, nosocomial pneumonias, and surgical site

infections) for which adaptation and modification of existing infection

control methods as practiced within an acute care general hospital may

improve patient outcome and effectiveness in the setting of a health

network or integrated delivery system.

3. Publish and disseminate research findings.

4. Program in training. Recipients will develop and demonstrate

innovative training programs for hospital epidemiologists and infection

control practitioners which respond to current and likely changes in

the organization of health care delivery.

B. CDC Activities

1. Provide technical assistance in the design and conduct of

research activities, in the design and implementation of innovative

approaches to hospital epidemiologic and infection control practice,

and in the design of educational and training strategies and the

dissemination of educational and training materials.

2. Provide assistance regarding development of study protocols,

data collection methods, and analyses as necessary.

3. Assist in the development of data management processes and

protocols.

4. Participate in the preparation of study findings for publication

and presentation.

Technical Reporting Requirements

Progress reports on project activities should be submitted within a

non-competing continuation application and in an annual report. An

original and two copies of a final performance report must be submitted

within 90 days after the end of the project period. These reports must

address progress toward overall objectives as represented in the

Purpose and Recipient Activities sections of this announcement.

Financial status reports must be submitted no later than 90 days

after the end of each budget period. A final financial status report is

required no later than 90 days after the end of the project period. All

reports are submitted to the Grants Management Branch, Procurement and

Grants Office, CDC.

Application Process

Letter of Intent

In order to assist CDC in planning for and executing the evaluation

of applications submitted under this Program Announcement, ALL PARTIES

INTENDING TO SUBMIT AN APPLICATION ARE REQUESTED TO SUBMIT A LETTER OF

INTENTION TO APPLY TO CDC BEFORE THE APPLICATION DUE DATE. The letter

should include (1) name and address of institution and (2) name,

address, and telephone number of contact person. Notification should be

provided by facsimile or, postal mail to: Sharron P. Orum, Grants

Management Officer, Grants Management Branch, Procurement and Grants

Office, Centers for Disease Control and Prevention (CDC), 255 East

Paces Ferry Road, NE., Room 314, Mailstop E-18, Atlanta, Georgia 30305;

facsimile: (404) 842-6513. Announcement Number 789 must be referenced.

Application Content

All applicants must develop their application in accordance with

the PHS Form 5161-1 (revised 5/96), information contained in this

cooperative agreement announcement, and the instructions outlined

below.

[[Page 36543]]

General Instructions:

1. All pages must be clearly numbered.

2. A complete index to the application and its appendixes must be

included.

3. The original and two copies of the application must be submitted

unstapled and unbound. No bound materials will be accepted.

4. All materials must be typewritten, single spaced, and in

unreduced type (no smaller than font size 12) on 8\1/2\'' by 11'' white

paper, with at least 1'' margins, headers, and footers.

5. All pages must be printed on one side only.

Specific Instructions:

The application narrative must not exceed 20 pages (excluding

budget and appendixes). Unless indicated otherwise, all information

requested below must appear in the narrative. Materials or information

that should be part of the narrative will not be accepted if placed in

the appendices. The application narrative must contain the following

sections in the order presented below:

1. Abstract: Provide a brief (two pages maximum) abstract of the

project. State the length of the project period (maximum is 3 years)

for which assistance is being requested (see ``Availability of Funds''

for additional information).

2. Background and Need: Discuss the background and need for the

proposed project. Demonstrate a clear understanding of the purpose and

objectives of this cooperative agreement program. Illustrate and

justify the need for the proposed project that is consistent with the

purpose and objectives of this cooperative agreement program.

3. Capacity and Personnel: Describe applicant's past experience in

conducting projects/studies similar to that being proposed. Describe

applicant's resources, facilities, and professional personnel that will

be involved in conducting the project. Include in an appendix

curriculum vitae for all professional personnel involved with the

project. Describe plans for administration of the project and identify

administrative resources/personnel that will be assigned to the

project. Provide in an appendix letters of support from all key

participating non-applicant organizations, individuals, etc., which

clearly indicate their commitment to participate as described in the

operational plan. Do not include letters of support from CDC personnel.

Letters of support from CDC will not be accepted in the application.

4. Objectives and Technical Approach: For each of the proposed

Recipient Activities (A.1.a., A.1.b., A.2., and A.3.,) described under

Program Activities, describe specific objectives which are measurable

and time-phased and are consistent with the purpose and goals of this

cooperative agreement. Present a detailed operational plan for

initiating and conducting the project which clearly and appropriately

addresses all Recipient Activities. (If proposing a multi-year project

for one or more of the Recipient Activities, provide a detailed

description of first-year activities and a brief overview of activities

in subsequent years. Clearly state the proposed length of the project

period for each of these activities.) Clearly identify specific

assigned responsibilities for all key professional personnel. Include a

clear description of applicant's technical approach/methods which are

directly relevant to the study objectives.

Describe specific study protocols or plans for the development of

study protocols. Describe the nature and extent of collaboration with

CDC and/or others during various phases of the project. Describe in

detail a plan for evaluating study results and for evaluating progress

toward achieving project objectives.

a. Within the research component of the program, as described in

Recipient Activities A.1., applicants should submit proposals for each

of the listed activities (A.1.a. and A.1.b.), although both activities

will not necessarily be funded at each site. The design and plan for

implementation of each of the projects should demonstrate the

recipients' implementation of the innovative approaches sought in this

announcement. Describe methods for inclusion of Women, Racial, and

Ethnic Minorities.

1. Within research activity A.1.a., assessing the relationship

between nurse-to-patient ratios in ICUs and the risk of bloodstream

infections (BSI) in ICU patients. Recipient, ideally as part of a

multi-hospital system so that data can be collected from ICUs at

several large hospitals, should conduct prospective surveillance for

BSIs using standardized methods. Prospective surveillance should be

conducted at different types (e.g., medical, surgical, pediatric,

neonatal) of ICUs. Definitions, denominators, and rate calculations at

all participating facilities will be done using standardized criteria

and methods such as those used in the NNIS system; e.g., use of central

venous catheter days as the denominator. Standardized methods will also

be used to control for severity of illness (on admission and at the

time of BSI in those with BSIs) and underlying disease. Recipients will

then also assess daily and monthly change in the nurse-to-patient ratio

and its effect on the BSI rate. Recipient should stratify by nurse

level of training and perform observational studies to assess nursing

practices and attempt to calculate periodic handwashing indices.

Monthly ICU-specific BSI rates should be calculated and correlated with

the nurse-to-patient ratio. Among the outcomes of interest will be to

determine if there is a threshold nurse to patient ratio level below

which ICU patient risk of BSI significantly increases or whether there

is a linear relationship between nurse staffing and infection risk.

2. Within research activity A.1.b., studying clinical performance

indicator systems and outcomes measures for infectious diseases and

infection control practice. The goal of this activity should be to

determine the relative utility of outcome indicators derived from more

traditional infection control surveillance methods and those derived

from indicator systems based on data collected from International

Classification of Diseases, 9th Revision,(ICD-9) codes; i.e., from

medical record coding and/or the uniform bill, for measuring quality of

care and for directing quality improvement activities. Recipients

should have access to multiple institutions, through collaboration with

national or regional health care systems or through agencies or

organizations already operating clinical performance indicator systems

at multiple institutions. The validity of performance indicators should

be evaluated using strict epidemiologic criteria to determine which

measures will best assess quality of care across five parameters:

a. Do the indicators measure true outcomes or do they measure

processes of care?

b. Can the indicators be related to processes of care in a way that

permits quality improvement methods to be applied to identify and

correct problems?

c. Does the methodology for data collection and analysis ensure

comparability of data between institutions?

d. Is the risk adjustment methodology adequate to ensure accurate

inter-hospital comparison?

e. How do the validity and comparability of infection control/

infections disease performance measures compare to other types of

performance measures (e.g., anaesthesia

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mortality, cardiovascular complications, medication errors, etc.)?

In the second and third years of this activity, recipients should

assess the utility of performance indicators as a tool for improving

quality of care. Assessments may include correlation between outcome

measures and changes in health care practice or institutional policy

(e.g., ``plan-do-check-assess'' cycle) and/or the use of clinical

practice guidelines to modify practice.

b. Within the component to adapt and modify existing infection

control methods to the setting of a health network or integrated

delivery system (Recipient Activities A.2.), modified and enhanced

approaches to infection control and healthcare epidemiologic methods

should be rigorously evaluated and compared to existing practice. Among

these approaches may be the use of practice guidelines or critical

paths, implementation of disease management, care management, or

outcomes management models, quality management techniques, and/or other

techniques developed for this program. Comparisons should be based on

specific outcome measures and should include cost-effectiveness and/or

cost-benefit analysis. Modifications should demonstrate applicability

to the continuity of care modeled by a health network or integrated

delivery system, e.g., the concept of ``covered lives.'' Specific

activities which could demonstrate such modifications and adaptations

may include:

1. Implementation of outcome measures for infection control and

infectious diseases management as part of a clinical performance

indicator system, and demonstrated use of these outcome data in

assessing and, as necessary, altering and modifying clinical and

administrative practices.

2. Implementation of systems to monitor patient risk factors and

outcome through the continuum of care, i.e., prior to and after acute

care hospital admission, with the ultimate goal of continuous

monitoring of infection risks and health outcomes of both individual

patients and populations of patients enrolled in a managed care

organization or health network.

3. Development and implementation of programs to reduce the

incidence and prevent the spread of antimicrobial resistance within the

population served by a health network or integrated health care system,

with special emphasis on groups at highest risk, e.g., patients in

intensive care units, nursing home residents, patients with long-term

indwelling devices, and patients on chronic antimicrobial therapy.

4. Use of management information systems to enhance physician

practice, especially for antimicrobial prescribing, as by providing

``on-line'' access to patient-specific clinical, microbiologic, and

pharmacologic data that assist physicians in selecting appropriate

antimicrobial therapy.

5. Assessment of existing risk-adjustment methods and, as

necessary, development of more accurate risk-adjustment methods, for

comparing surveillance data between facilities and between providers,

including comparisons of individual providers practicing in multiple

facilities.

c. Within the component of the program to develop and demonstrate

innovative training programs which respond to changes in the

organization of health care delivery (Recipient Activities A.3.),

changes which may require this response include increased delivery of

care through managed care organizations, increased utilization of

outpatient and home health care, implementation of quality management

programs in tandem with infection control programs, implementation of

clinical practice guidelines and outcomes management, etc. These model

training programs should include core curricula, didactic approaches,

and experiential learning for infection control practitioners and

hospital epidemiologists. Recipients should incorporate recommendations

of applicable professional societies and certifying bodies such as the

Association for Practitioners in Infection Control, the Society for

Healthcare Epidemiology of America, the American Board of Internal

Medicine subspecialty board for Infectious Diseases, and the National

Association for Healthcare Quality.

5. Budget: Provide in an appendix a budget and accompanying

detailed justification for the first-year of the project that is

consistent with the purpose and objectives of this program. If

proposing a multi-year project, also provide estimated total budget for

each subsequent year. For the research component of Recipient

Activities (A.1.) provide separate budgets for each of the two research

activities (A.1.a. and A.1.b.) If requesting funds for contracts,

provide the following information for each proposed contract: (1) Name

of proposed contractor, (2) breakdown and justification for estimated

costs, (3) description and scope of activities to be performed by

contractor, (4) period of performance, and (5) method of contractor

selection (e.g., sole-source or competitive solicitation).

6. Human Subjects: If the proposed project involves human subjects,

describe in an appendix adequate procedures to ensure that individuals

of both sexes and various racial and ethnic groups will be included in

this CDC cooperative agreement whenever feasible and appropriate.

Identify gaps in knowledge about health problems that affect women and

racial and minority populations and describe efforts for conduct

studies to address these problems.

Evaluation Criteria

Applications will be reviewed and evaluated based on the following

weighted criteria:

1. Background and Need (15 Points)

Extent to which applicant's discussion of the background for the

proposed project demonstrates a clear understanding of the purpose and

objectives of this grant/cooperative agreement program. Extent to which

applicant illustrates and justifies the need for the proposed project

that is consistent with the purpose and objectives of this grant/

cooperative agreement program.

2. Capacity (25 Points Total)

a. The extent to which background information and other data

demonstrate that the applicant has the appropriate organizational

structure, administrative support, and ability to access appropriately

defined target populations or study objects, and that this access will

ensure an adequate sample size and representativeness so that

epidemiologic analysis of risk factors and evaluations of intervention

strategies will be appropriate and statistically valid. (10 points)

b. Extent to which applicant documents that professional personnel

involved in the project are qualified, by training and experience; have

demonstrated achievement in research related to that proposed, as

evidenced by curriculum vitae, publications, etc.; and have an

appropriate projected level of effort directed toward accomplishment of

the proposed objectives. (10 points)

c. Extent to which applicant demonstrates appropriate

collaborative and consortia arrangements needed to fulfill the

operational plan. Extent to which application includes letters of

support from non-applicant organizations, individuals, etc. and that

these letters clearly indicate the author's commitment to participate

as described in the operational plan. (5 points)

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3. Objectives and Technical Approach (60 Points Total)

a. Extent to which applicant describes specific objectives of the

proposed project which are consistent with the purpose and goals of

this cooperative agreement program and which are measurable and time-

phased. (5 points)

b. Extent to which applicant presents a detailed operational plan

for initiating and conducting each of the specific research projects

clearly and appropriately addressing all aspects of Part 1 of Recipient

Activities. Extent to which applicant clearly identifies specific

assigned responsibilities for all key professional personnel. Extent to

which the plan clearly describes applicant's technical approach/methods

for conducting the proposed studies and extent to which the plan is

adequate to accomplish the objectives. Extent to which applicant

describes specific study protocols or plans for the development of

study protocols that are appropriate for achieving project objectives.

(25 points)

c. Extent to which applicant presents a detailed operational plan

for developing innovative approaches to infection control and health

care epidemiology practice well adapted to integrated health care

delivery systems, clearly and appropriately addressing all aspects of

Part 2 of Recipient Activities. (25 points)

d. Degree to which the applicant has met the CDC Policy

requirements regarding the inclusion of women, ethnic, and racial

groups in the proposed research. This includes:

1. The proposed plan for the inclusion of both sexes and racial and

ethnic minority populations for appropriate representation.

2. The proposed justification when representation is limited or

absent.

3. A statement as to whether the design of the study is inadequate

to measure differences when warranted.

4. A statement as to whether the plans for recruitment and outreach

for study participants include the process of establishing partnerships

with community(ies) and recognition of mutual benefits. (5 points)

4. Budget (Not Scored)

The extent to which the budget is reasonable, clearly justified,

and consistent with the intended use of cooperative agreement funds.

5. Human Subjects (Not Scored)

Whether or not exempt from the Department of Health and Human

Services (HHS) regulations, are procedures adequate for the protection

of human subjects? Recommendations on the adequacy of protections

include: (1) Protections appear adequate and there are no comments to

make or concerns to raise, (2) protections appear adequate, but there

are comments regarding the protocol, (3) protections appear inadequate

and the Objective Review Group (ORG) has concerns related to human

subjects; or (4) disapproval of the application is recommended because

the research risks are sufficiently serious and protection against the

risks are inadequate as to make the entire application unacceptable.

Executive Order 12372 Review

This program is not subject to the Executive Order 12372 review.

Public Health System Reporting Requirements

This program is not subject to the Public Health System Reporting

Requirements.

Catalog of Federal Domestic Assistance Number

The Catalog of Federal Domestic Assistance Number is 93.283.

Other Requirements

Paperwork Reduction Act

Projects that involve the collection of information from ten or

more individuals and funded by the cooperative agreement will be

subject to review by the Office of Management and Budget (OMB) under

the Paperwork Reduction Act.

Human Subjects

If the proposed project involves research on human subjects, the

applicant must comply with the Department of Health and Human Services

Regulations (45 CFR Part 46) regarding the protection of human

subjects. Assurance must be provided to demonstrate that the project

will be subject to initial and continuing review by an appropriate

institutional review committee. The applicant will be responsible for

providing evidence of this assurance in accordance with the appropriate

guidelines and form provided in the application kit.

Women, Racial and Ethnic Minorities

It is the policy of the Centers for Disease Control and Prevention

(CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR)

to ensure that individuals of both sexes and the various racial and

ethnic groups will be included in CDC/ATSDR-supported research projects

involving human subjects, whenever feasible and appropriate. Racial and

ethnic groups are those defined in OMB Directive No. 15 and include

American Indian, Alaskan Native, Asian, Pacific Islander, Black and

Hispanic. Applicants shall ensure that women, racial and ethnic

minority populations are appropriately represented in applications for

research involving human subjects. Where a clear and compelling

rationale exists that inclusion is inappropriate or not feasible, this

situation must be explained as part of the application. This policy

does not apply to research studies when the investigator cannot control

the race, ethnicity and/or sex of subjects. Further guidance to this

policy is contained in the Federal Register, Vol. 60, No. 179, pages

47947-47951, dated Friday, September 15, 1995.

Application Submission and Deadline

The original and two copies of the completed application Form PHS-

5161-1 (revised 5/96, OMB Number 0937-0189) and appendices must be

submitted to Sharron P. Orum, Grants Management Officer, Grants

Management Branch, Procurement and Grants Office, Centers for Disease

Control and Prevention (CDC), 255 East Paces Ferry Road, N.E., Mailstop

E-18, Room 314, Atlanta, Georgia 30305, on or before August 15, 1997.

Applications will be considered to meet the deadline if they are:

1. Deadline: Applications shall be considered as meeting the

deadline if they are either:

a. Received on or before the deadline date; or

b. Sent on or before the deadline date and received in time for

submission to the objective review group. (Applicants must request a

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

receipt from a commercial carrier or U.S. Postal Service. Private

metered postmarks shall not be acceptable as proof of timely mailing.)

2. Late Applications: Applications which do not meet the criteria

in 1.a. or 1.b. above are considered late applications. Late

applications will not be considered and will be returned to the

applicant.

Where to Obtain Additional Information

To receive additional written information, call telephone (404)

332-4561. You will be asked to leave your name, address, and telephone

number. Please refer to Announcement 789. You will receive a complete

program description, information on application procedures, and

application forms. If you have questions after reviewing the contents

of all the documents, business

[[Page 36546]]

management technical assistance may be obtained from Albertha Carey,

Grants Management Specialist, Grants Management Branch, Procurement and

Grants Office, Centers for Disease Control and Prevention (CDC), 255

East Paces Ferry Road, NE., Room 314, Mail Stop E-18, Atlanta, Georgia

30305, telephone (404) 842-6591; electronic mail at [email protected].

Programmatic technical assistance may be obtained from Steven L.

Solomon, M.D., Hospital Infections Program, National Center for

Infectious Diseases, Centers for Disease Control and Prevention, 1600

Clifton Road, Mailstop A07, Atlanta, GA 30333, telephone (404) 639-

6476; electronic mail at [email protected].

You may obtain this and other CDC announcements from one of two

Internet sites. CDC's homepage at http://www.cdc.gov or the Government

Printing Office homepage (including free on-line access to the Federal

Register at http://www.access.gpo.gov).

Please refer to Program Announcement 789 when requesting

information and submitting an application.

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) referenced in the Introduction

through the Superintendent of Documents, Government Printing Office,

Washington, DC 20402-9325; telephone (202) 512-1800.

Dated: July 1, 1997.

Joseph R. Carter,

Acting Associate Director for Management and Operations, Centers for

Disease Control and Prevention (CDC).

[FR Doc. 97-17700 Filed 7-7-97; 8:45 am]

BILLING CODE 4163-18-P